nhs croydon clinical commissioning group governing … · subject to typographical errors...

NHS CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY

Meeting in Public

Tuesday 3 July 2018 2.00 – 4.00pm

Markee Room, Croydon Conference Centre,

Surrey Street, Croydon CR0 1RG

Croydon Clinical Commissioning Group Governing Body Meeting in Public

Agenda

Meeting: 3 July 2018, 2.00 – 4.00 pm Location: Markee Room Croydon Conference Centre, Surrey Street, Croydon

Members of the public are welcome to attend this meeting of Croydon CCG’s Governing Body meeting. There will be the opportunity to ask questions during the Open Space. Questions will be limited to one question, plus one supplementary question, per person.

Item Time Lead Enclosure

1 2.00 Apologies for absence Chair Verbal

2 Declaration of Interests

Chair Verbal

3 Minutes of the meeting held on 1 May 2018 - Action Log (no actions outstanding)

Chair Enclosure 1

4 Matters Arising

Chair Verbal

Standing Items

5 2.10 Joint Chair/Chief Officer Report For information

Agnelo Fernandes/

Andrew Eyres

Enclosure 2

Presentation

6 2.20 Children’s Services (& Maternity) For information

Stephen Warren

Presentation

Strategy

7 2.35 Out of Hospital Update ▪ Update on Out of Hospital Estates & IT programme

For noting and agreement

Martin Ellis Presentation Enclosure 3

Delivery

8

2.55 Month 12 Integrated Performance & Quality Report For noting

Elaine Clancy

Enclosure 4

Governance

9

3.05 Report from Integrated Governance & Audit Committee

For noting

Philip Hogan / Elaine Clancy

Enclosure 5

10 3.10 Report from Finance Committee ▪ 2017/18 Finance Period 2 (May 2018) ▪ 2017/18 QIPP Programme Period 2 (May 2018) For noting

Roger Eastwood /

Mike Sexton

Enclosure 6 Enclosure 6a Enclosure 6b

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11

3.20 Report from Quality Committee For noting

Amy Page / Elaine Clancy

Enclosure 7

12 3.30 Report from Primary Care Commissioning Committee For noting

Philip Hogan /

Martin Ellis

Enclosure 8

13 3.40 Emergency Planning Resilience and Response - Annual Report 2017/18 For approval

Elaine Clancy

Enclosure 9

For Information

14 Minutes of the Integrated Governance & Audit Committee For information

Philip Hogan

Enclosure 10

15 Minutes of the Quality Committee For information

Amy Page Enclosure 11

16 Minutes of the Clinical Leaders Group For information

Agnelo Fernandes

Enclosure 12

17 Minutes of the Finance Committee For information

Roger Eastwood

Enclosure 13

18 Minutes of the Primary Care Commissioning Committee For information

Philip Hogan

Enclosure 14

19 Register of Interests and Register of Gifts & Hospitality For Information

Elaine Clancy

Enclosure 15

Open Space for Public Questions

20 3.50

Any Other Business

21 3.55 Any other business

Chair

Date of next Meetings in Public of

3 September 2018: 14.00 until 16.00 Markee Room, Croydon Conference Centre

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Croydon Clinical Commissioning Group Governing Body Meeting in Public

DRAFT MINUTES

Date: Tuesday 01 May 2018 Time: 2:00pm – 4.00 p.m. Location: Markee Room, Croydon Conference Centre, Croydon

Present: In Attendance:

Governing Body Members ▪ Agnelo Fernandes (AF), Chair ▪ Andrew Eyres (AE), Accountable Officer ▪ Tom Chan, Medical Director and GP

Governing Body Member ▪ Emily Symington (ES) GP Governing

Body Member ▪ Roger Eastwood (RE) Lay Member –

Finance ▪ Amy Page (AP) Registered Nurse, Lay

Member ▪ Mike Sexton (MS) Chief Finance Officer ▪ Stephen Warren (SW) Director of

Commissioning ▪ Elaine Clancy (EC) Director of Quality and

Governance ▪ Martin Ellis (MC) Director of Primary and

Out of Hospital Care

▪ Rachel Flowers (RF) Director of Public Health, Local Authority

▪ Gordon Kay (GK) Healthwatch Manager ▪ Ben Smith (BS), Board Secretary

Apologies ▪ Philip Hogan (PH) Lay Member

Governance and Conflict of Interest Guardian

▪ Jon Norman (JN) Secondary Care Consultant

Apologies ▪ Barbara Peacock (BP) Director of

People, Local Authority

Ref: 2018/05/01

1 Introduction and Apologies Action

1.1 1.2 1.3

Apologies were noted. Dr Agnelo Fernandes opened the meeting. Members welcomed Gordon Kay as the new representative of Healthwatch.

Ref: 2018/05/02

2 Declaration Of Interests

2.1 There were no other specific declarations of interest other than the generic interest of practicing GPs.

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Ref: 2018/05/03

3 Minutes of the last meeting

3.1 The minutes of the meeting held on 06 March 2018 were agreed subject to typographical errors correcting the following sections: Correction: Remove Emily Symington from Attendee list (had been noted in apologies) Remove incorrectly retained paragraphs (from January meeting) at para 7.8 up to and including 7.12.

Ref: 2018/05/04

4 Matters Arising

4.1

All actions were noted to be closed.

Ref: 2018/05/05

5 Joint Chair/Chief Officer Report

5.1 5.2 5.3 5.4 5.5 5.6

Andrew Eyres and Dr Agnelo Fernandes presented the report. Andrew Eyres reported that the extended One Croydon Alliance agreement had been formally approved at a meeting in the Town Hall. The alliance made up of Croydon Clinical Commissioning Group (CCG), Croydon Council, Croydon Health Services NHS Trust, Croydon GP Collaborative, South London and Maudsley NHS Foundation Trust, and Age UK Croydon has signed a contract extension to have a wider remit, meaning eventually it will include further integration of services for people of all ages and disabilities in the borough.

Agnelo Fernandes described the 360⁰ Stakeholder survey and results showing improvement in the feedback provided by Member Practices and the CCG’s partners, particularly citing more visible leadership and variation of clinical outcomes being tackled.

Agnelo Fernandes also mentioned the Staff Survey that showed signs of encouragement citing appreciation of a visible culture change. The work of an active staff forum and introduction of staff awards had also been welcomed.

Andrew Eyres described the work of the Croydon Transformation Boad, and announced its new independent Chair, Jerry Cope. The Governing Body were told of John Goulston’s retirement from his role as Chief Executive of Croydon University Hospital after many years of service and wished him well for the future.

Agnelo Fernandes drew attention to the briefing on a measles outbreak across London (11 cases in Croydon since the beginning of March both among children and among adults) and commented that not all professions in contact with these groups have had the same imperative to be vaccinated as front line healthcare staff. Croydon’s Director of Public Health, Rachel Flowers replied that she has written to local GPs, schools and foster carers to inform them of the need for vaccination for children and there has been particular focus with schools.

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5.7 5.8

Andrew Eyres described the national plans for celebrating the 70th birthday of the NHS on 5th July 2018 and said that local celebrations to observe the occasion are being planned in Croydon around a families’ day and said he expected that the CCG’s communications and PPI leads would be inviting the involvement of the public and patients.

Tom Chan praised the improved stakeholder survey results and asked when these would be formally published. Andrew Eyres replied that these will be shared on the CCG website when released but did not have the details of when the national data, benchmarking the CCG against other areas would be available.

Ref: 2018/05/06

6 Improved Access to Psychological Therapies (IAPT) Presentation

6.1 6.2 6.3 6.4 6.5

Stephen Warren introduced Marlon Brown, Head of Mental Health and Neil Turney, Senior Commissioning Manager who provided the background to the CCGs performance against the national target for Improved Access to Psychological Therapies. Neil Turney explained IAPT services are ‘talking therapies’ designed for lower level mental health problems like anxiety and depression intended to prevent these problems escalating. NHS England sets three targets for IAPT based around prevalence of the above conditions that in Croydon has been estimated to be around 44,000 people, Historically, Croydon CCG had a low access rate to IAPT services and following work with NHS England in quarter 3 of 2017/18 an access rate of 10.78% had been reached for the year, compared to 3.75% in 2013/14. Improvements funded with an additional £300k funding had included: work with South London and Maudsley NHS Foundation Trust for additional promotion, new posts and referral management; leaflets intended to reach all houses in the borough; online resources accessible without referral and, along with Croydon Council, targeted promotion through large employers and Croydon Health Services NHS Trust. Though not achieving the 16.8% target as an average over the year, Croydon IAPT met the national run rate from the last week of February through to the end of March 2018. Marlon Brown said that as part of the Planned Care Transformation programme, mental health commissioners are working hard to ensure all IAPT targets are achieved on a consistent basis. The plan for 2018/19 is for the Service to deliver 4.2% access in Quarters 1-3, and increase to 4.75% in Quarter. 4. Neil Turney said the IAPT service still requires more referrals and promotion from primary care services and communications plan to continue in 2018/19.

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6.6 6.7

Members and public in attendance indicated that some had not received the leaflet. A member of the public in attendance commented that a more recognisable name for the service than IAPT might yield improved take-up. Neil Turney said that commissioners would work with the CCG engagement team and their networks to examine options. There was a question about the length of time between first contact with the service and contact with a Mental Health professional. Neil Turney explained that this was complicated due to the nature of the triage that takes place but a few weeks was typical and the national standards in this respect were met. A member of the audience indicated that using a register of carers could help to target those who may benefit from IAPT. Neil Turney said that the Carer Centre had been approached and that commissioners will work with GPs and the primary care variation team to look at how this audience could be approached. An individual in the audience shared a positive experience of the IAPT service received by a family member Members thanked Marlon Brown and Neil Turney for the presentation and praised the significant improvement described.

Ref: 2018/05/07

7 Developing our Strategic and Operational Plans

7.1 7.2 7.3 7.4 7.5

Croydon CCG 2018/19 Operating Plan Stephen Warren presented the Operating Plan. Stephen Warren advised members that a draft Operating Plan had been submitted ahead of the 3rd April 2018 deadline described in the 2018/19 planning process. The Operating Plan, which had been seen by members in Draft, reflected all CCG work programmes including the improvement arrangements for continuing healthcare. The Operating Plan was described as a comprehensive document, underpinned by recent contract negotiations and incorporated finalised activity changes with detail of the transformation programmes. Mike Sexton explained that the Financial Plan incorporated had been finalised in March 2018 and, since then, year end and the contracting round had progressed according to plan. Mike Sexton welcomed the inclusion of significant QIPP within contracts and advised that all major contracts for 2018/19 are signed with the exception of Kings College Hospital for which negotiations were in their final stages after working through risk sharing Mike Sexton drew attention to a significant risk around the unknown scale of the waiting lists at St George’s hospital and said that further details were awaited by the CCG. Members were reminded of the risk described within the March 2018 meeting that relates to expectations of the SW London CCGs

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7.6 7.7

making a collective 1% surplus representing £7.4m and the £1.2m contribution that this would attribute to Croydon CCG. Mike Sexton said that the CCG was striving for a break even position and that adding this contribution to required savings would increase the QIPP target to £27.6m. Mike Sexton stressed that a continued focus on further forward looking plans for 2019/20 alongside delivery of plans in 2018/19 would be essential. The Chair noted the praised the sustained work of the executive and predecessors resulting in the realistic prospect of achieving break even. The Governing Body

▪ NOTED the final Operating Plan for 2018/19 including financial plans.

Ref: 2018/05/08

8 Reports from Committees – Integrated Governance & Audit Committee (IGAC)

8.1 8.2 8.3 8.4

Agnelo Fernandes introduced the revised reporting arrangements that represented work to enhance the CCG’s governance as discussed in Governing Body seminars. In the absence of Philip Hogan, Roger Eastwood, Lay Member – Finance and Vice Chair of IGAC reported on the annual review of the Committee and advised that it was considered to have delivered against its terms of reference. Roger Eastwood, supported by Elaine Clancy described the proposed change to the IGAC terms of reference in recognition of the changed Chief Officer arrangements that make the existing Accountable Officer attendance expectations extremely challenging. It was proposed to invite Andrew Eyres, Accountable Officer when the committee felt this attendance to be necessary. Roger Eastwood described the Integrated Governance and Audit Committee’s involvement in reviewing the draft Annual Report and draft Annual Accounts when the committee met on the 19th April 2018 and said that the committee is scheduled to meet on 21st May 2018 to review the final drafts. Final sign-off is reserved to the Council of Members and is scheduled for their meeting on 24th May 2018. On behalf of the Integrated Governance and Audit Committee, Roger Eastwood requested that the Governing Body delegates authority to the committee to recommend the draft Annual Report and Annual Accounts to the membership rather than requiring a special meeting of the Governing Body to be convened. The Governing Body:

▪ NOTED the annual review of the Committee and its Terms of Reference

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▪ APPROVED the IGAC Terms of Reference following their

minor amendment as described.

▪ AGREED to Delegate authority to the Integrated Governance and Audit Committee for the review of the Final CCG Annual Report 2017/18 and Final Annual Accounts and to recommend their approval to the Council of Members.

Ref: 2018/05/09

9 Reports from Committees – Finance Committee

9.1 9.2 9.3 9.4 9.5 9.6

Roger Eastwood, Lay Member – Finance reported on the annual review of the Finance Committee and advised that it was considered to have delivered against its terms of reference in its activities over the previous twelve months. Roger Eastwood advised that the Finance Committee had last met on the 23 April 2018 and had received and reviewed the Month 12 Finance Report and QIPP report. The Committee had confirmed that £8.1m additional QIPP that had been requested by NHS England but had not been agreed by the CCG, remained unidentified Roger Eastwood described that the reduced frequency of Governing Body meetings in public, enabling more strategic focus and seminar time, had meant that procurement decisions were increasingly sought through Chairs Action. Roger Eastwood recommended that a more satisfactory approach, considered at IGAC, would be to increase the remit of the Finance Committee to approve the procurement decisions that it currently has authority to recommend. Mike Sexton provided further detail on the Finance Report and QIPP Programme report for period 12 (March 2018). Mike Sexton described a correction to the Chair’s report coversheet that described the CCG delivering a £19.9m deficit that was correctly reported as £13.9m deficit thereafter. Mike Sexton said that underpinning this result, was the delivery of an unprecedented level of QIPP efficiency savings of £21.2m (4.3% of annual allocation). Mike Sexton described the 2017/18 result putting the CCG in a strong position to follow through and deliver the 2018/19 financial plan that was agreed in March 2018. Mike Sexton reported that the CCG will be seeking to deliver £26.4m QIPP in2018/19 to deliver an in-year breakeven position of which, Mike Sexton reported that to date £24.6m has been identified, leaving a further £1.7m to find with several pipeline projects under investigation

The Governing Body:

▪ NOTED the annual review of the Committee and its Terms of Reference

▪ NOTED the Finance Report (M12) and QIPP Report (M12), in particular the CCG delivered a £13.9m deficit in line with its forecasts and delivered £21.2m (4.3%) efficiency savings.

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▪ AGREED to delegate authority to the Finance Committee for

the approval of procurement decisions on behalf of the Governing Body and for this to be reflected in a change to the Finance Committee Terms of Reference.

▪ APPROVED the revised Terms of Reference of the Finance

Committee confirming that the Accountable Officer has an “open invitation” to attend.

Ref: 2018/05/10

10 Reports from Committees – Quality Committee

10.1 10.2 10.3 10.4 10.5 10.6 10.7

Amy Page, Registered Nurse Governing Body Member and Quality Committee Chair introduced the report of the annual review of the Quality Committee and advised that it was considered to have delivered against its terms of reference in its activities over the previous twelve months. Amy Page described calling commissioners to the Committee, most recently from the Integrated Commissioning Unit to hear from the joint commissioning of services for children with special educational needs and/or disabilities (SEND) and on safeguarding monitoring of looked after children (LAC). Amy Page described that the Joint Impact Assessment Panel had, through 2017/18, enabled greater assurance that quality impact and impact on equality is considered as part of every service change and QUIPP scheme. A minor change to the Terms of Reference had been recommended to correct a legacy issue that suggested the Quality Committee reports to the Integrated Governance and Audit Committee and not directly to the Governing Body. Due to the sequencing of committee and Governing Body meetings, the most recent Integrated Performance and Quality report for month 11 had not been received by the Quality Committee and was presented by Elaine Clancy. Elaine Clancy reported that Croydon CCG had seven patients waiting over 52 weeks in February in particular King’s (five). The report gave confirmation that patients had been reviewed and there was no indication of patient harm as a result of a prolonged wait for treatment. Elaine Clancy reported that in M11, Croydon Healthcare Services NHS Trust’s (CHS) 4 hour A&E performance continued to be challenged, remaining below the national standard at 87.11%. Croydon CCG met 5 out of 8 cancer wait standards for February. Elaine Clancy attributed breaches to the challenge posted by shared pathways across a number of providers and sites and said that a new weekly shared care telephone conference has been initiated to give greater oversight. Elaine Clancy said that the Month 11 report generally shows an improved performance towards the required trajectory.

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10.8 10.9 10.10 10.11

Elaine Clancy said that seven serious incidents had been reported: six in CHS and one in South London and Maudsley NHS Foundation Trust (SLAM), and said that each would have an investigation and root cause analysis (RCA). Elaine Clancy reported that Clinical Quality Review arrangements had been established across out of hospital services, with meetings taking place for Intermediate Care, Croydon Urgent Care Alliance (CUCA) and for General Practice; each chaired by Tom Chan, Medical Director Agnelo Fernandes asked the committee Chair whether the Quality Committee has sufficient access to information to confidently triangulate service data with patient feedback. Amy Page replied that this is a challenge but explained how assurances are received from teams and individuals close to the services. There was a discussion of the different means by which the patient experience could be examined for contradictions to positive data but also how relationships with providers were key. Gordon Kay described how Healthwatch decide on issues to be tested but said that they could also be pointed to data by the CCG. Andrew Eyres described the importance of analysis to recognise patients not accessing care and deteriorating such that their risk increases. The Governing Body: ▪ NOTED the Integrated Quality and Performance Report Month

11. ▪ NOTED the annual review of the Quality Committee and its

Terms of Reference

▪ APPROVED Terms of Reference for the Quality Committee including the amendment clarifying reporting arrangements

Ref: 2018/05/11

11 Reports from Committees – Primary Care Commissioning Committee

11.1 11.2 11.3

Roger Eastwood, Lay Member – Finance reported on the annual review of the Primary Care Commissioning Committee and advised that it was considered to have delivered against its terms of reference while the committee, that met in public before the Governing Body, was established in July so had not yet met over 12 months. Roger Eastwood said that no significant change to terms of reference was required but that national guidance ensuring the independence of the Conflict of Interest Guardian had been acknowledged in the terms of reference section that indicates which Lay Members should chair the Committee. It was reported the Committee had an overview of the Primary Care Transformation programme. Martin Ellis added that four practices

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had received CQC visits since establishment of the committee. The Governing Body: ▪ NOTED the Primary Care Commissioning Committee Chair’s

report including the review of the Committee activities and Terms of Reference

▪ APPROVED Terms of Reference for the Primary Care Commissioning Committee including a reference to conflict of interest guidance to inform selection of the Lay Chair.

Ref: 2018/05/12

12 Chair’s Action – Language Line Services

12.1 12.2 12.3

Martin Ellis explained that the CCG currently commissions language and British Sign Language (BSL) interpreting from Language Line. Following a 3 year contract, extended by a further 2 years, the contract was due to end 31st March 2018. The CCG sought to award a call-off contract from a national framework agreement, established through a Public Contracts Regulations 2015 compliant procurement process. The interpreter and BSL service had been provided jointly to Croydon Health Services Trust (CHS). Chairs action was taken on 31st March 2018 to avoid a gap in provision after a delay arising from a late CHS decision whether or not to continue commission the service jointly. The Governing Body:

▪ RATIFIED the Chair’s action to: Approve the direct award of the language and British Sign Language interpretation contract with Language Line for 36 months from 1st April 2018 with an option to extend by 24 months

Ref: 2018/05/13

13 Chair’s Action: Award of Interim Contract to current Community Ophthalmology Provider, Complete Ophthalmic Services (COS)

13.1 13.2

Stephen Warren described the background to Chair’s Action being taken. The Ophthalmology transformation programme was still progressing and there was no agreed model of care. The current community service contract ended on 30th April 2018, with no further extensions available. Therefore to support the transformation programme progress and a new model developed and agreed jointly with key stakeholders, the CCG sought to extend the current contract with COS to maintain service provision in the community. Chair’s action was taken on 3 April 2018 with support from Mike Sexton, Chief Finance Officer and Roger Eastwood, Lay Member –

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Finance as the Governing Body had not met in public since 6 March 2018 to approve procurement decisions. The Governing body:

▪ RATIFIED the Chair’s Action to: Award an “interim” contract to the current community ophthalmology provider, for an 11 month period, whilst the transformation of Ophthalmology services in Croydon is being undertaken.

Ref: 2018/05/14-19

14 Minutes of the Integrated Governance and Audit Committee

The minutes were presented for information and there was no discussion. The CCG Governing Body noted the Minutes.

15 Minutes of the Quality Committee

15.1


16 Minutes of the Clinical Leaders Group

16.1


17 Minutes of the Finance Committee

17.1 The minutes were presented for information and there was no discussion. The CCG Governing Body noted the Minutes.

18 Minutes of the Primary Care Commissioning Committee

18.1

The minutes were presented for information and there was no discussion other than to note these are reviewed in the preceding meeting that meets in public before the Governing Body. The CCG Governing Body noted the Minutes.

19

19.1 The minutes were presented for information and there was no discussion. The CCG Governing Body noted the Minutes.

20. Register of Interests and Hospitality

20.1

The register of interests and hospitality were presented.

Roger Eastwood, Lay Member advised that a correction was required in respect of his entry that should refer to the “National

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Federation of ALMOs” (not “ALMOS as listed).

Emily Symington advised that a correction was required to her newly

added entry confirming this is a financial interest as a paid role

providing GP clinical expert supporting group consultation training

on an ad-hoc basis (Georgina Craig Associates Limited –a company

with close links to Experience Lead Care)

The CCG Governing Body noted the Registers of Interest and Hospitality.

21 Open Space for Public Questions

21.1 21.2 21.3 21.4 21.5

21.6

21.7

21.8

No questions were submitted in advance of the meeting.

A member of the public in attendance asked about the criteria and procedures for Cataract operations, whether this followed NICE guidance. Tom Chan said he had seen discharge summaries that indicated the current arrangements and invited the enquirer to make direct contact with him.

A member of public in attendance described serving on a Colorectal meeting where there had been mention of referrals still coming through in paper form in the previous fortnight suggesting the Electronic Referral System (ERS) might not be implemented. Agnelo Fernandes gave clarification on the 2 week rule. Martin Ellis said that a team of trainers were working with practices and 61% of practices were taking referrals via ERS. Martin Ellis said allowing dual reporting with paper referrals until full assurance was given was a safety matter but agreed that a timescale needed to be set. ME advised the ERS project should report to the Croydon Transformation Board to agree the point of ‘paper switch off’.

A member of public in attendance asked what progress had been made in the transformation of planned care (around dermatology, gynaecology and diabetes). Stephen Warren advised that the design stage had been completed and, following detailed pathway engagement, had commenced the procurement phase. There was a discussion about lay representative participation on procurement panels and Stephen Warren said that PPI panels will be updated.

Andrew Eyres noted the timings and the need to keep interested parties updated. The importance of maintaining continuity in the face of challenges posed by changes to commissioner personnel was acknowledged, after member of the public described the frustration of diabetes exercises that had to be restarted.

Gordon Kay reported that workshops had up to 30 members of public and that Ros Spinks was looking to promote this but interested individuals had to apply. Stephen Warren explained some training is given around appreciation of the required process and timescales which indicates a time commitment of roughly two full days.

A member of the public who attended a Practice patient participation group raised a concern about DNA by patients taking same day

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21.9 21.10

appointments. Agnelo Fernandes replied that the CCG cannot prescribe the warning or sanctions such patients are given but would be supportive of efforts to standardise the message given in such circumstances that might seek to understand the reason and explain the impact of such behaviour.

[Rachel Flowers left the meeting at 15.44]

A member of the public in attendance asked what the CCG can do to offer support to Practice Patient Participation Groups across London. It was noted that the CCG is supportive of the national arrangement and Andrew Eyres indicated some examples in Lambeth and described what an ‘at scale’ approach to PPG might look like. Andrew Eyres said that every practice needs to think how it engages with its registered patients and recognised that there is often a limited database of contacts. Agnelo Fernandes said that Paulette Lewis, Lay Member (PPI) could oversee what exemplar arrangements exist nationally.

Agnelo Fernandes noted that there is an informal PPG network that could think about solutions. Gordon Kay described that healthwatch may be able to offer a different sort of support.

Ref: 2018/05/22

22 Any Other Business

22.1 Martin Ellis said that the CCG was procuring an arrangement to enable wifi access to the public in all Croydon CCG practices.

Date of Next Meeting

Tuesday 3 July 2018 14:00 until 16:00, Croydon Conference Centre, Croydon for Meeting on Tuesday 6 December

Signed…………………………………………………….. Dated………………………………………………………

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING IN PUBLIC

3 July 2018

Title of Paper: JOINT CLINICAL CHAIR AND ACCOUNTABLE OFFICER REPORT

Lead Director Dr Agnelo Fernandes Clinical Chair Andrew Eyres Accountable Officer

Report Author Dr Agnelo Fernandes Clinical Chair Andrew Eyres Accountable Officer

Committees which have previously discussed/agreed the report

N/A

Committees that will be required to receive/approve the report

N/A

Purpose of Report For information and noting

Recommendation:

The CCG Governing Body is asked to receive the report for information.

Background:

This is the regular joint report of the Clinical Chair and Accountable Officer to update CCG Governing Body members on developments in the local health and care system and on wider policy issues and developments as appropriate. The report follows the regular format followed by the CCG, however, we always welcome your feedback on the format and content of the report in order to inform future reports.

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Joint Clinical Chair and Accountable Officer Report

Overview of Key Business Activities

The following summary highlights key meetings and events undertaken since the last Governing

Body (May 2018):

▪ Croydon Transformation Board, Alliance Board and, Delivery Group

▪ Croydon Professional Cabinet

▪ Croydon Health and Social Care Scrutiny Sub-Committee

▪ Croydon Health and Wellbeing Board

▪ South West London Clinical Chairs

NHS 70

As you will know, 2018 will mark the 70th birthday of the NHS. The official date is Thursday 5 July

and we are joining up with our partners to celebrate it in style. We will be taking over a large space

in the popular Whitgift Centre in the centre of Croydon and will be teaming up with local partners

such as Croydon Health Services NHS Trust, Croydon Council, South London and Maudsley NHS

Foundation NHS Trust and Healthwatch Croydon. We’ll be asking the public to share their NHS

experiences and to find out more about what services they can access in Croydon. We will also be

hosting an event for staff and their families on the Saturday to celebrate and thank them for their

commitment to the CCG and to the wider NHS.

We’re pleased to say that Brian Dickens, a practice

manager in Thornton Heath, has won the London

Regional NHS70 Parliamentary award for Excellence

in Primary Care. Brian’s development of the local

based social prescribing programme in the Thornton

Heath has had a huge impact on a number of

individuals, GP practices, local providers and the

community as a whole. His community development

approach has engaged at all levels and has changed

the health and well-being of numerous lives. The

programme is built on a sustainable model of local capacity building and local input and he is proud

to be part of such an effective community change programme. Brian feels that this recognition and

award is for everyone involved he hopes it develops a model for all to follow.

Increase in NHS funding announced

In June 2018, the Prime Minister announced that the NHS will receive increased funding of £20.5bn

in real terms per year by the end of the five years compared to today – an average 3.4% per year

overall.

The aim for this increase is for the NHS to improve core performance and lay the foundations for

further service improvements. The funding will be front-loaded with increases of 3.6% in the first two

years, which means £4.1 billion extra next year.

This intention is that the long-term funding commitment will mean the NHS has the financial security

to develop a 10-year plan. The plan will be developed by the NHS, working closely with government

and be published later this year. We will work to understand what this will mean for Croydon over

the summer. Whilst this is higher than the 2.4% planning assumptions we have been using, it is

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unclear what commitments have been made nationally again these funds, in particular the funding of

the recent pay award in over the next 3 years.

New Governing Body appointments and changes

We’d like to formally welcome Dr Vaishali Shetty and Dr Mike Simmonds as new members of our

Governing Body. Vaishali has worked in Croydon since 2006 across a range of roles, including Out

of Hours GP and in Croydon University Hospital as a Senior House Officer. Mike is a lead for the

New Addington/Selsdon GP network and has worked closely with CCG colleagues as a Clinical

Lead for Cancer, Paediatrics and Children’s Mental Health.

Both are longstanding members of the Croydon GP community and we are confident that they will

make valuable contributions to Croydon’s Governing Body over the course of their tenure.

Roger Eastwood and Philip Hogan, being similarly qualified, have agreed to swap portfolios to give

greater protection to the Conflict of Interest Guardian role. The Council of Members agreed that

Philip Hogan will become Lay Member (Finance) and will continue to chair the Primary Care

Committee in addition to chairing the Finance Committee. Roger Eastwood becomes Lay Member

(Governance & Conflict of Interest Guardian) and will chair the Integrated Governance and Audit

Committee.

Annual Report 2017/2018 and our 2018 AGM

We are pleased to say that our 2017/18 Annual Report and Accounts have been approved and

published on our website. You can read them in full here.

We will be producing a summary annual report for our Annual General Meeting, which will take

place on Tuesday 25 September 2018 from 1pm in Braithwaite Hall, in the Town Hall. We will be

following on from last year’s successful format and will be hosting a marketplace for our partners

and CCG programmes to engage with the public and our GP members. We will also be presenting

on our activities and highlighting some of ours and our partners’ successes.

Conflict of Interests training

We are pleased to report that all Governing Body has completed their conflict of interest training.

You can find out more about conflicts of interests, and how the CCG deals with them here.

New Cabinet for Croydon Council

After the local elections in May 2018, we welcome the new councillors and cabinet to Croydon

Council. We welcome Cllr Jane Avis, Cabinet member for families, health and social care, Cllr

Louisa Woodley as Chair of the Health and Wellbeing Board and that Cllr Sherwan Chowdhury as

Chair of the Scrutiny Health & Social Care Sub-Committee. We congratulate all councillors on their

(re)election and look forward to working further with colleagues with whom we have established

relationships and to building relationships with new councillors.

CCG 2017/18 360 Stakeholder Survey

At May’s Governing Body we updated you about the CCG 360 Stakeholder Survey. This is carried

out each year by IPSOS Mori on behalf of NHS England. The survey asks our member practices

and partners across the NHS, the local authority and voluntary sector a number of questions

designed to determine how they view the CCG and our teams. The results of this survey contribute

to this through the CCG Improvement and Assessment Framework. The framework draws together

the NHS Constitution, performance and finance metrics and transformational challenges and plays

an important part in the delivery of the Five Year Forward View.

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We’re pleased to be able to give some more detail around our results. As commented in May, our

results this year show a significant improvement from last year, and our results are also now

consistently higher than the national average on the majority of responses. We copy some

highlights below:

• 81% feel the CCG has clear and visible leadership, compared to a national average

response of 69%

• 76% feel the CCG is an effective local system leader, compared to a national average

response of 72%

• 68% feel that the leadership of the CCG is delivering high quality services that

demonstrate value for money compared to a national average response of 59%

• 66% have confidence in the leadership of the CCG to deliver improved outcomes for

patients, compared to a national average response of 61%

• 65% feel the CCG demonstrates that it has considered the views of patients and the

public when making commissioning decisions, compared to a national response of 56%

Again, we’d would like to thank all our stakeholders for the part they have played in working together

across our member practices and with our key partners to improve health in Croydon.

Croydon Transformation Board update

The One Croydon Transformation Board met in May 2018. The Board is made up of key

representatives of the partners of the One Croydon Alliance: Croydon Council, Croydon Health

Services NHS Trust, South London and Maudsley NHS Foundation Trust, Age UK Croydon, the

Croydon GP Collaborative and NHS Croydon CCG. At the May meeting, items for discussion

included:

The Croydon health and care plan’s ‘direction of travel’ was considered in May 2018. The next

meeting, in July, will focus on the emerging plan and the governance to strengthen delivery.

Croydon’s health and care plan will reflect the wider direction of change in the borough including

Croydon Council’s new operating model which was presented at the meeting. Croydon Council will

be moving to a model that will ensure services become the place of first resort, not the last. The

ethos is to work with individuals and families in particular, at an earlier point in the cycle of their

health, employment or housing to make sure the right services are provided at the right time and in

the right place.

The primary care working at scale bid was presented including the need to ensure alignment of

Croydon Council and NHS localities to support the development of integrated hubs in the community

as far as possible.

The capital estates wave 4 bids were discussed. The local prioritisation process is underway to meet

the SWL prioritisation timetable.

There was a focus around the delivery of the Out of Hospital business case which is demonstrating

good progress in terms of outcomes.

The newly appointed Independent Chair of the Transformation Board and the Alliance Delivery

Board presented his early reflections of the Board which included focus on three areas: the alliance

journey, meeting structure and processes and

accountability.

Primary care at scale event

On Tuesday 26 June over 450 health professionals

came together to Croydon CCG’s first primary care

conference: “Working at Scale: Transforming General

Practice”. We discussed working at scale for GPs –

what that means and might look like for Croydon. We

Happy birthday NHS!

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looked at how Croydon GPs and, by extension, their patients, can perhaps benefit from working at

scale, for example, online consultation, in diagnostics and how pharmacists can play a role. We

welcomed national keynote speakers from NHS England, the National Association of Primary Care

and the Royal Pharmaceutical Society to a panel which opened the afternoon. The speakers

discussed how GPs have benefitted from working at scale around the country and how they have

managed to balance keeping the local feel while benefitting from the advantages of working at scale.

Dr Nav Chana, GP in Mitcham and Chairman of the National Association of Primary Care, said

“Events like today are vital to allow health professionals at the centre of local care to make the

connections to develop new ways of working organically. That’s how we developed primary care at

home. Now there are over 213 primary care at home sites across the country covering around 16%

of the population, all of which were led from the bottom up. It’s about balancing the local, personal

feel of a single practice with having the

scale required to make real change.”

We also managed to celebrate the

achievements and dedication of our

primary care colleagues in our awards

ceremony. The winners were

nominated by their colleagues from

across the GP networks in Croydon.

We also wished the NHS a happy 70th

birthday!

Carers week

The CCG recognised Carers Week 2018, which ran

from 11-17 June. We publicised local activities for

those who care for people of all ages and promoted

valuable resources, such as the active local Carers

Centre and talking therapies services. More

information about the local Carers’ centre can be

found here.

LAS rated ‘good’ by CQC

We are pleased to note that the Care Quality Commission (CQC) has rated London Ambulance

Service Good overall, following an inspection that took place in March 2018. It was previously rated

‘Requires Improvement’ at its last inspection. The Trust was rated Outstanding for being caring and

Good for being safe, effective, responsive and well-led. Two core services had a number of areas

which Required Improvement and this inspection was designed to assess what progress had been

made. Inspectors found examples of outstanding care at the trust, which has treated people that

have been involved in major incidents in London in recent years. In addition CQC undertook a well-

Our award winners

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led inspection. At a previous inspection CQC rated well-led as Requires Improvement. At the time

inspectors were not sufficiently assured of progress made to remove the trust from special

measures, which had been in place since 2015. You can read the full report here.

The CCG’s Strategic Risk Update

The CCG’s Board Assurance Framework, detailing high level strategic risks is provided for the

Governing Body. All risks on the full Risk Register are reviewed individually by risk owners, and

high-level risks are scrutinised by the Integrated Audit and Governance Committee.

Each risk is also regularly reviewed by the relevant Committee of the Governing Body with assigned

responsibility for overseeing its mitigation. The CCG’s Internal Auditors have been assisting the

improvement of the CCG’s Risk Management process by developing a map of our assurances that

will inform the review of strategic risks by the Integrated Governance and Audit Committee in

September 2018.

There are a total of 16 strategic risks on the Governing Body Assurance Framework which have been mapped against the strategic objectives as follows:

Objective Total Risks

15+ 5 - 12

1.

To commission high quality health care services that are

accessible, provide good treatment and achieve good patient

outcomes

7 2 6

2.

To reduce the amount of time people spend avoidably in hospital

through better and more integrated care in the community, outside

of hospital for physical and mental health

1 1 1

3. To achieve a breakeven position in year 2017/2018 and

sustainable financial balance by 2020/2021 3 3

4.

To support local people and stakeholders to have a greater

influence on service we commission and support individuals to

manage their care

1 1

5.

To have all Croydon GP practices actively involved in

commissioning services and develop a responsive and learning

commissioning organisation

2 2

16 6 10

The CCG’s full risk register, available on request, details the controls in place to mitigate these risks

and the assurances received by the Governing Body and its committees to have to confidence that

these controls are effective.

Staff awards We are pleased to announce the latest winners in our staff awards. These are run by our staff

forum; all winners are nominated by their colleagues for being visible examples of the CCG’s values.

Neil Turney Professional / Outcomes focused

Angela Vernon Outcomes focused

Regina Odior Outcomes focused

Marlon Brown Professional / Patient Focused

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Croydon CCG at the Palace Sally Innis, Head of Safeguarding, Designated Children, represented the

CCG at one of the Queen’s three gardens parties held over the year at

Buckingham Palace. Sally took her father where they spent an afternoon

visiting the gardens at Buckingham Palace, with a tea and slice of cake.

Sally’s Father spoke with Prince Charles and the Duke of Kent about his

service in the war. The highlight of their day was meeting Karen Gibson,

leader of the choir that sang at Prince Harry and Meghan Markle’s wedding.

Dementia awareness

Staff once again showed off their baking skills, this time in

support of Cupcake Day to raise awareness and funds for the

Alzheimer’s Society. Colleagues ate delicious cakes, all in

the name of charity of course, to raise over £90 for this

charity which does so much to fund research and create

lasting change for people affected by dementia. To find out

more about the Alzheimer’s Society, please visit

www.alzheimers.org.uk.

The Governing Body also completed dementia training as

part of their recent seminar.

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERNING BODY

26TH June 2018

Title of Paper: Update on the Out of Hospital Estates and IT programme

Lead Director Martin Ellis Director of Out of Hospital and Primary Care

Report Author Simon Keen

Committees which have previously discussed/agreed the report.

Finance Committee – 25th June 2018


Governing Body

Purpose of Report For noting and agreement

Recommendation:

The Governing Body is asked to:

▪ Note the allocation of £9.8m of STP Capital to Croydon CCG for Estates, Implementation and IT Capital requirements to support the Croydon STP Primary & Community Care transformation (Out-of-Hospital and Planned Care) programmes

▪ Note the proposed implementation approach and principles ▪ Note the current key issues ▪ To agree to delegate authority for signing off the Outline and Final Business Case

(OBC/FBC) for the Out of Hospital programme to the Finance Committee ▪ To agree decisions regarding the current STP Capital Wave 4 bids (currently being

prioritised by the SWL STP) for a primary care centre in Coulsdon (CALAT Centre) are delegated to the Finance Committee

Background:

• The key objectives for the 2017 ‘Wave 3’ STP Capital bids are to:

o Make additional space and facilities for MDTs in GP practices

o Where required, provide additional clinical capacity in GP practices to support

activity as it moves from secondary care to Out of Hospital care in line with

the Out of Hospital and Planned Care transformation programme plans

o Deliver the necessary I.T. to support the GP Practice and Care Home

elements of the transformation programme

o Provide the project support to the roll out of estates and I.T. across Croydon

GP practices

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• In 2017, the CCG submitted a Croydon NHS bid to provide:

o Estates capital to fund internal improvements to GP practices to support

additional MDT, administration and clinical capacity (£7,060,000 plus 34%

GP contribution under NHS (General Medical Services - Premises Costs)

Directions 2013)

o IT capital to support additional IT capability within practices, for peripatetic

Out of Hospital staff and telemedicine / remote support for care homes

(£1,505,000)

o Programme management, training and support (£1,225,000)

• This bid was sponsored by the principle NHS and Local Government bodies in

Croydon Borough in support of the One Croydon programme

• The CCG has been notified that this programme is supported by NHS England /

NHS Improvement and the CCG should present a Full Business Case (FBC) to gain

approval to implement.

• The CCG’s approach to implementation in summary is:

o To work within the existing Croydon transformation (Out of Hospital and

Planned Care transformation programmes) structure to create a working

team of all relevant stakeholders to develop, plan and monitor the delivery of

the programme

o To align this Out of Hospital programme with the Primary Care Working at

Scale programme to realise the Place / Locality model for primary and Out of

Hospital Care in Croydon

o To work closely with the CCG’s Croydon Transformation Board partners to

optimise the use of the estates asset base across Croydon through the

Croydon Health and Social Care Board (chair: John Goulston). Initial

discussions have been held with CHS to understand the synergies between

CHS Community Care and primary care estates. It is agreed by the Croydon

Health and Social Care Board that this collaboration will be extended to

Croydon Council and other providers of health and social care estates assets

across the Borough

o To define the multi-year requirements for Out of Hospital activity by speciality

by GP Network in line with the overall CCG transformation plan (Out of

Hospital and Planned Care transformation) and associated financial goals

o To work with the GP Networks as commissioners to seek Network responses

in estates and IT to meet the activity requirements. This is expected to

include Network plans as to the disposition of services and associated

estates and IT impacts

o To support the Networks and GP Collaborative in the development of their

responses with the required professional support and advice

o To implement the estates and IT improvements in line with the agreed plan

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New Coulsdon GP-led Primary Care Centre (CALAT site) ▪ The CCG has submitted a bid to the STP under the NHSE/NHSI STP Capital bid Wave

4 process as part of the Croydon Transformation Board (CTB) estates proposal ▪ That the CTB proposed to the STP the consolidated prioritisation for the SWL Capital

Wave 4 bids, with joint equal first priority for

o Croydon CHS - the extension and refurbishment of Croydon University Hospital

ITU and HDU (£12.5m gross)

o Coulsdon GP Primary Care Centre - the delivery of a new GP-led primary health

centre for Coulsdon (£6.0m gross)

The CCG’s firm bid for this Wave 4 round delivers a new GP-led primary care health centre of approximately 1500m2 GIA in a prime location in Coulsdon, Croydon. The site has been identified and outline planning permission obtained for the scheme by Croydon Council’s housing development company Brick by Brick. The site is D1 planning case status. As part of the planning permission, an outline form factor for the building was submitted. This was for a 3-floor building with required access (ambulance, etc). It is expected that the primary service offerings at the new site would include primary, out of hospital, mental health, social and third sector care. Note that the commercial structure of the CALAT scheme is still in development but is currently expected to be funded from NHS, Community Infrastructure Levy (CIL) and Section 106 monies and, potentially, private sector sources.

Key Issues:

Key Issues Out of Hospital Estates & IT Programme

• The CCG is seeking clarification as to the financial implications of this programme.

o STP Capital is Treasury overlay funding outside the current Department for

Health / NHS allocation. The implications of this for a primary care scheme

are being clarified between the CCG and NHS England

o It is anticipated that the estates element will be treated as current

improvement grants with no depreciation implications for the CCG. This is to

be confirmed (the revenue implications have been budgeted by the CCG in

the normal manner). It is anticipated that the IT capital elements will be

placed and depreciated on the NHS England asset register and depreciated

as usual

o The CCG is exploring ways in which the programme costs can be capitalised

against the resultant assets. This potentially will require the support and

agreement of CCG members – for example; the use of the contractor’s

professional fees elements of estates projects under Premises Directions to

drive a shared programme delivery team

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• At present, there is no ability to draw down funding to develop the required FBC with

consequent financial risk to the CCG’s 2018/2019 financial position. CCG Finance

are exploring ways to mitigate this risk

• It is expected that an updated version of the Premises Costs Directions may be

revised in the timescales of this programme. This may allow more flexibility of the

permitted percentage grant to contractors

• The CCG has potential access to additional estates capital funding (Community

Infrastructure Fund [CIL], Section 106, GLA funding) in certain Croydon geographies

and may choose to augment the Out of Hospital funding is appropriate

The CCG is seeking clarify as to whether FBCs for separate programme elements can submitted on different timelines. The CCG wishes to proceed with the implementation of the Airdale support model for care homes quickly due to the potential savings which could be delivered. Next Steps – Out of Hospital Estates & IT Programme

• Build a team to develop the programme and deliver the FBC case. It is anticipated

that this team would comprise:

o A programme director

o A planning analyst to develop the activity volume plans by Network to

underpin the CCG commissioned Out of Hospital services

o An estates analyst to identify the potential improvement schemes in GP

practices which could support this Out of Hospital programme

o An IT analyst to identify the potential improvement schemes in GP practices

which could support this Out of Hospital programme

For a period of approximately 6 months

• It is planned that the FBC case would include specialist estates and IT

implementation contractors to guide practice implementation projects

Key Issues – Coulsdon CALAT Bid

• The bid will require further detailed work if it progresses to the next stage of the

process. Ideally, this work should be scheduled now to maximise its chances of

being funded.

Next Steps – Coulsdon CALAT Bid The final submission to the STP for review is 27th June 2018. The STP will submit the prioritised bids, after STP approval, to NHS England / NHS Improvement on July 16th. If the CALAT bid is successful and moves to the next evaluation stage (there were 3 such stages for the Out of Hospital Estates & IT Programme), additional detail and financial build will be required. The CCG has acquired additional specialised financial resources to support these additional stages.

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Governance:

Corporate Objective To achieve sustainable financial balance by 2020/21. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care. To have all Croydon GP practices actively involved in commissioning services and develop a responsible and learning commissioning organisation.

Risks

Risks as identified in the CCG Out of Hospital strategic outline case

Financial Implications

As set out in the Value for Money case within the strategic outline case

Conflicts of Interest

None identified

Clinical Leadership Comments To be addresses as part of the implementation programme

Implications for Other CCGs

None

Equality Analysis

To be addresses as part of the implementation programme

Patient and Public Involvement

To be addresses as part of the implementation programme as required by defined schemes

Communication Plan To be addresses as part of the implementation programme as required by defined schemes

Information Governance Issues

To be addressed as part of the existing IG projects across Croydon and SWL.

Reputational Issues

None

Author: Simon Keen, Head of IT and Estates Version 2: 26th June 2016

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3 July 2018

Title of Paper: INTEGRATED PERFORMANCE & QUALITY REPORT

Lead Director Elaine Clancy Director of Quality and Governance

Report Author Andrea Davis Head of Quality Leo Whittaker Head of Performance, Assurance & Emergency Planning


Quality Committee Senior Management Team


Governing Body

Purpose of Report For Discussion and Noting

Recommendation:

The Quality Committee is asked to: ▪ Note and discuss the Integrated Performance & Quality Report, which is reporting

Month 12 – March 2018 data, where available, and the actions being taken to address key concerns at the time of reporting.

Background:

This report forms part of the CCG’s Quality Assurance activities for their main healthcare providers. Content is based largely on validated Month 12 – March 2018 data, however the latest position is included around service quality, patient safety and decisions that have arisen, where available.

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Key Issues:

Performance Health Care Acquired Infections The CCG had a case of MRSA assigned to it in March. This brought the annual total to 6, compared with 3 in 2016/17. MRSA screened blood cultures taken at time of admission are assigned to CCGs unless the patient was admitted from another provider organisation. The March case has been referred for review to be changed to ‘third party’ on this basis. Diagnostic Waits (6 week wait) The CCG missed the national standard by 0.1% in March. This largest volume of breaches occurred against CT scans, with 35 x 6 week breaches from 754 tests. This was largely due to CHS reduced capacity at CHS as radiographers are trained on the new CT scanner. To mitigate this, CHS is running additional scanning lists in April and May. Accident and Emergency In M12, CHS’ 4 hour A&E performance remained below the national standard with 87.9%. The Trust is operating against a revised trajectory, agreed with NHSI and NHSE, to meet 95.0% for March. The All Types position is composed of Type 1 performance of 71.76% and type 3 at 97.98%. Issues affecting the type 1 position remain availability of middle-grade emergency clinician and bed capacity. In addition to previously reported actions, multi-disciplinary representation on daily A&E calls with the CCG and Surge Hub are facilitating more effective discharges. Cancer Waits Croydon CCG met 6 out of 8 cancer wait standards for March. The CCG did not achieve the 31 day standard for drug regimens - this was due to 2 breaches across 41 pathways. No systemic issues have been identified as a cause and the CCG achieved this target for the year. The CCG also under performed against the 31 day radiotherapy pathway due to 2 breaches out of 35 pathways. Both were unavoidable due to patient fitness for treatment and patient choice. Cancelled Operations In Q4, out of the 42 last minute cancellations of elective treatments at CHS, 1 was not rescheduled within 28 days. This led to a 2.4% performance against a 0 threshold. Information is being requested from the Trust. This is usually a good performing area, however there were 3 breaches earlier in the year. Coincidentally, the annual position is also 2.4%. Mixed Sex Accommodation (MSA) Croydon CCG had 2 MSA breaches occurring at East Sussex hospital and Royal Berkshire Hospital. The former has introduced a new system of reporting and are working to verify that the increases relate to improved data capture and not increased mixing. Royal Berkshire is working with NHSI to improve its MSA position.

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IAPT Access Croydon achieved the rate necessary for compliance in the March. The CCG will need to sustain the increase in IAPT referrals to have a chance of compliance for Q1. Weekly monitoring of data continues. This provisional data is showing a decline following completion of a number of actions which were successful in Q4. The CCG is revising its action plan to engage with healthcare professionals and the public to promote the service. IAPT Recovery Monthly monitoring shows the CCG met the 50% target in March. Recovery will benefit from an investment in the service as there is some evidence that larger, stable services have better recovery outcomes. Early Intervention in Psychosis EIP recovered a compliant position in March following two months of missing the standard. M12 saw a 66.7% achievement against the 50.0% standard. The annual average was 59.1% of people referred for a NICE compliant, first intervention for psychosis seen within 2 weeks. In 2018/19 the standard increases to 53.0%. Care Programme Approach This mental health indicator underperformed in Q4 with 82.1% against a 95% target. This is the first time the CCG has not met the quarterly target since 2013/14. The Mental Health team are liaising with the service provider to understand what has changed. Initial indications from the data suggest more patients were discharged in Q4 than usual, whereas the number of patients followed up within 7 days only marginally increased.

Improvement & Assessment Framework There has been no new update following the April (Q3) scorecard publication. It should be noted that the latest data can range from more than 12 months out of date for some indicators and as recent as March for others due to various national timetables for publication of data. Croydon CCG are within the best quartile for 11 indicators, inter-quartile for 18 and worst quartile for 12. Commissioners leading for areas which include worst quartile performance have been asked to develop recovery action plans which will be reviewed and signed-off by directors and monitored in a monthly operational meeting. The CCG attended a year-end assurance meeting with NHSE in May. A summary report and slide pack reporting on this has been taken to the Quality Committee.

Quality Premium Due to publication timetables, not all QP indicators have data up to March. An update is provided here on known performance / availability of data. Gateway Metrics (% deduction if not met) For 2017/18 the following gateways have not been passed. Meeting the financial control total – the CCG finished 2017/18 financial year with a £7m adverse variance on its control total of £6.9m. This means a 100% deduction of any QP money achieved. Other gateways include the A&E 4 hour wait, 18 Weeks Referral to Treatment, 62 day cancer wait and 8 minute response time for ambulance calls. All carry a 25% penalty if not met. The only gateway achieved by the CCG in 2017/18 was the 18 week standard.

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Quality Premium indicators QP1 was to achieve a 4% increase or 60% absolute performance of cancer diagnoses at stages 1 or 2. The most recent data is from 2016, which showed a drop from 2015 (54.7% to 51.5%) meaning the CCG did not achieve this QP. QP2 was to improve in responses to the GP patient survey around access and experience. Surveys go out around December; results are not published until July 2018. QP3 was to ensure >80% of Continuing Health Care (CHC) decisions on funding eligibility are made within 28 days and for <15% of CHC assessments to take place in hospital. As of Q3 the year to date position was 30.6% and 23.2% respectively. An improvement plan is in place, the CCG also reports progress to NHSE. In March, significant progress was made in clearing the backlog of cases waiting for a decision. QP4 was to increase access to Children’s and Young People’s Mental Health (CYPMH) services to 32%. Q3 provisional data indicated the CCG was on track to achieve this, a significant improvement on the previous year with an estimated access rate of 12%. Q4 data is being collated for submission at time of writing. QP5 was to reduce bloodstream infections (BSI) reported at a CCG level and reduce inappropriate prescribing of anti-biotics. Date for BSIs has not been available nationally in 2017/18. The CCG is compliant with the reduction of inappropriate anti-biotics in primary care as evaluated by M10 data. QP6 was locally determined. The CCG elected to maintain improvements in the dementia diagnosis rate and maintain compliance against the 66.7% target. This was achieved, with March data showing the CCG at 66.7% having achieved above 67% most of the year. Estimated prevalence of dementia used for the calculation of performance increases in 2018/19 introducing a risk that the CCG will fail the target in April. Due to the financial gateway being missed, the CCG will not attract any 2017/18 QP payment. The total amount, assuming all targets met, was circa £2m. Processes and action plans are being reviewed to improve achievement in 2018/19. The details of changes to this framework will be highlighted in future reports.

Quality Croydon Health Services NHS Trust Due to an increase in medication SIs reported by the Trust, a deep dive into those reported during the period 1 April 2017 to 31 March 2018 has been undertaken. Draft outcomes have been shared with Croydon CCG, but further work is required and will be monitored at monthly CQRG meetings. There was a total of 12 Serious Incidents reported by CHS in March 2018, none of which were Never Events. Work on the recommendations made by the CQC are underway including the secondment of a SLAM Speciality Practitioner to work with the Trust to review the pathway for mental health patients admitted via ED and develop best practice policy and strategy.

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South London and the Maudsley NHS Trust (SLaM) SLaM reported 3 SIs in March 2018, none of which were Never Events. An internal review of self-harm SIs reported in 2015/16 and 2017/18 has been undertaken and the findings and learning presented to the May 2018 4 Borough CQRG meeting. SLAM are hosting a 4-borough multi-agency workshop on 15 May 2018 following an internal review of Mental Health Act Assessments. The Croydon Urgent Care Alliance (CUCA) Serious concerns have been raised by Croydon CCG at CUCAs continued failure to present a comprehensive action plan against the recommendations made by the CQC. Intermediate Contracts CQRGs Following discussions at the March CQRG regarding an incident reported by Moorfields Eye Hospital at St Georges, relating to non-referral of 16 patients, an action plan has now been received and will be reviewed at the next meeting which is due to take place on 21 May 2018.

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care.

Risks Risks identified in this paper are considered and included in the Corporate Risk Register as appropriate.

Clinical Leaders comments where appropriate

None


Any financial implications of improving quality would be reported separately. Performance breaches in A&E, RTT, Cancer Waits and Ambulance Response times will impact adversely on the CCG’s Quality Premium award for 2017/18.

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Conflicts of Interest No conflicts of interest have been identified or declared as relevant to decision making processes relating to this report.

Clinical Leadership Comments Not applicable in influencing the content of this report.

Implications for other CCGs

Where the CCG is the host commissioner, it is required to ensure it manages quality and performance of these providers. There is currently no single host commissioner for South London and Maudsley NHS Foundation Trusts; where significant quality risks are identified in this Trust the information will be shared with relevant CCGs.

Equality Analysis

Any action plans developed for those areas of high risk will take into account the needs of all our communities.

Patient and Public Involvement There are no current projects or recommendations resulting from this report that require PPI.

Communication Plan Outputs of this report are communicated at the Clinical Quality Review Group for the relevant providers, and at CCG Governance meetings.

Information Governance Issues Patient confidentiality is maintained.

Reputational Issues

Failure to achieve performance standards, deliver improvements in IAF Clinical Priority Areas, manage quality issues effectively or identification of poor quality could attract adverse attention from patients, the public and NHS England.

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Longer, healthier lives for

all the people in Croydon

Integrated Performance & Quality Report

March (M12) 2017/18

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Contents

Page 2 of 25

Heading Page

1. Croydon CCG Scorecard – Operating Plan Indicators Page 3

2. Operating Plan Exceptions Management Page 4

3. Improvement and Assessment Framework (IAF) Dashboard Page 12

4. IAF Clinical Priority Areas Page 13

5. Quality Premium Page 16

6. Quality Assurance – Serious Incidents (SI) Page 19

7. SI Commentary Page 20

8. Croydon Health Services (CHS) Complaints and Friends & Family Test (FFT) Page 21

9. South London and Maudsley (SLaM) NHS Foundation Trust - Complaints and FFT Page 22

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CCG Scorecard - Operating Plan (OP) Indicators

Page 3 of 25

2017/18

Target Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb MarRolling 12 Month

Trend

Recent

Movement2017/18 2016/17 2015/16

Healthcare Acquired Infection

E.A.S.4 MRSA (PIR Assigned) Monthly 0 1 0 0 1 0 0 0 0 2 0 1 1 ► 6 3 3

E.A.S.5 C Difficile Monthly 5 4 7 7 9 4 2 8 3 4 3 5 6 ▲ 62 58 61

Referral To Treatment

E.B.3 RTT 18 weeks (incomplete pathways) Monthly 92.0% 91.2% 91.7% 91.9% 92.2% 92.1% 92..2% 92.8% 92.9% 92.7% 92.7% 92.7% 92.7% ► 92.3% 91.9% 93.6%

E.B.4 Diagnostic tests waiting time Monthly 99.0% 94.2% 94.7% 95.9% 97.1% 98.4% 99.7% 99.6% 99.2% 99.3% 99.4% 99.5% 98.9% ▼ 98.0% 98.0% 94.3%

E.B.S.4 RTT 52 weeks (incomplete pathways) Monthly 0 7 7 7 7 4 2 6 3 6 4 7 12 ▲ 72 68 27

Urgent Care

E.B.5 A and E waiting times (CHS) Monthly 95.0% 88.40% 91.20% 90.60% 88.30% 90.10% 90.90% 94.80% 93.00% 89.40% 86.80% 88.10% 87.90% ▼ 89.9% 89.0% 92.3%

E.B.S.5 Trolley waits over 12 hours (CHS) Monthly 0 0 0 0 0 0 0 0 0 0 0 0 1 ▲ 1 1 0

E.B.S.6 Urgent operations cancelled for a second time or more (CHS) Monthly 0 0 0 0 0 1 0 0 0 0 0 0 0 ► 1 0 0

E.B.S.7 Ambulance handover within 30 minutes (CHS) Monthly 0 80 108 102 120 86 93 53 63 125 186 165 136 ▼ 1317 950 458

E.B.S.7 Ambulance handover within 60 minutes (CHS) Monthly 0 1 2 3 7 3 0 0 0 4 15 7 17 ▲ 59 46 7

Mixed Sex Accommodation / Cancelled Operations

E.B.S.1 Mixed sex accommodation breaches Monthly 0 1 0 1 0 0 0 1 0 1 5 0 2 ▲ 11 3 0

E.B.S.2 Cancelled Ops (CHS) Quaterly 0 ▲ 2.4% 0.4% 1.5%

Cancer Waiting Times

E.B.6 Cancer two weeks (monthly) Monthly 93.0% 97.2% 96.4% 95.6% 96.5% 95.0% 94.7% 97.4% 96.8% 95.5% 95.9% 97.3% 97.3% ► 96.3% 96.7% 95.3%

E.B.7 Breast symptoms two weeks (monthly) Monthly 93.0% 97.5% 98.1% 100.0% 99.0% 93.8% 98.2% 99.1% 98.2% 99.0% 98.5% 100.0% 99.3% ▼ 98.5% 97.6% 95.3%

E.B.8 Cancer first definitive treatment 31 days (monthly) Monthly 96.0% 96.9% 98.5% 93.9% 99.2% 98.3% 97.5% 98.0% 97.4% 99.2% 96.6% 98.0% 97.2% ▼ 97.6% 97.7% 98.0%

E.B.9 Cancer subsequent treatment 31 days, surgery (monthly) Monthly 94.0% 100.0% 83.3% 100.0% 87.0% 93.3% 100.0% 95.0% 100.0% 93.3% 88.2% 100.0% 100.0% ► 95.2% 96.1% 96.1%

E.B.10 Cancer subsequent treatment 31 days, drug (monthly) Monthly 98.0% 100.0% 100.0% 97.9% 100.0% 98.0% 95.9% 100.0% 100.0% 97.6% 100.0% 97.9% 95.1% ▼ 98.5% 99.0% 99.8%

E.B.11 Cancer subsequent treatment 31 days, radiotherapy (monthly) Monthly 94.0% 89.8% 90.3% 100.0% 95.0% 91.4% 97.1% 96.3% 94.4% 91.4% 100.0% 100.0% 93.8% ▼ 94.5% 96.5% 98.0%

E.B.12 Cancer composite, 62 days first treament plus rare cancers (m) Monthly 85.0% 86.8% 81.6% 89.0% 82.6% 84.6% 79.5% 78.7% 90.4% 87.8% 83.7% 83.9% 89.5% ▲ 84.7% 84.4% 82.4%

E.B.13 Cancer first treatment 62 days, Screening (monthly) Monthly 90.0% 100.0% 89.5% 85.7% 80.0% 90.0% 92.3% 77.8% 91.7% 100.0% 86.7% 66.7% 100.0% ▲ 89.3% 94.9% 92.4%

E.B.14 Cancer first treatment 62 days, Consultant upgrade (monthly) Monthly 85.0% 78.6% 86.7% 75.0% 73.3% 89.5% 76.9% 80.0% 100.0% 90.9% 88.2% 58.3% 93.3% ▲ 84.2% 88.4% 87.1%

Mental Health

E.A.S.1 Dementia Diagnosis Rate Monthly 66.7% 66.8% 65.9% 66.7% 66.9% 67.5% 67.0% 67.9% 67.6% 67.7% 67.6% 67.4% 66.7% ▼ 66.7% 67.4% 66.5%

E.A.3 IAPT (Access) as a proportion of prevalence Monthly 0.95% 0.6% 0.8% 1.0% 0.9% 0.9% 0.7% 1.0% 0.8% 0.7% 1.1% 0.9% 1.5% ▲ 10.80% 11.04% 10.36%

E.A.S.2 IAPT (Recovery) Monthly 50.0% 46.8% 39.0% 48.9% 50.0% 53.0% 43.0% 50.7% 43.3% 51.7% 47.2% 39.1% 50.0% ▲ 47.1% 46.5% 46.6%

E.H.1_B1 IAPT 6 week wait - Referral to Treatment Monthly 75.0% 98.00% 84.80% 97.00% 92.00% 93.00% 92.00% 94.00% 91.00% 96.00% 95.00% ▼ 94.30% 95.4% N/A*

E.H.2_B2 IAPT 18 week wait - Referral to Treatment Monthly 95.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0% ► 99.9% 99.9% N/A*

E.B.S.3 Care Programme Approach (CPA) Quarterly 95.0% ▼ 91.8% 97.8% 97.8%

E.H.4 Early Intervention in Psychosis (Max 2 week wait) Monthly 50.0% 40.0% 50.0% 53.8% 75.0% 75.0% 45.5% 55.6% 81.8% 100.0% 37.5% 37.5% 66.7% ▲ 59.1% 65.9% N/A*

Indicator Reporting

9.4%

95.5%95.9%

0.0%

82.1%

2.4%

OutturnTrend

0.0%

95.7%

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Operating Plan Exceptions Management

Page 4 of 25

Indicator / Issue Cause Action Timescale / Assurance

E.A.S.4 MRSA ▪ Croydon CCG had a case of

MRSA assigned to it in March, which was identified at CHS.

▪ The CCG has six cases of MRSA reported for 2017/18. □ 2 assigned to third parties □ 3 assigned to the CCG □ 1 assigned to a provider

▪ Blood cultures collected at time of admission to hospital that are positive for MRSA are assigned to the CCG.

▪ The Clinical Infection Prevention and Control Lead within NEL CSU investigates MRSA cases requiring a Post Infection Review (PIR)

▪ This case has been referred for a review as it is likely to be third party assigned.

▪ The NEL CSU Infection prevention control lead highlights any significant concerns to the CCG when they arise.

E.A.S.5 C.Difficile ▪ Croydon CCG had 6 cases

reported in March. ▪ For 2017/18, the CCG had a

total of 62 cases against a target of 55. 40 of these were community assigned.

▪ Of the 6 cases in March, 3 were assigned to community, 3 were assigned to providers (CHS and SGH)

▪ Root cause analysis is undertaken for all hospital acquired cases to see if there are any lapses in care / lessons to be learnt.

▪ Lapses of care or any concerning themes would be escalated to the CCG by the CSU infection prevention control lead.

E.B.4 Diagnostics (Croydon Health Services) The CCG failed the diagnostic standard in March 2018 with an outcome of 98.95%

• 83 breaches for 7,895 diagnostic waits.

• The last time the CCG recorded a failure of the standard was August 2017

The rise in breaches was

driven by: ▪ CT up 26 to 35

breaches (from 9 in February 2018) and;

▪ Sleep studies up 15 to 21 from 6 the previous month. Almost all of the breaches for these 2

▪ The CT breaches were related to: 1. The need to replace one of

the two scanners at Croydon Health Services – which is now complete, and,

2. Train the staff on the new scanner – this work is

▪ Croydon Health Services has confirmed that with the mitigation in place that it expects to report no breaches for CT in April or May 2018.

▪ Feedback and assurance with regard to sleep studies has been requested of Croydon

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tests are attributed to Croydon Health Services.

ongoing. The number of patients on the lists has had to be reduced to accommodate the training but Croydon Health Services have mitigated this by running additional evening and weekend scan lists in April and these will continue into May.

Health Services, and is awaited

E.B.S.4 52 Week Waits ▪ The CCG had 12 patients

waiting over a year for treatment in March. □ 9 of 12 occurred at KCH □ 2 occurred at SASH □ 1 occurred at CHS

▪ KCH □ 2 x in General surgery,

both delays reportedly due to capacity issues. One has now been treated (in April), the other is awaiting a Time to Come In (TCI) for whom a clinical harm assessment is yet to be finalised.

□ 3 x T&O, one due to capacity issues, one due to hospital cancellation, one due to patient availability. Two are awaiting a TCI, one has been booked in.

□ 1 x Neurosurgery, due to patient cancellation and

▪ KCH is reviewing its recovery action plan.

▪ The SWL Performance Team monitor long waiters (+35 weeks) and have requested Root Cause Analyses (RCAs) for all Croydon CCG patients that have waiting over 52 weeks.

▪ The CCG is developing its own action plan to reduce the number of patients waiting over 18 weeks.

▪ KCH report 249 patients waiting over 52 weeks in March, which is an increase from 198 in February 2018. The majority of these patients are on admitted pathways and the worst specialties are General Surgery (x96) and T&O (x92).

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now removed from waiting list.

□ 1 x Ophthalmology, patient cancellation and availability of lens due to complexity. Awaiting a TCI.

□ 1 x Plastic surgery, due to capacity issues, awaiting a TCI and review for clinical harm.

□ 1 x Breast surgery, due to capacity as a result of backlog clearance being prioritised. Awaiting a TCI

▪ SASH □ 1 x General surgery,

breach due to internal processes. The patient will be reviewed at an outpatient attendance in early May.

□ 1 x Neurology, breach due to capacity issues. The clock has stopped on this pathway.

▪ CHS □ 1 x ENT, now treated. This

patient had an incorrect clock stop as a result of being transferred to

▪ CHS plan to improve the review of all patients referred to another clinician during weekly tracking processes.

▪ Patients not available for treatment for 3 months or DNA

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Page 7 of 25


another clinician and not being tracked appropriately. A review for clinical harm found there had been none.

□

preoperative assessment will be clinically reviewed.

E.B.5 A&E Waiting Times (CHS) ▪ CHS did not meet the 95.0%

standard for March, or the local recovery trajectory of 95.17%, with monthly performance of 88.11% for ‘all types’ A&E activity seen in 4 hours.

▪ Type 1 achieved 71.76%. ▪ Type 3 achieved 97.98%.

▪ CHS’ type 1 performance was largely due to: □ Delays for patients waiting

for initial assessments leading to delayed treatment decisions.

□ Lack of middle-grade medical staff.

□ Bed availability. Escalation areas open over winter have been full leaving no additional flex in capacity.

▪ CHS is working to □ Reduce escalation beds to

release medical and nursing staff.

□ Reviewing out of hours escalation and in line with Operational Pressures Escalation Levels (OPEL) framework.

□ An ambulance turnaround group has been established with with CHS and LAS, Croydon CCG, 111 and the Surge Hub to improve reduce handover times and explore alternative care pathways.

□ Multi-disciplinary representation on the daily CHS A&E calls to facilitate effective discharge.

▪ Progress of the emergency care recovery plan is reviewed at senior level at the Emergency Care Delivery Board on a monthly basis.

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E.B.S.7 Ambulance handover breaches (30 & 60 minutes) ▪ There were 136 x 30 minute

breaches and 17 x 60 minute breaches at CHS, in March 2018.

▪ More than half of the 60 minute breaches occurred over Mon 5th – Wed 7th March when CHS reported bed pressures, having to staff an additional 91 escalation beds.

▪ The current location of the Emergency Department, awaiting for completion of the refurbishment presents other issues which add to delay.

▪ Actions for reducing ambulance handover breaches are incorporated within the A&E recovery plan overseen by the A&E Delivery Board.

▪ Examples of actions being taken include: □ Direct conveyance of

patients to the Rapid Assessment Medical Unit (RAMU).

□ LAS’ increase in See & Treat

E.B.S.1 Mixed Sex Accommodation ▪ There were two Mixed Sex

Accommodation (MSA) breaches for Croydon CCG in March.

▪ One breach was reported by each of East Sussex Healthcare NHS Trust and Royal Berkshire NHS Foundation Trust.

▪ East Sussex implemented a ‘real-time’ system of recording MSA breaches in February. This has led to an increase in reporting. Challenged services at East Sussex and nationally are Critical Care and Rapid Assessment areas. Priority is given to safety and speed of care.

▪ East Sussex Trust is working to verify that the increases relate to the change of system of reporting and not due to increased mixing.

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▪ Royal Berkshire saw an increase to the number of mixed sex accommodation (MSA) breaches in February reducing back slightly in March. The breaches mainly relate to the Acute Medical Unit (AMU) and Emergency Department Observation Bay (ED Obs).

▪ Royal Berkshire is working with NHSI to improve its MSA breaches.

E.B.10 Cancer Subsequent

Treatment, 31 Days (Drugs)

▪ Croydon CCG did not meet the standard with an outcome of 95.1% due to 2 breaches out of 41 pathways

▪ Royal Marsden Hospital □ 1 breach due to a medical

delay for fertility treatment. ▪ Kings College Hospital

□ 1 breach due to a patient who did not attend (DNA)

▪ Actions to avoid administrative errors identified within the breach review and implemented

E.B.11 Cancer Subsequent

Treatment, 31 Days

(Radiotherapy)

▪ Croydon CCG did not meet the standard with an outcome of 93.8% due to 2 breaches out of 32 pathways.

▪ Royal Marsden Hospital □ 1 due to patient fitness

which delayed treatment. □ 1 due to patient choice as

patient had a holiday scheduled.

▪ Both breaches were unavoidable due to patient fitness and choice.

▪ Breaches have been reviewed at the Trust level PTL meetings.

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E.A.3 IAPT Access Rate ▪ Croydon CCG has seen a

significant increase in performance in Q4, resulting in a provisional rate in M12 which is sufficient, if sustained, to meet the national standard.

▪ Provisional Q4 performance was 3.51% with M12 delivering 1.5%

▪ Additional funding for Q4 was

provided to SLAM to increase capacity and deliver the 4.2% standard for the period.

▪ Whilst SLAM was able to recruit additional therapists, referrals (both GP and self-referrals) needed to be increased. This proved challenging to do in less than 3 months available, leading to the standard being missed, with a provisional position of 3.5%.

▪ The CCG will need to work with its partners to ensure a continued programme of promotion of the service and raising awareness.

▪ The CCG is putting together a programme of communications and engagement with healthcare professionals and the public to increase utilisation of the service.

▪ A step change in performance is required in Q4 as the standard changes from 4.2% to 4.75%. Based on the experience of the step change in Q4 2017/18, this work will begin in Q3 (Oct).

▪ The CCG has made additional

investment in 2018/19 in order to meet this national commitment.

▪ Work begun in 2017/18 will be

continued to ensure performance is sustained and improved.

▪ Performance in Q1is at risk

based on provisional weekly data.

E.B.S.3 Care Programme Approach ▪ Croydon CCG has fallen

below the 95.0% standard for the first time.

▪ The CCG has been compliant each quarter since 2013/14.

▪ This indicator monitors the proportion of patients who are follow-up within 7 days of

▪ Croydon CCG is liaising with SLaM to understand the cause of this drop in performance.

▪ Review of the data indicates there were a higher proportion of discharges in Q4 (112 compared to 93 average Q1 – Q3) without a proportional

▪ To be confirmed.

▪ The 2018/19 average is 91.8% compared to the 2017/18 average of 97.8%

▪ Causes will be picked up by the Me

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being discharged from Mental Health, inpatient care.

increase in follow-ups, (92 in Q4 compared with 89 average in Q1 – Q3).

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Improvement and Assessment Framework (IAF)

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Quarterly IAF Dashboard produced by NHSE, April 2018

Better Health Period CCG Peers England Trend

R 102a % 10-11 classified overweight /obese2013/14 to

2015/1638.8% 6/11 189/207

103a Diabetes patients who achieved NICE targets2016-17 38.6% 10/11 141/207

103b Attendance of structured education course2016-17* 2.7% 8/11 150/207

R 104a Injuries from falls in people 65yrs +17-18 Q2 2,393 10/11 168/207

R 105b Personal health budgets 17-18 Q3 3.45 10/11 193/207

R 106a Inequality Chronic - ACS & UCSCs17-18 Q2 2,338 10/11 134/207

R 107a AMR: appropriate prescribing2017 12 0.884 8/11 33/207

R 107b AMR: Broad spectrum prescribing2017 12 7.2% 3/11 45/207

R 108a Quality of l ife of carers 2017 0.62 1/11 148/207

Sustainability Period CCG Peers England Trend

R 141b In-year financial performance17-18 Q3 Red ➔ #N/A #N/A

R 144a Utilisation of the NHS e-referral service2018 01 46.5% 9/11 158/207

Leadership Period CCG Peers England Trend

R 162a Probity and corporate governance17-18 Q3 Fully Compliant ➔ #N/A #N/A

163a Staff engagement index 2016 3.79 9/11 105/207

163b Progress against WRES 2016 0.16 3/11 169/207

164a Working relationship effectiveness16-17 61.90 10/11 171/207

166a CCG compliance with standards of public and patient participation (not available)

R 165a Quality of CCG leadership 17-18 Q3 Red ➔ #N/A #N/A

Key

Worst quartile in England

Best quartile in England

Interquartile range

Better Care Period CCG Peers England Trend

R 121a High quality care - acute 17-18 Q3 58 5/11 137/207

R 121b High quality care - primary care17-18 Q3 65 2/11 145/207

R 121c High quality care - adult social care17-18 Q3 63 3/11 39/207

R 122a Cancers diagnosed at early stage2016 51.5% 10/11 125/207

R 122b Cancer 62 days of referral to treatment17-18 Q3 85.0% 4/11 75/207

122c One-year survival from all cancers2015 73.4% 3/11 42/207

122d Cancer patient experience 2016 8.9 2/11 38/207

R 123a IAPT recovery rate 2017 12 47.5% 9/11 162/207

R 123b IAPT Access 2017 12 2.4% 11/11 205/207

R 123c EIP 2 week referral 2018 02 58.3% 11/11 187/207

123d MH - CYP mental health (not available)

R 123f MH - OAP 17-18 Q3 215

123e MH - Crisis care and liaison (not available)

R 124a LD - reliance on specialist IP care17-18 Q3 35 ➔ 2/11 15/207

124b LD - annual health check 2016-17 49.5% 2/11 95/207

124c Completeness of the GP learning disability register2016-17 0.47% 3/11 96/207

R 125d Maternal smoking at delivery 17-18 Q3 6.7% 6/11 43/207

125a Neonatal mortality and stil lbirths2015 4.1 2/11 75/207

R 125b Experience of maternity services2017 79.0 9/11 183/207

R 125c Choices in maternity services 2017 60.9 7/11 101/207

R 126a Dementia diagnosis rate 2018 02 67.4% 8/11 113/207

126b Dementia post diagnostic support2016-17 83.4% 1/11 7/207

R 127b Emergency admissions for UCS conditions17-18 Q2 2,738 10/11 158/207

R 127c A&E admission, transfer, discharge within 4 hours2018 03 86.9% 1/11 51/207

R 127e Delayed transfers of care per 100,000 population2018 02 9.4 10/11 90/207

R 127f Hospital bed use following emerg admission17-18 Q2 536.8 8/11 158/207

105c % of deaths with 3+ emergency admissions in last three months of l ife (not available)

128b Patient experience of GP services2017 82.8% 1/11 153/207

R 128c Primary care access 2018 01 100.0% ➔ 1/11 1/207

R 128d Primary care workforce 2017 09 0.94 1/11 136/207

R 129a 18 week RTT 2018 02 92.7% 1/11 25/207

130a 7 DS - achievement of standards (not available)

R 131a % NHS CHC assesments taking place in acute hospital setting17-18 Q3 12.5% 3/11 85/207

132a Sepsis awareness (not available)

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IAF Clinical Priority Areas

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2016/17 Rating

Improvement & Assessment Framework Indicator

Latest Data

CCG Rank / Quartile range

(unless later data available)

Comments C

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122a Cancers diagnosed at early stage

2016 51.5% 125/207 – Interquartile

122b Cancer 62 days of referral to treatment

Q3 2017/18 85.0% 75/207 – Interquartile SWL Cancer Strategic Leadership Forum coordinating improvements across SWL Trusts

122c One-year survival from all cancers

2015 73.4% 42/207 - Best Quartile

More Croydon patients diagnosed with cancer are surviving after a year. The CCG’s one-year survival rate has increased between 2014 and 2015, with 71.1% to 73.4%, respectively.

122d Cancer patient experience 2016 8.9 38/207 - Best Quartile

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126a Dementia Diagnosis Rate Mar (M12) 2017/18

66.7% Croydon CCG has maintained compliance for 11 out of the 12 months in 2017/18

126b Dementia Post Diagnostic Support

2016/17 79.0% 7/207 - Best Quartile

The latest scorecard from NHSE shows that Croydon are ranked 7th in the country. Increasing from 79% to 83.4% in 2016/17, meaning more people diagnosed with dementia in the past 12 months had a face to face review of their care plan.

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123a IAPT Recovery Rate Mar (M12) 2017/18

50.0% The YTD position is 47.5%. This is expected to improve one the service is operating at capacity and stabilised.

123b IAPT Access Q4 2017/18 3.51%

£300k investment made to deliver compliance in Q4, 2017/18. Whilst this was not achieved based on provisional data, the CCG continues to work with SLaM to publicise the service and increase referrals.

123c Early Intervention for Psychosis

Mar (M12) 2017/18

66.7% The CCG was compliant as an average for 2017/18. A performance recovery action plan is being developed for 2018/19.

123d Children & Young People MH Access

- - No data available

Provisional Q3 data shows that the CCG are on track to deliver the 35% access rate for CYPMHs by the end of 2017/18. Q4 data is being compiled for NHSE Submission w/e 20/05/18

123e MH Crisis Care and Liaison - - No data available

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2016/17 Rating

Improvement & Assessment Framework Indicator

Latest Data

CCG Rank / Quartile range

(unless later data available)

Comments

123f MH Out of Area Placements - - No data available The CCG is working to reduce out of area placements to zero in 2017/18. In January there were 17 occupied OAP bed days.

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124a Reliance on specialist Inpatient beds

Q3 2017/18 35 15/207 – Best Quartile There have been improvements in 124a and 124b since the last publication. 124c is a new count. An action plan is being developed to raise awareness of the benefits to individuals with LD from maintaining the LD register and offering health checks in Primary Care. Work is being planned with Public Health, Primary Care Commissioning, Variation team, the LD team within the council and the GP Lead.

124b Annual Health checks 2016/17 49.5% 96/207 - Interquartile

124c Completeness of GP LD register

2016/17 0.47% 96/207 - Interquartile

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103a Diabetes patients who achieve NICE treatment targets

2016/17 38.6% 141/207 - Interquartile

CCGs received 2016/17 annual ratings diabetes in January. The CCG received a ‘Requires Improvement’ based on these two indicators from the most recent results from the National Diabetes Audit. Local data shows that far greater numbers of people accessed structured education. Nationally, this is under reported and is being addressed by the introduction of a new data collection. The CCG is developing a comprehensive action plan to improve performance against these metrics.

103b Attendance of structured education

2016/17 2.7% 150/207 - Interquartile

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125a Neonatal mortality 2015 4.1 75/207 – Interquartile

125b Experience of maternity services

2017 79.0 183/207 – Worst Quartile A recovery action plan is being developed by the Integrated Children’s and Maternity team.

125c Choice in maternity services 2017 60.9 101/207 – Interquartile

125d Maternal smoking at delivery Q3 2017/18 6.7% 43/207 - Best Quartile

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Quality Premium

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QP1. Early Cancer Diagnosis

QP2. GP Access & Experience

Commissioner 2013 2014 2015 2016

07V NHS Croydon CCG 46.5% 52.7% 54.7% 51.5%

08J NHS Kingston CCG 34.1% 55.2% 54.5% 55.9%

08R NHS Merton CCG 47.7% 48.1% 52.8% 54.2%

08P NHS Richmond CCG 39.3% 53.3% 53.6% 55.6%

08T NHS Sutton CCG 43.9% 49.7% 52.0% 50.8%

08X NHS Wandsworth CCG 46.6% 49.5% 51.8% 55.9%

QP1. This Quality Premium (QP) existed in 2016/17 and

continues in to 2017/18.

▪ To achieve QP1 the CCG must demonstrate either an increase of 4 percentage points in the proportion of all staged cancers staged at 1 or 2, from the 2016 baseline or achieve >60% in 2017.

▪ Data is published with a significant lag, in calendar years. The most recent available nationally published data is from 2015, meaning that the 2016 baseline is not yet known.

UPDATE: The CCG’s 2016 performance, published in April is

lower than 2015.

QP2. This QP also applied in 2016/17.

▪ The measure of success in QP2 is to achieve 85% of respondents, to the July 2018 GP Patient Survey results, reporting a good experience of making an appointment to see their GP or a 3 percentage point increase in the same question, compared to July 2017.

▪ The CCG did not achieve the improvement target in 2016/17.

▪ Data is published annually, which will limit the ability of the CCG to quantify progress in-year.

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Quality Premium

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0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

Q1 Q2 Q3 Q4

QP3. CHC Quality Premium Indicators

Acute Setting Decision in 28 days

Acute Setting Target (Max) Decision Target (Min)

0.00%

5.00%

10.00%

15.00%

20.00%

25.00%

30.00%

35.00%

2016/17 Estimate* 2017/18 National Standard 2017/18 QP Stretch Target

QP4. CYPMHs Access Rate.

QP3. This QP is made up of two parts, each worth half of the

available award.

Part a) >80% of CHC eligibility decisions to be made within 28 days

from receipt of notification of potential eligibility.

Part b) <15% of all full CHC assessments tack place in an acute

hospital setting.

The CCG has not met the CHC QP targets Q1-Q3. Year to date:

▪ 30.6% of CHC eligibility decisions were made within 28 days from receipt of the eligibility checklist.

▪ 23.2% CHC assessments occurred in an acute setting.

Action plans have been developed to deliver the targets by March

2018 against monthly trajectories.

QP4. The options available for the MH QP were:

1. Reduction in out of area placements 2. Equity of IAPT access and outcomes 3. Improved access to Children’s and Young people’s MH

services.

▪ Option 3 was selected as the most pertinent to Croydon and the decision ratified by SMT. This also aligns with the new CYPMHs national priority to increase access, as mandated through ‘Next Steps’.

▪ To achieve this QP the CCG needs to either deliver a 14% point increase on the 2016/17 baseline or achieve a 32% proportion of diagnosable 0 – 18 year-olds a diagnosable condition, starting treatment in 2017/18.

UPDATE: Q4 data is being collated to report to NHSE at time of writing.

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Quality Premium

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QP5. Bloodstream Infections (BSI)

2,100

2,120

2,140

2,160

2,180

2,200

2,220

2,240

2,260

2,280

2,300

2,320

64.5%

65.0%

65.5%

66.0%

66.5%

67.0%

67.5%

68.0%

68.5%

Dementia Diagnosis Rate

Register Rate National Target

QP6. This QP is aligned to the national standard and

the IAF clinical priority area.

▪ Building upon the improvement seen in 2016/17, when Croydon CCG became compliant against the 66.7% standard for the proportion of people listed on the local dementia register as a proportion of the estimated prevalence of dementia among the over 65s.

▪ 2017/18 saw an increase in the estimated prevalence and a change in the data source used nationally to determine CCGs’ performance.

UPDATE: The CCG ended the year with a compliant position,

66.7% in M12.

Reducing gram negative blood stream infections (BSI) across the health economy.

1a) 10% reduction in all E.coli BSI reported at CCG level. – Still awaiting national data

1b) Collect and report a core primary care data set for all E.coli BSI Q2-Q4 2017/18. – Still awaiting national data

Reduction of inappropriate antibiotic prescribing for urinary tract infections (UTI) in primary care.

2a) 10% reduction in trimethoprim:Nitrofurantoin prescribing against June 2015 – May 2016 – Met at M10 with 0.388 against 0.743 target

2b) 10% reduction of trimethoprim items prescribed to patients >70 years of age. – Met at M10 with a 2,935 against 4,950 target

Sustained reduction of inappropriate prescribing in primary care.

3) Items per STAR-PU must be equal to or below 1.161 – Met at M10 with a 0.881 against 1.161 target

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Quality Assurance – Highlight Reporting

Page 18 of 25


Croydon Health Services (CHS) NHS Trust reported 12 SIs in M12 in comparison to 8 in M11. Whilst the number of SIs reported has increased, this represents a small number when compared to all clinical incidents reported during the same period.

• Increase in SIs reported in month 12.

▪ Comparison of total number of SIs reported against total number of clinical incidents reported in the same period.

▪ Assurance received that SIs reported are low when compared to incidents reported in the same period.

The 3 highest categories under which SIs have been reported by CHS NHS Trust over the last 6 months are Sub-optimal Care of the deteriorating patients (13), Medication incidents (9) and Diagnostic incidents (6).

• High number of SIs reported by CHS under specific STEIS categories.

• CCG and CHU Monitor trends and categories of SIs reported and undertake deep divers where required/requested.

▪ The CCG reviews deep dives and monitors at monthly SI Review meetings.

High number of SIs reported by CHS under STEIS category “Medication Incidents”, including 1 Never Event and increase in low harm incidents.

▪ Issues around in-patient and discharge medicine management.

▪ Issues around safe storage of medications.

▪ The Trust is undertaking a deep dive into Medication SIs reported during the period 1 April 2017 to 31 March 2018.

▪ Draft report shared at April CQRG, but further work on this is required. Report to be represented at the May CQRG meeting.

The Croydon Urgent Care Alliance (CUCA) have failed to provide a comprehensive action plan to address the issues identified in the CQC report published in December 2017.

▪ Serious concerns raised by Croydon CCG at May 2018 CQRG meeting.

▪ Additional urgent meeting called with the Provider and held on 11 May 2018, where updated, detailed action plan received.

▪ A final version of the action plan is expected by 24 May 2018.

▪ Croydon CCG will meet with the Provider bi-weekly to review progress and any issues identified.

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Quality Assurance – Serious Incidents

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0

2

4

6

8

10

12

14

Serious Incidents Reported by Providers

CHS NHS Trust - Countof SIs Reported

NHS Croydon CCG -Count of SIs Reported

SLaM NHS FT - Count ofSIs Reported

CHS NHS Trust - Countof No of days to report

▪ A deep-dive has been undertaken by the Trust of medication SIs reported during the period 1 April 2017 to 31 March 2018 and the draft

report was presented to the April 2018 CQRG meeting. However, further work is required prior to completion of this report, which will be represented at the May 2018 CQRG meeting. Overarching action plans for sub-optimal care of the deteriorating patients and diagnostic incidents remain as standing items on the monthly SIRM agenda.

▪ SLAM reported 3 SIs in M12 under category, Disruptive/aggressive/violent behaviours, unauthorised absence and

Apparent/actual/suspected self-inflicted harm, the latter of which continues to be the highest category under which SIs are reported by the Trust. An internal review of self-harm SIs reported in 2015/16 and 2017/18 has been undertaken and the findings and learning presented to the May 2018 4 Borough CQRG meeting.

▪ SLAM are hosting a 4-borough multi-agency workshop on 15 May 2018 following an internal review of Mental Health Act Assessments.

The aim will be to identify areas of the pathway which have led to delays and cancellations within each borough and area and to agree on actions and mitigations for future avoidance. Attendance to the workshop has been extended to Local Authority, Metropolitan Police, London Ambulance Service and CCG Safeguarding, Quality and Commissioning team representatives.

▪ Croydon Health Services (CHS) NHS Trust reported 12 SIs in M12, none of which were Never Events. Whilst the number of SIs reported during the period has increased, this represents a small number when compared to all clinical incidents reported during the same period.

▪ The 3 highest categories under which SIs have been reported by CHS NHS Trust over the last 6 months are Sub-optimal Care of the deteriorating patients (13), Medication incidents (9) and Diagnostic incidents (6).

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Quality Assurance – CHS Patient Experience

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95%

96%

97%

98%

99%

100%

101%

0

10

20

30

40

50

60

Oct-17 Nov-17 Dec-17 Jan-18 Feb-18 Mar-18

Patients Experience - Complaints Received

No. of complaints received % acknowledged within 3 day target

0.00%

20.00%

40.00%

60.00%

80.00%

100.00%

120.00%


FFT Score and Response Rate (In-patient services and A&E )

Inpatients A&EInpatients response rate A&E response rate

▪ CHS NHS Trust received 57 complaints in Month 12, 100% of which were acknowledged within the 3-day target.

▪ The top 3 areas in which complaints were received were Integrated Adult Care (34), Integrated Surgery, Cancer and Clinical Support (12) and Integrated Women’s, Children’s and Sexual Health (7).

▪ Work on the action plans produced by the Trust following publication of the CQCs patient experience survey’s within Maternity, Children and Young Peoples and Adult inpatients services are underway and will be monitored at monthly CQRG meetings.

▪ CHS NHS Trust’s internal target for Patient Experience FFT is currently set at 90%. The Trust met this target for both A&E and Inpatients in M12 achieving 90% and 91% respectively.

▪ Whist In-patients saw a slight increase in patient responses in M12, response rates continue to remain low, particularly when compared against the national average; A&E 4.6% against 12.8% and Inpatients 15.4% against 22.6%.

▪ CHS NHS Trust have confirmed that an electronic text-based system used for capturing patient experience is due to be piloted in outpatients and emergency department in May 2018, prior to being rolled out across the Trust.

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Quality Update

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0.00%

10.00%

20.00%

30.00%

40.00%

50.00%

60.00%

70.00%

80.00%

90.00%

100.00%


Patient Experience - FFT Score and Response Rate (SLAM/England)

FFT - Recommend SLAM FFT - Recommend England

Oct Nov Dec Jan Feb Mar

Adults Mental Health 10 14 5 5 13 10

Child and Adolescent Mental Health 0 0 0 0 0 1

Mental Health Older Adults 0 0 0 0 0 0

Learning Disabilities 0 0 0 0 0 0

0

2

4

6

8

10

12

14

16

No

of

Co

mp

lain

ts r

ece

ive

d

Patient Experience - Complaints Received

▪ In M12, 3.9% of SlaM patients completed the FFT test and of these, 88% would recommend the service to their friends and family if they needed similar care or treatment.

▪ When benchmarked nationally, SLAM continues to remain below the average recommendation rate of 89%, though they have seen a slight increase in both response rate and recommend rate from M11 (2.7 and 82% respectively).

▪ SLaM received 11 complaints in M12 involving Croydon CCG residents, 10 within the Adult Mental Health Services and 1 within Child and Adolescent Mental Health.

▪ All complaints were acknowledged within the 3-day target.

▪ Themes and learning from Trust wide

complaints are included in quarterly reports prepared by the Trust and presented at 4 Borough CQRG meetings.

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Quality Update

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CQC Visit Updates

▪ Croydon Health Services NHS Trust The CQC published their Inspection Report on Croydon Health Services NHS Trust on 21 February 2018 and whilst some areas of improvement were noted since the last inspection in 2015, the overall rating remains “Requires Improvement”.

The Trust presented their CQC action plan to the April CQRG meeting, but was asked to update and include RAG ratings and action owners. The action plan will continue to be monitored at monthly CQRG meetings.

In order to meet the CQCs recommendations around mental health, a Specialist Practitioner has been seconded from SLAM for 6 months to support the identification of best practice and to put into place a robust mental health framework. Along with SLAM colleagues, the following work is hoped to be achieved:

□ Review the pathway for mental health patients admitted via ED; □ Review of the existing mental health enhanced observations including the initial

risk assessment, education of staff and provision of appropriate workforce; □ Development of best practice policy and strategy.

▪ SLaM

Specialist eating disorder services Following concerns received from a group of patients regarding Tyson West 2 Ward at The Bethlem Royal Hospital in Beckenham, an unannounced inspection was undertaken by the CQC in February 2018. The 18-bed, women only ward accepts patients from many parts of the country as well as locally. The CQC published their report on 19 April 2018 and although they did not give this ward a rating, concerns were found, as well as areas of good practice.

The Trust is due to submit their action plan to the CQC on 7th May 2018, which will be shared with the 4-broughs and monitored through their monthly CQRG meetings.

Community-based mental health services for adults of working age The CQC published their report on SLAM Community-based mental health services for working age adults on 31 October 2017, with an overall rating of “Requires Improvement”.

The Trusts action plans to address the “must do” and “should do” recommendations made by the CQC are presented at the monthly 4-Borough CQRG meetings, together with an action plan to address statutory and mandatory training requirements.

Progress continues and during the period April – May 2018 there has been a specific focus on the following areas:

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□ Risk assessment training and risk assessment and care planning auditing across

both CAGs. The majority of teams have now participated in the training workshops;

□ All teams have embedded an audit programme in relation to risk assessments and care planning;

□ Work continues to address delays in Mental Health Act assessments with key stakeholders;

□ Work continues with regards to the waiting times in the Croydon A&L team. At the end of April 2018, the 4 borough CCG’s met independently with the CQC as part of their quarterly monitoring of SLAM, where concerns and issues regarding compliance against CQC recommendations were discussed and outcomes and details of future visits are shared. The Croydon Urgent Care Alliance (CUCA)

The CQC published their report on the Croydon Urgent Care Centre in December 2017, with an overall rating of “Requires Improvement”. At the CQRG on 2 May 2018, serious concerns were raised by Croydon CCG at CUCAs continued failure to present a comprehensive action plan against the recommendations made by the CQC, despite repeated requests and offers of assistance by the CCG.

A further urgent meeting was therefore requested and scheduled for 11 May 2018, with representation from Croydon CCG, Croydon Health Services NHS Trust and Croydon GP Collaborative (CGPC). A more comprehensive action plan was re-presented and monitoring and implementation of this will be led by the CGPC. A final version of the plan is expected to be completed by 24 May 2018, once CUCAs internal governance processes are complete. In the meantime, Croydon CCG will meet with the lead bi-weekly to review progress and any issues identified.

Care Homes Quality

Quality issues identified within Croydon Care and Nursing homes are reported below by

exception:-

□ Addington Heights Care Homes based in New Addington improved their CQC rating from “requires improvements” in February 2017 to “Good” in all the domains during an inspection conducted on the 20th February 2018.

□ Croydon’s Tigh Sogan care home was rated as “Outstanding” overall by the CQC in April 2018, an improvement since the CQCs previous visit in 2015, when the home was rated as “Good”.

□ Elmwood Nursing Home in Croydon has appointed a new home manager to strengthen leadership. The care home remains under provider level concerns with the Local Authority.

□ Hill House Nursing Home as appointed a new home manager. □ 3 service users were on an End of Life Care (EOLC) pathway at Heatherwood

Nursing Home in April 2018. The Homes ability to manage these patients with the

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support of the Hospice links in with avoidance of hospital admissions and promotes patients’ choice to die at their preferred place of residence.

□ Lloyd Park Nursing Home reported 3 Healthcare Associated Infections (HCAIs) during March 2018 (1 Urinary tract infection and 2 chest infections). Croydon CCG Quality Nurse Advisor will meet with the Home Manager to review these.

□ 7 Deprivations of Liberty (DoLs) referrals were submitted by Thackeray House Nursing Home in March 2018, which is indicative of compliance with the Mental Capacity Act (2005).

□ Work continues to progress on the Care Home Dashboard, which is being constructed by the Business Intelligence team, following data collection from the Quality Nurse Advisor.

□ Compliance with data entry by care homes onto the CarePulse database which is managed by NHS London Purchased Healthcare Team has been reviewed by the Quality Nurse Advisor and found to be variable. All Any Qualified Providers (AQP) registered care providers are required to upload quality premiums to this database, in line with the AQP contracts, so that Croydon CCG can monitor quality issues (i.e. complaints, SIs, falls, pressure sores, UTIs).

The Quality Nurse Advisor will work with the NHS London Purchased Healthcare Team and Local Authority to promote this going forward. Primary Care Quality The next Primary Care CQRG meeting is due to take place on 13 June 2018. Further updates from the outcome of this meeting will be provided in future reports. In the meantime, further work is being undertaken to enhance the local and national Primary Care Quality Dashboards. Intermediate Services CQRG Meeting Following discussions at the March CQRG regarding an incident reported by Moorfields Eye Hospital at St Georges, relating to non-referral of 16 patients, an action plan has now been received and will be reviewed at the next meeting which is due to take place on 21 May 2018.

Assurance has been received that 15 of the 16 patients have now been contacted and given new appointment dates and actions to mitigate all issues identified from this incidents have been undertaken.

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3 July 2018

Title of Paper: REPORT FROM THE CHAIR OF THE INTEGRATED GOVERNANCE

AND AUDIT COMMITTEE

Lead Director Philip Hogan, Lay Chair, Integrated Governance and Audit Committee

Report Author Elaine Clancy, Director of Quality & Governance Ben Smith, Board Secretary


N/A


CCG Governing Body

Purpose of Report For noting

Recommendation:

The Governing Body is asked to note the report of the Integrated Governance & Audit Committee:

▪ That the Integrated Governance and Audit Committee reviewed the Final CCG Annual Report 2017/18 and Final Annual Accounts 2017/18 and recommended their approval by the Council of Members (that was duly given).

▪ Note the outcome of the annual accounts process.

Executive Summary:

The Integrated Governance Committee is a Committee of the Governing Body but also provides oversight reporting of the handling of Quality Risks and Financial Risks from the Quality Committee and Finance Committee respectively.

The Integrated Governance Committee has met once since the Governing Body in May 2018. The papers on the agenda on 21st May 2018 were:

• 2017/18 Annual Report

• Annual Internal Audit Report 2017/18 and Internal Audit Plan 2018/19

• Final Draft Annual Governance Statement

• Local Counter Fraud Specialist Annual Report and 2018/19 Workplan

The committee met on Monday 21 May 2018, and reviewed these papers. The final draft CCG Annual Report 2017/18and CCG Annual Accounts for 2017/18 were received and reviewed. The annual accounts included the Presentation of Annual Accounts Letter of Representation and Consistency Statement The final submission deadline was 25 May 2018 (Friday) and the annual report and annual accounts were recommended for approval by the Council of Member prior to this date.

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The External audit report findings were presented and discussed. As expected, the value for money and regularity opinions from the external auditors were qualified because the CCG had spent more than its allocated resource limit. The Financial Statements Opinion (true and fair) was unqualified As in previous years, the external auditors will write to the Secretary of State advising him of the breach of revenue resource limit, as they are required to do under s30 of the Local Audit and Accountability Act.

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes.

Risks Failing to make appropriate preparations for the Annual report, Annual Accounts or Annual Governance Statement would place the CCG at a reputational risk, initially, principally with its auditors and authorising bodies such as NHSE.

No risks for the Risk register or BAF were raised.

Financial Implications There are no budgetary provisions made within this paper or in respect of this process, nor are there anticipated to be any budgetary implications.

Conflicts of Interest No conflicts of interest have arisen or been recorded to date.

Clinical Leadership Comments Not applicable

Implications for Other CCGs Not applicable

Equality Analysis Not applicable

Patient and Public Involvement Not applicable

Communication Plan To be made available to Governing Body members


Not applicable

Reputational Issues Failure to manage quality, financial and conflict of interest issues effectively would attract adverse attention from patients, the public and NHS England.

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3 July 2018

Title of Paper: REPORT FROM THE CHAIR OF THE FINANCE COMMITTEE

Lead Director Roger Eastwood, Lay Chair, Finance Committee

Report Author Mike Sexton, Chief Finance Officer Ben Smith, Board Secretary


N/A


CCG Governing Body

Purpose of Report For approval

Recommendation:

The Governing Body is asked to note that: ▪ The committee has met twice since the last Governing Body meeting (21 May 2018 and

25 June 2018)

▪ The Finance Report (M2) and QIPP Report (M2), including (i) the risks and mitigations, (ii) the identification of the full £27.6 QIPP target, and (iii) use of alternative data sources and trend analysis to improve the timeliness of

the management response to risks. ▪ The committee reviewed and provided feedback on the draft Financial Improvement and

Recovery Plan that will be submitted to NHSE on 29 June 2018. The document incorporates the 2018/19 Operating Plan as well as 3 – 5 Year financial planning. The document does not reflect the recent funding announcement which we await further detail on.

▪ The committee is developing joint working arrangements with the Finance Committees of the SWL CCG Alliance to ensure collective delivery of the £7.5m surplus SWL CCG control total. Whilst all CCGs are carrying risks, greater risk lies with Sutton CCG and Richmond CCG.

▪ The Wave 4 capital bid for Coulsdon redevelopment was submitted for prioritisation to

SWL Health and Care Partnership. The business case was ranked 4= across SWL and remains a live bid for Wave 4. Feedback has been provided to strengthen the case for final submission.

▪ The committee reviewed the initial version of the NHSE Financial Governance and Control Self-Assessment tool, with key remedial actions in place prior to final submission.

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Executive Summary:

The Finance Committee is a Committee of the Governing Body and with oversight reporting to the Integrated Governance and Audit Committee (IGAC) (in its position of oversight for CCG internal control and governance). It has been established to ensure a robust financial strategy is in place and to oversee the organisation-wide system of financial management, working with IGAC to ensure viability, effectiveness and financial probity within the CCG.

The papers on the Governing Body agenda are:

• Finance Report (Month 2)

• QIPP Report (Month 2) The committee met on Monday 21 May 2018 and on Monday 25 June 2018. The key business on 21 May 2018 meeting was as follows:

• Review of CCG financial planning, including (i) noting the Governing Body has agreed a £1.2 confirmation that the full £27.6m QIPP savings had been identified for implementation and (ii) budget virements to align budgets with the outcome of contract negotiations (e.g. QIPP into contracts).

• The key risks to delivering the CCG’s £1.2m share of the SWL control total are: - Delivering QIPP (emergency care, MH inpatients, planned care, prescribing) - Repatriation of St George’s/Kings waiting list activity to CHS or other providers - Possible transfer of 2000 patients to Surrey - Inadequate funding of 2018/19 pay awards including outsourced services,

primary care and CHC. - Outcome of responsible commissioner arbitration. - Anticipated allocations – overseas visitors (£1m) and extended access (£2m).

• Receiving an update on Estate and IT capital developments, including the ambition to bid for Wave 4 STP capital, in addition to the £10m allocated to Croydon CCG in Wave 3.

• Considered the opportunity for closer collaboration across SWL CCGs in the context of a joint £7.5m surplus control for 2018/19. This included finance committees meeting together on a regular basis.

The key business on 25 June 2018 meeting was as follows:

• Review of Month 2 Financial Performance and QIPP delivery, based on the limited actual data available, but also in the context of run-rate trends from 2017/18.

• Review of the draft Financial Improvement and Sustainability Plan to be submitted to NHSE on 30 June 2018. In Addition to the 2018/19 Operating Plan, the documents emphasis key enablers and develops a longer term view on QIPP development.

• Review of the CSU In-Housing Business Case which has been prepared jointly by all 6 SWL CCGs. The financial exposure is capped at the current level of expenditure on CSU services.

• Review of Wave 4 Capital Bid

• Review of SWL on closer collaboration to deliver the SWL control total of £7.5m surplus.

• Review of the Finance Governance and Control Self-Assessment

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Governance:


Risks Failing to make appropriate preparations for such a report would place the CCG at a reputational risk, initially, principally with its auditors and authorising bodies such as NHSE.









Not applicable


Report Author: Mike Sexton

Email address: [email protected]

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

3 JULY 2018

Title of Paper: 2018/19 FINANCE: PERIOD 02 (MAY 2018)

Lead Director Mike Sexton Chief Finance Officer

Report Author Edward Odoi Chief Management Accountant


Senior Management Team – 19 June 2018 Finance Committee – 25 June 2018


Clinical Leaders Group – 4 July 2018

Purpose of Report For discussion and noting

Recommendation:

The Governing Body is asked: ▪ To note the CCG is reporting a year-to-date surplus of £0.2m (Nil variance) and a

forecast in-year surplus of £1.2m (Nil variance). This reflects the 2018-19 plans submitted to NHS England.

▪ To agree the budget virements detailed in section 2b which achieve final alignment of budget lines with contract values.

▪ To note the performance on meeting the Public Sector Payment Policy (95% within 30 days) and cash management.

▪ To note the actions being taken to mitigate the risks identified.

Background:

Financial Performance Targets and Duties

▪ NHSE has given the CCG a financial target to deliver an in-year surplus of £1.2m (cumulative deficit of £67.2m) for 2018/19

▪ Under the Health and Social Care Act, the CCG has a general statutory obligation to contain expenditure within its allocated resources;

▪ The above duties are enshrined in the CCG’s constitution.

▪ The CCG has a duty to use resources for the purposes intended and to demonstrate value for money;

▪ The financial position is reported to the Finance Committee and Governing Body on a monthly basis.

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Key Issues:

Financial Performance ▪ Based on the two months ended 31st May 2018, NHS Croydon Clinical Commissioning

Group (the ‘CCG’) forecasts a surplus of £1.2m (£67.2m cumulative deficit) against the financial plan of £1.2m surplus (£67.2m cumulative deficit) submitted to NHS England.

▪ It should be noted that there is no contractual acute or prescribing data available at Month 2. To mitigate this position, alternative data sets have been used to identify trends, including reviewing trends in February and March 2018.

▪ Key risks are:

➢ Limited availability of in-year data on acute and prescribing.

➢ Delivery of £27.6m QIPP (incl adverse indicators on GP referral trends, CHS emergency escalation beds open during Q1, and Mental Health Bed Occupancy higher than planned)

➢ Insufficient funding to cover the 3-year staff pay deal.

➢ Unquantified waiting list backlog at St George’s and Kings

➢ Potential impact of transfer of 2000 patients to Surrey

Governance:

Corporate Objective To achieve financial surplus of £1.2m in 2018/19

Risks • Delivery of £27.6m QIPP (incl adverse indicators on GP referral trends, CHS emergency escalation beds open during Q1, and Mental Health Bed Occupancy higher than planned)

• Insufficient funding to cover the 3- year staff pay deal.

• Unquantified waiting list backlog at St George’s and Kings

• Potential impact of transfer of 2000 patients to Surrey

Financial Implications The CCG is mitigating risks to achieve the £1.2m surplus required.

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Conflicts of Interest No specific conflicts of interest.

Clinical Leadership Comments Clinical Leadership Group is supporting the delivery of the QIPP and transformation programme.

Implications for Other CCGs Croydon CCG works closely with the other SWL

CCGs as part of the SWL Health and Care

Partnership.

Equality Analysis All QIPP and expenditure programmes are

required to have an EIA, compliance monitored

by the PMO.

Patient and Public Involvement All service redesign, QIPP projects and

expenditure reductions must meet the requisite

PPI requirements.

Communication Plan The 2018/19 Financial Position and QIPP Programme have been share in the public domain and with stakeholders.


Restrictions on access to patient level activity data limiting the ability of CCG to review provider performance and to monitor some QIPP schemes.

Reputational Issues Delivery of financial plan.

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Finance Report May 2018 (Month 2)

Mike Sexton - Chief Finance Officer

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Contents

1. Finance Scorecard

2. Key Indicators

3. Summary Financial Position

4. Acute Services

5. Mental Health, Community, and Primary Care Services

6. Prescribing

7. Other Programme Services and Running Costs

8. Risks and Mitigations

9. Statement of Financial Position

10. Appendices

- Revenue Resource

- Capital Allocation

- Analysis of Aged Debt

- Expenditure with Alliance Partners

- Referral and First Outpatient Activity

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1. Finance Scorecard – May 2018

Financial Strategy Financial Performance

• The CCG refreshed its 5-Year Financial Model

(2017/18 – 2021/22) and agreed it with Croydon

Transformation Board partners in November 2017.

• The QIPP challenge to deliver £1.2m surplus in

2018/19 is ££27.6m

• Joint working through the OneCroydon Alliance is

supporting the delivery of integrated schemes.

• The CCG reports an in-year finance forecast

position of £1.2m surplus (£67.2m cumulative

deficit) against the financial target of £1.2m surplus

(£67.2m cumulative deficit) in line with the original

detailed plan submitted to NHSE.

• The £1.2m forecast surplus is predicated on the

delivery of £27.6m QIPP.

Financial Governance Financial Risk

• The Internal Audit programme reviews various

areas of the CCG governance and control.

• Improved assurance has been reported on CHC

processes, following the implementation of the

transformation plan with the NEL CSU.

• Finance Committee will be reviewing the CCG

against the NHSE Financial Control and

Governance Assessment.

The delivery of the £27.6m QIPP

• Some adverse indicators on GP referral, CHS

Escalation beds, and Mental Health Bed Occupancy.

• Favourable run rate trend for prescribing and

placements.

Insufficient funding to cover the recently agreed 3- year

staff pay deal.

2000 patients transferring to Surrey

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2a. Key Indicators – May 2018

Financial Performance Target/ Indicator

Measure Target Current ForecastM02

Revenue

Resource Limit (RRL)

NHSE Set Target (In Year) £1.2m £1.2m

Statutory Duty (In-Year) Breakeven £1.2m

Statutory Duty (Cumulative) Breakeven (£67.2m)

Capital Resource Limit

(CRL)

Stay within CRL £0.3m £0.3m

Cash Forecast Stay with Cash Forecast £559.2m £559.2m

Better Practice

Payment Policy

Payment of valid invoices within 30 days 95% NHS: 91.05%, Non-NHS:

97.75%, Total:95.87%

Cash Balance % of initial drawings in bank account at end

of the month

1.25% 1.0%

QIPP Delivery of Identified Programme Savings £27.6m £27.6m

Running Costs Stay within running cost envelope. £8.4m £8.4m

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2b. Budget Virements

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Finance Committee agreed the budget Virements above and QOB has agreed the split of the £2.9m

Unidentified QIPP which will be actioned for M03 reporting

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3a. Month 02 Financial Position Summary – May 2018

➢ The CCG is reporting an in-year outturn

surplus of £1.2m (Nil variance).

➢ The service line year-to-date, and

forecast, favourable variances are

expected to be offset by risks on other

lines e.g. acute. For Month 2, this

overall risk assessment is reflected in

”Other Programmes Services”.

➢ Note the excellent performance against

the Public Sector Payment Policy (95%

within 30 days) and cash management.

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3b Month 12 QIPP Summary – May 2018

The CCG is forecasting to deliver the £27.6m QIPP target. The Plan Care programme year to date favourable

variance is due to unspent invest, no year to date savings achieved on this line.

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4a. Acute Services

The CCG did not receive a full set of

Month 1 Acute monitoring reports from

providers in time for reporting Month 2.

As a result, the performance year to date

for acute providers has shown a break-

even position.

The forecast position reflects the agreed

contracts value for the year and a

conservative estimate on over

performance especially where the

contract value has not yet been agreed.

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4b.CHS Escalation Beds

A key indicator of the quality

improvement from the out of hospital

business case is avoiding the use of

escalation beds.

The graph outlines the actual use of

escalation beds from April 2017 to May

2018 .

The graph shows early success in

December 2017, that was lost during and

after the winter period. The number of

beds has been reducing as we approach

the summer, but remains higher than the

system wide plans.

To address this issues, there are a suite

of actions from the “Return on Investment

Review”, including senior led review of

stranded patients and MADE events have

assisted in reducing the beds use since

April 2018 with focus on closure of all

beds by end of July 2018.

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4c. GP Referral Patterns – 2015/16 –2018/19

Next Steps

- To further investigate the referral trend at both Practice level and speciality.

- Align this to the current Peer Review evaluation.

- Develop an action plan to address upward referral trend.

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- The graphs above provide an illustration of GP referrals across five South London providers (Kings, CHS, Kingston, SGH and ESTH).

- There has been a downward trend as illustrated below. The referral pattern since October 2017 appears to be similar to that of 2016-17.

- The average referrals for 2017-18 was 7,079.

- For M1 (2018-19) there have been 7551; which is 1200 more than M1 2017-18

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4d. e-RS Utilisation

The graph shows Croydon CCG's progress

increasing utilisation of the e-Referral System

(eRS) since October 2017, compared to SWL

CCGs and SEL CCGs (as an alternative STP

benchmark).

Croydon's progress has been largely due to

securing additional resource from NEL CSU to

visit GP Practices to provide eRS training. This

programme of work is managed within the

Croydon Primary Care Team. Increasing use of

eRS aligns to the roll out of the Advice and

Guidance function as a related QIPP scheme to

reduce unnecessary Outpatient attendances.

The national target is for all (100%) GP referrals,

for a new Outpatient Attendance, to be sent via

eRS from April 2018/19. Nationally this is not

being achieved.

The Croydon's recovery trajectory is to meet

100% by the end of Q1 2018/19, which is

consistent across all SWL STP members. This

remains achievable for Croydon.

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5a. Mental Health, Community, and Primary Care

Mental Health (including Learning Disabilities):

The Mental Health reflects a forecast underspend of

£281k, this is mainly driven by credit notes received for

prior year NCA invoices.

Community Health Services:

The Community Health Services reflects a forecast

underspend of £23k relating to expected underspend on

Non-NHS providers contracts.

Continuing Health Care:

The Continuing Health Care reflects a forecast

underspend of £344k driven mainly by underspend on

the Learning Disabilities Continuing Health Care clients

no longer eligible for Continuing Health Care.

Primary Care including Delegated-Commissioning:

The Primary Care £38k underspend relates to prior year

Local Incentives Schemes accrual not required.

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5b. Adult Mental Health Inpatient Occupied Bed Days

TBC

The Adult Mental Health Occupied Bed Days

(OBDs) is reporting an adverse variance of

103 for April 2018 (M1) which is mainly

driven by delay discharge.

Initial analysis is indicating that significant

staff vacancies in community services is a

key contributory factor in not achieving the

plan occupancy levels.

The Croydon Mental Health Programme

Board is reviewing actions to strengthen

community services and maintain the

excellent discharge rates achieve in

2017/18.

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6. Prescribing Expenditure Trend and Update

Note: Prescribing data has a two month processing lag. Month 1 data is due end of June 2018.

The graph above reflects the 2017-18 full year position: the better than plan trend has continued in the

actual data for February and March. It should also be noted that the NCSO issue is now negligible in line

with 2018/19 planning assumptions. The actual cost for the last two months of 2017/18 was £0.3m less

than the plan.

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7. Other Programme Services and Running Costs

➢ Other Programme Services: OBC, NHS 111,

Service Redesign, NHS Property Services Ltd

recharge, Safeguarding and Marie Stopes. This

is reflecting a forecast underspend of £99k

relating to prior year accrual not required.

➢ Unidentified QIPP: The £2.8m schemes have

been identified and will be transferred to

service lines in Month 3. The variances on this

line reflects a global risk assessment on

services lines that have no reported actual data

yet e.g. acute.

➢ The running costs budget is £8.4m and is

forecasting a small underspend of £39k.

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8a. Risk and Mitigations

The risk analysis is unchanged from

the from the analysis in the operating

plan.

An additional risk is the funding to be

allocated to the CCG to fund the 3-year

pay deal may not be sufficient to cover

the actual cost and also the merging of

a Croydon GP Practice with a Practice

in East Surrey which may result in

about 2000 patient list transfer.

To mitigate further risk, the CCG is

reviewing all budget areas and balance

sheet (prior year accruals)

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9a. Statement of Financial Position

▪ The Statement of Financial Position (as at 31st May

2018) is summarised in the adjacent table. The net

working capital position (net £50.4m liability)

reflects £56.2m of creditors offset by debtors and

prepayments of £5.8m

▪ The Balance Sheet is showing a negative £379k

cash balance. The actual balance in the bank

account was £407.5k; the difference was due to a

BACS payment at the end of the month that cleared

through the bank accounts the following day.

▪ Included within prepayments is £2.1m relating to

the Maternity WIP and included within accruals is

£3.4m relating to Partially Completed Spells.

▪ A significant element of the accrued liabilities

relates to prescribing cost and NHS activity which

has yet to be billed. The balance relates to non-

SLA expenditure and contingencies.

▪ The value of the CCG’s net Fixed Assets as at 31st

May 2018 is £432k.

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9b. Capital Spend Update

This table outlines the capital plan for

2018/19.

There is no activity to date to report.

The majority of this expenditure is

managed by the NELCSU IT Serivce.

.

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10a. Appendix 1 - Revenue Resource Limit

The Revenue Resource Limit

(RRL) is the statutory

expenditure limit for the CCG

on revenue expenditure.

The total revenue resource limit

for 2018/19 is £493.3m

(including Running Costs).

The cash funding for the CCG

(Maximum Cash Drawdown) is

based on the RRL (£493.3m),

but also includes funding for

historic deficit adjustment

(£68.3m).

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10b.Capital Allocations

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10c. Expenditure with Alliance Partners

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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP

GOVERNING BODY

3 JULY 2018

Title of Paper: 2018/19 QIPP PROGRAMME – MONTH 2 REPORT

Lead Director Mike Sexton, Chief Finance Officer

Report Author Kate Archer, Head of PMO


QIPP Operational Board (QOB) – 18 June 2018 Senior Management Team – 19 June 2018 Finance Committee – 25 June 2018


Clinical Leaders Group – 4 July 3018

Purpose of Report For information and noting

Recommendation:

Govenring Body is asked to note:

▪ Month 2 Year to Date performance is reported as on plan (£2.97m)

▪ A full year forecast outturn of £27.6m against a target of £27.6m;

▪ Note the change of structure of the report and comment on appropriateness.

Background:

The QIPP programme is a range of initiatives to deliver quality and outcome benefits to patients, and consequential financial benefits, through Quality improvement of services, Innovation in delivering healthcare, Productivity improvement, and Prevention of disease and illness. The clinically-led QIPP programme is expected to improve care for patients by reducing the need for high-cost hospital care. The 18/19 QIPP programme has been built around six primary programmes that collectively identify a total of £27.6m:

1. Out of Hospital transformation 2. Planned Care transformation 3. Mental Health transformation 4. Named Patients 5. Medicines Management transformation 6. Corporate projects

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Key Issues:

• Implementation is slipping for some projects which may result in a change in forecast outturn

• SUS data is not yet available to confirm our estimations of progress.

• GP referrals higher in April 2018 than April 2017.

• CHS escalation beds not shut form April 2018 as planned

• MH bed occupancy higher than planned

Governance:

Corporate Objective To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve in year financial balance in 2018/19.

Risks

Failure to deliver cost savings detailed in the paper represents a significant risk to the financial sustainability of the organisation.


Delivery of our QIPP target is a vital contribution to achieving financial balance.


No specific conflicts of interest.

Clinical Leadership Comments The CCG Medical Director chairs the QIPP Operational Board (QOB) alongside the Chief Finance Officer as Business co-chair. The CCG Chair attends most QOBs. Each QIPP scheme has an identified GP Lead.


The CCG is fully engaged with the South West London (SWL) STP process. The PMOs across SWL meet regularly to share ideas and align approaches.

Equality Analysis

All projects are conducting Equality Impact Assessments as they move through the development lifecycle.


Patients are included at programme board level, supporting the developments of QIPP schemes both currently and for the future.

Communication Plan Each project manager develops their own bespoke Communication and Engagement plan as part of project planning.


Monitoring of some schemes is impaired by the inability to access patient level data.

Reputational Issues

QIPP programme delivery is critical in addressing CCG authorisation conditions and directions.

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QIPP Report

Mike Sexton - Chief Finance Officer

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Contents1. QIPP Scorecard

2. Key risks and mitigation

3. Overview of 18/19 portfolio

4. Year to date status

5. Programme Highlight Reports:

Programme 1 – Planned Care highlight report

Programme 2 – Out Of Hospital highlight report

Programme 3 – Mental Health highlight report

Programme 4 – Medicines Optimisation highlight report

Programme 5 – Named Patients highlight report

Programme 6 – Corporate highlight report

6. Developing future QIPP

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1. QIPP ScorecardQIPP Strategy QIPP Performance • 2018/19: All £27.6m QIPP is idenfitied against

specific schemes. No unidentified QIPP.

• The QIPP efficiency challenge has been assessed for the next 5 years (circa £15m / 2.4% pa)

• Service level targets for 2019/20 and 2020/21 are currently being finalised. Planning is underway with a QIPP workshop on 4th July to kick off project development

• Month 2 Year to Date performance is reported as on plan (£2.97m)

• Overall, we remain on track to deliver £27.6m QIPP in 2018/19

• SUS data and prescribing data has a 2 month processing lag. Other local data sources have been used to assess delivery.

(SUS = Secondary User Service = consolidation of acute data from providers (primary) and passed back to commissioners (secondary) on responsible commissioner basis)

QIPP Governance QIPP Financial Risk• QIPP delivery is robustly governed by the QIPP

Operational Board (QOB) chaired by Medical Director. Each programme reports monthly.

• Deloitte audited ‘QIPP readiness’ for 2018/19 in December 2017, rating us GREEN overall

• 2018/19 Plan, including QIPP, has been assured and signed off by NHS England.

• SUS data is not yet available to confirm our estimations of progress.

• GP referrals higher in April 2018 than April 2017.• CHS escalation beds not shut form April 2018 as

planned• MH bed occupancy higher than planned

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2. Key risks & mitigations The following are the key risks to delivering the quality, and consequential financial benefits, of QIPP projects:

• 18/19 sees the highest QIPP target ever for Croydon however the largest amount to date was also agreed in contracts

• The original unidentified £2.8m gap has now been identified - specific projects with allocated leads. Where necessary PIDs are being developed prior to implementation.

• Key to success this year is sustainability, hence planning is commencing on 2019/20 projects with managerial & clinical workshops booked for 4th & 11th July

• Some projects have outstanding documentation, which is being chased

• Despite copious preparation, there has been slippage of planned care implementation as well as suggestions of reduced FOT to some projects

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3. Overview of 18/19 QIPP portfolio

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Programme No. of projects

Planned full year

savings (£m)

Full year forecast

outturn (£m)

Variance (£m)

CQC Quality Domains

Safe Effective Well-led Caring Responsive

1 Planned Care 16 4.2 4.3 0.1

2 Out of Hospital 16 8.1 8.1 0.0

3 Mental Health 6 4.5 4.5 0.0

4 Medicine Optimisation 9 3.7 3.7 0.0

5 Named Patients 5 4.4 4.4 0.0

6 Corporate 5 2.7 2.6 -0.1

Total 57 27.6 27.6 0.0

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3. Overview of 18/19 QIPP portfolio

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Savings by month M1 M2 M3 M4 M5 M6 M7 M8 M9 M10 M11 M12 Total

Planned savings (£m) 1.46 1.51 1.53 1.75 2.20 2.18 2.37 2.37 2.37 3.33 3.34 3.21 27.61 0.00Forecast savings (£m) 1.46 1.51 1.48 1.82 2.33 2.32 2.62 2.68 2.77 2.87 2.91 2.85 27.61 0.00Variance from plan 0.00 0.00 (0.05) 0.07 0.14 0.14 0.25 0.30 0.40 (0.46) (0.43) (0.36) 0.00

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ProgrammePlanned cumulative

M2 savings (£m)Actual cumulative M2 savings (£m)

Variance (£m)

Planned full year savings (£m)

Full year forecast outturn (£m)

Variance (£m)

Deliverability RAG

Financial RAG

Planned Care 0.14 0.24 0.10 4.22 4.30 0.09Out of Hospital -Phase 1 0.98 0.98 0.00 5.87 5.87 0.00Out of Hospital -Phase 2 0.07 0.07 0.00 2.23 2.23 0.00Mental Health 0.52 0.43 (0.08) 4.55 4.55 (0.00)Medicine Optimisation 0.57 0.57 0.00 3.66 3.66 0.00Named Patients 0.62 0.62 0.00 4.42 4.42 0.00Corporate 0.07 0.05 (0.01) 2.67 2.58 (0.09)Total 2.97 2.97 0.00 27.61 27.61 (0.00)

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• Plan of £2.97m for M1 & M2 combined; reported as achieved in full to NHS England• SUS data not available due to server migration therefore figures are largely estimated,

although intelligently. Project status for such projects is largely known• No data available for Medicines Optimisation given national time lag in reporting• Recoverable slippage reported for Mental Health – NCA project due to error in

forecasting plan across 12 months. This has been rectified to latter 6 months.• Non-recoverable slippage reported for Planned Care - cardiology, respiratory and ENT

projects although unspent investment portrays the programme as above savings target• Additional projects proposed to close unidentified gap, as well as mitigate for slippage• Concern that planned care implementation has slipped and further is likely, with savings

in year irrecoverable• Concern that OOH Phase 2 is largely still in outline plan and may slip

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Programme 1 – Planned Care highlight report

Programme 2 – Out Of Hospital highlight report

Programme 3 – Mental Health highlight report

Programme 4 – Medicines Optimisation highlight report

Programme 5 – Named Patients highlight report

Programme 6 – Corporate highlight report

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1 – Planned Care Responsible Director: Stephen WarrenGP Lead: Farhan Sami

RAG ratings: Financial savings Quality improvements Programme deliverability PerformancePr

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The planned care programme supports the vision of change set out in the NHS Five Year Forward Plan, SWL STP and local priorities including understanding and considering the Croydon population health with the aim to improve health across the entire population. Initiatives include supporting self-care, developing integrated clinical pathways, supporting secondary care in shifting care into the community and primary care and delivering care according to best practice.

Currently the programme is undertaking procurement for MSK, Dermatology, Diabetes, ENT and Anti-Coagulation projects. These procurements are on track with an exception to ENT and Diabetes.

New care models / pathways are being delivered for Dermatology, Gynaecology, Ophthalmology, Digestive Diseases, Cardiology, Respiratory and Neurology.

Cardiology and Respiratory projects are significantly behind schedule and have been reforecast to deliver around £285k less than planned QIPP. ENT is also behind schedule and Dermatology may experience a change of scope.

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Activity & performance outcomes

• No actual savings have been made YTD; £0.24m reported is as a result of unspent investment• Plan to achieve 50% less 52 week breach patients in 2018/19 vs 2017/18. NHSE have stated that all CCGs

need to achieve 0 52 week breaches by March 2019.• Plan to achieve KPIs which will deliver 62 Day Cancer Target to safeguard timelay access to diagnosis,

treatment and provide patient-centered care and improving cancer outcomes• Plan to achieve reductions or changes in settings of care across Dermatology, MSK, Gynaecology,

Ophthalmology, ENT, Digestive Diseases, Cardiology, Respiratory and Neurology services, and as a result deliver associated financial savings

• Plan to achieve Performance targets against Quality Premium (Early Cancer Diagnosis) - Demonstrate a 4% improvement in the proportion of cancers diagnosed at stages 1 and 2 in year 2018

compared with 2017.- Or Achieve greater than 60% of all cancers that are diagnosed at stages 1 and 2

Review of 1 year cancer survival rates- Cancer patient experience

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1. Cardiology / Respiratory – Model of Care sign-off not agreed between CCG / CHS – risk to £227k savings across the two projects.

2. Moorfields – Slow engagement for ECIs, risk to delivery of transformation projects, risk to CCG / Moorfields relationship due to impending AMD Audit

3. Procurement delays – risk of delays to procurements, specifically ENT and Diabetes.

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Plan 4.2Forecast 4.2Variance 0

Plan 0.14Actual 0.24Variance 0.1

Year to date (£m)

Full Year (£m)

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2 – Out of Hospital Responsible Director: Martin Ellis GP Lead: Tom Chan

RAG ratings: Financial savings Quality improvements Programme deliverability Performance Pr

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date The Out of Hospital programme seeks to transform care for older age adults focussing on patients aged 65 and over. It is in its second year of the 2

year initiative and eight months since implementation commenced, the Integrated Community Networks (ICNs) and Living Independently for Everyone (LIFE) schemes are in progress. These schemes include Rapid Response Services, intermediate care services and reablement and A&E liaison services designed to prevent unnecessary admissions as well as enhanced MDTs including a range of health and social care professionals. . Analyses of NE-emergency admissions suggest that the increase in admission for the over 65’s in Dec 2017 was lower than it was in the same period of 2016.

Three of the projects in the programme (End of Life Care, Falls and Care Homes) are in the final stages of its Business case development, two of the three projects business cases have been agreed in principle at QOB; however the finance aspect of third business case (Care Homes) is being finalised with CHS finance. Mobilisation work on the planned transformation is being undertaken with engagement being the primary focus. All of the alliance partners and external clinicians are working together in bringing about the cultural shift required for the transformation to take effect.

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• RoI 2A: Local Voluntary Partnerships tender documentation drafted, incl Service Specification, Information & Advice document and Operational, Delivery and Financial model; specification of requirements is being drafted to support the procurement process for the E-Marketplace solution, to include Directory of Service

• RoI 3D: Organisational development activities started. Task and Finish group set up by operational teams to develop workforce training and development / competency framework. Ten priority areas have been identified on training and how it can be delivered

• RoI 6B: Readmission audit undertaken and report presented at PDG. Recommendations to be implemented. -Discharge to Assess Pathway 3 Pilot authorisation gained to proceed from QOB and Alliance Delivery Board - A new approach to the procurement of the Reablement Provider for the South has been implemented.

• RoI 6B: Clinical governance strategy defined and taken through Governance for agreement and implementation

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1. There is a risk of delayed implementation as a result of the capital investment expected from NHSE. However, the business case needs to be re-considered and the appropriateness of the telehealth model re-considered. .

2. There is also a risk that the Financial modelling isn’t agreed with CHS finance which would delay the entire programmme as a whole. Fortnightly meetings are ongoing with both finance teams involved into mitigate this risk.

3. There remains a risk of poor engagement from clinicians and service users alike – hence the mobilisations and engagement plans re-focussed to mitigate any poor engagement. Fo

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Plan 1.05Actual 1.05Variance 0

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3 – Mental Health Responsible Director: Stephen WarrenGP Lead: Bobby Abbott / Dev Malhotra


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The SLaM OBDs risk share plan 18/19 has been received and is being reviewed at 4 borough level. This plan informs the revised expected savings against the original plan of £2.3m QIPP.

Penrose option have acquired all the properties for the service & completed their recruitment. This re-procurement is enabling what was a male only provision expand/extend its provision to include a wider cohort of patients as well as a female provision as well;

The NCA Policy is with the clinical lead for review. The contract has been sent to providers for review and consultation. Publication is imminent which will enable the redirection of Croydon patients, once clinically safe to repatriate, but also prevent referrals to NCA providers in the first place.

Core24 remains a part of the A&E avoidance scheme, as part of the scheme there is ongoing work to identify the different cohorts of patients, however early indications appear to suggest that the Core 24 element of the scheme has had an impact on the current level activities and average LoS.

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• Ongoing commissioning tasks have brought about a downward trajectory of inpatient activity but length of stay (LoS) remains high

• New community provision has been acquired & forensic MH-Working group set up and includes multi-agency input. PPI event scheduled with confirmed attendance by local Councillor.

• Core24 continues in operations to tackle activity and LoS – benefit realisation currently being developed.• Savings slippage is due to delays in publishing the NCA policy. This will be rectified within year. Fi

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1. There is a risk of activity and average LoS remaining high due to a shortage of discharge placements & other enablers.

2. There is risk that restructured provision might impact on Patient Choice of accommodation.3. There is a risk of double counting the activity between the initiatives under the Acute admission avoidance

scheme.4. There remains the risk the review of placements would generate a need for more independent accommodation for

which there is a current shortage.5. There is a risk that the policy once published isn’t adhered to and doesn’t little with the redirection of Croydon

patients. For e

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4 – Medicines Optimisation Responsible Director: Martin EllisGP Lead: Tom Chan


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Medicines Optimisation QIPP programme is made up of primary care elements and aim to provide the framework to support CCG’s vision to deliver Healthier Lives for all the people in Croydon.

In the last month key focus areas for the Medicine Optimisation team have been;• Arranging and preparation of reports for annual prescribing practice visits.• Reviewing patients on high cost items and specials. • ICN pharmacists attendance at huddles.

In addition to agreed 18/19 Prescribing QIPP target, the team also intends to explore the stretch opportunities in Over The Counter Prescribing and implement all the recommendations from the NHSE consultation with partial impact, depending on the ailment, in 18/19 with completion in 19/20 and possibly 20/21 if particularly contentious.

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• Prescribing data is available with 2 months delay.

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1. Risks associated with not having a clinical lead/LMC support.2. During 17/18 we have seen an unprecedented level of financial pressures on the prescribing budget as a result of

the pricing concessions issued in response to short stock issues in generic drugs. This may continue into 18/193. Following GB decision & post-engagement the CCG has received numerous feedback including from NHS

England, regarding plans for stopping prescriptions for CMPA, seeking confirmation that it will not compromise patient safety.

For e

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5 – Named Patients Responsible Directors: Elaine Clancy (Stephen Warren)Clinical Lead: Elaine Clancy


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The Named Patients programme is made up of four individual projects that aim to improve the quality and care of complex patients by transformingcurrent services and ensuring patients are receiving appropriate care for their specific needs. These projects include: Continuing Health Care, Personal Health Budgets, Children’s Transformation and Learning Disabilities.

Most projects are in the early implementation stage with Personal Health Budgets reliant on an external IT solution (My Care Banking) to be deployed into the CCG to start seeing savings for 18/19. Implementation of the new IT solution is expected to start on the 1 August and a number of patient & provider engagement events have been organised to generate interest.

The Learning Disabilities project has had a successful start to the year with a number of rigorous assessments undertaken to ensure that the required treatment plans for patients have been completed. The team have developed regular opportunities to work closely with organisations and service user representatives to ensure that service user’s voices are at the heart of service development and redesign. These include LD Partnership Board and key organisational partners such as People First, Mencap and Together we Can group are involved in improving the health and social care for people with LD.

The Children’s Transformation project is still being scoped. A number of key transformational initiatives will be presented to the QIPP Operational Board (QOB) on 18 June 2018.

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Learning Disabilities: • Five patients correctly transferred away from CCG funding from the original plan of 10.

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1. PHB: A delay in My Care Banking implementation (scheduled for 1 Aug) would jeopardise QIPP savings. The team are looking at ways to recover the shortfall by scoping out new clients outside the original cohort.

2. PHB: Lack of internal CCG resource. As PHB continues to develop the team will review resources to manage the potential rise in clients.

3. CHC: No joint funding policies in place – The team are currently looking at other CCG’s to adopt a’ best practice’ approach.

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6 – Corporate Responsible Director: Mike SextonGP Lead: N/A


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The Corporate programme brings together a number of projects that seek to ensure that our use of funds is as efficient as possible.

Budget and balance sheet reviews are ongoing across the organisation, led by the Deputy CFO.

Both locally and at SWL level, services offered by the CSU are under review to ensure that profit margins are minimised and where appropriate, services are in-housed.

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• There are no performance targets linked to this programme area

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1. The SWL Collaborative rebate may not be forthcoming. CFO escalating with SWL team2. CSU management reduction is being managed by SWL meaning that timelines and decisions, although

influencable, are not entirely within Croydon’s control3. The budget and balance sheet review project may identify cost pressures as well as areas for cost savings

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6. Developing 2019/20 QIPP:Pipeline opportunities under investigationProgramme Scheme Status

Planned Care

PathologyPathologist for South West London Pathology advise that many tests are not requested at the correct intervals, for the correct patients or the correct conditions to provide a robust diagnosis or enable management of the patients condition.

Draft business case written

Planned CareGynaecology ProcurementReprocurement of community Gynaecology services-stretch opportunity

Under investigation

Learning Disabilities

Intensive Support House (Crisis House)A support house designed to assist with the care needs for vulnerable patients. A preventative measure to reduce admissions to CHC. Draft business case written

Planned Care Patient Transport Service Scope for implementation of a new process and commissioning a single provider. SWL investigationPlanned Care Widowed 1st Appointments High number of gynae patients who had 1st appointment but no follow up or procedure Under investigationPlanned Care Transition of outpatient procedures Under investigationMental Health Community MH Service Review Assumptions discussed on 5th March with finance. Scoping to commence. Under investigationUrgent Care Roving GP Under investigationUrgent Care A&E Streaming Under investigationUrgent Care Ambulatory Emergency Care Under investigationUrgent Care Admission avoidence scheme inc. Enhanced Rapid Response service & A&E Liaison service Under investigationUrgent Care Review of short stay pathways Under investigationUrgent Care A&E frequent attendence review Under investigationUrgent Care A&E Tariff Review Under investigationUrgent Care LAS Frequent Call Reduction Scheme Under investigationUrgent Care Shoulder ultrasounds - initiated by Tom Chan Under investigation

Urgent Care/OOH LASDedicated project manager to work with LAS, capturing issues across projects and support improving relationships

Under investigation

OOH

Community IV antibiotics & fluidsInvestigate dedicated managed service for Croydon. Viability study required prior to BC development.Planned to kick off imminently. Propose Q4 implementation. Savings probably 19/20 but may be accelorated pending results of viability study

Under investigation

OOH PEG feeding in the community Under investigationCorporate Iplato Switch to a cost effective text messaging service Under investigationPlanned Care Urology Croydon is an outlier in cystoscopy Under investigation

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6. Developing 2019/20 QIPP:Emerging opportunities to explore

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• Increase in dermatology full ups at Guys & St Georges*• Increase in critical care spend at Kings*• Refreshed Rightcare packs• Ideas flagged at NHS Benchmarking Network conference

* taken from CSU’s Day 10 report

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Annex 1 – full list of QIPP portfolio 2018/19

Programme Area Project Gross saving Investment Net saving

Planned Care Advice and Guidance £60,552 -£6,574 £53,978

Planned Care Cardiology £2,232,332 -£1,635,000 £597,332

Planned Care Dermatology £425,238 -£188,365 £236,873

Planned Care Digestive diseases £570,660 -£275,753 £294,907

Planned Care ECIs £934,572 -£189,000 £745,572

Planned Care ENT £477,982 -£322,338 £155,644

Planned Care Gynaecology £643,874 -£248,271 £395,603

Planned Care Introduction to Avastin £208,397 £0 £208,397

Planned Care IVF £429,000 £0 £429,000

Planned Care Moorfield Packages £100,000 £0 £100,000

Planned Care MSK £1,324,583 -£896,854 £427,729

Planned Care Neurology £231,402 -£88,000 £143,402

Planned Care Opthalmology £300,000 £0 £300,000

Planned Care Programme Delivery (Change Mngt) £0 -£187,072 -£187,072

Planned Care Respiratory £1,065,864 -£756,000 £309,864

Planned Care Virtual Fracture Clinic £215,000 £0 £215,000

Out Of Hospital- Phase1 End of Life £118,612 £0 £118,612

Out Of Hospital- Phase1 ICNs £3,699,138 -£1,957,000 £1,742,138

Out Of Hospital- Phase1 Intermediate Care £31,970 -£104,000 -£72,030

Out Of Hospital- Phase1 LIFE £3,047,146 -£390,000 £2,657,146

Out Of Hospital- Phase1 Mental Health £110,154 £0 £110,154

Out Of Hospital- Phase1 Drugs & Alcohol £799,000 £0 £799,000

Out Of Hospital- Phase 2 Care Homes £300,000 £0 £300,000

Out Of Hospital- Phase 2 Care Homes Airedale £200,000 £0 £200,000

Out Of Hospital- Phase 2 End of Life coordination centre £300,000 £0 £300,000

Out Of Hospital- Phase 2 End of Life phase 2 £200,250 £0 £200,250

Out Of Hospital- Phase 2 Falls phase 2 £200,000 £0 £200,000

Out Of Hospital- Phase 2 ICS continence £100,000 £0 £100,000

Out Of Hospital- Phase 2 ICS wheelchairs/contracts £100,000 £0 £100,000

Out Of Hospital- Phase 2 LIFE expansion into Kings/St Georges £300,000 £0 £300,000

Out Of Hospital- Phase 2 Greenbrook - GP variation £125,000 £0 £125,000

Out Of Hospital- Phase 2 Urgent Care Pathways £1,000,000 -£600,000 £400,000

Medicines Optimisation 18/19 BAU Workplan Activities £1,102,614 £0 £1,102,614

Medicines Optimisation SWL MO Workplan £718,474 £0 £718,474

Medicines Optimisation Category M Drugs £660,000 £0 £660,000

Medicines Optimisation 17/18 Focused Projects FYE £240,000 £0 £240,000

Medicines Optimisation Medicine Waste in Care Homes £225,129 £0 £225,129

Medicines Optimisation Medicine Rebate Scheme £100,000 £0 £100,000

Medicines Optimisation Pharmoutcomes £100,000 £0 £100,000

Medicines Optimisation Focused Prescribing Projects-ONS £56,000 £0 £56,000

Medicines Optimisation OTC Prescribing £250,000 £0 £250,000

Mental Health Community Forensic Beds £1,100,000 £0 £1,100,000

Mental Health Mental Health OBDs £2,333,000 £0 £2,333,000

Mental Health Mental Health Placements £500,000 £0 £500,000

Mental Health NCAs £500,000 £0 £500,000

Mental Health Voluntary Sector £114,000 £0 £114,000

Mental Health Core 24 - Acute MH Admissions £515,471 £0 £515,471

Named Patients Continuing Health Care Transformation £3,000,000 £0 £3,000,000

Named Patients CHC stretch £25,000 £0 £25,000

Named Patients Learning Disabilities £861,000 £0 £861,000

Named Patients Paediatric £200,000 £0 £200,000

Named Patients LD intensive support house £50,000 £0 £50,000

Named Patients Personal Health Budgets £381,468 -£74,432 £307,036

Corporate Local level CSU fee reduction £300,000 £0 £300,000

Corporate SWL level CSU management fee reduction £100,000 £0 £100,000

Corporate Budget & balance sheet £1,595,000 £0 £1,595,000

Corporate CSU mngt fee reduction stretch £250,000 £0 £250,000

Corporate SWL Collaborative rebate £400,000 £0 £400,000

Indentified £35,527,882 -£7,918,659 £27,609,223

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3 July 2018

Title of Paper: REPORT FROM THE CHAIR OF THE QUALITY COMMITTEE

Lead Director Amy Page, Governing Body Member Chair, Quality Committee

Report Author Elaine Clancy, Director of Quality & Governance Ben Smith, Board Secretary


N/A


CCG Governing Body

Purpose of Report For noting

Recommendation:

The Governing Body is asked to note the update on matters discussed at the Quality Committee. The Quality committee had a verbal update on the month 12 performance report due to the validated data not being available on the date of the committee. The data is subsequently validated and has been seen and approved by SMT. The committee thoroughly reviewed the Quality risks and the mitigations for them and actions were recommended for colleagues to attend the next committee in July. The committee discussed the latest validated data for the IAF and mitigations and action plans for improvements. The committee was able to review the DRAFT Quality accounts for CHS and SLAM and discuss quality issues and priorities for both providers for 2018/19.

Executive Summary:

The Quality Committee is a Committee of the Governing Body but also provides oversight reporting to the Integrated Governance and Audit Committee (in its position of oversight for CCG internal control and governance) and has been established to oversee the application of quality in services commissioned.

The Quality Committee has met once since the last Governing Body meeting The papers on the agenda at the May meeting were:

• Integrated Performance and Quality report M12 (report not available due to data validation – verbal update given)

• Improvement Assessment Framework (IAF) update

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• Croydon CCG Strategic And Operational Quality And Safety Risks

• Contract Quality Review Arrangements – Croydon Urgent Care Alliance (CUCA)

• Patient & Public Involvement report Quarter 4

• Quality Accounts – SLAM

• Quality Accounts – CHS

• Ophthalmology at St George’s Site

• Continuing Healthcare Improvement Update

• CQRG Minutes – for information

• Serious Incident Quarterly Report

Due to the timing of CCG accounts, No QIPP Report (Quality Annex) was presented to the Committee Copies of the approved minutes from the March 2018 Quality Committee are included in the Committee Minutes papers

Governance:


Risks Failing to make appropriate preparations for such a report would place the CCG at a reputational risk, initially, principally with its auditors and authorising bodies such as NHSE.









Not applicable


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REPORT TO CROYDON CLINICAL COMMISSIONING GROUP GOVERINING BODY MEETING IN PUBLIC

3 July 2018

Title of Paper: Primary Care Commissioning Committee Chair’s Report

Lead Director/ Governing Body Member Philip Hogan Lay Member Croydon Primary Care Commissioning Committee, Chair

Report Author Martin Ellis Director for Primary and Out of Hospital Care (Executive Director Lead for IT) Vasudha Rai Business Manager, Primary and Out of Hospital Care


Senior Management Team 19 June 2018


Governing Body

Purpose of Report For Information and Noting

Recommendation:

The Governing Body is asked to: ▪ Note the feedback from the Primary Care Commissioning Committee held on 1 May

2018.

Background:

The Croydon CCG Primary Care Commissioning Committee is a Committee of the Governing Body. The Primary Care Commissioning Committee has been established and functions as a corporate decision-making body for the management of the functions delegated to the CCG (from NHS England) and the exercise of the delegated powers. The Primary Care Committee has met in public in each quarter since being established and holding its inaugural meeting in July 2017 and has held additional meetings where urgency and commercial sensitivity required the meetings to be held in private. These meetings in private have been reported to the next meeting in public through Chair’s reports.

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Key Issues:

On 1 May 2018, the Primary Care Commissioning Committee met in public and received the following agenda items:

• Committee Terms of Reference Annual Report

• Primary Care Finance Report (Period 6)

• Update on GP Transformation/ Working at Scale Plan

• Commissioning Update including contractual and practice updates

• Update from Care Quality Commission visit into GP Practices Committee Terms of Reference Annual Report The Committee was asked to agree the following changes to the Terms of Reference for the Primary Care Commissioning Committee: ▪ Insertion of a note indicating that national guidance (issued since approval of these

Terms of Reference June 2017) advising that the Conflict of Interest Guardian should

not hold the role of Primary Care Commissioning Committee Chair such that the Chair

should be elected from an alternative Lay Member present.

The Terms of Reference had been reviewed and found to adequately represent the functions and duties of the Committee and were renewed for the year 2018/2019. Primary Care Finance Report (Period 6) The Primary Care Committee noted:

▪ The 2017/18 financial performance for Primary Care is full year outturn of £0.1m underspend (driven mainly by adverse variance on Local Incentives Schemes (£0.2m) and Primary Care IT (£0.1m) budget lines offset by favourable variance on the Premises budget £0.2m and £0.2m of unused budget for Indemnity insurance contributions as the cost was centrally funded by NHS England.

▪ The two component elements of the budget are: ▪ Primary Care Services (£7.3m annual budget): outturn of £0.3m overspend ▪ Primary Care Delegated Commissioning (£50.4m annual budget): outturn of

£0.4m underspend Update on GP Transformation/ Working at Scale Plan

NHS England is investing £500 million in a national sustainability and transformation package to support GP practices, which includes additional funds from local clinical commissioning groups (CCGs). Croydon CCG is working to transform general practice and wider primary care to ensure resilience and sustainability. Transformation across Croydon is four-fold:

1. Primary Care Transformation Update

The Primary Care Transformation update for May 2018 was split into 3 key areas of

progress:

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▪ Network Development ▪ Working at Scale ▪ GPFV

2. Working at Scale Plan Croydon CCG have submitted a Working at Scale Plan to the SWL STP. This is aligned to the STPs agreed layers of transformation from focussing on our most complex care patients to the potential future general practice commissioning model as part of an LCS. The 5 layers describe the objectives to be delivered in partnership with Croydon General Practice Collaborative. To deliver the objectives in the layers in slide 4, the STP have applied for funding from NHS England to support the delivery of the agenda. Croydon CCG have applied for c. £1million. This is a 12-month programme with 6 months funding released in June 2018 and the remaining money released upon delivery of the agreed objectives by end of December 2018. The CCG are planning on hosting a conference specifically focused on General Practice Working at Scale on Tuesday 26 June 2018, with a view to exploring new models of care from across the UK and Europe. This will also give, and a chance to network with colleagues a chance to network and understand the future impact for the wider Croydon health and social care system with local and national system leaders. 3. CCG Primary Care Team Restructure In ensuring that CCG Primary Care Team is fit for purpose (as detailed in the March Primary Care Commissioning Committee), a Consultation to restructure the CCG Primary and Out of Hospital Care team commenced 12 April. By putting in place dedicated Primary Care Business as usual and Transformation leads, this restructure aims to allow the CCG Primary Care team to better meet the increasing demands of Primary Care Business as usual and Primary Care Transformation in Croydon. 4. Extended Access Update In line with the London Extended Access Specification, additional Extended Access appointments are now available for patients across Croydon. These appointments are booked directly by the patient’s registered GP practice for Shirley/Woodside/Mayday and Thornton Heath patients with Purley/New Addington/Selsdon & East Croydon booking via NHS 111. However, it is envisaged that patients will be able to book directly via their GP practice by the end of May 2018. 5. Review of LCS/PDDS

A comprehensive review of all 14 LCS and PDDS are currently taking place. A task & finish group has been set up with practices managers and the LMC meeting monthly. The review will look at aligning all schemes to strategic priorities within the wider health & social care system.

6. Engagement The CCG continues to engage with practices through a number of forums and is working with collaboratively with CGPC. Commissioning Update including contractual and practice updates The Primary Care Commissioning Committee received a report on Commissioning Update which included contractual and practice updates.

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The contractual update reflected all the contractual changes within Croydon. The Committee is updates on the following changes.

• Partnership changes,

• Partnership retirements,

• Change in practice details,

• Contractual changes

• Mergers

• Terminations

• PMS to GMS changes

• Contractual breach notices

• List closures

• Branch closures and openings The Committee received updates on the following practices:

• South Norwood Hill Medical Centre

• Edridge Road Community Health Centre South Norwood Hill Medical Centre The Care Quality Commission (CQC) inspected the practice on 5 May 2016, 1 February 2017 and 14 September 2017. The practice was rated as “Inadequate” on all occasions. The practice was served with a Remedial Notice relating to four contractual breaches covering the following areas: compliance with all relevant legislation; clinical governance, infection control; and storage of vaccines. The practice acknowledged and acted upon the Notice and submitted their action plan with evidence as requested, detailing how they remedied the breaches. This was analysed and found to be complete and satisfactory. On 15 February 2018, the CQC made a further visit and the practice was rated “Good” in all areas. Subsequently, it was agreed at the Primary Care Commissioning Working Group meeting on 19 April 2018 that a letter following up from the Remedial Notice would be sent to the practice lifting the Remedial Notice as all contractual breaches have been remedied. Edridge Road Community Health Centre The Primary Care Commissioning Committee had noted a range of issues relating to this practice and received an update from a short term Task and Finish Group to review these:

• The need for assurance from The Practice Surgeries Ltd that a robust action plan is in place to address the areas identified in the CQC inspection report.

• Short term premises concerns due to considerable building works above the practice premises (Development of disused office block into residential flats)

• Medium to Long term premises – consideration of the need to ensure adequate General Practice provision including premises for the growing population in Central Croydon

• Scope of service to be procured. Current APMS contract includes core APMS (GP)

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services and provision of the Special Allocation Scheme for Croydon

APMS contract

A contract breach notice was issued following with a response date to provide further

information to the NHS England South West London team by 16 April 2018. Legal advice

has recommended a 6 month notice period in line with the APMS contract terms.

Procurement – Scope of services

Plans and timetable have been developed to commence the procurement of a new

provider. As part of the specification development there was a need to review the scope of

services to be procured. Currently the APMS contract is for the provision of Primary

Medical Services to a registered population and provision of a Special Allocation Scheme –

available for referral of patients by all Croydon practices.

The Primary Care Commissioning Committee approved the following recommendations:

• That the specification for the procurement to be for a provider to deliver Primary

Medical Services and the Special Allocation Scheme.

• That the procurement timeline be commenced with immediate effect.

• That notice be issued to the current contract holder in line with the procurement

timeline.

Update from Care Quality Commission visit into GP Practices The CQC have been undertaking a schedule of planned visits to practices in Croydon over the last three months. The current status for CQC inspections in Croydon was noted as follows:

The Committee will be updated on Brigstock and South Norwood Partnership outcome when the report is published. There will be return visits to those practices rated Inadequate or Requires Improvement within the next 6-12 months. There is a high level of engagement between the CCG Primary Care Team and CQC Inspection team through regular conference calls. Additionally, the CQC Inspection team have been invited to attend the Primary Care Working Group on a regular basis.

Location Type Date of CQC visit

Date report published

Overall Rating

Shirley Medical Centre

Comprehensive 05/01/2018 8/3/18 Requires Improvement

South Norwood Hill Medical Centre

Comprehensive 15/02/2018 29/3/ 2018 Good

Queenhill Medical Practice

Comprehensive 06/02/2018 15/3/18 Good

Coulsdon Medical Centre

Comprehensive 07/02/2018 18/4/18 Inadequate

Brigstock and South Norwood Partnership

Comprehensive 17/04/2018 Not Published Not known

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The CCG Primary Care team and the NHS England South West London team are actively working actively with those practices in Special Measures or rated as Inadequate/ Requires Improvements to ensure comprehensive and deliverable action plans are in place.

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes To achieve sustainable financial balance by 2018/19 and NHS business rules of 1% surplus by 2020/21 To have all Croydon GP practices actively involved in commissioning services and develop a responsive and learning commissioning organisation

Risks

None as a result of this paper





Clinical Leadership Comments None as a result of this paper



Equality Analysis




Communication Plan None as a result of this paper



Reputational Issues


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19 JUNE 2018

Title of Paper: Emergency Planning Response and Resilience (EPRR) Annual

Report 2017/18

Lead Director Elaine Clancy Director of Quality and Governance

Report Author Leo Whittaker Head of Performance, Assurance and Emergency Planning


CCG Senior Management Team


CCG Governing Body

Purpose of Report For Information and Noting

Recommendation:

The CCG Governing Body is asked to note: ▪ The CCG’s assurance rating for 2017/18 ▪ The change in RAG ratings of core standards between 2016/17 and 2017/18 ▪ Updates of any training and exercises undertaken in the past year to improve the

organisation’s emergency planning capability and resilience ▪ A summary of health-related Major Incidents in Croydon in 2017/18.

Background:

An EPRR report is required to go to Governing Body no less frequently than annually. The NHSE EPRR Assurance process is undertaken for all CCGs and NHS Providers. The CCG’s submitted self-evaluated rating was agreed with NHSE as having achieved ‘Full’ compliance. This has been achieved through maintaining a work plan which focused on mitigating amber ratings against the core standards, year on year. Another key factor is the collaborative working between the EPRR support from the CSU and through the mature working relationship with Croydon Council’s resilience team.

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Key Issues:

Steady progress has been made with respect to improving RAG ratings against standards between 2016/17 and 2017/18. This can be seen in comparing between tables 1 and 2 below.

Table 1 - EPRR Core Standards by Heading with RAG rating 2017/18

Core Standard Headings NHSE Agreed Rating

Green Amber Red

1 Governance 4 0 0

2 Duty to assess risk 3 0 0

3 Duty to maintain plans – Emergency and

Business Continuity* 14 0 0

4 Command and Control 5 0 0

5 Duty to communicate with the public 2 0 0

6 Information sharing 1 0 0

7 Cooperation 5 0 0

8 Training and exercise 3 0 0

Total 37 0 0

Deep Dive - Governance 6 0 0

*One of the core standards under Duty to maintain plans has been split out in to a number

of core standards.



Green Amber Red

1 Governance 4 0 0


3 Duty to maintain plans – Emergency and Business Continuity*

6 0 0




7 Cooperation 5 0 0


Total 27 2 0

Deep Dive - Business Continuity 5 0 0

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The CCG has engaged with a number of multi-agency exercises in 2017/18 and has adhered to its local work-plan. An review of progress against the 2017/18 work-plan is included in Appendix 1. The 2018/19 work-plan is shared in Appendix 2.

Governance:

Corporate Objective To ensure that the CCG’s operations are not unnecessarily interrupted by internal or external disruptions.

Risks

An annual risk assessment is undertaken to inform the Croydon CCG Business Continuity Plan. Key risks are mitigated by action cards and exercises.

Financial Implications There are none.

Conflicts of Interest There are none.

Clinical Leadership Comments Clinical Leads will be informed of any issues by exception.


Croydon CCG will be seeking to undertake multi-agency EPRR exercises in 2018/19 which may be of interest to other CCGs. The SWL Health and Care Partnership (formerly the SWL STP) will be considering its role within EPRR arrangements in 2018/19.

Equality Analysis

Not required for this annual report on progress against NHSE assurance.


The Director of Quality and Governance will work with PPI leads to engage our local population where required.

Communication Plan This paper will be made public on the CCG’s website. A summary statement on the organisation’s assurance level was made in the CCG Annual Report, 2017/18.


Information Governance is not a concern in publishing this paper.

Reputational Issues

Failure to manage EPRR effectively would attract adverse attention from patients, the public, CCG staff and NHS England.

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Croydon CCG Emergency

Preparedness Resilience and

Response (EPRR) Report

2017/18

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1. Introduction

The following report is the annual EPRR report to Croydon CCG Governing Body, which is

required annually. The report is intended to summarise the outcome of the 2017/18 EPRR

Assurance process, give updates on work carried out against the annual work plan and outline

multi-agency exercises that the CCG has participated in. The report also provides a briefing on

incidents which occurred locally, that had a significant health-response component or required the

CCG to step-up its response function.

2. Background

Emergency Preparedness Resilience and Response (EPRR) is defined by a series of statutory

responsibilities covered by the Civil Contingencies Act (2004) which requires NHS-funded

organisations to maintain a robust capability by planning for, and responding to, incidents that

could impact on health or services to patients.

Category 1 organisations are most easily defined as those at the forefront of an emergency

response. In the case of the NHS these are Acute Trusts, Community Health providers and

Ambulance Services. NHS England Area and Regional Teams are also in this category due to their

central coordination role.

Category 2 organisations are co-operating bodies that are placed under slightly lesser obligations

than category 1. They have a role in planning and prevention and respond to reasonable requests

to assist. CCGs are category 2 responders.

Both types of organisation undergo an annual assurance process, evaluating their compliance

against core standards of good practice. The outcome of the assurance process is included within

NHS organisations’ annual reports.

3. Role of CCGs

CCGs are to support NHS England to discharge its EPRR functions and duties locally. This will

include:

Planning and Prevention

▪ Ensuring that resilience is commissioned as part of standard provider contracts, reflecting

local risks identified through multi-agency planning.

▪ Cooperate with NHS-funded providers to fully participate in EPRR exercises and testing as

part of the NHSE EPRR assurance process.

▪ Develop, test and update business continuity plans.

▪ Prevent business as usual pressures and minor incidents in the local health economy from

becoming significant incidents or emergencies.

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▪ Ensure providers respond to routine operational pressures such as pressure surge and

internal major incidents.

Response

▪ Respond to reasonable requests to assist and co-operate in the event of an incident

▪ Support NHSE Area Teams to effectively mobilise applicable providers.

▪ CCGs need to provide their commissioned providers with a route of escalation on a 24/7

basis to manage local incidents to maintain performance (e.g. coordinating and authorising

A&E diverts)

4. Assurance Process

In July 2017, NHS England (London) wrote out to all Accountable Emergency Officers of NHS

funded services, and CCGs within the region, outlining the approach to be used to provide

assurance to NHSE of the compliance of NHS organisations to the EPRR Core Standards. This

included Acute, Community, Mental Health, Specialist providers, CCGs, Ambulance Services, 111

service providers and Commissioning Support Unit organisations.

The NHS England Core Standards for Emergency Preparedness, Resilience and Response

(EPRR) are the minimum standards which NHS organisations and providers of NHS funded care,

must meet.

These standards are reviewed and updated as lessons are identified from testing, national

legislation and guidance changes and/ or as part of the rolling NHS England governance

programme.

All organisations were required to complete a RAG rated self-assessment against the core

standards, with Acute Trusts required to complete the Chemical, Biological, Radiological, Nuclear

and Explosive (CBRNe) core standards.

Evidence to be provided to support the self-assessment included:

▪ Major Incident Plan (category 1 responders)

▪ Corporate Business Continuity Plan

▪ EPRR Policy / Strategy

▪ Pandemic Influenza Plan

Submission of the RAG rated core standards and the above types of evidence were submitted 13

September 2017, along with an overall compliance rating level.

CCG assurance review meetings were held, individually, by NHSE’s London Region EPRR Team.

Commissioners were asked to go through their self-rated assessments and agree actions with

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NHSE. Based on this meeting, CCGs are invited to make any required changes and resubmit the

assurance within 2 weeks.

4.1. Levels of compliance CCGs self-rate as meeting one of the four levels of compliance in table 1. The thresholds for overall assurance ratings are based upon the number of core standards which were considered red, amber or green. See table 1.

Table 1 - 2017/18 EPRR Compliance Levels

Compliance Level Evaluation and Testing Conclusion

Full Arrangements are in place that appropriately addresses all the core standards that the organisation is expected to achieve. The Board has agreed with this position statement.

Substantial

Arrangements are in place however they do not appropriately address one to five of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed.

Partial

Arrangements are in place, however they do not appropriately address six to ten of the core standards that the organisation is expected to achieve. A work plan is in place that the Board has agreed.

Non-compliant

Arrangements in place do not appropriately address eleven or more core standards that the organisation is expected to achieve. A work plan has been agreed by the Board and will be monitored on a quarterly basis in order to demonstrate future compliance.

5. Croydon CCG’s Level of Compliance

The standards are split over 8 headings, the number of core standards and rating agreed with

NHSE are given in table 2. Table 3 contains core standard ratings from 2016/17 for comparison.

This is followed by an overview of each area and examples of actions taken / required.

Croydon CCG has sought to reduce any amber rated areas, year on year. This consistent focus

has resulted in the 2017/18 rating being ‘fully compliant’ for the first time in the CCG’s history.

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Improvements were made in the domains of ‘Command & Control’ and ‘Training & Exercise’ during

2017/18.



Green Amber Red

1 Governance 4 0 0







7 Cooperation 5 0 0


Total 37 0 0

Deep Dive - Governance 6 0 0

*One of the core standards under Duty to maintain plans has been split out in to a number of core

standards.



Green Amber Red

1 Governance 4 0 0







7 Cooperation 5 0 0


Total 27 2 0

Deep Dive - Business Continuity 5 0 0

*A number of indicators under the Duty to maintain plans heading were grouped together in 2016/17

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5.1. Command and Control Due to a planned power down of Bernard Weatherill House in October (weekend of 27-30th), the

CCG updated and tested staff contact details to ensure that there was a reliable mechanism to

advise staff of any issues on Monday morning accessing the building or IT.

Identifying staff that would be interested in undertaking loggist training has been difficult for the

past few years. However, during 2017/18, two new members of staff joined the CCG that had

previously undertaken this training, closing down a long-standing ‘amber’.

5.2. Training and Exercise The CCG undertook its annual Business Continuity Plan exercise as well as participated in a

number of multi-agency exercises delivered by the Croydon Borough Resilience Forum (see

section 7). Greater participation from the wider organisation was achieved in 2017/18, with

Primary Care, Communications, Urgent Care and well as Pharmacy staff attending more BRF

exercises.

5.3. Deep Dive – Governance The deep dive consisted of six additional questions. These centred around the process of

reporting the results of the 2016/17 EPRR assurance to Governing Body and the public (through

the Annual Report), meetings held internally to progress work plans and attendance at NHSE held

network meetings.

6. Generated Work Plan

The CCG, supported by NEL CSU, has drawn up a work programme and timetable for the coming

year. This is a live document, intended to be updated, incorporating any lessons learnt from

exercises and training. The 2018/19 action plan can be found in appendix 1.

Progress will be monitored against the work programme to ensure compliance with agreed

timescales. The work plan is reviewed quarterly with the Accountable Emergency Officer (AEO) at

scheduled catch up meetings and with the Head of Performance, Assurance and Planning, no less

than monthly.

7. Training / Exercise

This section contains a brief summary of training and exercises that the CCG has engaged with during 2017/18.

7.1. ‘No notice’ Call Cascade The purpose of this communications exercise was to test the resilience of the process of alerting CCG staff and key partners of an incident. Staff had been advised, on 6 October 2017, that an out

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of hours call cascade test would be carried out within two weeks, in preparation for the BWH shutdown over the weekend of 27 October 2017. The exercise commenced at 0717 hrs on Monday 16 October 2017.

7.2. Business Impact Analysis training Heads of Departments, or their deputies, received training on carrying out Business Impact Analyses for their respective team roles. This included identifying those activities which, if not carried out within 48 hours or less, become critical to the organisation. Attendees were also advised on maintaining an out-of-hours emergency cascade list for staff. The completed BIAs informed the refresh of the BCP.

7.3. Business Continuity Plan (BCP) Training and Exercise The BCP incorporates information from individual teams BIA, for most significant risks and critical activities. On 5 December 2016, training for Executive Directors and Heads of Department was provided immediately prior to table-top testing of the plan. This annual Business Continuity exercise was carried out on 18 January 2018. The scenario exercised was based on loss of staff due to extreme weather conditions preventing travel in to Bernard Weatherill House, compounded by loss of access to remote IT services for people able to work from home. The group followed the BCP to meet the demands of the exercise, which was interspersed with discussion / follow up challenges from the facilitator. A number of refinements were identified through the course of the exercise which has been incorporated in to the final BCP and work plan for the coming year.

7.4. Participation in Partner Training or Exercise In addition to the above, Croydon CCG participated in the following externally delivered exercises: June 2017 – Exercise Downfall (structural collapse) The scenario used was that of a multi-story carpark in Croydon’s town centre collapsing due to structural failure. This was arranged and facilitated by the Croydon Council Resilience team as a Borough Resilience Forum (BRF), mulit-agency exercise.

July 2017 – Exercise East Croydon (terrorist attack at transport hub) This was another BRF exercise, jointly facilitated by the Metropolitan Police and the Croydon Council Resilience Team. The scenario saw a vehicle-borne improvised explosive device identified at East Croydon train station. Complications, such as evacuating people from their homes within the designated threat radius and switching off electricity supplies to overhead tram cables tested the BRF’s ability to coordinate across a number of agencies. September 2017 – Counter terrorism training Delivered by the Metropolitan Police Service (MPS) on the request of the CCG. This training

covered advice given to UK residents in the case of a marauding terrorist attack.

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October 2017 – Exercise Fever (Pandemic flu) A BRF multi-agency exercise to test how members coordinate in the scenario of an influenza

pandemic. The output of this exercise was an overarching multi-agency plan. Roles and

responsibilities were clarified and tested.

November 2017 - Counter terrorism training A repeat of the September training, made available to members of staff unable to attend the

previous training.

February 2018 – Exercise Gwynyn (Chemical attack in a crowed place) A BRF exercise based upon the scenario of toxic gas being released on a bus and within a cinema. This exercise was attended by a couple of subject matter experts. February 2018 - Counter terrorism training Training delivered by MPS, provided to CCG and Council staff. This was similar to previous

counter terrorism training delivered in September and November.

March 2018 – Exercise Safer City (UK threat from international terrorism moves to critical) This was an exercise undertaken by London boroughs. Croydon Council invited a number of BRF member organisations to participate. The purpose was to test arrangements to step up following a change in threat level to critical – meaning an attack would be expected imminently.

8. Incidents

This section summarises incidents that trigger the activation of an emergency response by the

CCG, over the course of the 2017/18 financial year.

8.1. WannaCry Cyber Attack On 12 May 2017, the CCG was alerted to a major cyber-attack when it was requested, by its IT

service provider, to shut down all computers within the head office and at all GP practices. The

request was confirmed as being genuine and coordinated through team leaders within the CCG.

A number of staff then volunteered to contacted GP practices and community pharmacies to pass

on the warning.

The IT service provider updated the system over the weekend with software updates and closely

monitored the situation on Monday when staff returned to work. An internal debrief was held on

Monday 15 May 2017.

No South West London NHS organisations were infected with the malicious virus; however, there

were some disruptions due to cautionary measures being taken.

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8.2. Loss of email

4 - 6 October 2017 There was a disruption to emails due to the CCG’s migration from @croydonccg.nhs.uk to

@swlondon.nhs.uk email address. The move was part of an update to the CCG’s IT, which has

enabled greater capability of staff to work remotely and participate in video conferencing.

23 – 25 October 2017 Loss of N3 connection nationally. The CCG’s IT service provider was in contact with British

Telecom, the operators of the secure NHS network.

8.3. Transport disruption due to snow and ice During February and March 2018 there were a few days of disruption to public transport due to

snow and ice. The CCG’s resilience was improved by using Microsoft Office 365 following the

migration in October. This enabled more members of staff to have access to their emails and files

through remote access.

8.4. Waddon gas leak and evacuation Police were called to the site of a collision between a car and a gas terminal in Waddon on Sunday

18 March 2018, around 2020hrs. The collision led to a severe gas leak and the need to evacuate

local residents from their homes, within a 500 metre radius. The local authority opened up two rest

centres, the first in Waddon leisure centre, the second in the Salvation Army building.

Approximately 300 displaced individuals were temporarily house in the rest centres, with many

others going to stay at friends and family.

A call was received early on Monday morning at the CCG with a request from the Local Authority

to support people in rest centres who had left their prescriptions in their homes. The CCG liaised

with CHS who agreed to send a district nurse to assess patients and dispense needed medication.

Trams between Mitcham Road and Reeves Corner were replaced with a bus service due to the

proximity of the incident to the track, and Purley Way was closed to traffic until 1000hrs on Monday

19 March. Residents were allowed to return to their homes on Monday evening.

9. Commitment to Further Develop EPRR

The CCG continues to work closely with members of the Croydon Resilience Forum and NHSE

EPRR forums. Internally, further engagement with all staff will be maintained through

communications exercises and training. Opportunities to prepare for Major Incidents and Business

Continuity events through exercise and planning will be explored with key partner organisations,

within Croydon and with members of SWL Health and Care Partnership.

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10. Future Reports

Updates against the work programme will be taken to Senior Management Team in 6 months and

an annual report will be taken to Governing Body in Q4 of 2018/19.

11. References

NHS Commissioning Board Business Continuity Management Framework (service resilience),

January 2013

NHS Commissioning Board frequently asked questions (FAQs) on the future arrangements for

health Emergency Preparedness, Resilience and Response (EPRR), January 2013

Summary of Published Key Strategic Guidance for Health Emergency Preparedness, Resilience &

Response (EPRR), November 2014

https://www.gov.uk/preparation-and-planning-for-emergencies-responsibilities-of-responder-

agencies-and-others, 15 January 2015

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Croydon CCG EPRR Work Plan 2017/18

Page 1 of 4

Croydon CCG Work Plan 2017/2018 - REVIEW

Date Started Clinical Commissioning Group

Event Notes RAG Status

Ongoing Attendance at South London LHRP Network

Meetings, LHRP Patch Meetings and SW London CCG Forums

The AEO will attend NHS England LHRP Patch and Network meetings to represent CCG, supported by NEL CSU as required and requested. As per NHS England requirements NEL CSU cannot solely represent the CCGs.

Ongoing Quarterly BC Briefing with the CCG AEO

Regular quarterly briefing with the AEO, EPLO and Senior Risk Manager from CSU, to discuss the progress of EPRR projects, issues, actions and to ensure oversight of EPRR in the CCG this should enable greater accuracy when auditing EPRR for the annual assurance.

Ongoing Attend multi-agency training and exercise

sessions Where appropriate CCG to attending and taking part in multi-agency training and exercise sessions.

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April Training Needs Analysis & Exercise

Programme

A Training Needs Analysis (TNA) will be completed for the CCG by CSU resource, to identify training needs of staff.

An Exercise schedule will then be created which adheres to EPRR core standards.

The TNA will identify any relevant staff not currently trained in the management of business continuity incidents and those that require an in year refresher.

A schedule of regular training and exercising for the CCG will be implemented to support CCG EPRR requirements. This will include;

➢ Business impact analysis training for required staff

➢ BCM incident management training

➢ Strategic Business continuity exercise (either Table top or live at the CCGs discretion)

➢ Bi-annual communications exercise

➢ CCG wide staff business continuity awareness training (as required)

This document and the Croydon CCG EPRR Policy outline the

intended EPRR actions for the year

April Policy Review NEL CSU will revise the EPRR policy in line with new guidance from NHSE. The AEO will present the revised policy to the SMT for review and approval.

Reviewed in May 2017

April EPRR risk assessment process

NEL CSU will initiate the EPRR risk assessment process. NEL CSU will provide draft risk assessments by 31st April 2017 to the CCG. Where possible this will be based on information collected from the Borough Resilience Forum and/or Local Authority Community Risk Register where available

The CCG AEO will have the risk assessments approved by an appropriate internal forum and relevant risks added to the CCGs corporate risk register.

Once signed off, the Risk Assessment will form a key part of the updated business continuity plan.

The CSU will support the CCGs to identify mitigation actions as appropriate.

Updated in May 2017.

Sits as Appendix 4 in Croydon CCG BC Plan

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September

subject to NHSE schedule

EPRR Assurance process

Submission of the CCG self-assessment for the EPRR Assurance process undertaken by NHS England.

Following completion of the actions within the NHSE Assurance the CCG will receive an action plan, which will feed into this annual work plan and the annual EPRR report to the executive board.

Submitted on time

October Business Impact Analysis (BIA) process

NEL CSU to deliver a short training session for CCG Teams taking part in the BIA process they will also be given a user guide with practical examples.

Dates for meeting with Heads of Service or appropriate deputies are organised by the CCG.

Heads, service, or appropriate deputies will then complete BIA process with NEL CSU assistance (where required). The BIA process will be overseen by the AEO to ensure completion dates and schedules are kept.

2 December 2018

November Business Continuity Plan updated

NEL CSU will conduct a full review of the BC plan based on the updated BIA data. The BC Plan will be taken to the CCG’s SMT for review.

The CCG AEO will ensure that SMT signs-off the plan.

Updated in January

December Strategic Business Continuity Management

training

NEL CSU will provide training to any manager who will be expected to lead a Business Continuity incident for their role.

A full strategic BC training and exercising session will be undertaken in December with all actions and recommendations completed by February 2018.

18 January 2018

December Table Top strategic Exercise – Business

Continuity

NEL CSU will provide a strategic table top exercise to test the business continuity plan and procedures contained within. This will include a post-Exercise report with officer owned recommendations and actions for improvements. This will feed into the annual NHS Assurance audit programme.

18 January 2018

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Bi-Annual Comms Exercise including external partners Test of the CCG incident communications in line with NHSE EPRR core standards requirements. Will be undertaken with relevant supporting CCGs.

May exercise deffered due to Cyber attack.

Completed on 6 October 2018

Quarterly Refresh Call Cascade lists Request heads of service update their own call cascade list and share with Q&G Business Manager. To include key partners’ contact details.

Requests made. Reminders in light of

October 27-30 Building maintenance.

As requested Major Incident Awareness Training Multi-agency or other training for all staff. Counter-Terrorism

training being delivered in Sept & Nov

As requested Business Continuity Staff Awareness

Training General awareness training for staff on Business Continuity, their responsibilities and the plans and procedures in place for the CCG.

Not carried out. However, 3 dates of

counter terrorism training was provided by MPS for CCG staff.

As requested Croydon Multi-Agency Major Incident

Exercise

NEL CSU will help to support the development of an appropriate multi-agency exercise to be delivered through Croydon CCG with input from the Croydon Borough Council and the Croydon Resilience Forum.

Croydon Council held 4 major incident exercises

in 2017/18. The CCG participated in all,

however, the CCG did not develop and lead its

own multi-agency exercise.

The delivery of this work plan is dependent on CCG staff working in partnership with NEL CSU Business Resilience Team within the agreed timescales.

Delays to information return could have a negative impact on the CCGs response to the EPRR Assurance Process.

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Croydon CCG EPRR Work Plan 2018/19

Expected Start Date

Event Location Notes Progress

April Policy Review N/A NEL will revise the EPRR policy in line with new guidance from NHSE. It is NELs expectation that the AEO will present the revised policy to the Executive Board by for review and approval.

Draft shared with CCG

April

Training Needs Analysis & Exercise Programme

Sits as an appendix to the CCG EPRR Policy

N/A A Training Needs Analysis (TNA) sits as an appendix to the Croydon CCG BC Policy V4 and is supported by this Annual Work Plan


April EPRR risk assessment

process N/A

NEL will review the CCG EPRR risk assessment that sits as an appendix to the Corporate BC Plan. NEL will provide draft risk review and update to the CCG for commend and consideration.

The EPRR risk assessment is on the risks within the London LHRP risk register and BRF community risk registers (where available). The CSU will support the CCGs to identify mitigation actions as appropriate.


June / July

Call Cascade Exercise N/A Test of the CCG incident communications in line with NHSE EPRR core standards requirements. Will be undertaken with Croydon Council, supporting CCGs, partners and stakeholders

A exercise brief will be written and shared

with the CCG by

2018 05 31

June / July

Business Continuity Management Staff Awareness

Training CCG Site

General awareness training for staff on Business Continuity, their responsibilities and the plans and procedures in place for the CCG.

CCG will look for a date

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Expected Start Date


June Business Impact Analysis

(BIA) Review CCG Site

BIAs will be refreshed and reviewed by service leads; activities should be reviewed to ensure the information is up to date and all resource information should be updated to ensure that details around; minimum staff numbers, ICT access and resources, and Internal / external dependencies are correct

2017 BIAs shared with the CCG for review

July BIA review meetings CCG Site NEL will host a short BIA review session with each service lead to ensure information in the reviewed BIAs is correct and additional follow up information can be sought (as required)

July / August

Business Continuity Plan updated

N/A

NEL will conduct a full review of the BC plan based on the updated BIA data.

Additional information will be added around communications best practice and a cyber security action card will be added to cover response and recovery actions in the first 48 hours to a major cyber attack

September /

October

Strategic Business Continuity Management training

CCG Site NEL will provide training to any manager who will be expected to lead a response to a Business Continuity incident for their role.

September /

October

Table Top strategic Exercise – Business Continuity

CCG Site

NEL will provide an exercise to test the BC plan and procedures contained within. This will include a post-Exercise report with officer owned recommendations and actions for improvements. This will feed into the annual NHS Assurance audit programme.

September

subject to NHSE

schedule

EPRR Assurance process N/A

NEL will complete a draft EPRR Assurance for the CCGs consideration and review the CCG is responsible for submitting the final version to NHSE London EPRR Team.

If requested NEL will support the CCG during EPRR Assurance meetings, following submission of the Assurance and sign off by NHSE London Team. NEL will create an action plan for the CCG which will cover any outstanding Amber actions.

Ongoing

Attendance at South London LHRP Network Meetings,

LHRP Patch Meetings and SW London CCG Forums

As Required

The AEO will attend NHS England LHRP Patch and Network meetings to represent CCG, supported by NEL as requested.

As per NHS England requirements, NEL cannot solely represent the CCGs at LHRP or EPRR Patch Meetings.

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Expected Start Date


Ongoing Quarterly BC Briefing with the

CCG AEO CCG Site

NEL will hold a regularly quarterly briefing with the AEO to discuss the progress of EPRR projects, issues, actions and to ensure oversight of EPRR in the CCG this should enable greater accuracy when auditing EPRR for the annual assurance.

Ongoing Support the CCG (where

appropriate) at multi-agency training and exercise sessions

N/A

Where appropriate NEL will support the CCG when attending and taking part in multi-agency training and exercise sessions. NEL cannot attend exercises without a CCG representative also being present.

The delivery of this work plan is dependent on CCG staff returning required information to the NEL Business Resilience Team within the agreed timescales. Delays to information return could have a negative impact on the CCGs response to the EPRR Assurance Process.

RAG Rating for EPRR Work Plan Progress

Colour Progress Rating

Green Completed

Amber In Progress

Red Outstanding

White Ongoing actions – not applicable

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3 July 2018

Title of Paper: MINUTES OF THE INTEGRATED GOVERNANCE AND AUDIT COMMITTEE

Lead Director Philip Hogan, Lay Member

Report Author Elaine Clancy, Director of Quality and Governance


None


Croydon Clinical Commissioning Group (CCG) Governing Body

Purpose of Report For Information

Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Integrated Governance and Audit Committee meeting held on

19 April 2018.

Background:

The Integrated Governance and Audit Committee (IGAC) provides the Governing Body with a means of independent and objective review of financial, quality, corporate governance, assurance processes and risk management across the whole of the CCG’s activities (clinical and non-clinical). The approved minutes of the meeting held on 19 April 2018 are attached. The Integrated Governance and Audit Committee met on 21 May 2018 and the approved minutes of the meeting will be brought to the next Governing Body.

Key Issues:

The Key issues discussed at the Integrated Governance and Audit Committee on the 19 April 2018 were :

▪ IGAC Terms of Reference review ▪ Review of CCG Committee Terms of Reference ▪ Internal Audit Progress Report & Tracker ▪ Internal Audit Report 2017/18 Head of Internal Audit Opinion

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▪ External Audit Progress Report and Emerging Issues ▪ External Audit Plan 2018/19 ▪ Draft Annual Governance Statement ▪ Draft CCG Annual Report ▪ Draft CCG Annual Accounts ▪ Updated Annual Accounts Timetable ▪ Report on Losses and Special Payments ▪ Report on Waiver of Standing Orders and Prime Financial Policies ▪ Local Counter Fraud Specialist Progress Report ▪ Register of Interests/ Gifts Hospitality / Decisions Log

Governance:

Corporate Objective To commission high quality health care services that re accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve financial balance. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care.

Risks

No new risks were identified as a result of this paper.


None


None

Clinical Leadership Comments None

Implications for Other CCGs None

Equality Analysis

EIA are considered in the development of all quality and governance processes.

Patient and Public Involvement None

Communication Plan None

Information Governance Issues None

Reputational Issues

None

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Croydon Clinical Commissioning Group Integrated Governance and Audit Committee

Minutes

Date: Monday 19 April 2018 Time: 09.00 – 11.00 Location: Room 1.10, Bernard Weatherill House


Members: ▪ Philip Hogan (PH), Lay Member for

Governance - Chair ▪ Roger Eastwood (RE), Lay Member for

Finance ▪ Amy Page (AP) Registered Nurse, Lay

Member

▪ Andrew Eyres (AE) Accountable Officer ▪ Elaine Clancy (EC) Director of Quality

and Governance ▪ Mike Sexton, (MS) – Chief Finance

Officer ▪ Nick Atkinson (NA) - Internal Audit,

RSMUK ▪ Sarah Ironmonger (SI) External Audit,

Grant Thornton ▪ Matthew Dean (MD) External Audit,

Grant Thornton

▪ Ben Smith (BS) Board Secretary-minutes

▪ Marion Joynson, Deputy Director, Finance

▪ Lizzie Whetnall, Head of Communications & Engagement (NELCSU)

▪ Stephanie Kendrick, Communications Manager (NELCSU)

Apologies Apologies

▪ Tom Chan (TC), GP Governing Body Member and Medical Director

▪ Agnelo Fernandes (AF) CCG Clinical Chair

Action

1 Introduction and Welcome Apologies were noted.

2 Declarations of Interest There were no declarations of interest relevant to the Agenda

3 3.1

Minutes of Last Meeting The notes of the meeting held on 29 January 2018 were agreed as a correct record

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4 4.1 4.2 4.3

Matters Arising and Action Log The Committee were advised that the update on Service Auditor Reporting for Capita (in respect of GP payments) would be brought to the May 2018 Committee. All other actions were noted to be complete.

MS

5 5.1 5.2 5.3 5.4

IGAC Terms of Reference Review and Annual Review Elaine Clancy presented the annual review of the Committee and advised that it was considered to have delivered against its terms of reference through its meetings in 2017/18. The Terms of Reference for the committee had been reviewed and Elaine Clancy said that they had been found to adequately represent the functions and duties of the Committee and should be recommended for approval by the Governing body without significant amendment for 2018/19. Elaine Clancy noted that the expected attendance of the CCG Accountable Officer may need to be reviewed in recognition of the changed Chief Officer arrangements that make routine attendance by the current Accountable Officer incompatible with the current scheduling. It was proposed to invite Andrew Eyres, Accountable Officer when the committee felt this attendance to be necessary. Integrated Governance and Audit Committee is asked to :

▪ AGREED the content of the draft Annual Report of the Integrated

Governance and Audit Committee for 2017/18.

▪ NOTED the Terms of Reference of the Committee have been

reviewed and the recommendation, subject to Committee review, is that they should be adopted for a further year, subject to consideration of the following change:

- change required attendance of the Accountable Officer to ‘by invitation’

6 6.1 6.2 6.3

Outcome of Review of Committees and Terms of Reference Elaine Clancy presented the report Elaine Clancy explained that the Finance Committee and Quality Committee had each reviewed their respective business activities conducted in the past year and concluded that their terms of reference adequately represent the functions and duties of the Committee and should be recommended for approval for 2018/19 by the Governing body subject to minor amendment. In accordance with the IGAC terms of reference, the outcome of these reviews was reported to the committee for noting. Members supported the recommendation of the Finance Committee that delegation should be sought from the Governing Body for the Finance

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6.4

Committee’s approval of procurement decisions in light of the Governing Body meeting in public less frequently and as an alternative to the current reliance on Chairs action. Ben Smith said that the Primary Care Commissioning Committee had not met to agree their report and the proposed point of clarification in the Terms of Reference. These were scheduled on the committee’s agenda for 1st May 2018 and would report to the Governing Body to be held on the same day. Andrew Eyres noted that a full year had not yet elapsed since the Primary Care Commissioning Committee was established. The Integrated Governance and Audit Committee noted the Annual Reviews and updated terms of Reference for the Finance Committee, Quality Committee and Primary Care Commissioning Committee.

7 7.1 7.2 7.3 7.4 7.5 7.6

Internal Audit Update and Draft Head of Internal Audit Opinion Nick Atkinson presented the report Nick Atkinson advised the committee that since the previous Integrated Governance & Audit Committee meeting, no audit reports had been finalised, the draft report: Assurance Map 8.17.18 was presented and described as work in progress pending consideration from executives. Members were introduced to the three lines of defence described and Nick Atkinson flagged that Executives might consider the apparent opportunities for external assurance might include the performance of local general practices and generally in the areas of: strategy, human resources and the CCG Estates Strategy. Andrew Eyres flagged that various arrangements with the CQC and NHS England scrutiny could be identified by Executives. Nick Atkinson described that Six management actions (three high, one medium and two low) that were due for implementation were followed up. The CCG has made steady progress on implementing the agreed management actions from previous reviews, however progress still needs to be made in fully implementing five outstanding actions which relate to the continuing healthcare review. In relation to ongoing audits, Nick Atkinson drew attention to section 3 of the report that describes looking ahead at reports still to be presented. The audit of Cyber-security was reported to have neared completion before the auditors became aware of further arrangements coordinated by a team across South West London which were likely to improve the assurance given than would otherwise have been provided. Andrew Eyres commented that he was aware not all controls reside in the CSU and that he was aware of arrangements through his Joint role as Lambeth CCG Accountable Officer and said that it may be helpful to be clear that while there is an emphasis on prevention from attacks,

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7.7 7.8 7.9 7.10 7.11 7.12 7.13 7.14 7.15

Croydon CCG as a corporate body is a relatively low user of personal data and the upcoming messaging about the level of risk should be considered in this context. There was an update on information received around the Primary Care Audit. Nick Atkinson said that it was anticipated to provide reasonable assurance and that the joint regional team were felt to have settled reasonably well in its first year. Nick Atkinson stressed the importance of the team and their controls working well given their criticality in relation to the CCG’s delegated responsibilities for primary care commissioning and that the Capita SAR was not expected to be especially assuring when it is eventually received. Nick Atkinson added that the Conflict of Interest audit draft had been sent to Elaine Clancy for sign off and advised the report contained nothing of alarm. Members were advised that auditors had returned to verify the implementation of continuing healthcare controls and that close off for actions is sought pending some chasing for supporting paperwork. Nick Atkinson reported that an audit into the Management of IT services was progressing and largely complete and a number of issues had been identified which seemed to vindicate directing audits to this area. The auditor is working with Simon Keen, CCG Head of IT and Estates. The Internal Audit Plan was introduced as a single plan across the SW London CCG. A correction was flagged in relating to the Croydon CCG’s CFO name and had been rectified in the latest draft. Where areas can be covered once, a single audit will be used. Nick Atkinson presented the draft Head of Internal Audit Opinion and said that a final draft should be able to be circulated ahead of the May IGAC meeting. Members were advised that the amber-green RAG rating of reasonable was not expected to change on the basis of the IT and Cyber audits. Members attention was drawn to the wording at para1.3 of the Head of Internal Opinion in relation to continuing healthcare. Nick Atkinson commented that the CCG had opened the organisation to internal audit in a positive manner and that there were broadly good systems of internal control. It was noted that the areas where issues are flagged are those outside the CCG’s direct control, while Andrew Eyres acknowledged that these contacted activities remain the CCG’s responsibility. Amy Page said she welcomed having had sight of the progress through which Elaine Clancy’s professional concerns around Continuing Healthcare had led to tangible actions towards being more assured around the service. Nick Atkinson said that he will look to include reference to the Service

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Auditor Reports when available but that these are not expected to have a negative impact. The Integrated Governance and Audit Committee: NOTED the progress report and the Draft Head of Internal Audit Opinion.

8 8.1 8.2 8.3 8.4 8.5 8.6 8.7

External Audit Update. Sarah Ironmonger presented Audit Plan 2018/19 covering both the Financial Statements and the Value for Money Conclusion, and explained the external auditors are required to issue an opinion on these by the end of May 2018 in line with the national deadline. In relation to the key risks listed, Sarah Ironmonger advised that secondary healthcare was the focus of the audit taking place and reported that advice on going concern would follow. Sarah Ironmonger explained the threshold for material uncertainty. In respect of value for money, Sarah Ironmonger said that their audit opinion had been qualified on this basis in previous years. A judgement was taking place around planning and whether the CCG reflected unidentified £8.1m QIPP had been recognised from the outset and through the year. The Chair said that the committee understood the principle behind the opinion. Sarah Ironmonger replied to a question from Roger Eastwood and confirmed that she has, through Grant Thornton, sufficient resources to complete the audit. Sarah Ironmonger presented the Progress Report and report of emerging issues The CCG Annual Report benchmarking was presented by Sarah Ironmonger. The CCG were noted to be ‘behind the pack’ on: the disclosure of strategic risks; working with local health economy on: prevention partnership input; evidence of changes in primary care delivery by use of different structure; period since last update of conflicts of interest register; rating for Corporate Governance Statement/AGS and empowerment given to key stakeholder. However, Sarah Ironmonger said that as a high level summary this should be seen as a relative position Sarah Ironmonger emphasised to the committee that the Annual Report should be telling the CCG’s story rather than being checklist directed. The Integrated Governance and Audit Committee: ▪ AGREED the Annual Audit Plan ▪ NOTED the latest Progress Report and Emerging Issues Update

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9 9.1 9.2 9.3 9.5 9.6

Annual Governance Statement Elaine Clancy presented the draft of the Annual Governance Statement. Elaine Clancy advised the committee that highlighting had been lost on the version submitted in some packs and so Members should be aware that the CCG did not plan to report No Significant Control Issues. The latest draft was reported to be consistent with the Head of Internal Audit Opinion. Roger Eastwood and Mike Sexton said that a view will be needed around the CCG’s Going Concern position when the annual accounts are submitted. Clarification was given in respect of the Governing Body membership table used that will be adapted to show the non-voting members. Philip Hogan identified a correction around his tenure dates where they have been incorrectly entered for the Committee in Common. Further content was suggested around the Primary Care Commissioning Committee. Ben Smith advised that he would update the draft accordingly. Andrew Eyres confirmed that the annual governance statement was in a state of significant update and re-drafting. The updated draft will be shared with Members when issued to NHS England.

BS BS

10 10.1 10.2

Draft CCG Annual Report Elaine Clancy presented the draft of the Annual Report version 2.2 and introduced Lizzie Whetnall and Stephanie Kendrick from the CCG’s Communication team who had been involved in coordinating the drafting of the report. Elaine Clancy explained that the drafting was work in progress and described the timetable for issuing a further draft version to NHS England. Elaine Clancy said that endorsement of a final version should be arranged no later than 21 May 2018 ahead of the Council of Members meeting on Thursday 24 May 2018 (noting that the Council of Members have reserved authority to approve the annual accounts). Instead of holding a separate meeting of the Governing Body, Elaine Clancy said that the scheduled IGAC meeting date could be used if, given the broadly shared membership, the Governing Body agrees to delegate authority to the committee to recommend a final version of the annual report and annual accounts.

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10.3 10.4 10.5

Amy Page praised the drafting of the report in its explanation of the One Croydon Alliance. Amy Page also flagged what appeared to be an error in financial figures on the page relating to exit packages. Mike Sexton said this would be checked and corrected. Members discussed the appropriate inclusion of reference to the recent Secretary of State letter referencing the independent reconfiguration panel concerning the CCG’s IVF decision in April 2017. There was a discussion around the necessary reporting around equal pay. Elaine Clancy clarified that WRES data monitors this and that 2 VSM females are within the reported figures while Agenda for Change provides a framework in the NHS for deciding pay. Elaine Clancy commented that nationally there are thought to be gender differences around negotiating the starting salary of a new appointments. The Integrated Governance and Audit Committee reviewed the current draft of the Annual Report and provided feedback regarding its progression and direction

11 11.1 11.2 11.3 11.4 11.5

Draft CCG Annual Accounts Marion Joynson tabled a slide pack and talked through the key notes of the Annual Accounts. Reference was also made to the letters that needed to be sent to Grant Thornton from the Chair or the Committee and the Chief Finance Officer. Attention was drawn to the key financial performance targets specifically: the CCG had delivered a deficit of £13.9m as planned. Mike Sexton noted the CCG had therefore breached its statutory revenue resource limit; £21.2m QIPP programme had been fully delivered in year. Better Payment Practice Code had met the target for non NHS payables as well as for NHS payables. Marion Joynson drew attention to page 16 of the presentation noting that less revenue recorded in 2017/18 compared to the previous year and described this related to the timing on resolving disputes around responsible commissioner guidance. £1m of invoices were considered to be valid disputes in arbitration and a provision has been entered in the accounts. Marion Joynson described the Operating Expenses categories and advised the increase in ‘pay’ was attributable to in-housing financial management Quality functions as well as the new Executive post. Around £50m is attributable to Primary Care Commissioning delegated to the CCG from April 2018. There was also discussion of the costs of organisational change. Nick Atkinson said that spend on Mental Health, given the national focus seemed very low. Marion Joynson replied that this was in part due to presenting figures for Foundation Trusts split from NHS Trusts but

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11.6 11.7 11.8 11.9 11.10

significantly due to the transformation work with SLAM that reduced occupied bed days and length of stay, primarily for improved quality and patient experience. Mike Sexton described the timetable for reviewing the annual accounts and said it had been agreed that Finance Committee would see the revised pages before a draft version is issued to NHS England at 5 pm (23rd April 2018). Members commented on the draft accounts. Rogers Eastwood queried the description of Directors and noted that Lay Members seem broadly equivalent to Non-Executive Directors of NHS Trusts. Sarah Ironmonger said the relevant section seemed to refer to Executive Directors It was advised that references concerning insurance to NHS Litigation Authority might now reflect their current branding of NHS Resolution. Mike Sexton explained Related Party Transactions and explained the increased figure on last year is in light of the CCG’s delegated responsibility for commissioning of primary care, such that the entirety of payments to the GP practices of Governing body members are disclosed. Marion Joynson and Mike Sexton were thanked for the presentation of the Annual Accounts that Nick Atkinson said had been very helpful The Integrated Governance and Audit Committee

▪ AGREED to recommend to the Governing Body: - That responsibility for recommending the Annual Accounts

and Annual Report for approval by the Council of Members be delegated from the Governing Body to the Integrated Governance and Audit Committee. IGAC will meet on 21 May 2018 and Council of Members will meet on 24 May 2018.

The Integrated Governance and Audit Committee: ▪ NOTED The final date for requesting changes to this draft will

be close of play 19 April 2018. ▪ NOTED The draft responses to the following enquiries from

the external auditors: - Understanding how the Integrated Governance and Audit

Committee gains assurance from management. - Management’s response to Risk Assessment for the financial

year ending 31st March 2018.

12 12.1

Report on Losses and Special Payments This report was deferred

13

Report on Waiver of Standing Orders and Prime Financial Policies

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13.1 This report was deferred

14 14.1

Local Counter Fraud Specialist Progress Report This item was deferred

15 15.1 15.2 15.3

Register of Interests and Declarations of Hospitality Elaine Clancy presented the Register of Interests and reported that there have been no declarations of gifts and hospitality since the version reviewed by the Governing Body. The Committee were advised of recent additions and changes to the register since the last review including additions for the CCG Lay Member, Governance (new interests advised to the committee at the January meeting); and the CCG Lay Member, Finance. Ben Smith advised that updated Register of Interest forms for Governing Body Members and Clinical Leads were issued on 22 March 2018 for update and returns are being compiled. The Integrated Governance and Audit Committee NOTED the Register of interests and NOTED that no further Gifts and Hospitality been declared NOTED the copy of the correct decision log as loaded onto the CCG website.

16 16.1

Risk Review There were no additional matters to be escalated for the Governing Body’s attention

17 17.1

Any Other Business There were no additional items of business.

18 Date of Next Meeting Thursday 21 May 2018

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3 July 2018

Title of Paper: MINUTES OF THE QUALITY COMMITTEE

Lead Director Amy Page, Registered Nurse, GB Member

Report Author Elaine Clancy, Director of Quality and Governance


None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the approved minutes of the Quality Committee meetings held on 26 March

2018.

Background:

The Croydon CCG Quality Committee provides the Governing Body and Integrated Governance and Audit Committee with a means of independent and objective review of quality, corporate governance, assurance processes and risk management across the CCG’s clinical activities.

The minutes of the meeting of 26 March are attached. Quality Committee met on 26 March 2018. The minutes for this meeting will be brought to the next Governing Body meeting.

Key Issues:

The main issues discussed at the Quality Committee Meeting on the 22 January 2018 were:

▪ Integrated Performance and Quality report M7. ▪ Croydon CCG Strategic And Operational Quality And Safety Risks ▪ Safeguarding Update ▪ Looked After Children Health Assessment Update ▪ Quality Assurance visit update ▪ Equality and Diversity Annual Report

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▪ Terms of Reference for the Primary Care Contract Quality Review Group ▪ QIPP Highlight report ▪ Continuing Healthcare Review

Governance:


Risks

No new risks were identified as part of this report


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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QUALITY COMMITTEE

MINUTES Date: Monday 26 March 2018 Time: 2.00 – 4.00 Location: Room 1.09


Members: ▪ Amy Page (AP) – Chair - Lay

Member, (Registered Nurse (AP) ▪ Ben Smith (BS) Board Secretary ▪ Elaine Clancy (EC) Director of

Quality and Governance ▪ Jon Norman (JN) GP, Governing

Body Member, Secondary Care Consultant

▪ Paulette Lewis (PL) – Lay Member – PPI

▪ Sally Innis (SI) Head of Safeguarding

▪ Simon Lee (SL) Associate Director of Quality and Governance

▪ Tom Chan (TC) – Medical Director

▪ Amanda Tuke (AT) Joint Head of Children and Maternity Integrated Commissioning (items 10 and 15)

▪ Michelle Perry (MP) Minutes ▪ Rachael Colley (RC) Associate Director of

Continuing Health Care (item 16) ▪ Ruth Frost (RF) Head of Primary Care (item 5) ▪ Sean Crilly (SC) Planned Care Commissioning

Programme Lead (item 9)

Apologies: ▪ Emily Symington (ES) Governing

Body Member ▪ Martin Ellis (ME) Director of

Primary Care and Out of Hospital

1. Introductions and Declarations of Interest Action

1.1 Introductions were made and Paulette Lewis was welcomed to the Committee as the new lay member for PPI. There were no declarations of interest declared.

2. Minutes of the last meeting

2.1 The minutes of the 22 January 2018 were agreed as an accurate record.

3. Action Log and Matters Arising

3.1

The action log was reviewed and members agreed that the following items are closed: QS-135 QS 136

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3.2 3.3

QS 137 - Simon Lee (SL) agreed to speak to Valerie Richards and ensure that any updates from the Joint Impact Assessment Panel (JIAP) will be brought to the Quality Committee and significant updates highlighted. Jon Norman (JN) requested that the significant updates are highlighted with a different colour and no more than one page on the decisions log. Elaine Clancy (EC) emphasised the amount of progress that has been made through JIAP and absolute assurance around quality benefits of QIPP driven by SL. Action: SL to update significant changes from JIAP decisions log accordingly.

SL

4. Update Primary Care CQC quality points following PCCC

4.1 4.2 4.4

Ruth Frost (RF) updated members following the Primary Care Committee and advised that the CQC have made planned and comprehensive visits to selected practices over a period of three months. RF advised that a number of practices have good ratings, whilst one practice (Edridge Road) remains in special measures, however they are working closely with Edridge road to go through their action plan and further meetings are in place. RF brought to the attention of the members that South Norwood Hill Medical Centre received a ‘good’ rating having previously been in special measures and advised that she is currently looking at ways to continue to support further progress. The group discussed how management systems, leadership and governance are amongst the key issues that are currently being addressed. RF informed members of a report yet to be published for Coulsdon Medical Centre who have been issued with a notice of intention to cancel registration with the CQC. The press are aware due to the GP informing patients/residents that he is being closed down. RF concluded that work with Coulsdon Medical Practice is underway to address continuity of care to all 3700 patients. The GP is required to respond to the report on factual accuracy by Tuesday 27 March 2018, the LMC are involved and the press have been referred to the CQC.

5. Croydon CCG Strategic And Operational Quality And Safety Risks

5.1 5.2

EC reported no significant changes to quality and safety risks. Amy Page (AP) commented that a couple of risks had a last review date recorded as January 2018. Ben Smith (BS) replied that, in the case of COR 010, actions had been updated (with the PPI Lay Member vacancy filled) but further review is needed with leads to determine whether the risk has been mitigated to the extent that the risk can be closed.

6. Integrated Performance and Quality report M10

6.1

Simon Lee (SL) presented the integrated performance and quality report and highlighted that there were four 52 week waits, two at Croydon Health Services (CHS) and two at Kings College Hospital (KCH) however, SL

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confirmed that no harm came to any of the patients. SL advised that there are on-going issues with accident and emergency with type 1 performance being the main issue. The Accident and Emergency Board are currently working to progress with a number of actions still outstanding. SL informed members that Croydon CCG met 5 out of 8 cancer wait standards in January however are not overly concerned due to there being no systematic issues having been identified. SL added that five mixed sex accommodation breaches occurred at Epsom and St Helier Trust likely due to winter pressures, he reminded the committee that this was permitted during the winter period. SL explained that IAPT are making progress although still below trajectory. A number of meetings with NHSE and the intensive support team for IAPT have taken place following performance and everything possible is being done to progress. SL advised that there were six serious incidents at Croydon Health Services and one at SLaM in January 2018. Tom Chan advised members that the IAPT service was progressing well and that message’s to GP’s about how to refer patients had been circulated along with a request for rooms for IAPT practitioners. Jon Norman (JN) acknowledged the starting point on IAPT and expressed no concern. SL reported the findings from the CQC report. JN did express concern ITU being flagged up twice at CHS. Paulette Lewis (PL) challenged how leadership anticipate the changes/pressures and enquired what is in place to tackle these issues. Tom Chan noted the trainees issue and pressures around not wanting to live in Croydon. Members had a discussion around making Croydon an attractive place to work and live. Amy Page asked about how A&E at the trust will reach their 95% target. EC responded that they will not achieve 95%because they are currently below 90% and there will not be enough time to improve significantly on that. AP noted that under the IAF framework, Croydon have been celebrated being 7th nationally. AP enquired if there is a clear time line for the SLaM suicide prevention strategy. EC advised that although it is happening there is currently no timeline of when it will be published. AP requested an update in the next report on medicines serious incidents further to a note that they are being monitored. Action: SL to update around medicines serious incidents at the next quality committee.

SL

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6.12 6.13

EC noted that the mental health transformation work in conjunction with South West London might miss the Croydon challenge. JN enquired as to whether the 60 minute handovers have reduced EC advised they are significantly better from earlier in the year. AP expressed concern around the new emergency department having slipped and EC responded by informing that construction challenges are being citied.

7. CQC Inspection report – CHS

7.1 7.2

EC presented the CQC inspection report in more detail and highlighted that the outpatient’s and surgery reports are improved. EC stated that CHS are waiting for an unannounced inspection for other areas of the Trust.

8. QIPP Report Quality Annex - Planned Care

8.1 8.2 8.3

Sean Crilly (SC) presented the planned care QIPP report on behalf of Aarti Joshi (AJ). The focus of the report is on the outcomes of the physio pilot and page 3 sets out what the pilot hopes to achieve. SC explained the test is looking to see if the primary care based model of care would be better for patients. So far it have been proven to a degree. There has been a lot of positive feedback from patients. The report was discussed in great detail. TC added that the pilot has been very helpful for the GP’s and those who have not yet received the service have expressed a requirement to do so. AP enquired if the reduction in orthopaedic referrals in elective TNO would impact on outpatients sessions that the trust need to run. SC responded that they would target the patients who can be treated in a different way. AP concluded the level of detail presented is encouraging.

9. SEND report

9.1 9.2

Members were introduced to Amanda Tuke (AT). AT announced that the report had been to governing body and is being presented to quality committee for more detail. The report sets out the implications for the CCG of the statutory requirements for children with disability and it summarises the current position of progress at the Crystal Child Development Centre. The report also sets out the current position of commissioning activity and future plans. AT informed members that there has been slow progress due to commissioning resources. There is impending OFSTED CQC inspection. There is focus on where there is an oversight in complaints and changes to the widening of SEND tribunals. JN noted this being quite directive. AP stated there is lack of clarity and consistency around cross borough arrangements and EHCP medicals. AT responded that the speech and language therapist are unable to attend every school and therefore negotiating across the boroughs to ensure that the childrens requirements are met. AT explained that Gill Brockall (designated medical officer) has found that there is a different approach to medicals across boroughs. JN suggested that incentivising GP’s to carry

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out medicals from a younger age could be beneficial. JN noted that he is relatively assured that there is fairly solid progress on medical assessments. PL said she is seeking assurance that Croydon residents are getting the service and care that expected contractually. AT responded that the service is not yet where it should be. AP requested for an update in one year. Action: Amanda Tuke to bring update to quality committee on SEND report in one year.

AT

10. LAC Health Assessment update

10.1 10.2 10.3 10.4 10.5 10.6

Members agreed to bring forward the LAC health assessment update. AT stated that she has been working with Sandra Richards to increase delivery of the health assessments to meet statutory requirements. A demand and capacity analysis took place for 800 children. Findings were that monies commissioned would fund approximately 400 children. AT informed members that a recommendation to SMT that the contract to the North Croydon Medical Centre is extended for another year on the basis of the number of assessments delivered and extra funding for CHS LAC nursing service, had been approved. AT estimated that this will provide enough capacity to meet requirements. AT presented a trajectory and advised that she is optimistic that they will be in a better position next year. AP expressed assurance that progress is being made. Sally Innis added that the work at North Croydon medical practice is quality assured and there is a continued issue around DNA which is around 20%. AP requested a 6 monthly update. Action: AT and SI to update on LAC health assessments in 6 months’ time.

AT/SI

11. Terms of Reference review: Review of effectiveness and compliance

11.1 11.2 11.3

Ben Smith presented the review that governing body members are already aware of. BS highlighted section 5 which states that some clarity is required on the members due to the fact there are changes to personnel. AP noted that on page 103 under ‘Responsibility of quality committee’ number 3 – ‘to advise the IGAC and therefore governing body’ requires amending as IGAC do not report to governing body. EC added that clarity around member’s attendance and reason for attendance. BS agreed to update on Tony Brzezicki, Paula Lloyd-Knight and Paulette Lewis and Andrew Eyres. Action: Ben Smith to update the Terms of Reference to include members as currently described.

BS

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12. SGH Clinical Harm Update – Feb 18

12.1

EC stated the SGH Clinical Harm Update is for information and to inform that there is oversight in the challenges of St. Georges and its implications for Croydon patients. The committee were assured that there is a governance mechanism in place.

13. PPI report – Quarter 3

13.1

Members acknowledged they are assured and impressed by the continued good work the PPI team are doing.

14. CQRG Minutes

14.1

EC informed the group that the CQRG minutes were signed off as a true and accurate representation of dialogue at the CQRG meeting.

15. Continuing Healthcare Update

15.1 15.2 15.3 15.4 15.5 15.6

EC introduced Rachael Colley to the group. RC updated members from a quality perspective of the CHC improvement and transformation plan and the progress to date. RC advised that a review of the domiciliary care providers has taken place. The review will initially look at the placement officers who are responsible for finding the packages of care and ensuring the contracts are robust, this will be going live in April 2018. RC advised that 15 care homes will take part in an audit from April which will be repeated over a six month period. RC expressed slight concern around non AQP homes not completing the audits required for quality assurance. However advised work is underway with business services to potentially delay invoices being paid whereby they have significantly breached the AQP agreement. The group were encouraged that CHC is moving in the right direction. AP requested a 4 monthly update on CHC. Action: RC to update QC on a four month basis.

RC

16. Quality Risks

16.1 The committee agreed the areas in which members would like highlighted are:

• TC flagged Edridge Road and Coulsdon practices and advised that he would work closely with Ruth Frost to ensure progress.

• EC informed the group that work to improve the LAC HA would continue and confirmed an update at 6 months.

• AP asked for a CQC update from the Trust at the next committee meeting and if the action plan is ready it will be presented.

Any Other Business

The group did not address any other business.

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17.1

Date of next meeting: Monday 21 May 2018 2–4 pm Room: 1.14 - BWH

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3 July 2018

Title of Paper: MINUTES OF THE CLINICAL LEADERSHIP GROUP

Lead Director Agnelo Fernandes, Chair

Report Author Martin Ellis, Director of Primary and Out of Hospital Care


Clinical Leadership Group




Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Clinical Leadership Group meetings held on:

7 March 2018 and 2 May 2018

Background:

The purpose of the Clinical Leadership Group (CLG) is to provide clinical and corporate support to the Croydon Clinical Commissioning Group (CCG) Governing Body. The group supports the Governing Body to realise and deliver the strategic aims and objectives of the CCG, addressing local and national targets and health care needs. The minutes of the meetings held on 7 March 2018 and 2 May 2018 are attached. Minutes of the 6 June 2018 CLG meeting will be brought to the next meeting

Key Issues:

The following were the key issues discussed on the 7 March 2018:

▪ Governing Body and Finance Highlights ▪ Update on Clinical Leads recruitment ▪ Planning for March GP Open Meeting ▪ SMI QOF (Severe Mental Illness Quality & Outcomes Framework) ▪ ERS (NHS e-Referral Service) ▪ Draft Carers Strategy ▪ Learning Disability Health Checks ▪ Feedback from Network Meetings

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A workshop was held on 4 April 2018 in place of the regular CLG meeting. The following were the key issues discussed on the 2 May 2018:

▪ Governing Body and Finance Highlights ▪ Update on Clinical Leads recruitment ▪ Feedback from GP CQRG ▪ Feedback from GP Open Meeting held in March ▪ Network Transformation ▪ Primary Care Update - Outpatient Activity Performance ▪ Feedback from Network Meetings

The following were the key issues discussed on the 6 June 2018:

▪ Governing Body and Finance Highlights ▪ Business Cases

- Care Homes - End of Life Care - Falls

▪ Primary Care Transformation ▪ Reducing Variation in Primary Care update ▪ Learning Disability Health Checks ▪ Children’s Health Services Transformation Strategy and Business Case ▪ Optimised Risk Stratification ▪ Feedback from Network Meetings

Governance:

Corporate Objective To commission high quality health care services that are accessible, provide good treatment and achieve good patient outcomes. To reduce the amount of time people spend avoidably in hospital through better and more integrated care in the community, outside of hospital for physical and mental health. To achieve sustainable financial balance by 2020/21. To support local people and stakeholders to have a greater influence on services we commission and support individuals to manage their care.

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To have all Croydon GP practices actively involved in commissioning services and develop a responsible and learning commissioning organisation.

Risks

No new risks were identified as part of this report.


None


None



None

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None



None

Reputational Issues

None

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Croydon Clinical Commissioning Group Clinical Leadership Group Meeting

MINUTES

Date: Wednesday 7 March 2018 Time: 13:30 – 15:30 Location: Board Room, Davis House, Robert St, Croydon CR0 1QQ


▪ Dr Tom Chan (TC), Medical Director ▪ Dr Bobby Abbot (BA), Clinical Network

Lead (rotating Co-Chair Part A) ▪ Dr Ameesh Patel (AP), Deputy Clinical

Lead (rotating Co-Chair Part B) ▪ Dr Amit Abbot (AA), Deputy Clinical

Lead ▪ Dr Yinka Ajayi-Obe (YAO), Clinical

Network Lead ▪ Dr Tony Brzezicki (TB), Clinical Lead

Planned Care ▪ Dr Karthiga Gengatharan (KG), Clinical

Network Lead ▪ Dr Shamaila Masood Hussain (ShM)

Deputy Clinical Lead ▪ Dr Sam Randle (SR), Clinical Lead – IT ▪ Dr Farhhan Sami (FS), Clinical Network

Lead ▪ Dr Mike Simmonds (MSi), Clinical

Network Lead ▪ Dr Nishal Velani (NV), GP Lead – End

of Life Care

▪ Olu Ajayi (OA) IT Project Lead, Croydon CCG

▪ Claudette Allerdyce (CA), Associate Chief Pharmacist, Croydon CCG

▪ Martin Ellis, (ME), Director of Primary and Out of Hospital Care, Croydon CCG

▪ Ruth Frost (RF), Head of Primary Care, Croydon CCG

▪ Vasudha Rai (VR), Business Manager, Primary and Out of Hospital Care, NELCSU

Apologies:

▪ Dipti Gandhi (DG), Clinical Lead – Diabetes

▪ Dr Kamran Khan (KK), Clinical Lead – Education

▪ Dr Agnelo Fernandes (AF), Clinical Chair

▪ Dr Dev Malhotra (DM), Clinical Lead – Mental Health

▪ Dr Josephine Sheyin (JS), Clinical Lead – IUC & NHS 111 Dr Emily Symington (ES), Croydon CCG Governing Body Member

▪ Teresa Chapman (TC), Practice Manager Representative

▪ Stephen Warren (SW), Director of Commissioning, Croydon CCG

▪ Mike Sexton (MSe) Chief Finance Officer, Croydon CCG

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1 Welcome, Introductions and Clinical Lead work headlines Action

1.1 1.2

Tom Chan welcomed everyone to the meeting and explained that a number of apologies had been received as colleagues were attending a Croydon Health Summit organised by Croydon Council. Members introduced themselves and provided a brief update on their achievements since the last meeting.

2 Apologies for absences

2.1 Apologies noted above.


3.1 3.2

GPs present in the room declared their conflict of being providers as well as commissioners. There were no other new declarations of interest reported.


4.1

The minutes of the previous meeting were agreed as an accurate record.

5 Matters Arising

5.1 5.2 5.3 5.4

CLG 16 – CMC The Clinical Leadership Group noted that Martin Ellis had emailed practices in relation to the CMC targets, CLG 17 – GP Forward View Tom Chan reminded Clinical Leads to send their ideas to the Primary Care team. Martin Ellis explained that each network had adopted a different approach and a catalogue of ideas captured was being compiled and would be shared so that networks could learn from each other. Martin Ellis reassured that the monies available as part of the GP Forward view was ring fenced and there was a need for networks to be more proactive and have plans in place. The action log was reviewed and updated.

6 Governing Body and Finance Highlights

6.1 6.2

Tom Chan reported that the Governing Body meeting held on 6 March 2018, had received an update on the social prescribing project that was happening in the Thornton Heath network. Reference was made to the social prescribing video that was available on the CCG’s website which demonstrated how a patient had benefitted from the project. It was envisaged that social prescribing could help to alleviate the burden on GP time. Tom Chan reported that the Governing Body had also received an update on the Operating Plan.

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7 Update on Clinical Leads recruitment

7.1 7.2

The Clinical Leadership Group noted that there were vacancies for GPs for the role of Assistant Clinical Chair, GP Governing Body members, Clinical Network Leads and Deputy Clinical Network Leads. Martin Ellis explained that the role descriptions had been updated to reflect that GP Governing Body members would provide clinical leadership in a specific area. Adverts for the GP Governing Body members would be sent out shortly. Martin Ellis advised clinical leads to discuss with GP colleagues and to encourage colleagues to apply.

8 Planning for March GP Open Meeting

8.1 8.2

The next GP Open Meeting was scheduled for 21 March 2018 would be focusing on workforce and new ways of working. A market place as well as lunch and networking session would be included prior to the formal part of the meeting. Martin Ellis explained that locums as well as practice managers were always invited to the meeting.

9 SMI QOF

9.1 9.2

Bobby Abbot explained that South London and the Maudsley NHS Trust needed some help collating some patient level information for one of their CQUINs. It was agreed that the Trust would send their requirements through Vasudha Rai, who would then pass it on to Practices. There was a discussion in relation to out of hours mental health services and it was agreed that a case could be developed as part of the GP Forward View funding.

10 ERS

10.1 10.2

The Clinical Leadership Group noted that as from June 2018, SWL trusts would not be accepting paper referrals. Attention was drawn to the training available to support this move. The Clinical Leadership Group noted that the pilot for ERS referral for specialties under the two week wait rule had concluded. A few issues had been noted, however, there was nothing to suggest that it was a not a safe way to refer patients. The PLT session would be used to update GP colleagues on the proposed pathway changes. Sam Randle explained that there was a need for further engagement with some practices as well. This would be discussed at the next LMC meeting.

11 Draft Carers Strategy

11.1

Lyndsey Hogg introduced the draft carer’s strategy and explained that the strategy had been co-produced with the Council to include adult and young carers making the strategy very user friendly and allowing for young carers to be included in the discussions for the people that they were caring for.

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11.2 11.3

The Clinical Leadership Group welcomed this strategy and commented that it contacted lots of important information that GPs colleagues would find useful. It was recommended that the Carers Support Centre have a stall at a future Open meeting. Lyndsey Hogg advised that her contract would shortly be coming to an end and suggested that members liaise with her colleague Stephen Bahooshy ([email protected] )

13 Learning Disability Health Checks

13.1 13.2

Amit Abbot explained that Croydon has a high ratio of patients with Learning Disabilities and annual health checks for this patient group was low. Health checks was vital for this patient group and there was a need to try and work through some processed to this easier. The Clinical Leadership Group noted that a PLT session would be used to raise the awareness for this check and offering training to practice nurses.

14 Feedback from Network Meetings

Feedback from Purley Network meeting Farhhan Sami reported that the network had received an update in Dermatology. Feedback from Thornton Heath Network meeting The Thornton Heath Network had a presentation from the social prescribing project and had done PDDS peer review. Feedback from East Croydon Network meeting Karthiga Gengatharn reported that the network had carried out a peer revies of the PDDS returns. Feedback from Mayday Network meeting Yinka Ajayi Obe reported that the network was of the view that NHS 111 was diverting patients back to the practices rather than hubs. This would be raised with the NHS 111 lead GP. The network had also discussed their concerns in relation to dementia prescribing. Feedback from Woodside Shirley Network meeting Bobby Abbot reported that the network had started their extended access. Some minor issues with vision and emis systems had been noted as well as some issues with regards to repeat prescriptions. Feedback from New Addington and Selsdon Network meeting Mike Simmonds reported that the network had discussed PDDS. There had also been a discussion in relation to huddles and the lack of support on palliative care. The Clinical Leadership Group noted that this was a contractual issue which would need to be resolved.


12.1

There were no further business to discuss.

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13 Date of Next Meeting

4 April 2018, 13:30 – 15:30, Braithwaite Hall, Croydon Council

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Croydon Clinical Commissioning Group Clinical Leadership Group Meeting

MINUTES

Date: Wednesday 2 May 2018 Time: 13:30 – 15:30 Location: Braithwaite Hall, Croydon Town Centre, Katherine Street, Croydon CR9 1ET


▪ Dr Agnelo Fernandes (AF), CCG Clinical Chair

▪ Dr Tom Chan (TC), Medical Director (Rotating Co-Chair Part A)

▪ Dr Kamran Khan (KK), Clinical Lead Education (Rotating Co-chair Part B)

▪ Dr Shahab Karim (SK) Deputy Clinical Lead

▪ Dr Tony Brzezicki (TB), Clinical Lead Planned Care

▪ Dr Shamaila Masood Hussain (ShM) Deputy Clinical Lead

▪ Dr Sam Randle (SR), Clinical Lead – IT ▪ Dr Farhhan Sami (FS), Clinical Network

Lead ▪ Dr Mike Simmonds (MSi), Clinical

Network Lead ▪ Dr Josephine Sheyin (JS), Clinical Lead

– IUC & NHS 111 ▪ Dr Nishal Velani (NV), GP Lead – End

of Life Care Dipti Gandhi (DG), Clinical Lead – Diabetes

▪ Dr Dev Malhotra (DM), Clinical Lead – Mental Health

▪ Dr Emily Symington (ES), Croydon CCG Governing Body Member

▪ Helen Goodrum (HG), Variation Lead, Croydon CCG

▪ Aarti Joshi (AJ), Associate Director for Planned Care

▪ Tumsilla Sethi (TS), Primary Care Lead for Transformation, Croydon CCG

▪ Claudette Allerdyce (CA), Associate Chief Pharmacist, Croydon CCG

▪ Martin Ellis, (ME), Director of Primary and Out of Hospital Care, Croydon CCG

▪ Ruth Frost (RF), Head of Primary Care, Croydon CCG

▪ Mike Sexton (MSe) Chief Finance Officer, Croydon CCG

▪ Vasudha Rai (VR), Business Manager, Primary and Out of Hospital Care, NELCSU

Apologies:

▪ Teresa Chapman (TC), Practice Manager Representative

▪ Dr Bobby Abbot (BA), Clinical Network Lead

▪ Dr Ameesh Patel (AP), Deputy Clinical Lead

▪ Dr Amit Abbot (AA), Deputy Clinical Lead

▪ Dr Yinka Ajayi-Obe (YAO), Clinical Network Lead

▪ Stephen Warren (SW), Director of Commissioning, Croydon CCG

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▪ Dr Karthiga Gengatharan (KG), Clinical Network Lead

1 Welcome, Introductions and Clinical Lead work headlines Action

1.1 Agnelo Fernandes welcomed everyone to the meeting.

2 Apologies for absences

2.1 Apologies noted above.


3.1 3.2

GPs present in the room declared their conflict of being providers as well as commissioners. There were no other new declarations of interest reported.


4.1 4.2

The minutes of the meeting held on 7 March 2018 were agreed as an accurate record. Feedback notes from the Clinical Leadership Group meeting held on 4 April 2018 was also noted.

5 Matters Arising

5.1 5.2

It was agreed than an update on paediatrics would be brought to the May Clinical Leadership Group. Mike Simmonds reported that the paediatrics team had started working with the mental health team in regards to asthma and were also looking at developing plans relating to childhood obesity. The action log was reviewed and updated.

6 Governing Body and Finance Highlights

6.1 6.2 6.3 6.4

Mike Sexton provided a verbal update from the Governing Body meeting that was held on 1 April 2018. The success in relation to IAPT had been noted and it was attributed to the increase in capacity and the number of SLaM referrals being seen within a primary care setting. There had also been positive feedback from the public. The Clinical Leadership Group noted that the CCG had achieved the forecasted £21m QIPP savings and was working towards achieving break even and aspiring to deliver a surplus. A QIPP saving of £27m would be needed to deliver this. Tom Chan thanked and commended the Finance Team for all their hard work and explained that 90% of QIPP savings had been identified. Tom Chan encouraged Clinical Leads to share any ideas that they might have. Agnelo Fernandes advised that there was a need to share this information with networks as well. They had been instrumental in the achievement of the savings.

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6.5 6.6 6.7 6.8 6.9

Mike Sexton reported that all contracts with key providers had been signed for the 2018/19 period. The contract with the One Croydon Alliance had also been signed. The Clinical Leadership Group noted that the results from the latest stakeholder survey was showing a marked improvement compared to the survey done the previous year. The Governing Body had been reflecting on the recent achievements. Agnelo Fernandes reflected that achieving the QIPP target had been a combination to the last 3 years. The CCG started in deficit and was finally starting to come out of that deficit whereas other CCGs were now forecasting deficit. The deficit had helped to carry out some transformational work in collaboration with system leaders. Mike Sexton explained that there had been a change in the chairs of some Committees following changes in the national guidance. Dev Malhotra referred to the improvement in IAPT targets and reflected that it was proportionate to the investment that had been made into the service and there was a need to ensure that the money was ring fenced for this. The Clinical Leadership Group noted that there was a need to discuss the £68m cumulative deficit with NHS England. This historical debt coincides with a period when the CCG was underfunded.

7 Update on Clinical Leads recruitment

7.1

Tom Chan explained that the closing date to apply for the GP governing Body roles had been extended till Tuesday 22 May 2018. The Group noted that there had been some expressions of interest but would welcome some more. Tom Chan encouraged Clinical Leads to apply and explained some of the duties that the role would entail.

8 Feedback from GP CQRG

8.1 8.2

Tom Chan reported that the GP CQRG had now met twice and the Terms of Reference had been finalised. There had been discussions in relation to CQC visits to practices. The Group had also been looking at quality dashboard as well as the Sepsis national strategy. Clinical Network and Deputy Network Leads were encouraged to attend these meetings. Martin Ellis reported that there was a number of support that could be provided to GP practices for e.g.

• Specialist support to the Practice such as Safeguarding, Meds Management etc.

• Sharing learning from the CQC with Practices and the GP Collaborative.

9 Feedback from GP Open meeting held in March

9.1

Martin Ellis reported that the open meeting held in March was a step change from the previous meetings and was starting to jointly identify the solutions. The focus had been on exploring new ways of working.

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9.2 9.3

The market stall had various providers and the talk from Modality was very well received. The March GP Open meeting had led to some vibrant discussion at Network meetings. Tumsilla Sethi reported that the CCG had been able to secure a £1M investment from the STP to develop Working at Scale. The May open meeting would focus on Workforce. Additionally a Working at Scale conference was being planned for 26 June 2016. The CCG was committed to ensuring that all stakeholders to enable Working at Scale would be able to have a dedicated time to think of the various models available. The Conference would be held at the De Vere Hotel in Selsdon and out of hours cover would be provided to ensure that colleagues from practices were able to attend. A celebration of the 70 years of the NHS was also planned for that afternoon. Details would be circulated to practices shortly. Kamran Khan flagged that there was a PLT session planned for 26 June 2018. There was a suggestion that the PLT session could be held in parallel with the Conference. Tumsilla Sethi and Kamran Khan would discuss and agree next steps.

10 Network Transformation

10.1 10.2 10.3

Martin Ellis presented on the plans with regards to Network Transformation and explained that as part of Primary Care Transformation the current network alignment was being looked at. Additionally, Commissioning Managers had been asked to advise on their requirements for clinical input with a view to using this information to ensure that Clinical Leadership was provided to all work streams. Dev Malhotra reflected that the communication loop did not always get completed. Practices would raise issues and networks would not get feedback on those issues. There was a discussion in relation to ensuring that Network Clinical Leads were supported. Clinical Leads also discussed the proposed network reconfiguration and it was agreed that there was a need to look at the current configuration and carefully appraise each option. Farhhan Sami reflected that initially there had been some negativity when networks were configured but practices had moved on since those early days. Networks were functioning better now. It was agreed that there was a need for networks to own their agenda and for Network Leads and Primary Care Development Managers to ensure that presenters are prepped prior to presenting at their network meeting.

11 Out Patient Activity Performance

11.1 11.2

Aarti Joshi presented this item to the Group and explained that the benchmarking data indicated significant differences from the other CCG within South West London. The Clinical Leadership Group discussed the data and noted that commissioning and cost activities were lower than other CCGs. It was noted that the Planned Care team was trying to analyse the data.

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11.3

Clinical Leads recommended that A&E data be also reviewed to understand if the high level of activity was from A&E attendances. Tom Chan advised that the Variation team would shortly be starting Variation Visits and requested Clinical Leads to feedback their thoughts on the Criteria for these.

12 Feedback from Network Meetings

12.1 12.2 12.3 12.4

Feedback from Purley Network meeting Farhhan Sami reported that the Network would be liaising with the Out of Hospital Team for data on roving GP. Feedback from Thornton Heath Network meeting The Thornton Heath Network had discussed paediatric asthma as well as working at scale. Practices within the Thornton Heath Network did not feel that huddles were helpful as the social care component was not working and would welcome some advice from colleagues from the Mayday Network. Feedback from New Addington and Selsdon Network meeting Mike Simmonds reported that the network had discussed the GPFV and were in discussion with the GP Collaborative with a view to adopting the paramedic model.


13.1 13.2 13.3 13.4

Physio Based in Practices Aarti Joshi explained that the reprocurement of this service would shortly be starting and advised that the team would be liaising with networks for their feedback and engagement. Right Care Emily Symington reported that Right Care plans were due in May and asked Clinical Leads to support the exercise. Smoking Cessation The Planned Care Team was working in collaboration with Croydon Council and the Medicines Optimisation team to support practices in delivering a consistent message to friends and family. Board to Board Agnelo Fernandes explained that the Governing Body was having a Board meeting with the CHS Board Members on 23 May with a view to promote joint working


14.1 6 June 2018, 13:30 – 15:30, Braithwaite Hall, Croydon Council

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3 July 2018

Title of Paper: MINUTES OF THE FINANCE COMMITTEE

Lead Director Roger Eastwood, Lay Member

Report Author Mike Sexton, Chief Finance Officer


None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the minutes of the Finance Committee meeting held on 23 April 2018

Background:

The Croydon CCG Finance Committee provides the Governing Body and Integrated Governance and Audit Committee with a means to exercise its role of independent and objective review of financial assurance processes and risk management across the whole of the CCG’s financial activities. The minutes of the meetings held on 23 April 2018 are attached.

Governance:

Corporate Objective To achieve sustainable financial balance by 2020/21.

Risks

Significant risks in delivering Detailed Financial Plan as outlined in the paper. The current risk rating of QIPP/Transformation is £14m of the £21m QIPP plan.


None


None


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Equality Analysis



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Croydon Clinical Commissioning Group

Finance Committee

Minutes Date: 23 April 2018 Time: 16.00-17.30 Location: Room 1.07

Members In Attendance

Present: ▪ Roger Eastwood, (RE) Lay Member – Chair ▪ Tom Chan (TC) GP Member ▪ Jon Norman (JN) Secondary Care

Consultant member

Present: ▪ Mike Sexton (MS), Chief Finance

Officer ▪ Marion Joynson (MJ), Deputy Finance

Officer ▪ Ben Smith, Board Secretary– for

minutes ▪ Aarti Joshi, Associate Director- Planned

Care for Stephen Warren.

Apologies: ▪ Agnelo Fernandes (AF) Clinical Chair (open

invitation)

Apologies: ▪ Andrew Eyres, Accountable Officer

(Open Invitation) ▪ Stephen Warren (SW), Director of

Commissioning

1 Apologies for Absence Action

1.1 The apologies were noted

Introductions and Declaration of Interest

2.1

No interests were declared.

3. Minutes From Last Meeting

3.1

The previous minutes were not agreed and would be re circulated for approval. [Minutes of 26 March 2018 will be considered again at the 21 May 2018 meeting]

BS

4. Action Log / Matters Arising

4.1

No outstanding actions remained on the action log. The actions concerning Terms of Reference and reporting the outcome of the Committee’s annual review were noted to have been endorsed by the Integrated Governance and Audit Committee on 19th April 2018 and scheduled for requesting approval by the Governing Body on 1st May 2018.

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4.2 Mike Sexton confirmed that all QIPP had been incorporated into CHS contract before signature and included paying at a marginal rate (57.5%) on non-electives, thus improving the alignment of the financial incentives with the desired outcomes of the Out of Hospital Business Case.

5. Annual Accounts 2017/18

5.1 5.2 5.3 5.4 5.5 5.6 5.7

Mike Sexton tabled the updated Annual Accounts, an earlier version of which had been reviewed at the Integrated Governance and Audit Committee on 19th April 2018. It had been agreed that Finance Committee would see the revised pages before a draft version is issued to the auditors and NHS England on 23rd April 2018. Key changes since the IGAC meeting were noted as follows:

• rounding correction at page 3

• consultancy disclosures enhanced for services of McKinsey and KPMG supporting System Review and out of hospital business case respectively.

• Related Party Transactions – MS explained the increased figure compared to the last financial year is in light of the CCG’s delegated responsibility for Commissioning of primary care, such that all entirety of payments to the GP practices of Governing body members are disclosed.

• MH Expenditure – the Annual Report now included narrative highlighting that the clinically appropriate work with SLAM to reduce inpatient length of stay had the result of significantly reducing expenditure over the period. MS reiterated the CCGs commitment to parity going forward.

JN asked MS to explain what had improved in relation to hitting the £21.1m QIPP delivery in full by year. MS responded that this related to improvement in the prescribing position and conclusion of the agreed position for CHS contracted activity at the last week of March 2018.

There was a discussion about the CHS assumptions of significant repatriation in 2018/19 and MJ said that turnaround advisors were supporting CHS to deliver their ambitions.

MS said that a value for money (VFM) opinion was expected from the CCG’s External Auditors and said it would be relevant to confirm their understanding that the CCG had delivered a £13.9m deficit in line with the CCG’s agreed plan but had missed the original NHS England expectation in relation to the £8.1m unidentified QIPP. It was likely that the VFM opinion would be qualified in some form as in previous years.

MS confirmed that the CCG is planning for break-even in 2018/19, subject to the discussion across SWL on delivering a £7.4m surplus.

The Committee noted the changes to the draft Annual Accounts and the latest draft was authorised for submission to NHS England in accordance with the national timetable deadline.

6 Finance Report (M12)

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6.1 6.2 6.3 6.4 6.5

Mike Sexton presented the final outturn Finance Report

MS said the CCG had met all public sector targets around invoices paid

within 30 days.

As above, MS advised that the CCG is reporting an outturn of £13.9m

deficit (£7.0m adverse variance), recognising the £8.1m unidentified QIPP

and £1.7m short stock drugs (NCSO) and that following previous advice

this was offset by £0.5m Category M benefit and £2.4m system reserve.

MS praised the sustained performance of the Pharmacy and Medicines Optimisation for sustained delivery of efficiencies and said that GPs should be commended for their contribution, adopting prescribing guidance and adhering to pathways through, peer review and referrals

MS drew attention to the debtors report on page 22 of the pack explaining that these are RAG rated on ‘collectability’ and that all have been through arbitration, much of which has been agreed in Croydon CCG’s favour with cash awaited. MS explained the responsible commissioner disputes that the CCG often have to argue are exacerbated by the number of care facilities in Croydon and common mistakes, especially regarding funding responsibility for Children, made about the rules that determine responsibility of the originating CCG. The Finance Committee: NOTED the Finance Report (M12) and that the CCG is reporting a

£13.9m deficit (£7.0m adverse variance), recognising the £8.1m unidentified QIPP and £1.7m short stock drugs (NCSO) and that following previous advice this was offset by £0.5m Category M benefit and £2.4m system reserve. NOTED the commendable performance against the Public Sector Payment policy

7 QIPP Report (M12)

7.1 7.2 7.3 7.4

MS presented the QIPP report and asked the Committee to note the full delivery of £21.2m QIPP in 2017/18. MS emphasised the importance of the Out of Hospital and Mental Health delivery and acknowledged that lessons were learned in areas of success and from slippages. Key to delivering in 2018/19 is the Clinical engagement developed through 2017/18 and the early warning of QIPP delivery slippage. Roger Eastwood acknowledged the improvements leading to the CCG achieving its highest ever QIPP and commented that the process does now feel like a sustained continuous process rather than an April – March exercise. The Finance Committee: NOTED the significant improvement in the quality and productivity of services through prevention and service innovation and transformation

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NOTED the full delivery of the consequent financial efficiency benefits £21.2m for 2017/18

8 2018/19 Plan update

8.1 8.2 8.3 8.4 8.5

Mike Sexton explained that breakeven for 2018/19 would require a QIPP target of £26.4m of which £24.6m had been identified with £1.7m still to be found. Mike Sexton highlighted a risk associated with discussion of a surplus target for SW London (£7.4m) and the consequent contribution that may be expected of Croydon without yet having discussed how this would be funded. MS advised it was important that Croydon took on some additional risk in respect of this issue, alongside all the other SWL CCGs. Mike Sexton added that an update will be provided for the Governing Body and that a telephone call may be scheduled to clarify Mike Sexton described progress on the contracting round. The CHS contract was agreed in late March, with the CCG negotiating QIPP into the non-local contracts though April and May. There was discussion about how a contribution to SW London might have to be found and that a 0.25% transformation fund is being created. MS stressed the importance of utilising this for Mental Health to meet the MH investment standard. The Finance Committee noted the update on the 2018/19 Finance Plan. A final update and detailed M1 budgets would be brought back in May 2018 for the record.

MS


9.1

There was no AOB except JN tenders his apologies for the Governing

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3 July 2018

Title of Paper: MINUTES OF THE PRIMARY CARE COMMISSIONING COMMITTEE

Lead Director Philip Hogan, Lay Member (Governance) and Conflict of Interest Guardian

Report Author Ben Smith, Board Secretary


None




Recommendation:

The CCG Governing Body is asked to: ▪ Note the approved minutes of the Primary Care Commissioning Committee held on 6

March 2018

Background:

The Croydon CCG Primary Care Commissioning Committee is a decision-making committee of the Governing Body responsible for the approval of arrangements for discharging the CCG’s responsibilities and duties associated with its primary care commissioning functions, including those delegated by NHS England in accordance with section 13Z of the NHS Act.

The minutes of the meeting of 6 March 2018 are attached. The Primary Care Commissioning Committee met in public on 1 May 2018. The minutes for this meeting will be brought to the next meeting. In the meantime, a summary of matters discussed is provided on the CCG website.

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Governance:


Risks

No new risks were identified as part of this report


None


None



None

Equality Analysis



None



None

Reputational Issues

None

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Croydon Clinical Commissioning Group Primary Care Commissioning Committee

MINUTES

Date: 6 March 2018 Time: 12 00 – 13 00 Location: Markee Room, Croydon Conference Centre, Surrey House, 5 – 9 Surrey Street,

Croydon CR0 1RG


▪ Philip Hogan, (PH) Lay Member Governance and COI, Croydon CCG (Chair)

▪ Andrew Eyres (AE), Chief Officer, Croydon CCG

▪ Elaine Clancy (EC), Director of Quality and Governance, Croydon CCG

▪ William Cunningham Davis (WCD), Regional Director of Primary Care, NHS England

▪ Martin Ellis (ME), Director of Primary and Out of Hospital Care, Croydon CCG

▪ Roger Eastwood (RE), Lay Member, Finance, Croydon CCG

▪ Agnelo Fernandes (AF), Clinical Chair , Croydon CCG

▪ Paulette Lewis (PL), Lay Member, PPI ▪ Mike Sexton (MS), Chief Finance Officer,

Croydon CCG ▪ Tom Chan (TC), GP Medical Director, Croydon

CCG ▪ Emily Symington (ES), GP Governing Body

Member, Croydon CCG

▪ Richard Brown (RB), Medical Director, Surrey and Sussex LMC

▪ Vasudha Rai (VR), Primary and Out of Hospital Care Business Manager, NELCSU

Apologies ▪ Jon Norman (JN), Secondary Care

Consultant, Croydon CCG ▪ Amy Page (AP), Registered Nurse, Lay

Member, Croydon CCG

Apologies ▪ Jai Jayaraman (JJ), Chief

Executive, Healthwatch ▪ Rachel Flowers (RF), Director of

Public Health, Croydon Council

Ref: 2018/03/01

1 Introduction and Apologies Action

1.1 Philip Hogan welcomed members to the meeting. Apologies were noted.

Ref: 2018/03/02


2.1 William Cunningham Davis declared that he was acting up as the

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Regional Director of Primary Care across London and he was attending the Committee as the Head of Primary Care for the South West London region. GP colleagues declared their conflict of being commissioners as well as providers. Tom Chan declared that he was a Partner at Greenwood Group Practice and that Country Park Practice (Agenda item 8) was also part of that Group.

Ref: 2018/03/03

3 Minutes of the Meeting held on 9 January 2018

3.1

The minutes were approved as a true record pending amendment to the attendees list to reflect that Tom Chan was not at the meeting.

Ref: 2018/03/04

4 Matters Arising/ Action Log

4.1

The action log was reviewed and updated.

Ref: 2018/03/05

5 Primary Care Finance Report

5.1 5.2 5.3

Mike Sexton presented the finance report and explained that 2016/17 financial performance for Primary Care was reporting a year to date and forecast underspend (driven by favourable variance on the £3/head, General Practice Extended Access and Training Care Navigators & Medical budget lines). The two component elements of the budget were summarised as:

▪ Primary Care Services (£7.3m annual budget): a year-to-date

£1.4m underspend and a forecast of £0.6m underspend.

▪ Primary Care Delegated commissioning (£50.4m annual budget): Year-to-date positions of £69k overspend and forecasts of £66k overspend.

Financial Plan 18/19 Mike Sexton reported that the CCG was expecting to receive a share of additional extended access funding. The additional transformation money would be held at SWL level; CCGs would need to prepare plans that demonstrated how they would spend their allocation, and how this met existing / future requirements before money was released. The Primary Care Commissioning Committee noted the report

Ref: 2018/03/06

6 GP Transformation

6.1

Martin Ellis provided an update on the GP Transformation agenda, detailed some of the work done and explained that the projects developed and delivered in 2017/18 across all the networks was being compiled into a catalogue which would be shared across all networks. GP extended access

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6.2 6.3 6.4 6.5 6.6

6.7 6.8 6.9

The Shirley/Woodside Network extended access went live on 19 February 2018. Appointments are offered between 6:30pm to 8:00pm Monday to Friday and between 8:30am to 1.00pm on a Saturday. Patients are able to pre-book appointments 2 weeks in advance via their own practice to see a GP, ANP or HCA. This service is available to all patients registered in the Woodside/Shirley network. The Thornton Heath & Mayday model would be provided through the GP Collaborative. It is expected that the service would go live on 19 March 2018, with appointments offered between 6:30pm to 8:00pm Monday to Friday and between 9:00am to 3:00pm on a Saturday. Patients will be able to pre-book appointments 2 weeks in advance via their own practice to see a GP or Nurse. Martin Ellis explained that Croydon patients are also able to access additional appointments through NHS 111 and be seen by clinicians at the 3 Urgent Care Hubs. Negotiations were being held with the current provider to allow for appointments to be pre-bookable. Future Plans Martin Ellis reported that a number of initiatives have commenced with the aim of ensuring the CCG/SWL Primary Care team was fit for purpose. A recent workshop was held to agree and formalise ways of working (i.e. defined processes for Quality, GP payments and GP contracts for example). Collaboration on and co-development of a Primary Care Strategy for Croydon would continue to include existing General Practice engagement & communication channels:

▪ Members matters (newsletter)

▪ General Comms to practices

▪ GP open meetings

▪ Network meetings

The March GP Open meeting would have focus on workforce and would have a market stall prior to the meeting. Martin Ellis explained that feedback received from the GP Survey was also being used to feed into the transformation agenda. The Committee noted that the previous year, the CCG was not seen as being very responsive organisation. Martin Ellis explained that there had been a change in the approach since the last GP Survey and he anticipated that this year’s results would be better. Agnelo Fernandes reflected that there was a need to consider bringing other members of the primary care family into this journey. The Committee noted that responsibility for the commissioning of dental, optometry and pharmacy etc. remained with NHS England. William Cunningham Davis reported that there had been a central restructure to allow for a local focus and would be able to bring updates.

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The Primary Care Commissioning Committee approved the report.

Ref: 2018/03/07

7 Commissioning Update

7.1 7.2 7.3 7.4 7.5 7.6 7.7 7.8

Contractual Changes An update on the contractual changes was presented for information. Practice Update Country Park/ Enmore Merger The Greenwood Group partnership have submitted a proposal to merge Country Park with Enmore Practice, by merging Enmore’s GMS contract into Country Park’s PMS contract. The Country Park practice is also in partnership with Greenside Group Practice (PMS) which have a main and a branch surgery in CR0. The Primary Care Commissioning Working Group held on 15 February 2018 reviewed the proposal and supported this agreement. In effect, this was only a structural change and would be beneficial to both patients and staff as the two practices share the same contractual signatories and are co-located in Woodside Health Centre, SE25. Working at scale would decrease the workload currently experienced due to the duplication of systems to achieve 2 sets of PDDS/QoF/LIS and DES targets. It would also enable staff to work to a single set of policies and procedures, and would allow for a wider skill mix and opportunity for clinical specialisation. The Primary Care Commissioning Committee approved the merger of Country Park and Enmore Road. Heathfield Surgery William Cunningham Davis explained that at the last meeting it was agreed that an update on patient movement as a result of the closure would be monitored and reported back to the committee. It was too soon to know the full effect of patient movement. Primary Care Support England had been able to confirm that of the 153 patients removed from Heathfield’s list; 115 registered with local practices, 37 have moved out of the area or are deceased and 1 was removed as mail was returned.

Of the 115 patients who registered locally, 35 chose Violet Lane, 7 Haling Park and 17 Birdhurst. The remaining 56 registered at one of 17 other practices in Croydon, the most notable being Friends Road (11), Selsdon Park (8) and Edridge Rd (7).

East Croydon Medical Centre have reported that there was a delay with process for the IT systems merger, moving patients from Heathfield’s Vision system to EMIS system. The practice continues to access patient notes on Vision.

Agnelo Fernandes commended NHS England’s Primary Care team for

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7.9 7.10

their responsiveness in dealing with queries in relation to these practices. GMS/ PMS Contract update William Cunningham Davis reported that all of the 41 PMS practices in Croydon have signed up to the new PMS contract with a start date of 1 October 2017. The Committee noted that 9 GMS Offers of Equivalence were sent to the 9 GMS practices in Croydon. Of these, 7 have signed up. South Norwood Medical Practice had not signed up to the Offer of Equivalence as they were in discussions with the CCG in relation to their practice. Enmore Practice had requested to merge with Country Park Practice

(PMS).

The Primary Care Commissioning Committee noted and approved the report.

Ref: 2018/03/08

8 Edridge Road Health Centre

8.1 8.2 8.3 8.4

Martin Ellis reported that the Edridge Road Community Health Centre had a planned comprehensive inspection from the Care Quality Commission (CQC) on 24 November 2017. This followed 2 previous inspections, one in October 2014 where the practice was rated Good and an inspection in June 2016 where they were rated as Requires Improvement in the Safe domain. The outcome of the inspection on 24 November 2017 was an Inadequate rating and the decision of the Chief Inspector of General Practice for the CQC was to place the service in special measures. The CCG/SWL Primary Care team had visited the practice a number of times to support. Additionally the practice was in breach of its contractual requirements, and would be served with breach notices. William Cunningham Davis explained that as part of their response to the breach notice, the practice would be required to submit their action plan to address the contractual requirements. Martin Ellis explained that the current contract to provide APMS services at Edridge Road Community Health Centre had expired and following an unsuccessful procurement for a new provider in 2016, the current providers have continued to provide services on a monthly rolling contract basis. There was a need to move forward on procurement of a new service provider and to commence a procurement process during 2018. It was recognised that there were a number of compounding factors that needed to be considered and assessed prior to commencement of the procurement process. A short-term Task and Finish Group had been established to explore the issues arising from the CQC inspection, premises issues and in preparation for the procurement. The task and finish group would also be considering the scope of service to be procured. The current APMS contract included APMS (GP) services and

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8.5

provision of the Special Allocation Scheme for Croydon. The Committee discussed the merits of jointly procuring for primary care services and Special Allocation Service versus separating these services and agreed that careful consideration should be given to these two elements. It was agreed that proposals and options as well as a procurement timetable would be brought to the Primary Care Commissioning Committee. The Primary Care Commissioning Committee noted the report.

ME

Ref: 2018/03/09

9 Update from Care Quality Commission Visits

9.1 9.2 9.3 9.4

Martin Ellis explained that the CQC have been undertaking a schedule of planned visits to practices in Croydon over the last 3 months. Published reports from 4 recent visits demonstrated a Good overall outcome demonstrating high quality care provided by General Practices in Croydon. The Committee would be updated as the reports was published. The Committee noted that all of the planned CQC visits had now taken place and no more visits were scheduled to Croydon GP practices in the immediate future. However, there could still be unannounced visits to practices. There would be a return visit to Edridge Road within the next 6 months and practices rated as Requires Improvement overall would also be re-visited. Martin Ellis explained that the CCG/ SWL Primary Care team was working closely with CQC Inspectors and added that the CCG was received 2 weeks’ notice ahead of planned visits. The Committee discussed the support that was provided to the practices ahead of CQC inspections and it was agreed that an overview of the current position in terms of CQC would be helpful to plan support packages. The Primary Care Commissioning Committee noted the report.

Ref: 2018/01/09

9 Open Space for Public Question

9.1 9.2

Q: Member of Public wanted clarification on the number of practices and the number which had signed up to GMS and PMS contracts. A: William Cunningham Davis clarified that whilst there were 54 practices holding contracts with NHS England. And the below table provided a breakdown of the type of contracts.

Area Total APMS PMS GMS

NHS Croydon CCG 56 4 41 9

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9.3 9.4

Q: Member of public wanted to know if there was any plans in place for networks to have their own website. A: Martin Ellis reported that the team would be including this within the catalogue so that other networks can do as well if they choose to.

Ref: 2018/03/10


10.1 There was no other business to discuss

Ref: 2018/0/11


11.1 1 May 2018 11 30 – 13 00 Croydon Conference Centre

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3 July 2018

Title of Paper: REGISTER OF INTERESTS AND DECLARATIONS OF GIFTS & HOSPITALITY

Lead Director Elaine Clancy, Director of Quality and Governance

Report Author Ben Smith, Board Secretary


None



Purpose of Report For information

Recommendation:

The CCG Governing Body is asked to ▪ Note the Register of Interests

Background:

Members of the CCG Governing Body and Clinical Leadership Group are required, on appointment to subscribe to a Code of Conduct. As part of that Code of Conduct members must declare any conflict of interest that arises in the course of conducting NHS Business. Members are required to declare any business interest, position of authority in a charity or voluntary body in the field of health and social care and any connection with a voluntary or other body contracting for NHS services. Declarations of interest are a core part of the corporate governance requirements of a CCG Governing Body and the CCG is required to ensure that steps are taken to ensure conflicts of interests are handled correctly. Croydon CCG Governing Body members are required to update their declaration on an annual basis and report any in year changes to the Board Secretary. The CCG’s Accountable Officer should be informed within 28 days of a member taking office of any interests requiring registrations, or within 28 days of any change to a member’s registered interests. The Register of Interests will be presented at each Governing Body meeting and published on Croydon CCG’s website.

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In line with NHSE guidance the CCG Governing Body approved the new Conflicts of Interest Policy in June 2017. This maintains the requirement to include staff Band 8C and above on the Register of Interests. The Policy is being reviewed in the light of NHS England statutory guidance issued in June 2017. A Register of Interests for all members of its practice (applicable to senior clinicians and managers who influence decision making) is now maintained. The CCG has an expectation that any such conflicts of interest are reported through minutes and reports, when made, to decision making committees of the CCG detailing where an interest has been declared in any discussion leading up to the request for a decision from such a committee.

Key Issues:

The Register of Interests is attached. There are recent additions to the register since the last review including entries for:

- Dr Vaishali Shetty (New) Governing Body GP Member, - Amy Page, Registered Nurse Governing Body Member (contract with another CCG) - Dr Dev Malholtra, GP Clinical Lead – Mental Health - Dr Kamran Kahn CCG GP Education Lead

As clarified at the May 2018 Governing Body meeting and recorded in the minutes, corrections have been made for the interests of:

- Roger Eastwood, CCG Lay Member, Finance (re National Federation for ALMOs) - Emily Symington, GP Governing Body Member (re Georgina Cave Assoc: paid role)

Staff departures and nil returns are included. Updated Register of Interest forms for Governing Body Members and Clinical Leads were issued prior to year end and returns have been reflected. Gifts & Hospitality There have been no declarations of gifts and hospitality since the version submitted in January 2018 and received by the Governing Body Procurement Decisions The CCG website displays the current version of recording procurement decisions and the management of any identified conflicts of interests and is maintained on an ongoing basis.

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Governance:

Corporate Objective Meets all objectives. EIA are considered in the development of all

Risks

No new risks were identified as a result of this paper.

Financial Implications The Governing Body declaration of interest forms part of good governance and financial management and is a requirement for public sector organisations

Conflicts of Interest None



None

Equality Analysis

EIA are considered in the development of all


None

Communication Plan This register will continue to be published on the CCG website


None. Relevant guidance from the Information Commissioner is considered in the publication of this register and FoI

Reputational Issues

None

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Croydon CCG Register of Interests

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Prof

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In

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Non

-Fin

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Pers

onal

In

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sts

Parchmore PartnershipPartner

X Direct Roles and Responsibilities held within member practices

To date Declare.Discuss where relevant with Conflict of Interest Guardian

Haling Park Medical PracticePartner



South Norwood Medical PracticePartner



Croydon GP CollaborativeParchmore Partnership, Haling Park Medical Practice and South Norwood Medical Practice are shareholders Declared March 2016

X Direct Shareholding 2016 To date Declare.Discuss where relevant with Conflict of Interest Guardian

London School of General PracticeGP Trainer

Direct Position of Authority in an organisation in the field of health and social care


Croydon Local Medical CommitteeMember

X Direct Position of Authority in an organisation in the field of health and social care

2002 12.5.17 Declare.Discuss where relevant with Conflict of Interest Guardian

National NHS Pathways Governance Group (Royal College General Practitioners)Chairman


2009 To date Declare.Discuss where relevant with Conflict of Interest Guardian

National Urgent and Emergency Care Steering Group - NHS EnglandMember


01-Jul-16 Declare.Discuss where relevant with Conflict of Interest Guardian

South London Faculty Board, Royal College of General PractionersMember

X Indirect Position of Authority in an organisation in the field of health and social care


NHS England (London) - Pan London Integrated Urgent Care Governance GroupChairman



London Ambulance Service Clinical Quality GroupGP Representative for NHS SW London



London Urgent and Emergency Care Clinical Leadership GroupMember

x Indirect Position of Authority in an organisation in the field of health and social care


National NHS Pathways Programme Board (NHS England/Health & Social Care Information Centre)MemberDeclared May 2016

x Direct Position of Authority in an organisation in the field of health and social care


Health Education England South LondonGP Trainer



Action taken to mitigate risk

Nature of InterestDeclared Interest- (Name of the organisation, nature of business and role)

Name,Current position (s) held, and dates

(i.e. Governing Body, Member, practice, Employee or other )

Date of InterestType of Interest

Is the interest direct or indirect?

(I / D)

Agnelo FernandesCroydon CCG Chair

Parchmore Medical Centre

Start Date: 01 July 2017

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Prof

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In

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Non

-Fin

anci

al

Pers

onal

In

tere

sts







(I / D)

Ref

Russell School Trust (Royal Russell School)Governor

X Indirect Other 2006 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Community Phlebotomy ServiceParchmore Partnership provides premises for this service

X Direct Other To date Declare.Discuss where relevant with Conflict of Interest Guardian

Community Anti-Coagulation ServiceParchmore Partnership provides premises for this service to Boots PLC


Community Minor Surgery ServiceParchmore Partnership provides premises for this service


Community Diabetes Service - Bromley HealthcareParchmore Partnership provide the premises for this service


Guy's, King's and St Thomas's Medical SchoolParchmore Partnership Medical Learner Centre


Dr ABC First Aid Training CompanyWife-owner. Provides training for schools/nurseries and some GP practices (there is no link to the CCG or contracting)

Indirect Other 2010 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Quintos Works Limited - Physiotherapy (non NHS)Parchmore partnership provides the premises for this service

X Direct Other 2010 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Circumcision CentreParchmore Partnership provide the premises for this service Declared October 2015


Agnelo Fernandes (continued)Croydon CCG Chair

Parchmore Medical Centre


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In

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Non

-Fin

anci

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Pers

onal

In

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sts







(I / D)

Ref

Greenside Group PracticeGP Partner



Enmore PracticePartner



Greenwood Group which includes Country Park PracticePartner


01-Oct-16 To date Declare.Discuss where relevant with Conflict of Interest Guardian

London and Surrey Healthcare Services Limited (facilitates Out of Hours GP work and CReSS work)Director

X Direct Directorship/Ownership 2012 Aug-17

Communitas LimitedGreenside Group Practice has a share in Communitas Limited

X Direct Shareholding To date Declare.Discuss where relevant with Conflict of Interest Guardian

Croydon GP CollaborativeGreenside Group Practice is a shareholder


Croydon Referrals Support Service (CReSS)Clinical Lead

X Position of Authority in an organisation in the field of health and social care

2011 31.1.17

Local Out of Hours Provider (Virgin)GP work

Other Jan-16

CReSSTriager

Other 31.1.17

London School of General Practice GP Trainer and Out of Hours Educational Supervisor for GP trainees

X X Direct Other 2014 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Richmond GP Alliance LtdClinical Reviewer for prior approval service (SW L d )


01-Jul-17 To date Declared Interest

Greenside Group Practice provides a local office hub for CReSS triage work.

Other 31.1.17

Tom ChanGP Governing Body Member (Medical Director)Network Deputy GP Clinical LeaderEast Croydon Network

Start Date: 1 May 2015 On Governing Body from June 2017

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Pers

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In

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sts







(I / D)

Ref

Upper Norwood Group PracticeGP Partner


2011 To date Highlighted in meeting if direct conflict

Croydon GP CollaborativeUpper Norwood Group Practice is a shareholder

X Direct Shareholding 2011 To date Highlighted in meeting if direct conflict

Communitas (previously Croydon PBC Limited)Upper Norwood Group Practice is a share holder


Croydon LMCMember



Primary Care Research NetworkProvide support costs ot the Upper Norwood Group Practice

X Direct Other 2011 To date Highlighted in meeting if direct conflict

St Georges Medical School and Kings College Medical SchoolGP Tutor


NHS EnglandGP Appraiser


London GP SchoolTrainer


Wife is Dr Yanushka patel - a GP in Croydon X Indirect Other To date Highlighted in meeting if direct conflict

Brother is Dr Ameesh Patel who is a Deputy Clinical Lead

X Indirect Other To date Highlighted in meeting if direct conflict

Brother Dr Ameesh Patel's spouse is a CCG Pharmacist.

X Indirect Other 01-Jul-16 To date Highlighted in meeting if direct conflict

Yogesh PatelGP Governing Body Member


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In

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anci

al

Pers

onal

In

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sts







(I / D)

Ref

Parchmore Medical CentreSalaried GP


01-Sep-15 To date Highlighted in meeting if direct conflict

Amersham Vale Training Practice (Lewisham CCG)GP


01-Sep-16 To date Highlighted in meeting if direct conflict

Croydon GP CollaborativeParchmore Medical Centre is a shareholder

X Direct Shareholding 01-Sep-15 To date Highlighted in meeting if direct conflict

Royal College of GPs Pan London AiT/First 5 CommitteeCommittee Member


05-Jul-05 To date Highlighted in meeting if direct conflict

UCL Medical SchoolAmersham Vale Training Practice is a teaching practice for the medical school

X Direct Other 01-Sep-16 To date Highlighted in meeting if direct conflict

Georgina Craig Associates Limited - GP clinical expert supporting group consultation training on an ad-hoc basis (no Croydon based training). This company has close links to Experience Lead Care which is contracted by Croydon CCG to support role out of group consultations in Croydon.


13-Mar-18 To date Highlighted in meeting if direct conflict.

Health Education EnglandGrant provided to Croydon CCG for group consultation training

X Indirect Other 01-Oct-15 Jun-16 Highlighted in meeting if direct conflict

Birdhurst Medical PracticeGP Partner



Croydon GP CollaborativeBirdhurst Medical Centre is a shareholder


Croydon LMCMember


2015 To date Declared Interest

Queenhill Medical PracticeGP Partner


To date Declared Interest

Croydon GP CollaborativeQueenhill Medical Practice is a shareholder

X Direct Shareholding To date Declared Interest

Croydon LMCMember



Minor Surgery and Joint InjectionsContractQueenhill Medical Practice povides premises for thi i

X Direct Other 2004 To date Declared Interest

Emily SymingtonGP Governing Body Member

Start Date: 1 September 2016

Vaishali ShettyGP Governing Body Member

Start Date: 1 June 2018

45

Mike SimmondsGoverning Body Member

Start Date: December 2015 (Network and clinical Lead) Governing Body Member since 1 June 2018

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Pers

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In

tere

sts







(I / D)

Ref

Eastbourne Homes Limited (Private company set up to provide housing services to council tenants and lease holders)

X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

South East Independent Living Limited (Management of real estate)Non Exec Director

X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

South Essex Homes Limited (management of council housing for Southend-on-Sea Borough Council)Non Executive DirectorDeclared 25 July 2016

X Indirect Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict

Eastwood Consultants Limited (Management consultancy activities)Director and Co Owner

X X Indirect Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

Eastbourne Housing Investment Company Limited (letting and operating of real estate)Non Exec Director

X Indirect Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict

National Federation of ALMOsSocial Housing Trade AssociationNon-Exec Director

X Indirect Non Exective Director 01-Apr-18 To date Highlighted in meeting if direct conflict

South East Independent Living Limited(provides supporting people services to over 65 year olds in East Sussex for Eastbourne, Lewes and Wealden districts and "Navigator" services for younger people with complex needs in East Sussex)Non Exec Director


To date Highlighted in meeting if direct conflict

08 The Collegiate Trust, PurleyNon Executive Director(Multi Academy Trust - no conflict)

X Indirect Non Exective Director 01-Dec-15 To date Highlighted in meeting if direct conflict

Woodcote Park Golf Club, Committee Member

X Indirect Other Oct 2017 To date Highlighted in meeting if direct conflict

ICMD2 LimitedService company providing services to Financial Services clients

X Direct Director and shareholder Nov 2017 To date Highlighted in meeting if direct conflict

The Haven + LondonCharity providing pastoral and mental health services to the London Creatives community

X Indirect Honorary Treasurer Oct 2017 To date Highlighted in meeting if direct conflict

GOVERNING BODY - LAY MEMBERS

Philip HoganLay Member Governance and Conflicts of Interest Guardian

Start Date: 1 May 2017

Roger EastwoodLay Member

Start Date: September 2014

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Black Country Partnership NHS Foundation TrustAssociate NED

X indirect Directorship/Ownership

PLK and Company Consultancy LimitedShareholder

X Direct Shareholding

BME Cancer Voice (MHI Charity)Chair


National Prostate Cancer Advisory GroupChinese TV and ITVMedia appearances in relation to cancer news stories

X Indirect Other

Christie Hospital NHS Foundation TrustMacmillan Patient Engagement Programme Lead Greater Manchester Cancer

x Indirect Other - Fixed term to 31 March 2018 22-May-17 31-Mar-18

PBL AssociatesManagement Consultancy

X Direct Directorship/Ownership 01-Mar-18 To date Highlighted in meeting if direct conflict

Womens HealthVice Chair - Health Sector


01-Mar-18 To date Highlighted in meeting if direct conflict

Nurses Association Jamaica (UK)BME Forum


01-Mar-18 To date Highlighted in meeting if direct conflict

Paulette Lewis MBELay Member, PPIStart Date 1 March 2018

44

Paula Lloyd-KnightLay Member PPI

Start Date: February 2017End Date: July 2017

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10 Jonathan NormanSecondary Care Consultant

None

Amy Page Consultancy Services (company used to deliver healthcare improvement and leadership coachingManaging Director

X Direct Directorship/Ownership 2008 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Leadership InsightAssociate Consultancy

X Direct Other 2012 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Cambridgeshire & Peterborough CCGDischarge Transformation Director 14th May - present.


14-May-18 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Mobius Partners LimitedConsultant(ceased)

X Indirect Other Jan-16

London NW Healthcare NHS Trust and NHS Brent CCG for Brent Harrow and Hillingdon CCG FederationWorking under contract through Amy Page Consultancy Ltd as the Emergency Access Improvement Director


12/09/2017 12/01/2018 Highlighted in meeting if direct conflict

Four Eyes InsightConsultant(ceased Feb 2016 then restarted)

X Indirect Other 01-Aug-16 To date Highlighted in meeting if direct conflict

12 Helen Pernelet Lay MemberStart Date: January 2013End Date: May 2017

None

Amy PageRegistered Nurse

Start Date: December 2012

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Lambeth, Southwark and Lewisham LIFTco. Director. Representing class B shares on behalf of Community Health Partnerships Ltd with the aim of inputting local knowledge to the LSL LIFTco, for the following LIFT companies: Building Better Health �Lambeth Southwark Lewisham LimitedBuilding Better Health �Lambeth Southwark Lewisham (Holdco 2) Limited Building Better Health �Lambeth Southwark Lewisham (Holdco 3) Limited Building Better Health �Lambeth Southwark Lewisham (Fundco 2) Limited Building Better Health �Lambeth Southwark Lewisham (Fundco 3) Limited Building Better Health �LSL (Fundco Tranche 1) LimitedBuilding Better Health �LSL (Fundco Holdco Tranche 1) Limited Building Better Health �LSL Bid Cost Holdco Limited Building Better Health �LSL Bid Cost LimitedBuilding Better Health - LSL (Holdco 4) LimitedBuilding Better Health - LSL (Fundco4) Limited


Lambeth Clinical Commissioning Group. Chief Officer.

X Direct 01/04/2013 To date Declare.Discuss where relevant with Conflict

Married to Director of Performance and Delivery - Kings Health Partners

X Indirect Personal 29/10/2012 To date Declare.Discuss where relevant with Conflict of Interest Guardian

13 Elaine Clancy Director of Quality and Governance

Start Date: June 2015

Parent Governor- Langley Park School for Girls x indirect 01/09/2017 To date Highlight in Meeting if direct conflict

14 Mike Sexton Chief Finance Officer

Start Date: June 2012

None

15 Paula SwannChief Officer

Start Date: May 2012

South London and Maudsley Mental Health Trust (SLaM) CCG Commissioner Council of Governors Representative

X Position in Authority in an organisation in the field of health and social care

2013 To date

16 Stephen WarrenDirector of Commissioning

Start Date: September 2012

None

39 Martin EllisDirector of Urgent and Primary Care

Start Date: July 2017

None

Andrew Eyres Chief Officer

Start Date: July 2017

GOVERNING BODY - DIRECTORS40

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GOVERNING BODY - IN ATTENDANCE

Council of the Association of Directors of Public Health (ADPH)



NICE Resource Impact Assessment Team Consultee


Declared Interest

Occasional Media appearances in relation to role as Director of Public Health for Croydon

X Indirect Other 2016 To date Declared Interest

Octavo (Croydon Schools Mutual) - delivers school improvement services across the Borough of CroydonDirector

Directorship/Ownership Declared Interest

Journal of Emotional and Behavioural DifficultiesMember of Editorial Board

Position of Authority in an organisation in the field of health and social care

Declared Interest

Director for Association of Director of Children's Services (ADCS) - Honorary Secretary.


2016 2019 Declared Interest

RIP/RIPFABoard Member


2016 2019 Declared Interest

CLINICAL LEADERSHIP GROUPEversley Medical PracticePartner


01-Jan-00 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Health Safeguarding Limited (provides healthcare conferences, workshops and seminars aimed at Safeguarding children and protecting adults) - Director

X Direct Directorship/Ownership 01-Jul-10 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Communitas (previously Croydon PBC Limited)Shareholder


Barbara PeacockExecutive Director - People Croydon Council


Paul GreenhalghExecutive Director People, Croydon Council

Start Date: January 2015End Date: 31 July 2016

Rachel FlowersDirector of Public Health

Start Date: 23 February 2016

Olayinka Ajayi-ObeGP Clinical LeaderMayday Network

Start Date: 1 November 2013

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Croydon GP CollaborativeEversley Medical Centre is a shareholder

X Direct Shareholding To date Declare.Discuss where relevant with Conflict

Croydon Health ServicesWife is Deputy Director for Safeguarding at CHS



London School of General PracticeGP Trainer


NHS EnglandGP Appraiser


Kings College HospitalGP TutorStart August 2016


Croydon Urgent Care AllianceEducational Supervisor of GP Trainees Out of Hours


Virgin/London School of General PractitionersEducational Supervisor of GP Trainees Out of Hours

X Direct Other

Shirley Medical PracticeGP Partner



Abbot Medical PracticeDirector(f l k d i t f )

X Direct Directorship/Ownership 2002 To date Declare.Discuss where relevant with Conflict

f I t t G diCommunitas (previously Croydon PBC Limited)Shirley Medical Centre is a shareholder

X Direct Shareholding 2010 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Bobby AbbotGP Clinical LeaderWoodside Shirley Network

Start Date: April 2012

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Croydon GP CollaborativeShirley Medical Practice is a shareholder

X Direct Shareholding 2015 To date Declare.Discuss where relevant with Conflict

Croydon LMCMember



Croydon Prescribing Care GroupMember



Shirley Oaks HospitalGP Sessions under GP extra service



Pharmaceutical Sponsored Educational EventsChairing and talking at occasional educational meetings


Richmond GP Alliance LtdClinical Reviewer for prior approval service (SW London)



Dr Amit Abbot is my brother and has recently been elected and is a Deputy Network Lead


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Locum GP X Direct Roles and Responsibilities held within member practices


Ajamay Limited (specialist practice medical activities)Shareholder

x Direct Shareholding To date Declare.Discuss where relevant with Conflict of Interest Guardian

Croydon CCG IFR Triage PanelMemberCommenced March 2015

x Position of Authority in an organisation in the field of health and social care

01-Mar-15 To date Declare.Discuss where relevant with Conflict of Interest Guardian

ESL2 (GP Learning Set)Member

Mar-17 Declare.Discuss where relevant with Conflict of Interest Guardian

Surrey and Sussex LMC Medical Director

x Position of Authority in an organisation in the field of health and social care

01-Feb-17 To date Declare.Discuss where relevant with Conflict of Interest Guardian

GP Collaborative Data Sharing Governance GroupMember



GP Collaborative Urgent Care Reference GroupMember



ASA (company providing private dental sedationsHusband is staff)

x Indirect Other To date Declare.Discuss where relevant with Conflict of Interest Guardian

Guys and St Thomas NHS TrustHusband is staff

x Indirect Other To date Declare.Discuss where relevant with Conflict of Interest Guardian

Ajamay Limited (specialist medical practices activities)

x Indirect Other To date Declare.Discuss where relevant with Conflict

f I G diCountry Park PracticeGP Partner


01-Apr-16 To date Declare.Discuss where relevant with Conflict of Interest Guardian

Greenwood Group PartnershipPartner - started 1 October 2016



Greenside Group PracticeNamed Partner



The Enmore PracticePartner


01-Apr-17 To date Declare.Discuss where relevant with Conflict of Interest Guardian


X Direct Shareholding To date Declare.Discuss where relevant with Conflict of Interest GuardianCroydon GP Collaborative

Country Park Practice is a shareholderX Direct Shareholding 08-Jul-05 To date Declare.

Discuss where relevant with Conflict of Interest Guardian

Karthiga GengatharanGP Clinical LeaderEast Croydon Network


Rajeev SagarGP Clinical LeaderThornton Heath Network


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The Moorings PracticePartner




X Indirect Shareholding 2011 To date Declared Interest

Croydon GP CollaborativeThe Moorings Practice is a shareholder

X Indirect Shareholding 2016 To date Declared Interest

Local Medical CommitteeMember



NHS England (South London)GP Appraiser



Shirley Oaks HospitalPrivate work as part of GP extra

X Direct Other 2011 To date Declared Interest

Farhhan SamiGP Clinical LeaderPurley Network


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Shirley Medical CentrePartner



Locum GP at other practices X Direct Roles and Responsibilities held within member practices


A&M Abbot Medical (Private Company for locum work and Medical)Director

X Direct Directorship/Ownership 2014 To date Highlighted in meeting if direct conflict



Croydon GP CollaborativeShirley Medical Centre is a shareholder


Richmond GP Alliance LtdClinical Reviewer for prior approval service (SW London)



Dr Bobby Abbot is my brother and is a Clinical Network Lead.

x Indirect Other 2014 To date Highlighted in meeting if direct conflict

Amit AbbotNetwork Deputy GP Clinical LeaderShirley/Woodside Network


DEPUTY CLINICAL LEADERSHIP GROUP 26

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Bramley Avenue SurgeryGP Partner

x Direct Roles and Responsibilities held within member practices


Croydon GP CollaborativeBramley Avenue Surgery is a shareholder

x Direct Shareholding To date Highlighted in meeting if direct conflict

Croydon Referrals Support Service (CReSS)GP Triager

x Direct Position of Authority in an organisation in the field of health and social care


SEQOL (a social enterprise running GP Out of Hours and Urgent Care Centre in SwindonGP O t f H k)

x Direct Other To date Highlighted in meeting if direct conflict

AT Medics Parkway Health CentreLocum GP


01-Aug-14 To date Highlighted in meeting if direct conflict

S Karim Limited (company used for locum work mostly in Croydon and Crawley area)Director

X Direct Directorship/Ownership 01-Aug-14 To date Highlighted in meeting if direct conflict

Parchmore Medical CentreHaling Park Centre

x Direct Roles and Responsibilities held within member practices

08-Aug-10 To date Highlighted in meeting if direct conflict

Spouse is an A&E Consultant at St Georges Hospital

x Indirect Other 01-Jan-15 To date Highlighted in meeting if direct conflict

Violet Lane Medical PracticeSalaried GP



Croydon GP CollaborativeViolet Lane Medical Practice is a shareholder

X Direct Shareholding 01-Mar-16 To date Highlighted in meeting if direct conflict

AP Medics Limited (company providing Locum Medical work)Director

X Direct Directorship/Ownership 1.1.15 To date Highlighted in meeting if direct conflict

AP Medics LimitedShareholder

X Direct Shareholding 10.1.15 To date Highlighted in meeting if direct conflict

South East London Doctors Co-Operative (SELDOC) (out of hours provider)Associate Clinical Governance Lead

X Direct Other 01-Sep-13 To date Highlighted in meeting if direct conflict

Spouse is a Pharmacy Advisor at the CCG x Indirect Other 24-Feb-14 To date Highlighted in meeting if direct conflict

Brother is Dr Yogesh Patel who is a GP Governing Body Member

x Indirect Other 01-Jul-16 To date Highlighted in meeting if direct conflict

Thusitha GooneratneNetwork Deputy GP Clinical LeaderPurley Network


Ameesh PatelNetwork Deputy GP Clinical LeaderMayday Network


Shahab KarimNetwork Deputy GP Clinical LeaderSelsdon/New Addington Network


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30

31

Shamaila Masood-HusainNetwork Deputy GP Clinical LeaderThornton Heath Network

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47 Dev MalholtraGP Clinical Lead - Mental Health

Brigstock and South Norwood PartnershipPartner


August 2001 To date Declared Interest

Croydon GP Collaborative, X Direct Shareholding

Laserase Croydon, Laserase Network. X Direct Shareholding

J-Links Physiotherapy Spouse carries out some work for this organisation

X indirect Other

Royal Marsden HospitalFamily Member Employed

X indirect Other

Royal College of GPs Examiner



Stovell House SurgeryGP Partner


09-Jun-05 To date Declared Interest

Croydon GP Collaborative & CommunitasPractice is shareholder (less than 5%)

X Direct Shareholding To date Declared Interest

Croydon CEPN steering groupChair



Kamran KhanGP Education Lead 1 April 2018

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CCG Staff - Band 8C and above

32 Sally InnisHead Safeguarding/Designated Nurse

None

33 Aarti JoshiAssociate Director Planned Care

None

34 Simon LeeAssociate Director Quality and Governance

A family member is employed by Marie Stopes International which is currently commissioned by the CCG to provide services.

X Indirect 12-Dec-16 To date Declared Interest

35 Janice SteeleChief Pharmacist and Variation Lead

None

36 Michael SuttonHead of Planned Care

None

38 Paul YoungAssociate Director Out of Hospital and Urgent Care Development and Delivery

None

39 Louise CoughlanChief PharmacistShared post with Croydon Health Services NHS Trust

Croydon Health Services NHS TrustChief Pharmacist (shared post)


12/09/2017 To date Highlighted in meeting if direct conflict

40 Rachael ColleyHead of Urgent Care / Seconded to CHC service

None

41 Kieran HouserHead of Out of Hospital Care

VodafoneMotif Bio PharmaceuticalAmryt Pharma

X Direct Small shareholding 06/11/2017 To date Highlighted in meeting if direct conflict

42 Fouzia HarringtonAD of Strategy & Planning

Palace for Life Foundation X Indirect Interests of family member.close friend (employment)


43 Ruth FrostHead of Primary Care

None

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nhs croydon clinical commissioning group governing … · subject to typographical errors...

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