AGENDA NHS Leeds CCGs Partnership:
Leeds Health Commissioning & System Integration Board
Date: Thursday 25 January 2018
Time: 14:00 – 17:00
Venue: Owlcotes Room, Pudsey Civic Hall, Dawson’s Corner, LS28 5TA
Item Description Lead Paper Time
LHCB 17/69
Welcome and Apologies
Purpose: To record apologies for absence and confirm the meeting is quorate
Philip Lewer N 14:00
LHCB 17/70
Declarations of Interest
Purpose: To record any Declarations of Interest relating to items on the agenda:
a) Financial InterestWhere an individual may get direct financial benefit fromthe consequences of a decision they are involved inmaking;
b) Non-Financial professional interestWhere an individual may obtain a non-financialprofessional benefit from the consequences of a decisionthey are involved in making;
c) Non-financial personal interestWhere an individual may benefit personally in ways that arenot directly linked to their professional career and do notgive rise to a direct financial benefit, because of thedecisions they are involved in making; and
d) Indirect InterestsWhere an individual has a close association with anotherindividual who has a financial interest, a non-financialprofessional interest or a non-financial personal interestwho would stand to benefit from a decision they areinvolved in making.
Philip Lewer N
LHCB 17/71
Patient Voice – Child and Adolescent Mental Health Services (CAMHS)
Purpose: To receive patient experience information to inform the Board’s decision making
Jo Harding N 14:05
LHCB 17/72
Questions from Members of the Public
Purpose: To receive questions from members of the public
Philip Lewer N 14:20
Item Description Lead Paper Time
FINANCE
LHCB 17/73
Finance Report Purpose: To receive the finance report and consider any issues escalated by the Finance & Commissioning for Value Committee
Visseh Pejhan-Sykes
Y 14:30
LHCB 17/74
Shared Employment Arrangements – Re-Charge Policy Purpose: To agree the proposed re-charge arrangements for Leeds CCGs staff
Visseh Pejhan-Sykes
Y 14:40
GOVERNANCE
LHCB 17/75
Minutes of the Previous Meeting held on 22 November 2017 Purpose: To approve the minutes of the previous meeting
Philip Lewer Y 14:50
LHCB 17/76
Matters Arising Purpose: To consider any matters arising that are not considered elsewhere on the agenda
Philip Lewer N 14:55
LHCB 17/77
Action Log Purpose: To review the outstanding actions from previous CCG Governing Body meetings
Philip Lewer Y
ASSURANCE
LHCB 17/78
Corporate Risk Register Purpose: To receive the corporate risks for review
Phil Corrigan Y 15:00
STRATEGY
LHCB 17/79
System Integration Purpose: To receive an update in relation to system integration
Nigel Gray Y 15:10
BREAK FOR 5 MINUTES
COMMITTEE CHAIRS’ SUMMARIES
LHCB 17/80
Primary Care Commissioning Committee – 23 November 2017 and verbal update from 24 January 2018 Purpose: To receive the summary for information and assurance
Philip Lewer Y 15:30
LHCB 17/81
Finance & Commissioning for Value Committee – 18 January 2018 Purpose: To receive the summary for information and assurance
Ben Browning Y
Item Description Lead Paper Time
LHCB 17/82
Interim Patient Assurance Group – 22 November 2017
Purpose: To receive the summary for information and assurance
Angie Pullen Y
LHCB 17/83
Clinical Commissioning Forum – 17 January 2018
Purpose: To receive the summary for information and assurance
Alistair Walling Y
LHCB 17/84
Quality & Performance Committee – 11 January 2018
Purpose: To receive the summary for information and assurance
Steve Ledger Y
COMMISSIONING
LHCB 17/85
Integrated Quality & Performance Report (IQPR)
Purpose: To receive the IQPR and consider any issues escalated by the Quality & Performance Committee
Sue Robins / Jo Harding
Y 15:40
LHCB 17/86
Chief Executive’s Report
Purpose: To receive an update on key issues from the CCGs’ Chief Executive
Phil Corrigan Y 15:55
17/87 Primary Care Rebate Scheme Policy
Purpose: To receive the policy for approval
Simon Stockill Y 16:05
STANDING ITEMS
LHCB 17/88
Questions from Members of the Public
Purpose: To receive questions from members of the public
Philip Lewer N 16:20
LHCB 17/89
Forward Work Programme 2017
Purpose: To receive, accept and input to the programme
Philip Lewer Y 16:30
LHCB 17/90
Any Other Business Philip Lewer N 16:35
Dates of Future Meetings: 21 March 2018
The Leeds Health Commissioning and System Integration Board is recommended to make the following resolution: ‘That representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970): LHCB 17/91
Private Minutes of the Previous Meeting held on 22 November 2017
Purpose: To approve the private minutes of the previous meeting
Philip Lewer Y 16:40
Item Description Lead Paper Time
LHCB 17/92
Award of Domiciliary Care Contracts
Purpose: To receive the proposed contract awards for approval
Sue Robins Y 16:45
ITEMS FOR INFORMATION
IFI1. Minutes of the West Yorkshire & Harrogate Joint Committee meeting held on 7 November 2017
Purpose: To receive the minutes for information
Phil Corrigan Y N/A
Forename Surname
GP
CC
G M
em
ber
Go
vern
ing
Bo
dy
Mem
ber
Oth
er
Co
mm
itte
e
Me
mb
er
Ban
d 8
d a
nd
ab
ove
or
Emp
loye
e D
ecis
ion
Mak
er
Emp
loye
e N
on
-Dec
isio
n
Mak
er
Co
ntr
act
or
Pra
ctic
e M
anag
er
Job Title
(where
applicable)
Lee
ds
Sou
th a
nd
Eas
t
Lee
ds
No
rth
Lee
ds
Wes
t Name of
practice
(where
applicable)
No
Interests
Declared
Declared Interest-
(Name of the
organisation and
nature of business)
Fin
anci
al In
tere
sts
No
n-F
inan
cial
Pro
fess
ion
al In
tere
sts
No
n-F
inan
cial
Per
son
al
Inte
rest
s Is the
interest
direct or
indirect?
Nature of Interest Interest From Interest Until Action Taken to Mitigate Risk
Ben Browning X X GP NED X Lofthouse
Surgery
GP Partner in
Lofthouse surgery
X Direct Could bid to provide healthcare
services to LSE CCG
19/06/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Ben Browning X X GP NED X Lofthouse
Surgery
Shareholder in Leodis
Care Ltd
X Direct Could bid to provide healthcare
services to LSE CCG
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Ben Browning X X GP NED X Lofthouse
Surgery
Member of Leodis
LLP (Shell company)
X Direct Now a dormant and non-trading
company
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Ben Browning X X GP NED X Lofthouse
Surgery
Spouse is a GP
Partner in Lofthouse
surgery
X Indirect Could bid to provide healthcare
services to LSE CCG
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Ben Browning X X GP NED X Lofthouse
Surgery
Spouse is city-wide
lead for Learning
Disability services
X Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Philip Lewer X Lay Chair X Present at various
leadership
programmes within
Tees, Esk and Wear
Foundation Trust and
Northumbria NHS
Foundation Trust
X Direct The Trusts could bid to provide
services to the CCG
2006 - to date Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Philip Lewer X Lay Chair X Lay Chair of NHS
Leeds West Primary
Care Commissioning
Committee
X Direct 1 April 2016 to
date
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Victoria Eaton PCCC Public Health
Consultant
X Public Health
Consultant in Leeds
City Council
X Direct Any decisions affecting joint
working with Leeds City Council
including policy and resource
decisions
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Victoria Eaton PCCC Public Health
Consultant
X Fellow of Faculty of
Public Health/Royal
College of Physicians
X Direct Involvement in professional
standards work nationally,
including influence on national
policy
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Victoria Eaton PCCC Public Health
Consultant
X Assessor for
Approved
Appointments
Committee - Faculty
of Public Health
X X Direct Direct involvement in senior
public health appointments
Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Tollefson X Lay Member -
Patient &
Public
Involvement
X Advisor on Standards
& Conduct - Leeds
City Council
X Direct LSE CCG engages with Leeds City
Council on provision of services
2007 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Tollefson X Lay Member -
Patient &
Public
Involvement
X Chairman of the
Board of Trustees -
The Prince of Wales
Hospice, Pontefract
X Direct The hospice could seek financial
support for patients treated from
the LSE area
03/06/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Tollefson X Lay Member -
Patient &
Public
Involvement
X Son is a Chartered
Accountant employed
by Mazars LLP
X Indirect Declared due to being a member
of LSE CCG's Audit & Governance
committee
08/07/1905 08/12/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Brian Roebuck X Lay Member -
Audit &
Governance
X Stonewater Limited -
Member of Group
Board/Chair
Designate of Risk and
Assurance
Committee/Member
of Finance Committee
X Direct A small number of tenants of
Stonewater Limited may be
patients within Leeds
01/01/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Brian Roebuck X Lay Member -
Audit &
Governance
X Symphony Housing
Group - Member of
Group Board
X Direct Symphony Housing is a group of
housing associations. It is based
in Liverpool and works
exclusively in the North West of
England
30/09/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Brian Roebuck X Lay Member -
Audit &
Governance
X Member of NHS
Barnsley Clinical
Commissioning Group
Governing Body
X Direct None 18/07/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Brian Roebuck X Lay Member -
Audit &
Governance
X Chair of NHS Barnsley
Clinical
Commissioning Group
Audit Committee
X Direct None 18/07/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
David Mitchell X Secondary
Care
Consultant
X British Association of
oral and maxillofacial
surgeons . British
Association of
Surgeon Oncologists.
X Direct Desire to improve clinical
services at a national level
01/01/2014 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
David Mitchell X Secondary
Care
Consultant
X Yorkshire &
Humberside Clinical
Sentate
X Direct None envisaged Declare conflict or perceived
conflict within context of any
relevant meeting or project work
David Mitchell X Secondary
Care
Consultant
X Grant to conduct
research in West
Yorkshire
administrated by
Leeds Teaching
Hospitals NHS Trust
X Direct None envisaged Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Ian Cameron X Public Health
Consultant
X X X Director of Public
Health Leeds City
Council
X Direct Any decisions affecting joint
working with Leeds City Council
including policy and resource
decisions
01/04/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Philomena Corrigan X X Chief
Executive
X X X Trustee for the
Foundation of
Nursing
X Trustee for the Foundation of
Nursing
01/12/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jo Harding X X Director of
Nursing and
Quality
X X X Husband is athe
Director of a property
development
company in York and
the company has
made an offer on a
property which is
currently owned by
the NHS Property
Company.
X Indirect 30/08/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Simon Hulme X X GP Non
Executive
Director
X Leigh View
Medical
Practice
GP Partner of Leigh
View Medical Practice
X GP Partner of Leigh View Medical
Practice
01/08/2002 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Simon Hulme X X GP Non
Executive
Director
X Leigh View
Medical
Practice
Shareholder of Leeds
West Primary Care
Network
X Shareholder of Leeds West
Primary Care Network
01/01/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Stephen Ledger X Lay Member
Assurance
X Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Liu X GP Non
Executive
Director
X GP Partner at Abbey
Grange Medical
Practice, Kirkstall,
Leeds
X GP Partner at Abbey Grange
Medical Practice, Kirkstall, Leeds
01/05/1996 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Liu X GP Non
Executive
Director
X Wife is a GP Partner
at Manor Park
Surgery, Bramley,
Leeds
Indirect Wife is a GP Partner at Manor
Park Surgery, Bramley, Leeds
09/ Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Liu X GP Non
Executive
Director
X Director of Leeds
General Practice
Limited
X Director of Leeds General
Practice Limited
03/01/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Liu X GP Non
Executive
Director
X Abbey Grange
Medical Practice is a
shareholder of Leeds
West Primary Care
Limited
X Abbey Grange Medical Practice is
a shareholder of Leeds West
Primary Care Limited
01/01/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X GP Partner at Leeds
Student Medical
Practice
X 08/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Leeds Local Medical
Committee Member
X 06/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Spouse is a Director
of Leeds
Haematology plc
Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Spouse is a trustee of
the British Society for
Haematology
Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Spouse is a trustee of
UK Myeloma Forum
Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Spouse is an
employee of the
University of Leeds
Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Spouse has an
honorary contract
with Leeds Teaching
Hospitals NHS Trust
Indirect Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Julianne Lyons X GP Non
Executive
Director
X Shareholder of Leeds
West Primary Care
Limited
X Direct 01/10/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Visseh Pejhan-
Sykes
X X Chief Finance
Officer
X X X Parent Governor at
Oxspring Primary
School
X 01/12/2014 15/11/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Visseh Pejhan-
Sykes
X X Chief Finance
Officer
X X X Vice Chair of
Governing Body at
Oxspring Primary
School
X 01/09/2016 15/11/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Visseh Pejhan-
Sykes
X X Chief Finance
Officer
X X X Niece works for CCG
as Digital
Communications
Officer
X Indirect 11/12/2017 Not to participate in any decisions
which may affect this post, e.g.
cut budget
Angie Pullen X PPI Lay
Member
X Senior Manager at
Epilepsy Action
X 04/07/1905 09/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Angie Pullen X PPI Lay
Member
X NHS England
Collaborative
Commissioning &
Engagement
Programme
X 08/07/1905 09/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Sue Robins X X Director of
Commissionin
g
X X X Member of Leeds
North CCG’s
Governing Body and
Management Team in
an executive capacity.
X 01/01/2017 31/03/2017 Declare interests to both Leeds
West CCG and Leeds North CCG
and at relevant meetings both
with CCGs and across external
organisations in Leeds.
Chris Schofield X Lay Member
Governance
X X X Member, Schofield
Sweeney LLP
X 01/01/1998 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Chris Schofield X Lay Member
Governance
X X X Member, Church
Bank House LLP
X 01/04/2006 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Chris Schofield X Lay Member
Governance
X X X Director of JBA Group
Ltd
X 05/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Chris Schofield X Lay Member
Governance
X X X Trustee, St Gemma’s
Hospice
X 08/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Sinclair X X Clinical Chair X Partner at Burton
Croft Surgery
X 15/06/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Sinclair X X Clinical Chair X Director of Sinclair
Healthcare (Sole)
X 02/07/1905 31/03/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Sinclair X X Clinical Chair X Partner of Viva
Healthcare LLP
X 04/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Sinclair X X Clinical Chair X Headingley Pharmacy
LLP – Viva Healthcare
has a 25% interest
Indirect 04/07/1905 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Gordon Sinclair X X Clinical Chair X Burton Croft Surgery
is a shareholder of
Leeds West Primary
Care Network Ltd
Indirect 01/01/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Simon Stockill X Medical
Director
X X X Partner at Sleights
and Sandsend
Medical Practice,
Whitby (Hambleton,
Richmondshire &
Whitby CCG)
X 01/04/2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Simon Stockill X Medical
Director
X X X GP Appraiser, NHS
England (Yorkshire &
Humber)
X 01/12/2013 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Simon Stockill X Medical
Director
X X X Clinical Lead for
Quality Improvement
Ready Programme,
Royal College of GPs
X 01/09/2016 01/08/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Partner Oakwood
Lane Medical Practice
X 10/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Director Jemjo
Healthcare Ltd
X 10/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Spouse business
Airtight International
Ltd
X 10/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Spouse business Nails
17 Ltd
X 10/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Director Leeds Jewish
free school
X 16/01/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Shareholder Alpha
Dealing Ltd
X 17/06/2014 01/04/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Director Brodetsky
Primary School
Foundation
X 17/06/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Jason Broch X X Clinical Chair X Foundation Trust
Governor Local
Authority Brodetsky
Primary School
X 01/09/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Freeman X Secondary
care
consultant
Mid Yorks
Hospitals
X Consultant Mid
Yorkshire hospitals
X 01/08/2002 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Freeman X Secondary
care
consultant
Mid Yorks
Hospitals
X Advisor Univadis
ScientifIc Committee
X 18/03/2013 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Freeman X Secondary
care
consultant
Mid Yorks
Hospitals
X Brother owner of
Freemans Pharmacy
X 01/01/1995 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Mark Freeman X Secondary
care
consultant
Mid Yorks
Hospitals
X Member BMA X 01/08/1992 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nigel Gray X Chief Officer -
System
Integration
Bevan Healthcare
Board (Non Exec
Director)
X 17/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nigel Gray X Chief Officer -
System
Integration
Spouse employed by
Leeds Teaching
Hospital Trust
X 17/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nigel Gray X Chief Officer -
System
Integration
X X X Sister employed by
Leeds Community
Healthcare (on
secondment to NHS
England from
11/1/2017)
X 17/08/2015 01/11/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nigel Gray X Chief Officer -
System
Integration
X X X Wetherby St James
Cof E Primary school -
Federated with
Scholes
X 14/09/2016 Left - date unconfirmedDeclare conflict or perceived
conflict within context of any
relevant meeting or project work
Diane Hampshire X Non Executive
Board Nurse
X X Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nick Ibbotson X GP Non-
Executive
Director
X Employee One
Medicare Arthington
Leeds
X 15/05/2015 31/08/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Nick Ibbotson X GP Non-
Executive
Director
X Holder of the GMS
contract and the
lease for the
Wetherby LIFT
building.
X 2006/08
Petra Morgan X Practice
Manger -
Street Lane
Practice
Management
executive
X General Manager
Street Lane Practice.
Services provided
over and above GMS
contract - cardiology,
Dermatology, Minor
X 01/03/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Petra Morgan X Practice
Manger -
Street Lane
Practice
Management
executive
X Enhance Primary Care
Ltd. Company set up
by SLP to host non
not core
GMS/Enhanced
Contracts - LNCCG
contracts including:
Wound care and
catheter service,
innovation
X 01/03/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Petra Morgan X Practice
Manger -
Street Lane
Practice
Management
executive
X Changing Faces -
Close links with the
charity as they
provide services
based at the practice
through our
Dermatology Service
X 01/03/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Peter Myers X Non-Executive
Lay Member -
Governance
X Chief Executive
Beverley Buidling
Society
X 05/08/2015 11/05/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Peter Myers X Non-Executive
Lay Member -
Governance
X Director Finance
Yorkshire Ltd
X 05/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Peter Myers X Non-Executive
Lay Member -
Governance
X Chairman of the
Equine and Livestock
Insurance Group
X 03-Aug-17 current Unlikely to cause conflict due to
nature of interest. If conflict
arises to declare and withdraw if a
decision is being taken.
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Astra Zeneca -
Pension provider
X 17/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Pfizer Ltd - Pension
provider
X 17/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Pfizer Ltd - Shares X 01/08/2013 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Graham Prestwich Ltd
- Director
X 17/05/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Bradford school of
Pharmacy - joint
chair, external
advisory board
X 18/01/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X University of Leeds -
Member of
Consensus
Development panel
for action to support
practices
implementing
research - a 5yr £2m
research project
X 11/07/2012 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Change - member of
the Board of Trustees
X 13/04/2013 Ended 2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X British Standards
Institute - member,
clinical service spec
Steering Group
X 11/11/2015 18/01/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Leeds Area
Prescribing
Committee - patient
representative
X 04/10/2013 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X National Blood
Transfusion Audit
programme -
member fo PPI panel
X 15/01/2014 Left in 2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Faculty of medical
leadership and
management -
associate member of
the faculty
X 15/01/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Medicines
Communications
Charter task and
finish group
X 15/01/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Leeds Teaching
Hospitals Trust - sister
is employee
X 11/11/2015 Left in 2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Wakefield Hospitals -
Sister is an employee
X In 2017 current
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Allied Health
Professionals
Medicines Project
Board
X 01/12/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Royal College of
physicians, Joint
advisory group on
gastrointestinal
endoscopy - member
X 01/12/2014 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Royal College of
physicians, Endoscapy
Services Quality
Assurance group
X 01/01/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Clinical standards
accreditation alliance -
lay member of
project board
X 06/01/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS England Medical
Directorate Quality
and Outcomes
Working Group -
member
X 01/12/2014 18/01/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS England Patients
and Information
Directorate PPI lay
member network
facilitator
X 13/01/2015 18/01/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Yorks and Humber
AHSN, Medicines
Safety Expert
Reference Group m-
member
X 22/06/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Journal of Medicines
Optimisation Clinical
Editorial Group -
member
X 22/06/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Journal of Patient
Preference and
Adherence Editorial
Board Member
X c.2016 current
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS England - cross
system sepsis
programme board -
member
X 26/06/2015 18/01/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Chief Professional
Officers Project Board
Medicines Prescribing
non pecuniary - lay
member
X 25/01/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Primary Care PPG
Research Group
Leeds University -
group member
X 25/01/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS England
Independent
Investigation
Governance
Committee for
mental health
homicides
X 05/02/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS England North
Region Independent
Investigations review
group
X 12/05/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Improvement Fellow
Bradford
Improvement
Academy
X 01/03/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Steering Group
member, LJWB
Dementia Living
Project
X 01/02/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Lay Member
Pharmacy Supply
Chain and Secondary
Uses Advisory group
X 01/02/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Lay Member Health
Foundation Q
Network
X 01/01/2017 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Lay Member
Independent Advisory
Group National
Mortality Case Record
Review
X 01/08/2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Lay Member of the
Board of the School
of Medicines
Optimisation
X 17/02/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X BME Health and
Wellbeing sub Group -
member
X 2016 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Yorkshire and
Humber Academic
Health Science
Network Strategic
Advisory Board
Member
X 07/06/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X Cancer Diagnosis
Safety Netting
Research Steering
Group Member
X 01/07/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X People Voices Group
Healthwatch Leeds
Member
X 01/01/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X West Yorkshire
Patient Experience
Network - Member
X 01/01/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X NHS Clinical
Commissioners Lay
Members Network
Steering Group
Member
X 19/05/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Graham Prestwich X Non-Executive
Lay Member -
PPI
X X X West Yorkshire and
Harrogate STP Lay
Members PPI
Assurance group
X 01/01/2017 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Partner - North Leeds
Medical Practice
X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Tutor - Primary Care
Training Centre
X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Member - BMA X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Member - Diabetes
UK
X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Member - Local Care
Direct
X C. 2004 c. 2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Member Circle Group X C. 2004 c. 2016 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Brother partner at
PWC
X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Sister in law partner
at PWC
X c. 2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Manjit Purewal X Medical
Director
X X X North Leeds
Medical
Practice
Owner/part owner
Reborne Healthcare
Ltd
X 10/08/2015 current Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Arshad Rafique X X GP Non-
Executive
Director
X Whitfield
Practice
GP Partner at
Roundhay Road
surgery
X Direct Could bid to provide healthcare
services to LSE CCG
01/07/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Arshad Rafique X X GP Non-
Executive
Director
X Whitfield
Practice
Zayan Healthcare
Limited - Director
X Direct Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Amal Paul X X GP Non
Executive
Director
X Roundhay Road
Surgery
GP Partner X Direct Could bid to provide healthcare
services to LSE CCG
01/07/2015 Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Amal Paul X X GP Non
Executive
Director
X Roundhay Road
Surgery
Director, Sindhu Deb
Company; may
provide Locum GP
service to the GPs
X Direct Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Amal Paul X X GP Non
Executive
Director
X Roundhay Road
Surgery
G P Appraiser, NHS
Leeds, provides
appraisal work for
GPS
X Direct Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
Ashfield Medical
Centre & The Grange
Medical Centre. GP
Partner, also my wife
is a GP partner here.
X Direct and
Indirect
31/12/2007 Ongoing To declare and not to take part in
discussion related to practice.May
need to leave for discussions,
dependent on circumstance
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
South and East Leeds
GP Group,
Shareholder via
practice
X Direct Shareholder 01/03/2016 Ongoing To declare this in any relevant
discussions and handle it at
discretion of chair as issues
require.
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
Member of Leodis
LLP, which is a
dormant and non
trading company
X Direct Shareholder 01/03/2008 Ongoing To discuss if this ever became
active and relevant
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
British Medical
Association, Member,
X Direct Lobbying: Department of Health 01/08/2007 Ongoing Declare if relevant and discuss
with chair.
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
Royal College of
General Practitioners,
Member
X Direct Lobbying: Department of Health 01/08/2007 Ongoing Declare if relevant and discuss
with chair.
Alistair Walling X X X Clinical
Director of
Primary Care
X Ashfield
Medical Centre
Fourteen Fish,
Brother – Director of.
company (provides gp
appraisal software
and other online
tools).
X Indirect 01/08/2012 Ongoing Declare and discuss if ever
became relevant. Exclude myself
from any dsicussions around
procurement decisions for
software in this area.
Dawn Jarvis X X X Associate
Director of
Corporate
Services
X X X Declare conflict or perceived
conflict within context of any
relevant meeting or project work
Patricia Newdall X PAG Member X X
Patricia Newdall X PAG Member X X
Patricia Newdall X PAG Member X X
Patricia Newdall X PAG Member X X Need to add in other
committee members
having reviewed the
list
Richard Killington X PAG Member X X
Edward Walley X PAG Member X X
David Tomkins X PAG Member X Member of Leeds
Community
Healthcare Trust
X Indirect Member 01/01/2013 Ongoing
David Tomkins X PAG Member X Trustee of Thackray
Medical Research
Trust
X Direct 10/12/2015 Ongoing
Lesley Stirling-
Baxter
X X Director of
Healthwatch Leeds
Community Interest
Company from April
2016
X Direct Healthwatch could bid to provide
to supply a service
Lesley Stirling-
Baxter
X X Husband works for
the Leeds
Safeguarding Adults
Board as a training
officer
X Indirect If the operation of the Leeds
Safeguarding Adults Board were
to be discussed
Lesley Stirling-
Baxter
X X I coordinate a support
network for people
with Ehlers Danlos
syndrome
X Direct If discussion affected service
provision for those with Ehlers
Danlos syndrome
Lesley Stirling-
Baxter
X X Director of
Healthwatch Leeds
X Direct If Healthwatch were to benefit
from the awarding of a contract
Apr-16
Tanya Matilaine
n
X X Chief Executive of
Healthwatch Leeds
X Direct Healthwatch Leeds may enter
into paid work with LSE CCG
about people's experiences of
health and care. Also a minor
contract delivery partner in the
social prescribing pilot through
Youthwatch
15/09/2015
John Beal X Healthwatch
Representativ
e (PCCC)
X Honorary Senior
Lecturer in Dental
Public Health,
University of Leeds
X
John Beal X Healthwatch
Representativ
e (PCCC)
X Chair, Healthwatch
Leeds
X
Robert Turner X PAG Member X Co-applicant with
Leeds and Bradford
University Staff for
research funding to
NJHR for the Iscomat
X Direct 2014 Ongoing Declare at PAG meetings if there
is a conflict
Robert Turner X PAG Member X Lead patient
representative on the
above Iscomat Rojaru
Programme
X Direct 2012 Ongoing Declare at PAG meetings if there
is a conflict
Roy Wilson X PAG Member X
Trevor Thewlis X PAG Member X X
Suzie Shepherd X PAG Member X Not returned form
Ansa Ahmed X PAG Member X Not returned form
Margaret Wilkinson X PAG Member X X Direct Chair of Shadwell Medical Centre
Patient Participation Group.
2012 Present
THIS PAGE IS INTENTIONALLY BLANK
Page 1 of 2
Agenda Item: LHCB 17/73 FOI Exempt: N
NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Finance Report for the nine months ended 31st December 2017
Lead Board Member: Visseh Pejhan-Sykes, Chief Finance Officer
Category of Paper Tick as
appropriate
()
Report Author: Judith Williams, Head of Corporate Reporting and Strategic Financial Planning
Decision
Reviewed by EMT/SMT: N/A
Discussion
Reviewed by Committee: N/A
Information
Checked by Finance (Y/N/N/A): N/A
Approved by Lead Board member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to:
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
Financial Implications
Communication and Involvement Issues N/A
Workforce Issues N/A
Equality Issues including Equality Impact assessment
N/A
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
N/A
Page 2 of 2
EXECUTIVE SUMMARY: This report provides an update on the combined financial positions of the Leeds CCGs for the nine months to 31st December 2017, and the expected outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs is provided in Appendix 1. The CCGs are on track to achieve the key financial targets. The biggest risk is around non achievement of QIPP.
NEXT STEPS: Updates on the 2017-18 financial position will continue to be presented to the Leeds Health Commissioning and System Integration Board and/or Senior Management Team (SMT) on alternate months to ensure that the CCGs’ financial position is formally reported and reviewed each month under the CCGs’ governance arrangements.
RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is requested to:
Note the Month 9 financial position; and
Discuss, comment and highlight actions required to progress and report to the next meeting of the Senior Management Team.
Leeds Clinical Commissioning Groups Partnership
Finance Report for the Nine months ended 31st December 2017
Page 1
Financial Performance Report 31st December 2017
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18
Target Performance RAG Target Performance RAG
£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 889,267 889,267 1,194,620 1,194,620
Programme spend less than allocation 793,973 795,347 1,067,869 1,069,703
Running costs spend less than allocation 13,093 12,194 17,459 16,259
Delegated Co-commissioning less than allocation 82,201 81,726 109,292 108,658
Planned Surplus in year 0 0 0 0
QIPP 26,175 17,850 34,900 23,800
Cash
Cash amount
requested for
month
Balance at month
end
Balance at month
end as % of
requested RAG Annual Cash LimitCash at bank balance within 1.25% of the monthly amount reqested or
£250k, whichever is greater £'000 £'000 % £'000Leeds North CCG 21,314 53 0.25% 290,660
Leeds South and East CCG 29,225 541 1.85% 421,436
Leeds West CCG 33,921 44 0.13% 476,791
Better Payment Practice Code (BPPC)
The BPPC requires the CCG to aim to pay 95% of valid invoices by the due
date or within 30 days of receipt of a valid invoice, whichever is later. By Value By Number By Value By Number RAGLeeds North CCG 100.00% 99.67% 99.84% 98.99%
Leeds South and East CCG 100.00% 99.79% 99.43% 99.86%
Leeds West CCG 100.00% 99.30% 99.07% 99.97%
Year to Date Forecast
NHS Non NHS
Page 2
Overview 31st December 2017
This report provides an update on the financial performance of the Leeds Clinical Commissioning Groups Partnership for the nine months to 31st December 2017 and the expected
outturn position for the 2017-18 financial year. Details of the performance of the individual CCGs are provided in Appendix 1.
The Leeds CCG's have submitted balanced plans to NHSE for 2017-18, with a citywide QIPP target of 3% (£34.9m) to achieve this position. The CCG is currently forecasting a breakeven
position. Relevant risks are highlighted in the commentary for each specific area below. But a key risk is that the QIPP targets remain unachieved. For 2017-18 a risk reserve is held to
mitigate this however the CCG's financial position moving forward is untenable without the realisation of this QIPP requirement.
In M7 a forecast underspend of £1.2m on running costs was released. It is possible to vire from running costs to programme and it is planned that this will be now spent within
programme areas, therefore the CCGs are still showing a balanced position overall, but an overspend on the programme element.
Page 3
Financial Position Summary 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Programme Services
Acute Services 422,706 423,958 1,252 563,607 565,290 1,683
Mental Health Services 98,609 97,649 -960 131,479 130,208 -1,271
Community Health Services 103,028 102,808 -220 136,810 136,491 -319
Continuing Care Services 39,601 39,236 -365 52,801 52,386 -416
Prescribing and Primary Care Services 114,112 113,690 -422 152,331 151,889 -442
Other 4,513 4,521 8 6,017 6,086 69
Primary Care Co-Commissioning 82,201 81,726 -475 109,292 108,658 -634
Total Programme Services 864,770 863,588 -1,182 1,152,338 1,151,008 -1,330
RUNNING COSTS 13,093 12,194 -900 17,459 16,259 -1,200
RESERVES 11,404 13,485 2,081 24,823 27,353 2,529
CCG Net Expenditure 889,267 889,267 0 1,194,620 1,194,620 0
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date Annual
Page 4
Allocations 31st December 2017
£'000 £'000 £'000 £'000
Opening Baseline Allocation 1,056,938 17,416 109,288 1,183,642
Subtotal Month 2 Adjustments 600 0 0 600
Subtotal Month 3 Adjustments 1,033 35 0 1,068
Subtotal Month 4 Adjustments 534 8 0 542
Subtotal Month 5 Adjustments 1,349 0 0 1,349
Subtotal Month 6 Adjustments 1,137 0 0 1,137
Subtotal Month 7 Adjustments -284 0 0 -284
Subtotal Month 8 Adjustments 5,473 0 0 5,473
Latent TB Qrt 3 non recurrent allocation 35 35
Diabetes Qrt 3 non recurrent allocation 157 157
Additional Winter Funding - Mental Health bids 600 600
Additional Winter Funding - (GP Winter Access Bid etc. ) 171 171
Quality Premium 16/17 stage one payment - All QP measures except for performance on cancers diagnosed at an early stage.132 132
GP WIFI - rounding correctn to M3 Allocation -2 -2
Subtotal Month 9 Adjustments 1,093 0 0 1,093
Closing Allocation 1,067,873 17,459 109,288 1,194,620
A bid was submitted for additional winter monies for mental health and a non recurrent allocation of £600k has been received across all 3 CCGs. Additional winter funding for GP access
etc has been received by LW CCG. Targets for Latent TB screening were met in Q3 and so the non recurrent allocation of £35k was received. Ongoing Diabetes non recurrent alloction
for Q3 has been received (spend will be across LTHT and LCH). The quality premium non recurrent allocation was received at LN. There is unlikely to be any quality premium at LW and
LSE as have failed on the national targets of A&E, RTT etc.
Running Costs Co-commissioningIN YEAR
ALLOCATIONLeeds Clinical Commissioning Groups Partnership
Allocations 2017-18
Programme
Page 5
Risks and mitigations 31st December 2017
Commentary
Key Risks £m £m £m £m
Acute Services 1.5 2.4 0.8 4.8
Mental Health Services 0.2 0.2 0.2 0.6
Community Health Services 0.2 0.2
Continuing Care Services 0.1 0.4 0.3 0.8
Primary Care Services/Prescribing 0.1 0.4 1.6 2.0
Primary Care Co-Commissioning 0.0
Other Programme Services 0.2 0.2 General other minor risks
1.9 3.4 3 8.6
Mitigations/Reserves £m £m £m £mContingency 1.5 2.1 2.4 6.0
Reserves 0.4 1.3 0.9 2.6
Delay/Reduce Investment Plans 0.0
1.9 3.4 3.3 8.6
£m £m £m £mTOTAL NET (RISK) / MITIGATION 0.0 0.0 0.0 0.0
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18 Leeds North CCG
Leeds South &
East CCG Leeds West CCG
TOTAL
for city
Reflects risks inherent in contract envelopes
set currently and resilience pressures in the
system. Recurrent unless mitigating action
taken
Unforeseen Pressures arising from integration
pilots and systems resilience
Potential service pressures, new national
demands, pressure on LD. Recurrent unless
mitigating actions taken
An area of growing pressure every year, risk
estimate follows past trends. Recurrent unless
mitigating action taken
NCSO risk at M08 is £4.03m, currently covered
within prescribing budgets by forecast
underspend based on PPA data. Risk is
reduced compared to previous month,
however anticipate that this is likely to go back
up given the increase in the number of
recommended products on the NCSO list.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18 Leeds North CCG
Leeds South &
East CCG Leeds West CCG
TOTAL
for city
Leeds North CCG
Leeds South &
East CCG Leeds West CCG
TOTAL
for city
Page 6
Acute Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Leeds Teaching Hospitals NHS Trust 304,496 304,496 0 405,994 405,994 0
Mid Yorkshire NHS Trust 19,110 19,909 799 25,480 26,545 1,065
Harrogate Foundations Trust 18,746 19,707 962 24,994 26,277 1,282
Bradford Foundation Trust 3,560 3,725 165 4,747 4,967 220
York Foundation Trust 1,738 1,959 221 2,318 2,613 295
Other NHS Trusts 3,574 2,031 -1,543 4,765 2,720 -2,045
Non contract Activity 5,911 5,910 -1 7,880 7,880 0
Non NHS Acute 32,596 33,041 446 43,461 44,056 595
Urgent Care 32,976 33,179 203 43,969 44,239 270
Total Acute Services 422,706 423,958 1,252 563,607 565,290 1,683
Year To DateLeeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18
Leeds Teaching Hospital Trust (LTHT) – The CCG and LTHT have agree a final position for 2017-18 at planned levels to allow the system to focus on winter and the basis of the new contract for
2018-19 onwards.
The CCG and LTHT are having regular discussions to agree the financial envelope for the 2018-19 contract and exploring the system benefit of moving away from a full payment by results
(PbR) contract. For the next contract management board (CMB) on 22nd January, the CCG is producing 2 papers looking at the principles of how the aligned incentives contract would work
detailing a number of scenarios which highlight potential risks and solutions for each party. The second paper focuses on the contract and system governance arrangements.
Mid Yorkshire Hospital Trust (MYHT) – An overtrade position of £1,065k is being forecast for Mid Yorkshire, this is an increase from last month due to a significant increase in activity at Month
8.
In Month 8 a number of patients have been discharged from critical care which has contributed to the increased forecast. We have also seen an increase in elective geriatric medicine which is
due to kidney or urinary tract infection and a high cost stroke procedure.
The year to date overspending position is due to elective and day case trauma and orthopaedic procedures and within critical care costs. The orthopaedics overtrade is driven by major knee
procedures which are overtrading at month 8 by £262k and major hip procedures by £260k. The activity increase at Mid Yorkshire is thought to be due to capacity issues at Spire Methley Park
but as this is now running close to full capacity we would expect trauma and orthopaedic activity to reduce at Mid Yorkshire over the remainder of the year. Outpatient Procedures are also
now significantly overspending due to Age Related Macular Degeneration which is overtrading by £227K at Month 8.
Harrogate District Hospital Foundation Trust (HDFT) - After reviewing the Month 8 data the Harrogate contract is overtrading by £1,282K. The overtrade is driven by critical care procedures
which are overtrading by £325K at Leeds North, this is a 229% overtrade due to a number of patients spending longer than average in critical care beds. Non-elective data continues to
overtrade within General Medicine, Geriatric Medicine and General Surgery. There are also significant overtrades due to outpatient procedures in specialties General Surgery, Urology and
Gynaecology.
Other Acute Contracts – The main forecast overspends are with Bradford Teaching Hospitals where the contract is overtrading by £220K due to non-elective activity in the geriatric & general
medicine specialties. The contract with York Hospital is also overtrading by £295K, this is due to general surgery, ophthalmology and trauma and orthopaedic day case activity. The CCGs are
holding specific reserves which will cover the overtrades
Non NHS Acute – The forecast for the Independent Sector hospitals at Nuffield and Spire Methley Park has increased due to an increase in activity in November in comparison with the phased
forecast at these hospitals. These relate to an increase in trauma and orthopaedic and gynaecology elective surgery at Nuffield and an increase in trauma and orthopaedic and spinal elective
surgery at Spire Methley. We have also seen an increase in activity within the Gastroenterology AQP due to the inter-provider transfer of patients, from Leeds Teaching Hospital Trust into the
community, who were on the waiting list at LTHT. Activity fluctuations over the remainder of the year can significantly impact on the forecast, and so are continually monitored. These
overtrades have been offset by the release of reserves, earmarked for the growth within these specialties. We have reduced the forecast for the Yorkshire Clinic contract to bring these
contracts closer in line with budget due to duplicated activity which the CCG challenged in the trading report data. We have also reduced the forecast within the Hearing Care AQP closer in
line with the budget due to reduced activity levels at Living Care.
Urgent Care - For urgent care contracts we are showing an overtrade of £172K overall, this is an increase of £98k from last month, this is predominately due to the Shakespeare WIC contract
which as seen a high level of activity in November increasing the forecast by £79K. The main budget areas within urgent care such as the Yorkshire Ambulance contract and non-contract
activity remain on plan.
Annual
Page 7
Mental Health Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Leeds and York Partnership Foundation Trust 70,389 70,389 0 93,853 93,852 0
Tees Esk and Wear Valley NHS Foundation Trust 825 785 -39 1,099 1,099 0
Bradford District Care NHS Foundation Trust 58 53 -5 77 71 -6
Independent/Voluntary Sector/LCC 3,733 3,628 -105 4,977 4,784 -193
Learning Disabilities 19,821 19,459 -362 26,428 25,946 -482
IAPT 869 869 0 1,158 1,158 0
Mental Health Specialist Services 1,316 1,106 -210 1,754 1,484 -270
Mental Health NCAs 401 324 -77 534 431 -103
Mental Health Other 1,198 1,036 -162 1,597 1,381 -216
Total Mental Health Services 98,609 97,649 -960 131,479 130,208 -1,271
Mental Health and Learning Disabilities (LD) services is forecast to underspend by £1,271k, this is a deterioration of £31k from AP08.
The Learning Disability forecast has increased by £190k due to the approval of 3 new CHC packages in AP08. There is continued scrutiny of this budget with Local Authority colleagues.
The Elective Funding forecast has reduced by £53k. This is due to a number of movements within the cohort including delayed discharges, changes to funding responsibility and
package costs. The forecast also includes two mental health S117 cases that, in the absence of a clear S117 agreement, have been approved by the CCG for joint funding with the LA.
There is a S117 review currently underway with CCG and LA colleagues and the CCG needs to consider all the risks and financial impact associated with any funding agreement.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date Annual
Page 8
Community Health Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Leeds Community Healthcare NHS Trust 73,654 73,655 1 98,206 98,206 0
Voluntary Sector/Local Authority 14,947 14,935 -12 19,929 19,913 -16
Community Beds 6,433 6,252 -180 8,577 8,336 -241
Hospices 3,841 3,826 -15 4,589 4,569 -20
Reablement 2,105 2,105 0 2,807 2,807 0
Children's Services excluding Continuing Care 1,513 1,504 -10 1,990 1,955 -34
Safeguarding 535 531 -4 713 704 -9
Total Community Health Services 103,028 102,808 -220 136,810 136,491 -319
The Community bed service went live on 1st November.We are actively working with commissioners and providers to ensure there is no disruption to services during the
implementation phase of the new Community beds model.We are currently forecasting an underspend on the Community beds service but will be closely monitoring this during the
next few months as the new model comes on line. Childrens Services forecasts have remained stable since month 8. The Childrens LTP budget is all now committed to various CAMHS
projects.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date Annual
Page 9
Continuing Care Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Continuing Healthcare 24,847 24,657 -190 33,129 32,908 -221
Continuing Healthcare PHBs 3,834 3,987 153 5,112 5,317 206
Funded Nursing Care 6,609 6,553 -56 8,812 8,738 -75
Children Continuing Care including PHBs 945 1,096 151 1,260 1,459 199
Continuing Healthcare - operational 1,727 1,515 -211 2,302 2,060 -242
Neuro-rehab 1,640 1,428 -212 2,187 1,904 -283
Total Continuing Care Services 39,601 39,236 -365 52,801 52,386 -416
CHC is a demand led service and can vary significantly month on month, and in AP09 the forecast has decreased by £38k citywide to a £416k forecast underspend as compared to a £377k forecast
underspend in AP08.
Continuing Healthcare – The forecast for Continuing Care current spend has increased this month. This is due to a notable increase in the amount of Fast Track patients received in December. However
this is more than offset by the amount of provision discharged in December, resulting in an overall small reduction in the forecast spend this month. As a demand led service the forecast may continue to
fluctuate throughout the year.
Continuing Healthcare PHBs – forecast spend has increased by £57k this month. PHBs must now be offered on commencement of a care plan, therefore the current trend of increases to the FOT is likely
to continue.
Funded Nursing Care – Small increase in forecast spend (£21k) this month. This is due to it being a demand led service.
Children’s Continuing Care incl PHB’s – Forecast spend has reduced by £13k this month, due to clawback of monies after audits of PHB accounts. Still forecasting an overspend overall, which is due to
JDAR costs.
Continuing Healthcare Operational – Forecast spend has decreased this month by £23k. Largely due to vacancies that remain unfilled.
Neuro Rehab – Forecast spend has reduced by £16k this month. Actively being case managed and regular meetings with case manager. Risk that forecast can fluctuate largely by admission of single
patients as care plans are high cost.
AnnualLeeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date
Page 10
Prescribing and Primary Care Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Prescribing 94,945 94,891 -55 126,594 126,485 -109
Ex centrally funded drugs 2,560 2,600 40 3,414 3,446 32
Oxygen contract 876 928 52 1,168 1,235 67
Prescribing staff 1,161 1,103 -58 1,548 1,489 -59
Primary Care Schemes 12,452 12,052 -400 16,783 16,411 -372
Primary Care - GP IT 2,118 2,117 -1 2,824 2,823 -1
Total Prescribing & Primary Care Services 114,112 113,690 -422 152,331 151,889 -442
Annual
Prescribing - Prescribing information is received two months in arrears, so the data received covers the period April to October 2017. Currently the true forecast based on national
expectations we would be showing an under trade position but there remains significant risks in the system around no cheaper stock obtainable (NCSO). The risk has reduced slightly in
month to £4.7M, significantly lower than the predicted risk in October of £7M. NCSO is effectively a concessionary price agreed by the Department of Health to reimburse pharmacies
for increased procurement costs when a particular generic product is in short supply or unavailable. Once agreed it is applied to all prescriptions dispensed for that product for the
whole month it is declared in. Currently the number of NCSO products has risen and so has the price agreed. At this stage it has been agreed with budget holders to forecast in line
with the budget until we have more information around the length of time the NCSO will continue for.
Primary Care – it should be noted that some schemes are still in development and some costs are back loaded towards later in the year but the main change from AP08 is in the new
models of care cost centre where the forecast has reduced by £170K as the full budget is no longer required.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date
Page 11
Other Services 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Non Recurrent Projects 4,513 4,521 8 6,017 6,086 69
Total Other Services 4,513 4,521 8 6,017 6,086 69
AnnualYear To Date
Non Recurrent Projects includes a variety of schemes. The largest schemes which involve all 3 ccgs are the care homes and social prescribing. Leeds West CCG care homes project is
now showing an underspend of £155k as notice has been given on the therapies element of the contract and there will be no costs for this in Q4. Additional funding to keep the gypsy
and traveller service running for Q4 at LW has been agreed, and also funding for an ethnic marketing campaign, showing as an overspend of £28k. The Leeds Integrated Discharge
Service is showing an underspend across the city of £95k due to vacancies within the service at LCH. The costs of Hospital to Home are now being shown here, £161k citywide, although
these may come out of the iBCF. Other costs included here but under discussion are a range of invoices from Community Health Partnerships, £125k citywide. All other smaller
schemes are currently forecast to spend in full in this financial year.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18
Page 12
Primary Care Co-Commissioning 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000GMS 18,115 18,059 -55 24,154 24,154 0
PMS 35,040 35,183 143 46,720 46,660 -60
APMS 3,189 3,258 69 4,252 4,217 -35
QOF 7,070 7,029 -41 9,428 9,428 0
Enhanced Services 2,109 2,042 -67 2,813 3,273 460
Premises - Reimbursed Costs 11,011 10,975 -36 14,405 15,000 595
Premises - Other 121 332 211 161 161 0
Prof Fees Prescribing & Dispensing 1,017 962 -55 1,356 1,156 -200
Collaborative Payments 13 15 2 17 17 0
Other GP Services (inc. PCO) 1,958 2,154 196 2,612 2,217 -395
Other Non GP Services 1,080 1,716 636 1,441 768 -672
Reserves (91811030) 1,477 0 -1,477 1,933 1,605 -327
Total Primary Care Co-Commissioning 82,201 81,726 -475 109,292 108,658 -634
The forecast for Primary Care Co-Commissioning in December has remained in line with the November forecast to show an underspend of £634K. The reason for the under spend is
business rates reductions due to the national review and in particular Leeds West CCG practices who are seeing reductions later than other CCGs. At Leeds North and Leeds South &
East a surplus reserve of 0.5% had been previously held within the budgets, this is no longer required as it will be funded from the main CCG reserves so the spend against this has been
released.
The LIFT buildings rent uplifts have been confirmed and paid for in December in line with RPI, this increase is £192.5k.
Year To Date AnnualLeeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18
Page 13
Running Costs 31st December 2017
Budget Actual Variance Budget Forecast Variance£'000 £'000 £'000 £'000 £'000 £'000
Pay 7,669 6,882 -787 10,226 9,466 -759
Non Pay/Income 5,424 5,312 -113 7,233 6,793 -440
Total Running Costs 13,093 12,194 -900 17,459 16,259 -1,200
£1.2m has been released as a forecast underspend in Month 7, as a result of vacancies and some areas of non pay,and this will effectively be available to spend in programme areas.
This will be kept under review as other savings may come on line in relation to one voice and accomodation changes, however it is anticipated that these will be offset by non recurrent
costs to do with aligning the organisation and the ledgers.
Leeds Clinical Commissioning Groups Partnership Revenue
Expenditure 2017-18Year To Date Annual
Page 14
Consolidated Statement of Financial Position 31st December 2017
31st December
2017 31st March 2017
£'000 £'000
Current AssetsTrade & Other Receivables 7,030 6,110
Cash & Cash Equivalents 224 156
Total Current Assets 7,254 6,266
Total Assets 7,254 6,266
Current LiabilitiesTrade & Other Payables: (79,127) (55,652)
Borrowings (640)
Provisions (649) (766)
Total Current Liabilities (80,416) (56,418)
Total Assets less Current Liabilities (73,162) (50,152)
Non-current LiabilitiesProvisions (1,290) (1,414)
Total Non-current Liabilities (1,290) (1,414)
Total Assets Employed (74,452) (51,566)
Financed by Taxpayers’ EquityGeneral Fund (74,452) (51,566)
Total Taxpayers’ Equity (74,452) (51,566)
Page 15
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Appendix 1
Leeds Clinical Commissioning Groups Partnership
Finance Report by CCG for the Nine months ended 31st December 2017
Financial Performance Report by CCG 31st December 2017
Leeds North Clinical Commissioning Group Revenue Expenditure
2017-18
Target Performance RAG Target Performance RAG
£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 215,634 215,634 292,166 292,166
Programme spend less than allocation 192,447 192,809 261,248 261,730
Running costs spend less than allocation 3,297 3,071 4,396 4,094
Delegated Co-commissioning less than allocation 19,890 19,754 26,522 26,342
Planned Surplus in year 0 0 0 0
QIPP 6,450 4,399 8,600 5,865
Leeds South & East Clinical Commissioning Group Revenue
Expenditure 2017-18
Target Performance RAG Target Performance RAG
£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 316,773 316,773 423,665 423,665
Programme spend less than allocation 284,119 284,589 380,125 380,752
Running costs spend less than allocation 4,109 3,826 5,480 5,103
Delegated Co-commissioning less than allocation 28,545 28,357 38,060 37,810
Planned Surplus in year 0 0 0 0
QIPP 9,375 6,393 12,500 8,524
Leeds West Clinical Commissioning Group Revenue Expenditure
2017-18
Target Performance RAG Target Performance RAG
£'000 £'000 £'000 £'000CCG Expenditure does not exceed planned level 356,861 356,861 478,789 478,789
Programme spend less than allocation 317,407 317,949 426,496 427,221
Running costs spend less than allocation 5,687 5,297 7,583 7,062
Delegated Co-commissioning less than allocation 33,766 33,615 44,710 44,506
Planned Surplus in year 0 0 0 0
QIPP 10,350 7,058 13,800 9,411
Year to Date Forecast
Year to Date Forecast
Year to Date Forecast
Financial Position Summary by CCG 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Programme Services
Acute Services 102,935 103,771 835 137,247 138,362 1,115
Mental Health Services 24,069 23,806 -263 32,092 31,751 -341
Community Health Services 24,909 24,753 -156 33,213 33,003 -210
Continuing Care Services 11,308 11,235 -73 15,077 15,002 -75
Prescribing and Primary Care Services 27,242 27,191 -52 36,324 36,268 -56
Other 610 635 25 813 862 49
Primary Care Co-Commissioning 19,890 19,754 -136 26,522 26,342 -180
Total Programme Services 210,963 211,145 182 281,288 281,590 302
RUNNING COSTS 3,297 3,071 -226 4,396 4,094 -302
RESERVES 1,373 1,418 44 6,482 6,482 0
CCG Net Expenditure 215,634 215,634 0 292,166 292,166 0
Leeds North Clinical Commissioning Group Revenue Expenditure
2017-18Year To Date Annual
Financial Position Summary by CCG 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Programme Services
Acute Services 150,338 150,798 459 200,450 201,075 625
Mental Health Services 36,407 36,054 -353 48,543 48,072 -471
Community Health Services 36,870 36,740 -130 48,600 48,406 -194
Continuing Care Services 12,433 12,307 -127 16,578 16,432 -145
Prescribing and Primary Care Services 41,617 41,297 -320 55,489 55,071 -418
Other 1,749 1,798 49 2,332 2,448 116
Primary Care Co-Commissioning 28,545 28,357 -188 38,060 37,810 -250
Total Programme Services 307,960 307,351 -609 410,052 409,315 -737
RUNNING COSTS 4,109 3,826 -283 5,480 5,103 -377
RESERVES 4,704 5,595 891 8,133 9,247 1,114
CCG Net Expenditure 316,773 316,773 0 423,665 423,665 0
Leeds South and East Clinical Commissioning Group Revenue
Expenditure 2017-18Year To Date Annual
Financial Position Summary by CCG 31st December 2017
Budget Actual Variance Budget Forecast Variance
£'000 £'000 £'000 £'000 £'000 £'000Programme Services
Acute Services 169,433 169,390 -43 225,910 225,853 -57
Mental Health Services 38,133 37,789 -344 50,844 50,385 -459
Community Health Services 41,249 41,314 65 54,998 55,083 85
Continuing Care Services 15,860 15,694 -166 21,147 20,952 -195
Prescribing and Primary Care Services 45,253 45,203 -50 60,518 60,550 32
Other 2,154 2,087 -66 2,871 2,775 -96
Primary Care Co-Commissioning 33,766 33,615 -151 44,710 44,506 -204
Total Programme Services 345,847 345,092 -755 460,998 460,104 -894
RUNNING COSTS 5,687 5,297 -391 7,583 7,062 -521
RESERVES 5,326 6,472 1,146 10,208 11,623 1,415
CCG Net Expenditure 356,861 356,861 0 478,789 478,789 0
Leeds West Clinical Commissioning Group Revenue Expenditure
2017-18Year To Date Annual
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Page 1 of 2
Agenda Item: LHCB 17/74 FOI Exempt: N
NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Shared Employment Arrangements – Recharge Policy and Memorandum of Understanding
Lead Board Member: Visseh Pejhan-Sykes, Chief Finance Officer
Category of Paper Tick as
appropriate
()
Report Author: Rosemary Reynolds, Deputy Chief Finance Officer - Corporate
Decision
Reviewed by EMT/SMT: N/A
Discussion
Reviewed by Committee: N/A
Information
Checked by Finance (Y/N/N/A): N/A
Approved by Lead Board member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to:
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
Financial Implications
Communication and Involvement Issues N/A
Workforce Issues
Equality Issues including Equality Impact assessment
N/A
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
N/A
Page 2 of 2
EXECUTIVE SUMMARY: NHS Leeds South and East Clinical Commissioning Group, NHS Leeds North Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group have established transitional collaborative arrangements for the 2017/2018 financial year. The associated Collaborative Agreement was approved on the 24th May 2017 (Leeds West and Leeds North CCGs) and 25th May 2017 (Leeds South and East CCG). This is attached at Appendix 1 to the Memorandum of Understanding (MOU). This MOU sets out the framework for the shared employment arrangements between the three statutory organisations and the associated sharing of pay and non-pay running cost expenditure. This MOU supersedes the three separate Memorandum of Understandings which were established in April 2013 between the three CCGs This MOU shall come into effect on 1 April 2017 and shall continue until it is terminated. This MOU is a formal agreement between three NHS bodies and is intended to set out the obligations between each CCG as parties to this agreement. This MOU sets out the principles which have been agreed between the CCGs in relation to shared management appointments and arrangements and the associated sharing of pay and non-pay running cost expenditure.
RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is requested to:
Discuss and agree the MOU framework and associated sharing of pay and non-pay running cost expenditure.
MEMORANDUM OF UNDERSTANDING IN RELATION TO SHARED EMPLOYMENT ARRANGEMENTS AND SHARED RUNNING COST NON-
PAY ARRANGEMENTS
2
1. Introduction NHS Leeds South and East Clinical Commissioning Group, NHS Leeds North Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group have established transitional collaborative arrangements for the 2017/2018 financial year. The associated Collaborative Agreement was approved on the 24th May 2017 (Leeds West and Leeds North CCGs) and 25th May 2017 (Leeds South and East CCG). This is attached at Appendix 1. This Memorandum of Understanding (MOU) sets out the framework for the shared employment arrangements between the three statutory organisations and the associated sharing of pay and non-pay running cost expenditure. This MOU supersedes the three separate Memoranda of Understanding which were established in April 2013 between the three CCGs. This MOU shall come into effect on 1 April 2017 and shall continue until it is terminated. This MOU is a formal agreement between three NHS bodies and is intended to set out the obligations between each CCG as parties to this agreement. This MOU sets out the principles which have been agreed between the CCGs in relation to shared management appointments and arrangements and the associated sharing of pay and non-pay running cost expenditure. The Leeds CCGs have established joint governance arrangements including the Leeds Health Commissioning and System Integration Board (“the Board”). The Board is a joint committee of the Leeds CCGs. In addition to the Board the following joint committees have also been established to support the Leeds CCG governance arrangements:
Joint Quality and Performance Committee
Joint Finance and Commissioning for Value Committee
Joint Patient Assurance Group
Joint Clinical Commissioning Forum The governing bodies of the 3 CCGs and the following statutory committees meet in common:
Remuneration and Nomination Committee
Audit Committee
Primary Care Commissioning Committee 2. Shared appointments and arrangements Executive Director appointments to the joint governance and committees in common arrangements are treated as shared appointments and therefore associated costs are recharged between the three separate statutory Leeds CCGs on an equal split basis (i.e. one third to each statutory CCG organisation) on the basis that it is the most appropriate split based on time spent and value added. Non-Executive and lay member posts which are CCG-specific are allocated wholly to the respective CCG. Appendix 2 details arrangements for specific positions.
3
3. Employment Arrangements All posts within the shared management structure are employed by one of the three CCGs – these being NHS Leeds South and East CCG, NHS Leeds North CCG and NHS Leeds West CCG. Joint HR policies across the 3 CCGs are now in place. Supervision of staff will take place through the relevant line management arrangements as per the functions of the shared management arrangements. NHS Leeds South and East CCG, NHS Leeds North CCG and NHS Leeds West CCG, shall bear the costs of remuneration, any liability issues or redundancy/dismissal costs as well as any pension/early retirement costs arising in connection with the employment of the shared management posts based on an equal apportionment split for Director and above, and anything below Director level will be split based on weighted capitation split. 4. Funding of Shared Appointments The CCGs shall bear the remuneration and associated employee costs arising in connection with each of the shared posts, which include but are not limited to income tax and national insurance. This will include any authorised expenses, on-costs and training and development costs. The funding for the joint Executive posts will be allocated equally across each CCG. For all other CCG appointments the funding shall be allocated on the basis of the weighted capitation population of each CCG. For the avoidance of doubt, the funding arrangements referred to above shall continue notwithstanding that the staff may not be performing their duties by reason or absence through sickness, leave or otherwise provided always that reimbursement shall be limited to the value of the payments payable in respect of the Staff by the CCG. 6. Non Pay Expenditure As a result of the shared management and governance arrangements, all non pay expenditure including costs associated with HQ property rents will be recharged on a weighted capitation basis between the three Leeds CCGs, with the exception of external audit costs which are specific to individual CCGs.
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1 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
Transitional Collaborative Agreement between
NHS Leeds North Clinical Commissioning Group,
NHS Leeds South and East Clinical Commissioning Group, and
NHS Leeds West Clinical Commissioning Group
May 2017
Appendix 1
2 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
This Agreement constitutes the entire agreement and understanding of the
CCGs and supersedes any previous agreement between the CCGs relating to the
subject matter of this Agreement.
Version Control
Date of amendment Details
27.02.2017 V1: Initial draft for consultation
12.05.2017 V2: revised version following comments
26.05.2017 V3: revised following comments from Governing Body meetings
Version: 3
Approved by:
NHS Leeds North Clinical Commissioning Group, NHS Leeds South and East Clinical
Commissioning Group, NHS Leeds West Clinical Commissioning Group
Date approved: 24 May 2017 (Leeds West & Leeds North CCGs), 25 May 2017 (Leeds South
& East CCG)
Date issued: May 2017
Responsible Director: Philomena Corrigan
Review date: November 2017
3 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
1. Background
1.1 Leeds has set out a bold ambition to be the best city for health and wellbeing. It has a
clear vision to be a healthy, caring city for all ages, where people who are poorest
improve their health the fastest. To realise this vision, the CCGs and Leeds City Council
need to change how we commission services so that the health and care system is
sustainable, services are of high quality and we make best use of the ‘Leeds pound’.
1.2 The three CCGs aim to ensure more integrated care, based on the needs of local people.
To do this, the Leeds CCGs and Leeds City Council will work together to change how care
is commissioned, and work with current and future providers to develop a new, more
integrated health and social care system.
1.3 The three CCGs have recognised that in a similar way to many healthcare economies
around the world, it will be necessary to adopt a Population Health Management (PHM)
approach. The key building blocks of PHM are:
Commissioning needs to be more strategic and outcomes-based rather than
activity-based.
Some current commissioning functions would be more effectively used to
develop a new provider landscape of integrated, accountable providers
working towards common goals.
This would be enabled by new payment and incentive mechanisms supported
by better use of information and technology.
1.4 To enable progress towards this vision, the CCGs have established transitional
governance arrangements that support joined-up, speedy and effective decision-making.
To oversee some functions, joint committees have been established to enable greater
co-ordination and integration of commissioning, whilst at the same time overseeing
leadership of system integration to develop provider relationships and new commercial
relationships. The governance arrangements will be reviewed after six months of
operation.
1.5 To oversee this transitional phase, the three CCGs in Leeds have set up the Leeds Health
Commissioning and System Integration Board (“the Board”). The Board is a joint
committee of NHS Leeds North Clinical Commissioning Group, NHS Leeds South and East
Clinical Commissioning Group and NHS Leeds West Clinical Commissioning Group. In
addition to the Board the following committees have been established to support the
CCG governance arrangements:
4 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
Remuneration and Nomination Committee
Audit Committee
Primary Care Commissioning Committee
Joint Quality and Performance Committee
Joint Finance and Commissioning for Value Committee
Joint Patient Assurance Group
2. Functions of the Leeds Health Commissioning and System Integration Board
2.1 The Board will be responsible for ensuring that the three Leeds CCGs work together
effectively to:
improve the health and wellbeing of the poorest, the fastest;
help people to live healthier, independent lives; and
ensure that people have access to quality health and care services.
2.2 Through transition, the Board will also oversee the development of a blueprint for
delivering PHM, which will clearly define the developmental journey for both strategic
commissioning and system integration. This means the CCGs working with partners, the
public and patients to commission services that are high quality, sustainable, and make
better use of scarce resources. It also requires the CCGs to support a more integrated
health and care system and develop, with providers, new service models.
2.3 Bringing together strategic commissioning and innovative, integrated, provider
responses will enable delivery of the Leeds Plan, within the West Yorkshire Sustainability
and Transformation Plan.
2.4 The Board will be responsible for:
a) ensuring delivery of a single set of joint priorities;
b) driving the strategic, outcomes and needs-based commissioning of health and
care services across Leeds;
c) ensuring a focus on tackling health inequalities and improving the health and
wellbeing of the poorest, the fastest;
d) designing health and care provision around the needs of patients, with greater
emphasis on prevention and self- care;
e) shaping innovative approaches by health and care providers, which enable them
to respond to our proposed approach to commissioning for outcomes;
f) driving new service models, which provide more integrated care for a specific
population, based on their needs and not disease pathways; and
5 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
g) driving the better use of business intelligence and technology, which will provide
the information that we need to commission effectively for outcomes.
2.5 The Board will be responsible for exercising the following functions, to the extent
permitted, including:
a) the strategic commissioning of health and care services that meet the
reasonable needs of our population;
b) agreeing and monitoring the annual work programme to support the delivery of
the Leeds Plan, shared CCG objectives and operational plans;
c) reducing health inequalities, by identifying high risk, high priority populations
and targeting resources, prevention and care to meet their needs;
d) making efficient and effective use of our collective resources by developing new
financial flows, monitoring the CCGs’ financial plans and the delivery of financial
targets set by NHS England;
e) ensuring continuous improvement in the quality of services commissioned on
behalf of the CCGs through the development of a common quality assurance and
reporting framework and quality improvement strategy;
f) ensure that arrangements are in place to secure public involvement in the
planning, development and consideration of proposals for changes and decisions
affecting the operation of commissioning arrangements;
g) supporting organisational development by establishing a single culture where
our staff adopt one set of values and behaviours;
h) promoting the integration of health and care services by driving new provider
approaches and service models;
i) monitoring provider performance and taking remedial action where necessary;
j) driving a consistent approach to understanding the needs of our population
through the better use of business intelligence and technology;
k) establishing a single risk management and Board Assurance Framework and
thereby ensuring all principal risks are identified, managed and mitigated with
appropriate plans, controls and assurance reported; and
l) setting up and overseeing the effectiveness of sub committees deemed
necessary, agreeing terms of reference and membership of any such sub
committees.
2.6 In exercising its functions, the Board will comply with the statutory duties set out in
chapter A2 of the NHS Act and included within the CCG Constitutions.
6 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
3. Roles and Responsibilities
3.1 The CCGs agree that where a Deputy assumes the role of its nominated Board Member
(subject to the agreement of the Board Chair) for a meeting, all references, within this
agreement, to a member that are relevant to the meeting will be read as referring to the
deputy as well. Each CCG must:
1. Ensure its nominated members attend every meeting of the Board, or at least 75% of
the meetings each year;
2. Make all reasonable efforts to inform the Chair in advance if a member is unable to
attend a meeting;
3. Ensure all members have considered all documentation and are prepared to discuss
matters at the meetings;
4. communicate openly and in a timely manner about concerns, issues or opportunities
relating to this Agreement; and
5. respond promptly to all requests for, and promptly offer, information or proposals
relevant to the operation of the Board.
4. Governance and Monitoring Arrangements
4.1 There are three levels of decision making:
i) Those that are reserved to the CCG Membership;
ii) Those that are reserved to the Governing Body; and
iii) Those that are delegated, by each CCG, to the Board.
4.2 Each CCG must ensure that the matters set out within the CCG Scheme of Reservation
and Delegation are reserved to each CCG membership, governing body or committee as
appropriate.
4.3 The CCGs acknowledge and agree that the role and remit of the Board will be as set out
in the terms of reference and it is the Board that makes decisions which bind the CCGs
and not the nominated members. The Board shall implement reporting mechanisms to
ensure that all decisions are notified to the CCG Governing bodies, the public, all
relevant stakeholders and other partner organisations as appropriate.
4.4 CCGs cannot delegate or share their liability for their respective statutory functions.
7 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
5. Principles for Commissioning
5.1 To benefit from the advantages of the CCGs working collaboratively the following 25
principles are to be endorsed.
1. Patients should always be at the centre of our focus as commissioners and services
are designed to wrap around the patient.
2. Commissioning must focus on the needs of the population, with a particular focus on
addressing inequalities and unwarranted variation.
3. Needs assessments should be comprehensive and holistic with consideration of
those most vulnerable to ensure equity and parity of esteem.
4. Commissioned services should lead to better outcomes for service users and their
families and must move towards providing integrated care for a specific population,
based on their needs and not on service activity and outputs.
5. Commissioning should be based on best practice, supported by professional
guidelines and informed by local clinicians with local knowledge
6. Services must be consistent as well as equitable, ensuring high quality and safe care
and enhancing the patient experience.
7. Decisions will balance population needs with individual needs, prioritising health
promotion and preventative health care where possible.
8. Ensure integration of services within the NHS and between the NHS and other key
partners, in particular the local authority, social care, emergency services, third
sector etc.
9. Commissioned services will be provided in the best place for the patient and their
family which should be within the community or people’s homes where it is safe and
appropriate to do so.
10. Commissioning will adhere to statutory requirements
Commissioning Culture
11. The CCGs must have a positive and trusting relationship, acting in good faith towards
each other and will seek:
i. To understand difference in opinion
ii. Solutions and consensus within these principles
iii. A positive and proactive approach to commissioning
iv. A system wide perspective whilst informing the local one
v. To hold each other to account when deviating from this agreement.
8 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
12. Accountability to public bodies, regulators and the public at large will be shared and
owned by all in a transparent and honest way, with particular reference to the Duty
of Candour where relevant.
13. Communication will be proactive and timely, agreed in an enabling manner and
shared with all stakeholders and the public, as much as possible
14. Leadership within commissioning structures will have lay and clinical leadership at
the most senior level
15. System leaders will act on behalf of the public and consider the population interest
above organisational interest, engaging with the public and public representatives
16. Conflicts of interest will be managed in a proactive and transparent manner and
those with conflicts of interest will be absent from relevant decision making, and will
accept and enact the decision of others.
17. Commissioning processes will ensure efficiency and effectiveness of systems and
processes, avoiding duplication where possible, mitigating risk and sharing
information, data and experience.
18. Act in a timely manner, recognising the time critical nature and respond accordingly
to requests
19. Learn from best practice of other commissioning organisations and seek to develop
as a collaborative to achieve the full potential of the relationship.
Commissioning Decision Making
20. Decisions will be transparent and include reference to public engagement, clinical
expertise and publically accountable governance structures.
21. Decisions will encourage innovation and new ways of working where required, public
and stakeholder participation and engagement, provider development where that
addresses identified needs and should build on previous learning.
22. Commissioners will place value at the heart of decision making to develop a
sustainable health and care system, referencing cost-effectiveness, resource
maximisation and return on investment. Prioritisation for decisions should be
balanced, just and safe.
23. Decisions will be explicit about the outcomes expected and the evidence of success.
24. Decisions will be explicit about the impact on geography and/or populations,
considering impact on localities when at large scale.
25. The CCGs will collaborate and co-operate to work towards ensuring that the
commissioning ambitions and intentions of each of the CCGs is met
9 CCG Collaborative Agreement NHS Leeds North Clinical Commissioning Group NHS Leeds South and East Clinical Commissioning Group NHS Leeds West Clinical Commissioning Group V3
6. Data Protection
The CCGs acknowledge their respective duties under the Data Protection
Legislation and shall give all reasonable assistance to each other where
appropriate or necessary to comply with such duties.
The CCGs may share information with each other which may comprise
anonymised and pseudonymised data to support decision-making by the Board,
but will not include any patient identifiable data.
Each CCG acknowledges that the other CCGs are subject to the requirements of
the FOIA and each CCG shall assist and co-operate with the others (at their own
expense) to enable the other CCGs to comply with their information disclosure
obligations.
MEMORANDUM OF UNDERSTANDING IN RELATION TO SHARED EMPLOYMENT ARRANGEMENTS AND SHARED RUNNING COST
NON-PAY ARRANGEMENTS (Appendix 2)
Leeds Partnership CCGs
Joint Committee Membership and associated split of costs between the three statutory Leeds
Clinical Commissioning organisations
Membership Basis of Split Post reference
Chair – Leeds S&E CCG 100% Leeds S&E A
Chair – Leeds North CCG 100% Leeds North B
Chair – Leeds West CCG 100% Leeds West C
CCG Accountable Officer 1/3 split D
Chief Officer for System Integration 1/3 split E
CCG Chief Finance Officer 1/3 split F
CCG Director of Nursing 1/3 split G
CCG Medical Director 1/3 split H
CCG Director of Commissioning 1/3 split I
Locality chairs and other lay members and other non-executive directors
100% to appointing CCG J
1
Draft Minutes NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting
Wednesday 22 November 2017 2:00pm – 5:20pm
Britannia Leeds Bradford Airport Hotel
Members Initials Role Present Apologies
Philip Lewer (Chair) PL Lay Chair
Dr Jason Broch JB Clinical Chair
Dr Ben Browning BB GP Representative
Philomena Corrigan PC Chief Officer
Nigel Gray NG Chief Officer System Integration
Jo Harding JH Director of Nursing and Quality
Dr Nick Ibbotson NI GP Representative
Dr Steve Ledger SL Lay Member - Assurance
Dr Julianne Lyons JL GP Representative
Peter Myers PM Lay Member - Governance
Dr Amal Paul AP GP Representative
Visseh Pejhan-Sykes VPS Chief Finance Officer
Graham Prestwich GP Lay Member - PPI
Manjit Purewal MP Joint Medical Director
Susan Robins SR Director of Commissioning,
Strategy and Performance
Dr Gordon Sinclair GS Clinical Chair
Dr Simon Stockill SS Joint Medical Director
Gordon Tollefson GT Lay Member - PPI
Additional Attendees
Paul Bollom PB Chief Officer Health Partnerships
(item 50)
Dr Ian Cameron IC Director of Public Health
Dylan Roberts DR Chief Information Officer
(items 42-58)
Cath Roff CR Director of Adults & Health
Tanya Matilainen TM Healthwatch Representative
Steve Walker SW Director of Children & Families
Dr Alistair Walling AW Clinical Leader
2
Laura Parsons (Minutes) LP Head of Business and Corporate
Services
Members of the Public Observing the Meeting – 0
No. Agenda Item Action
LHCB
17/42
Welcome and Apologies for absence PL welcomed everyone to the meeting. Apologies had been received on behalf of BB, NI, and SS. The Chair welcomed Tanya Matilainen, who had been appointed as the Healthwatch representative following the resignation of Lesley Sterling-Baxter.
LHCB
17/43
Declarations of interest Members were asked to make any declarations of interest in relation to agenda items. No declarations of interest were raised.
LHCB
17/44
Patient Voice JH presented a proposed patient voice schedule for 2018, aligned to the Leeds Health and Care Plan workstreams. The Leeds Health Commissioning and System Integration Board:
a) approved the proposed schedule of patient voice topics for 2018.
LHCB
17/45
Questions from Members of the Public There were no questions from the public.
LCHB 17/46
Minutes of the Meeting held on 21 September 2017 The minutes of the meeting of the Leeds Health Commissioning and System Integration Board of 21 September 2017 were agreed and approved as a correct record, subject to an amendment to section 17/36 (Finance Report) to clarify that spend differentials had been highlighted in relation to prescribing budgets across the county, and there would be a review to check for any inconsistencies. The Leeds Health Commissioning and System Integration Board:
a) approved the minutes of the meeting held on 21 September 2017, subject to the amendment noted above.
LP
LCHB 17/47
Matters Arising There were no matters arising.
LHCB
17/48
Action Log PL presented the actions from previous meetings of the Board. Updates were provided as follows: 17/35 – Include performance implications for Leeds CCGs as a result of West Yorkshire performance in the Integrated Quality & Performance Report – this was under development and an update would be provided in January 2018.
3
No. Agenda Item Action
17/37 – Provide a progress report about delivery of the Electronic Referral Service – SR informed members that this was in progress with a roll out plan in place. An update would be provided at the next meeting. The Leeds Health Commissioning and System Integration Board:
a) noted the action log and the update provided.
LHCB
17/49
Corporate Risk Register PC presented the corporate risks. The risks relating to underperformance against the18 week referral to treatment and 62 day cancer targets continued to be rated as red. The system resilience risk had increased in score from 12 to 16. There were concerns within the system due to an increase in delayed transfers of care. The procurement of community beds had created additional capacity, but further work was needed to co-ordinate the movement of patients into those beds. There was a new corporate risk relating to a practice receiving a rating of ‘inadequate’ from the Care Quality Commission (CQC). An action plan was being developed. JH and SS were involved with supporting the practice and this would be reported to the Primary Care Commissioning Committee. The Leeds Health Commissioning and System Integration Board:
a) reviewed the corporate risk register, and b) noted the controls, assurances and mitigating actions in place to
manage the risks.
LHCB
17/50
Leeds Health and Care Plan The Chair welcomed PB to the meeting to present an overview of the progress made to date in developing a Leeds Health and Care Plan. The Plan outlines the city’s approach to closing the gaps in health inequalities, quality of services and financial sustainability. The Board was asked to support the content of the Plan and agree that conversations with the public and staff continue on the basis of the draft. Engagement had already started through discussions with the Council’s Community Committees Project Initiation Documents (PIDs) had been agreed to support the programmes within the Plan, including quantitative information. The PIDs had been agreed by the Partnership Executive Group and each one is led by a Senior Responsible Officer. Managing the interplay between the different PIDs was a challenge. It was acknowledged that further discussions may be required in relation to the ‘fair shares’ approach to funding and the basis of this, to ensure that all organisations were signed up and supportive. TM highlighted the need for wide-ranging engagement, which would be critical to the success of the Plan in achieving a social movement. PB suggested that
4
No. Agenda Item Action
Patient Participation Groups could be used better to ensure effective engagement. The need to join up thinking around health and education was also highlighted, for example to help to address childhood obesity. It was agreed that there would need to be influence at a national level to support this. In relation to intelligence, it was agreed that a dashboard would need to be developed for the city to demonstrate progress against the Plan, which should be understandable for members of the public as well as commissioners. The Leeds Health Commissioning and System Integration Board:
a) approved the Leeds Health and Care Plan content as a basis for consultation with staff and members of the public;
b) approved the approach outlined in the paper for communication and consultation;
c) approved a commitment to align where appropriate CCG financial planning, quality improvement and commissioning to support the Leeds Health and Care Plan;
d) noted the requirement for further discussion of financial planning in partnership to detail the impact and benefits of the Plan; and
e) noted the requirement to continue to evolve the Plan, particularly in light of System Integration developments.
LHCB
17/51
System Integration and Population Health Management Progress Update NG presented an update on progress to establish a population health management (PHM) approach to commissioning and accountable care provision in Leeds. The progress made since 2014/15 was outlined, and the 10 PHM programme workstreams were confirmed. An outcomes workshop was planned to take place in the next week, and a partnership agreement was being developed with legal input. Partner organisations were already forming relationships such as GP federations and Local Care Partnerships. A public facing narrative had been developed and adapted in line with feedback from members of the public. Emerging risks included the need to ensure alignment with the Leeds Health and Care Plan, and potential regulatory and legislative issues. CR queried the governance around the shaping of commissioning, including the role of the Integrated Commissioning Executive (ICE) and implications for the local authority. It was acknowledged that the development of PHM has been inclusive, but alignment with other frameworks (such as the national frameworks for commissioning for better outcomes) needed consideration. It was agreed that there should be discussions at ICE around the development of system integration and strategic commissioning. It was acknowledged that the outcomes required further development with patient and public involvement, and to ensure that there were no conflicts with existing principles.
5
No. Agenda Item Action
It was suggested that the community asset based approach should be more prominent, as the success of the approach will rely on changing mindsets and focusing on what communities can do for themselves. It was requested that the workstreams be set out in a clear table to enable the Board to track progress against key milestones. The Board congratulated NG and his team on the progress made so far, and noted the points raised around alignment with existing frameworks, governance arrangements, focus on patient and public involvement and the measurement of progress against milestones.
The Leeds Health Commissioning and System Integration Board: a) noted the progress made to date in the establishment of the population
health management programme and underpinning workstreams and key next steps.
LCHB 17/52
Chair’s Summary of the Primary Care Commissioning Committees meeting in common – 20 September 2017 PL presented the summary of the Primary Care Commissioning Committees meeting held in common on 20 September 2017. The Leeds Health Commissioning and System Integration Board:
a) received the report.
LCHB 17/53
Chair’s Summary of the Audit Committees meeting in common - 27 September 2017 PM presented the summary of the Audit Committees meeting held in common on 27 September 2017. GT advised that the members of the Leeds South & East CCG Audit Committee had confirmed their agreement with the decisions taken, as the Leeds South & East Committee was not quorate at the meeting. The Leeds Health Commissioning and System Integration Board:
a) received the report.
LCHB 17/54
Chair’s Summary of the Remuneration & Nomination Committees meeting in common - 22 November 2017 GP provided a verbal update in relation to the Remuneration and Nomination Committees meeting held in common on 22 November. Four updated HR policies had been approved, and some recommendations had been agreed for approval by the individual CCG Governing Bodies. The Leeds Health Commissioning and System Integration Board:
a) received the report.
6
No. Agenda Item Action
LHCB
17/55
Chair’s Summary of the Finance and Commissioning for Value Committee meeting - 16 November 2017 PM presented the summary of the Finance and Commissioning for Value Committee meeting held on 16 November 2017. The Leeds Health Commissioning and System Integration Board:
a) received the report.
LCHB 17/56
Chair’s Summary of the Patient Assurance Group meeting - 25 October 2017 GT presented the summary of the Patient Assurance Group meeting held on 25 October 2017. An update on the prescribing engagement and over the counter medicines guidance would be provided at a future meeting. The Leeds Health Commissioning and System Integration Board:
a) received the report.
LHCB
17/57
Chair’s Summary of the Clinical Commissioning Forum meetings - 27 September and 15 November 2017 AW presented the summaries of the Clinical Commissioning Forum meetings held on 27 September and 15 November 2017. The purpose of the Committee had been discussed and there would be developments to the Terms of Reference, including the membership. The first iteration was included on today’s agenda for approval (agenda item LHCB 17/63). The Leeds Health Commissioning and System Integration Board:
a) received the report.
LHCB
17/58
Chair’s Summary of the Quality and Performance Committee meeting - 9 November 2017 SL presented the summary of the Quality and Performance Committee meeting held on 9 November 2017. There were concerns regarding the number of Delayed Transfers of Care (DTOCs) reported by Leeds and York Partnership NHS Foundation Trust (LYPFT), which appeared to have nearly tripled. Clarification was being sought as to whether this reflected a worsening position or a change in reporting method. PC explained that NHS England had been asked if the original baseline figures could be reviewed but had refused. The formula was complicated and was causing issues. It was agreed that a proposal should be made at the next Health and Wellbeing Board meeting to write to NHS England on behalf of the health and care partnership in Leeds to request that the baseline is changed. The Committee had requested further information on the risks being reported at West Yorkshire level and how this is aligned with the CCG risks. PC agreed that this should be considered by the Senior Management Team, and then report back via the Chief Executive’s report or the Quality & Performance Committee.
PC
PC
7
No. Agenda Item Action
IC highlighted the Emergency Preparedness, Resilience and Response self assessment which had been reviewed by the Committee and was being presented to the Board for information. It was clarified that the target date to reach substantial compliance was April 2018 rather than April 2017 as noted in the report. The Leeds Health Commissioning and System Integration Board:
a) received the report.
LHCB
17/59
Integrated Quality and Performance Report (IQPR) SR presented the IQPR. The four hour A&E target continued to be a challenge. Leeds Teaching Hospitals NHS Trust (LTHT) had submitted a target of 90% in 2017/18 and 95% in March 2018. Referral to treatment times also continued to be below the required standard. In relation to quality, JH advised that there had been no MRSA infections reported during September 2017, and a total of four had been reported to date during the current year. NHS England had reviewed the previous three instances of MRSA and accepted that LTHT was not at fault. LTHT was reporting within the expected numbers for C.difficile infection. Since the report was written, a measles outbreak had been confirmed in Leeds with 5 confirmed cases. Awareness raising exercises were being undertaken in the relevant areas of the city and via social media. An outbreak control meeting had been held today with a bronze command meeting taking place tomorrow. The Leeds Health Commissioning and System Integration Board:
a) received and reviewed the IQPR dashboards and noted the current areas of underperformance and mitigating action; and
b) supported the continued development of the IQPR.
LHCB
17/60
Finance Report VPS presented an update on the combined financial positions of the Leeds CCGs up to 31 October 2017 and the expected outturn position for the 2017/18 financial year. The CCGs were on track to meet their key financial targets. The main area of concern was the Quality, Innovation, Productivity and Prevention (QIPP) schemes which were not on track to deliver in full this year. As requested at the last meeting, additional information had been provided to the Board in relation to the QIPP schemes. Projects were in progress, but the financial impact had not yet materialised. A specification was put to tender in October to procure support to develop a systematic programme approach to QIPP, and the successful bidder had started this piece of work. Assurance was sought that the CCGs were on target to meet their budget position at the end of the year. VPS confirmed that the target would be met and contingency was available to ensure this if required, albeit on a non recurrent basis.
8
No. Agenda Item Action
In relation to the running costs underspend, VPS explained that there was an expectation to reduce running costs by 20% as part of the merger of the CCGs. NHS England would need approve the CCGs’ use of the savings. The Leeds Health Commissioning and System Integration Board:
a) noted the month 7 financial position.
LHCB
17/61
Public Sector Off Payroll Legislation (IR35 Rules) VPS presented an update on the revised HM Treasury off payroll rules, including the potential implications and risks to the CCGs and the mitigating actions being taken. Specialist employment tax advice had been sought from Ernst and Young (EY). Options relating to the payment mechanism for Clinical Leads had been considered by the Remuneration and Nomination Committees which had agreed that all Clinical Leads should be paid via payroll unless they formally request and alternative method of payment and approval is sought from HMRC. One such request had been received so far.
There was some concern that requiring payment via payroll may result in some Clinical Leads choosing to step down from the role. It was agreed that there should be a further report to the Board if difficulties arise in recruiting and retaining Clinical Leads. The Leeds Health Commissioning and System Integration Board:
a) noted the organisational risks identified as a result of the revised public sector off payroll legislation and the associate mitigating actions.
LHCB
17/62
Chief Executive’s Report PC presented the report and particularly highlighted the following:
The Leeds Better Care Fund (BCF) plan had been rated as ‘good’ by NHS England.
A review of transport services in Leeds was being undertaken and was being led by the CCG.
The West Yorkshire and Harrogate Joint Committee had met on 7 November. An update was provided on the stroke programme and it was agreed to ask CCGs to support the aspiration to detect and treat 89% of patients with Atrial Fibrillation. In relation to the elective care programme, the Committee had agreed an approach whereby prior to surgery, patients would be offered a choice of services to address lifestyle factors. The Executive Group had received a paper on innovation which showed that Leeds was ahead of other areas, and demonstrated the good work of the Leeds Academic Health Partnership.
Members were pleased to note that patients were driving the progress made against the Future in Mind plan relating to children and young people’s mental health and wellbeing.
9
No. Agenda Item Action
The Leeds Health Commissioning and System Integration Board: a) received the report; and b) in relation to the West Yorkshire & Harrogate stroke programme, the
Board agreed the aspiration to detect and treat 89% of patients with Atrial Fibrillation and the proposal to work collaboratively with the Yorkshire and Humber Academic Health Science Network on implementing a targeted and phased approach to working with local practices.
LHCB
17/63
Clinical Commissioning Forum – Terms of Reference PC presented the Terms of Reference of the Clinical Commissioning Forum for approval. The operation of this Committee would continue to develop as required and any resulting amendments to the Terms of Reference would be presented to the Board for approval. The Leeds Health Commissioning and System Integration Board:
a) approved the Terms of Reference of the Clinical Commissioning Forum as attached to the report.
LHCB
17/64
Questions from Members of the Public There were no questions from members of the public.
LHCB
17/65
Forward Work Programme 2017/18 PL presented the forward work programme for comments.
The Leeds Health Commissioning and System Integration Board: a) received the forward work programme.
LHCB
17/66
Any Other Business SL raised a query in relation to the summary of the Clinical Commissioning Forum (CCF) and the cost of commissioning additional primary care capacity over Christmas, New Year and Easter 2017/18, and assurance on value for money. MP confirmed that this was based on data and discussions with Local Care Direct to ascertain what extra capacity was required. This point had been considered at the CCF meeting. PL advised members that the interviews for the Clinical Chair position of the single Leeds CCG would take place in the next week, and following this a Chief Officer would be appointed.
The Leeds Health Commissioning and System Integration Board agreed that representatives of the press and other members of the public be excluded from the remainder of the meeting having regard to the confidential nature of the business to be transacted, publicity on which would be prejudicial to the public interest’ (Section 1 (2) Public Bodies (Admission to Meetings) Act 1970).
10
No. Agenda Item Action
LHCB
17/67
2017/18 Financial Support Considered following the resolution to exclude the press and public.
LHCB
17/68
Transition Update Considered following the resolution to exclude the press and public.
IFI1 Minutes of the West Yorkshire & Harrogate Joint Committee Meetings held on 4 July 2017 and 5 September 2017 The Leeds Health Commissioning and System Integration Board:
a) received the minutes of the West Yorkshire & Harrogate Joint Committee meetings held on 4 July and 5 September 2017 for information.
IFI2 Emergency Preparedness, Resilience and Response Self Assessment The Leeds Health Commissioning and System Integration Board:
a) received the Emergency Preparedness, Resilience and Response Self Assessment for information.
Date of Next Meeting: 25 January 2018, 2pm at Pudsey Civic Hall
Approved and signed by: Philip Lewer, Chair Date:
MINUTES ACTION LOG – LEEDS HEALTH COMMISSIONING AND SYSTEM INTEGRATION BOARD
1
ITEM NO:
ACTION NO:
ACTION: ACTION BY: COMPLETED/UPDATE
21 September 2017
LHCB
17/35
1 To include the performance implications for Leeds CCGs as a result of West Yorkshire performance within the IQPR
Phil Corrigan In progress - PC is leading the STP business intelligence programme. Verbal update to be provided in January.
LHCB
17/37
1 To bring a progress report about the delivery of the Electronic Referral Service (as part of the IQPR).
Sue Robins In progress – verbal update to be provided in January.
22 November 2017
LHCB
17/46
1 Minutes to be amended as agreed. Laura Parsons Completed
LHCB 17/58
1 SMT to consider alignment of risks reported at West Yorkshire level with CCG risks and report back to Board/Quality & Performance Committee.
Phil Corrigan In progress.
LHCB
17/58
2 Letter to be sent to NHSE (on behalf of the health and care partnership) relating to the baseline for DTOCs within LYPFT. To be proposed at Health and Wellbeing Board.
Phil Corrigan The Health and Wellbeing Board supported the suggestion that a letter be submitted to NHS England to challenge the current baseline and include support for a revised baseline for Leeds. The letter will be signed off by Cllr Charlwood, Chair of the Health and Wellbeing Board. Completed
LHCB
17/67
1 Board to be kept updated in relation to financial support decisions. Visseh Pejhan-Sykes
Completed
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1
Agenda Item: LHCB 17/78 FOI Exempt: N
NHS Leeds CCGs Health Commissioning and System Integration Board
Date of meeting: 25th January 2018
Title: CCG Risk Register Report
Lead Governing Body Member: Phil Corrigan, Chief Officer
Category of Paper Tick as
appropriate
()
Report Author: Joanna Howard, Head of Governance
Decision
Reviewed by EMT/SMT/Date: N/A
Discussion
Reviewed by Committee: Quality and Performance Committee 11 January 2018 Finance and Commissioning for Value Committee 18 January 2017 Primary Care Commissioning Committees in Common 24 January 2018
Information
Checked by Finance: N/A
Approved by Lead Governing Body member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
The CCG is required to have a robust risk management process in place
Financial Implications N/A
Communication and Involvement Issues N/A
Workforce Issues N/A
Equality Issues including Equality Impact assessment
N/A
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
N/A
2
EXECUTIVE SUMMARY: The CCG utilises Datix as an internal risk management system which enables risks to be recorded and managed by all members of staff. Each risk is aligned to a CCG committee for overview and scrutiny. The risks are included on the CCG operational risk register and reviewed within individual directorates and by the executive management team on a regular basis. The CCG committees receive and review the risks rated as high amber (12) and risks that are scored at 15 or above. The Leeds Health Commissioning and System Integration Board receive the corporate risk register (all red risks scored at 15 and above) for review at each meeting in association with the CCG Board Assurance Framework. The CCG Board Assurance Framework is currently under review following the approval of the CCG ambitions. The revised framework for 2018/19 will be presented at the March meeting for approval. As per the CCG risk management strategy all risks at a score of 12 and above are presented to the relevant CCG committee for review and assurance. Assurance or areas of concern are reported from the CCG committees to the Leeds Health Commissioning and System Integration Board (LHCSIB) via the CCG committee chair report. There are currently 54 active risks on the CCG risk register, six of which have been escalated to the CCG Corporate Risk Register and include:
Risk 541: System Resilience; impact on the health and social care system within Leeds. This risk has remained at a red 16 due to the increased likelihood of the risk occurring during the winter period. There is a robust local system delivery plan in place which is being monitored by the System Resilience Assurance Board as well as supporting escalation plans across all providers.
Risk 466: Achievement of the national ambulance standards. This risk has been reviewed and remained at a score of red 16 since the last meeting. The Joint Strategic Commissioning Board continues to provide oversight for the 999 and 111 contracts across Yorkshire and Humber.
Risk 532: Commissioner and/or Lead provider fails to achieve the operational standard for the 18 week Referral to Treatment Time. This risk has remained at a score of red 16 as LTHT continues to be non-compliant.
Risk 339: Cancer waiting times. The under achievement of overall performance for 62 day urgent GP referral to treatment of all cancers overall at LTHT remains a concern and therefore continues to be at a risk score of red 16. Under new arrangements the reporting of performance for patients referred later than 38 days, by a referring Trust, will be reviewed and there is a shared responsibility in the performance breach.
Risk 660: CQC inadequate practice. This risk has remained at the same level due to the concerns raised following a CQC inspection. The CCG is in discussion with the practice and a remedial action plan has been drafted. The practice level quality surveillance group is responsible for the monitoring of that action plan and will report to the CCG
3
Primary Care Commissioning Committee.
Risk 659: System resilience variable risk. This is a new risk that was added at a risk score of 16 in December 2017. Due to the current situation of stretched services and continued increasing demand there is a risk that this will impact system capability and capacity to respond to need.
The corporate risk register detailing the red risks can be found in appendix 1. The risk register includes a summary of the current controls and assurances in place to mitigate the risks. The Leeds Health Commissioning and System Integration Board is asked to review the risks on the corporate risk register, including the controls and assurances as well as the supporting information from the committees which can be found within the committee Chair summaries. Whilst some areas of performance and quality are not in line with agreed targets there is reasonable mitigation and action being taken to rectify the issues as well as established risk management systems and processes in place within the CCG. The CCG Quality and Performance Committee accepted the recommendation of reasonable assurance.
NEXT STEPS:
All risks will be reviewed as per the bi monthly cycle in accordance with the CCG risk management strategy and presented to the assigned committee for review.
Development of the new Board Assurance Framework which is aligned to the CCG ambitions.
The corporate risk register will be presented to the Leeds Health Commissioning and System Integration Board at each meeting.
RECOMMENDATION: The Leeds Health Commissioning and System Integration Board is asked to:
(a) Review the corporate risk register as presented to the Board and note the controls,
assurances and mitigating actions that are in place to manage the risks.
THIS PAGE IS INTENTIONALLY BLANK
1. Risk Register - January 2018
ID
Rev
iew
dat
e
Title Description Secondary Risks
Co
nse
qu
ence
(in
itia
l)
Like
liho
od
(in
itia
l)
Rat
ing
(in
itia
l)
Ris
k le
vel (
init
ial)
Controls Gaps in controls
Co
mm
itte
e R
esp
on
sib
le
Acc
ou
nta
ble
Dir
ecto
r
Man
ager
Costs Assurance Gaps in assurance Synopsis
Co
nse
qu
ence
(cu
rren
t)
Like
liho
od
(cu
rren
t)
Rat
ing
(cu
rren
t)
339
14
/12
/20
17
Cancer under
achievement
of 62 day
urgent GP
referral to
treatment
standard
overall at LTHT
Cancer waiting times - under
achievement of overall
performance 62 days urgent
GP referral to treatment of all
cancers, LTHT total.
Failure to deliver NHS
Constitution standards
required nationally.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t d
aily
. M
ore
like
ly t
o o
ccu
r th
an
no
t.
20
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
LTHT have weekly Access
Meetings to monitor. All
patients tracked and clinically
prioritised. Reports received
by LTHT Cancer Board.
Limited ability to influence
pathways in referring trusts,
leading to higher proportions of
patients referred later than day
38.
Qu
alit
y an
d P
erfo
rman
ce C
om
mit
tee
Susa
n R
ob
ins
- D
irec
tor
of
Co
mm
issi
on
ing
Fost
er,
Cat
her
ine
We await
conclusion of
national work
on breach
allocation.
Performance monitored monthly at
Elective Care Working Group and
actioned appropriately. LTHT has a
Cancer Board to oversee delivery of
recovery plans. reporting to LTHT Trust
Board. West Yorkshire actions being
developed.
There have been some improvements in the local CCG
position, but the LTHT Trust total position continues to
underperform; this is due to a variety of issues including the
number of patients who are cancelled due to bed or theatre
capacity due to the very significant bed and critical care
pressures particularly at the St James's site. There has been
no improvement in the late referrals position and 54% of
patients from other providers still arrive at LTHT after day 38.
The national Cancer Intensive Support Team has recently
reviewed the lung pathway again, with further
recommendations, and there is some additional funding to
increase the level of cancer tracking within LTHT.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
532
14
/12
/20
17
Commissioner
and/or Lead
provider fails
to achieve the
operational
standard for
the 18 week
Referral to
Treatment
Time
Failure to achieve the
Referral to Treatment Time
standard of no more than 8%
of patients waiting more than
18 weeks from Referral To
Treatment in each reporting
specialty at month end either
as a CCG or within LTHT as
lead provider for Leeds
residents.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
All relevant specialties have
clearance plans agreed with
Chief Operating Officer at
LTHT. Funding for additional
capacity agreed within
contracts. Work is ongoing to
create the capacity but there
are risks given the increased
demand on beds through non
elective pressures. Monthly
review of demand growth
against commissioned activity.
Focus on outpatient capacity
Qu
alit
y an
d P
erfo
rman
ce C
om
mit
tee
Susa
n R
ob
ins
- D
irec
tor
of
Co
mm
issi
on
ing
Lew
is,
Hel
en
Monthly update at joint LTHT /CCG
Elective Care Working Group to review
progress and identify any further
actions that can be taken by CCGs
Many of the pathways with high volumes of over 18 week
waits are commissioned by NHSE (dental, clinical genetics
and paediatric subspecialties) For CCG commissioned
specialties the specialties underperforming are: ENT (mostly
OP capacity issues being addressed by offering choice);
General surgery (mostly bed/theatre capacity where some
choice can be offered but not for more complex patients);
Plastics (mostly theatre capacity); orthopaedics (mainly
spinal outpatients); urology (mix of outpatients and
inpatients); ‘other’ mostly Paediatric ENT (mix of OP and IP).
There was an improvement in the number of waiters in
November, due to the focus on outpatient and day case
waiting times, and the Leeds CCG position has improved in
consequence. Inpatient/overnight stay capacity remains
exceptionally constrained, which is impacting on the
numbers of long waiters, particularly those who cannot be
operated on in the Independent Sector. There was a
colorectal 52 week breach at LTHT in November and this
patient has been cancelled again in December. A number of
patients have been contacted and offered choice in the
independent Sector to try to address some of the long
waiting issues, but some procedures cannot be carried out at
tariff in the private sector.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
541
17
/10
/20
17
System
Resilience Risk -
Impacts to the
health and
social care
system within
Leeds
There is a continual risk to
the delivery of a resilient
health and social care system
for the population of Leeds.
This is due to a multitude of
factors that hinder the
system’s ability to maintain
effective system flow
including: the increased
demand of referral into
community nursing services,
capacity to respond to
increased pressures resulting
from an incident, demand
exceeding capacity of
commissioned community
beds at time of surge and
demand exceeding in area
capacity of Mental Health
services at times of surge.
The impact is all partners'
ability to maintain quality
care delivery and may result
in all partners' ability to
maintain elective, urgent and
cancer activity, the
cancellation of services and
in extended waits for both
There is an additional risk in
the increased demand in
community services
including primary care, that
may result in additional
pressures at the front end of
the system which may
impact admission rates,
length of stay and which
ultimately affects system
flow.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t d
aily
. M
ore
like
ly t
o o
ccu
r th
an n
ot.
20
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
Robust escalation plans and
escalation process in place
across all providers with co-
ordination and system
management co-ordinated by
the CCG
Robust Local System Delivery
Plan monitored by the
Operational Resilience Group
and the System Resilience
Assurance Board.
Processes in place to ensure
all national, regional and local
requirements in terms of
planning and providing
assurance are in place.
Alignment with
commissioning agendas
including BCF
There is not full System wide
participation in the Leeds
Escalation process
The qualitative level of provider
reporting is varied occasionally
resulting in limited information
about operational challenges
Mutual Aid principles are not
being fully followed so there is
occasionally delay in obtaining
appropriate support
Syst
em R
esili
ence
Ass
ura
nce
Bo
ard
Qu
alit
y an
d P
erfo
rman
ce C
om
mit
tee
Susa
n R
ob
ins
- D
irec
tor
of
Co
mm
issi
on
ing
Tayl
or-
Tate
, D
ebra
The Leeds plan has focus on a longer
more strategic aims but recognises the
importance of the operational system
input as a timely check
City wide enabling groups to the Leeds
Plan include estates, workforce
development, transport
Partners have agreed to develop a
approach of support of mutual aid
Insufficient workforce skill,
capability and capacity and
the national agency cap to
deliver the commissioned
services, resulting in a
fatigued workforce and
poor quality experience for
patients.
To review the effectiveness of the agreed Escalation process
in managing current System escalations and helping system
recovery. Specifically the quality of provider triggers,
reporting and the mutual Aid principles which require
proactive provider to provider dialogue outside of any CCG
facilitated SitRep
To obtain system wide participation in providing daily
information to aid identification of pressures and the
remedial actions required
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
659
07
/12
/20
17
System
Resilience
Variable Risks
There is a risk that surges in
demand may impact system
capability and capacity to
respond to need. This is due
to the current situation of
stretched services and
continued increasing
demand, which oftentimes
occurs at inappropriate
points of access There are
additional risks that will be
generated by variable factors
including, extreme weather
aging population and acuity
of need, flu and workforce
issues. i.e industrial action.
The result of this risk is that
patient safety may be
compromised and the system
is saturated and unable to
deliver key services such as
cancer.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t d
aily
. M
ore
like
ly t
o o
ccu
r th
an n
ot.
20
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
There is a Leeds CCG wide
business continuity plan that
enables the CCG emergency
response to be enacted
EPRR Steering group is in
place
There are robust emergency
response plans in place across
all providers that provide
assurance to the CCG
There is a robust On Call
process and appropriate levels
of On call managers
On call personnel are upskilled
in our Incident Management
process and their roles and
responsibilities within
The BCP plan is not reflective of
the new organisation structure
Susa
n R
ob
ins
- D
irec
tor
of
Co
mm
issi
on
ing
Exle
y, S
arah
The EPRR action plans is monitored by
the EPRR steering group.
CCGP Contact details are up to date
Leeds System Escalation process with
Mutual Aid principles agreed
On Call Personnel training
Not all On Call personnel
have completed their
training
There has been intermittent meetings during 2017. The EPRR
steering group has been re-established with member
attendees from across the CCGP. The meeting will have
updated TOR and schedule of meets across all 2018. It will
review our EPRR submission and associated action plan and
provide an update to SRAB by the end Feb
Ensure that Escalation Distribution list is up to date so that
key stakeholders receive weather alerts
To keep a record of which On Call managers have completed
appropriate training/ upskill that enables them to meet their
obligation as a cat 2 responder in an emergency or a system
escalation
To complete the On Call training programme for On Call
Managers so that they are able to respond effectively to OOH
emergencies
On Call managers register for Leeds Alert notifications so that
they are able to receive timely alerts independently of
notification from Unplanned care Team
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
466
06
/10
/20
17
The
achievement
of the national
Ambulance
standards
There is risk to the quality of
care provided to all patients
requiring the assistance of
the Yorkshire Ambulance
Service (YAS). This is due to
the continued failure of the
ambulance service to meet
the national performance
targets across the city of
Leeds. As a result for
patients requiring this level of
service there is an escalated
risk with the potential to
impact on their health
condition, treatment and
recovery.
There is a continued risk to
the achievement of the
national standards for
ambulance services across
the Leeds CCG's. This is due
to increased demand,
insufficient workforce and
the process for managing
calls and the dispatch of
vehicles. This has the
potential to result is an
escalated risk for patients
with life threatening need
and failure.
There is a further risk in
continued development and
improvement of the
ambulance services due to
the current pressures
associated with workforce
challenges resulting in a lack
of engagement and a
strategic development
aligned with the
commissioners and local
populations needs.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t d
aily
. M
ore
like
ly t
o o
ccu
r th
an n
ot.
20
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
NHS Wakefield CCG are the
lead for the YAS 999 contact
and the newly formed the
Joint Strategic Commissioning
Board (JSCB).This will see the
System resilience Groups and
the West Yorkshire Urgent
and Emergency Care
Network/Vanguard directly
input into a new established
Joint Strategic Commissioning
Board for both 999 and 111
and GP out of hours. These
separate contracts will report
directly to their individual
contract management boards
and a joint quality board.
The SRAB will monitor YAS
performance to inform the
commissioning board.
The Leeds CCG partnership
Provider management Group
(PMG) are responsible for the
regular monitoring of both
999 & 111 performance in
terms of activity, quality and
finance.
The Ambulance Response
As the YAS 999 contract is a
Yorkshire and Humber wide
contract, individual
commissioners have limited
flexibility and influence to make
targeted improvements
specifically to their populations.
Qu
alit
y an
d P
erfo
rman
ce C
om
mit
tee
NLL
01
, SED
C, S
EMW
01
, Su
san
Ro
bin
s -
Dir
ecto
r o
f C
om
mis
sio
nin
g
Tayl
or-
Tate
, D
ebra
Agreement to
spend centrally
allocated
system
resilience
monies on
commissioning
extra capacity
within YAS
through sub
contracting
arrangements
within YAS.
Assurance is provided to Leeds CCG
through governance process across,
Yorkshire, West Yorkshire and Leeds
System Resilience Assurance Board
(SRAB).
NHS Wakefield CCG are the lead for the
YAS 999 contact and the newly formed
the Joint Strategic Commissioning
Board (JSCB).This will see the System
resilience Groups and the West
Yorkshire Urgent and Emergency Care
Network/Vanguard directly input into a
new established Joint Strategic
Commissioning Board for both 999 and
111. These will report directly to
separate contract management boards
and a joint quality board
The Leeds CCG Partnership Provider
Management Group (PMG) will be
responsible for the regular monitoring
of both 999 and 111 performance
including activity, quality and finance at
a local (Leeds) level
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
660
10
/11
/20
17
CQC
Inadequate
Practice
There is a risk that a practice
that has been rated as
inadequate by the Care
Quality Commission will be
unable to deliver the
required improvements in
the identified timescale.
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t d
aily
. M
ore
like
ly t
o o
ccu
r th
an n
ot.
20
Ver
y H
igh
Pri
ori
ty -
Red
uce
urg
entl
y in
volv
ing
Sen
ior
Man
agem
ent
CCG Quality Surveillance
Process activated to ensure
robust monitoring
arrangemetns
Quality review identified and
action plan requested from
the practice
Discussion with practice
planned with representatives
from the Local Medical
Committee
Scoping long term solutions to
address sustainability and
resilience plans
Pri
mar
y C
are
Co
mm
issi
on
ing
Co
mm
itte
e
Sim
on
Sto
ckill
CC
G M
edic
al D
irec
tor
Kir
sty
Turn
er
Quality Surveillience Group to monitor
progress against action plan
Enahnced surveillance monitoring
process
Multi team approach to review
approach (Medicines Optimisation,
Quality, Primary Care, Clinician)
Maj
or
Exp
ecte
d t
o o
ccu
r at
leas
t w
eekl
y. L
ikel
y to
occ
ur.
16
The YAS Ambulance Response Pilot (ARP) is now complete and national recommendations
in July 2017 stated that the new control measures will come into effect as of the 1st April
2018. These standards are focused on patients’ clinical needs and will help to ensure
consistent, rapid responses to those who genuinely need them, reduce long waits for
ambulance responses and bring all 999 calls under a consistent national framework. The
new standards are as follows:
Respond to Category 1 calls - in 7 minutes on average and respond to 90% of Category 1
calls in 15 minutes
Respond to Category 2 calls in 18 minutes on average and respond to 90% of Category 2
calls in 40 minutes
Respond to 90% of Category 3 calls in 120 minutes
Respond to 90% of Category 4 calls in 180 minutes
THIS PAGE IS INTENTIONALLY BLANK
1
Agenda Item: LHCB 17/79 FOI Exempt: N
NHS Leeds CCGs Partnership – Leeds Health Commissioning and System Integration Board Meeting
Date of meeting: 25th January 2018
Title: Strategy – System Integration update
Lead Governing Body Member: Nigel Gray, Chief Officer System Integration
Category of Paper Tick as
appropriate
()
Report Author: Becky Barwick and Gina Davy
Decision
Reviewed by EMT/SMT/Date: N/A Discussion
Reviewed by Committee/Date: Content discussed at Leeds Health and Care Partnership Executive Group 11th January 2018
Information
Checked by Finance (Y/N/N/A - Date): N/A
Approved by Lead Governing Body member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
There are a number of legal, contractual, statutory and regulatory implications which are being scoped through the Procurement and Assurance Workstream 8.
Financial Implications Work continues as part of workstream 7 (Finance) to scope and refine the existing spend on services and schemes currently being commissioned to support the initial population cohort (people living with frailty and at the end of life).
Communication and Involvement Issues A comprehensive Communications and Engagement Plan and public-facing narrative has been developed through the Communications and Engagement Workstream (Workstream 9)
Workforce Issues As part of the wider primary care workforce strategy for Leeds, the workforce requirements of delivering a PHM approach and in particular the design and delivery of new workforce models within Local Care Partnerships are being scoped
Equality Issues including Equality Impact assessment
An EIA will need to be carried out before there is any service change or redesign.
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
An assessment of IG issues is being undertaken through Workstream 10.
2
EXECUTIVE SUMMARY: The purpose of this paper is to provide a summary to the Board of the work of the System Integration team. It also provides an update on the core interdependent components of the Leeds approach to Population Health Management (PHM) and progress of the delivery programme and its ten workstreams. The paper outlines the key next steps for the programme, which include developing the commissioning approach to delivering the outcomes framework for people who are frail including those at the end of life.
NEXT STEPS: The programme continues to make good progress and is on track to deliver its aims. There are a number of key risks to delivery however actions have been put in place to mitigate against these risks. A key task for the System Integration Team in January / February 2018 will be to continue to meet with system leaders and offer ongoing support to help organisations understand the impact of the programme from an individual organisational perspective. Following the agreement of the outcomes framework for frailty and end of life and the supporting approaches to commissioning and governance, there will be a need to review and potentially refine workstream scope and delivery milestones.
RECOMMENDATION:
The Leeds Health Commissioning and System Integration Board is asked to:
a) RECEIVE this report and note the progress made to date in the
establishment of the PHM programme and underpinning workstreams and key next steps.
3
1. SUMMARY 1.1 The purpose of this paper is to provide a summary to the Board of the work of
the System Integration team. It also provides an update on the core interdependent components of the Leeds approach to Population Health Management (PHM) and progress of the programme and its ten workstreams.
1.2 The paper outlines the key next steps for the programme, which include
developing the commissioning approach to delivering the outcomes framework for people who are frail including those at the end of life.
2. BACKGROUND 2.1 Since May 2017 the Leeds CCGs Partnership System Integration Team has
been working with partners to develop the vision and approach to progress accountable care and strategic commissioning. In Leeds this programme of work is called Population Health Management (PHM). A delivery programme has been established with 10 workstreams.
2.2 The vision is to deliver the ambitions of the Leeds Health and Wellbeing
Strategy - to make sure that care is personalised and more care is provided in people’s own homes whilst making best use of collective resources to ensure sustainability, building on the strong assets of Leeds. Commissioning for outcomes and accountable care provision is seen by partners as our best opportunity to deliver the above ambition, close the health, care and finance gaps in our health and care system for the long term.
2.3 The Leeds approach to Population Health Management consists of four
interdependent components:
1. Strategic commissioning for outcomes 2. Incremental approach (starting with frailty and end of life segment) 3. Accountable care provision for alliance(s) of providers 4. Delivery of community based care through Local Care Partnerships
2.4 To deliver the above components a programme has been developed with ten
workstreams:
Workstream Title Lead Team / Organisation
Workstream 1 Commissioning Development
Sarah Lovell Leeds CCG Partnership
Workstream 2 Alignment with the Leeds Plan
Becky Barwick System Integration (Leeds Clinical Commissioning Partnership)
Workstream 3 Population Segmentation
Lucy Jackson Public Health (Leeds City Council)
Workstream 4 Commissioning for Population Outcomes
Sarah Lovell Leeds CCG Partnership
Workstream 5 Development of Provider Alliance(s)
Jim Barwick GP Federation
4
Workstream 6 Local Care Partnerships Development
Gaynor Connor & Chris Mills
Leeds CCG Partnership
Workstream 7 Finance Martin Wright System Integration (Leeds Clinical Commissioning Partnership)
Workstream 8 Procurement and Contracting
Michelle Van Toop
Leeds CCG Partnership
Workstream 9 Communications & Engagement
Carolyn Walker
Leeds CCG Partnership
Workstream 10 Analytics, Information Governance and IT
Nichola Stephens
Leeds Clinical Commissioning Groups Partnership, GP IT and Adults & Health Directorate Leeds City Council
2.5 The pace and momentum of work undertaken through the Population Health
Management programme has continued through November and December 2017 with positive progress made across all workstreams.
2.6 Following a request by the Leeds Health and Care Partnership Executive
Board (PEG) and Leeds Health and Care Board to Board Summit in September 2017, the System Integration Team developed detailed proposals and updates relating to the implementation of a PHM approach in Leeds. These included:
A Public Facing Narrative: The draft public facing narrative for the development of Local Care Partnerships as the delivery model for the Leeds approach to PHM, describing what this could mean for local people. There is a plan to further develop this narrative and then commence public engagement on the model early in the New Year.
Programme Brief: The draft PHM programme brief describes the technical detail around implementing the proposed Leeds approach including introducing the concept of a ‘System Alliance Agreement’ for consideration as a method of progressing with the initial segment.
Programme Highlight Report: A highlight report from the PHM programme plan describing each of the workstreams and key milestones.
Financial Context: The draft financial context provides a background to the system to understand current spend on each of the segments and supports further discussion in the system around the potential to use resources differently.
2.7 The proposals outlined above were developed through discussions with stakeholders including the Leeds CCG Partnerships Senior Management Team, Population Health Management Group and the Accountable Care Development Board during November / December 2017. In December 2017,
5
the proposals were presented to the Board to Board Summit and PEG as a suit of documents for consideration.
2.8 The proposals were positively received by both the Board to Board Summit
and PEG with key feedback as follows:
The need to ensure that messages and narrative are simple and clear to understand.
The need for a greater understanding about what this means for local organisations in 2018/19.
Members of PEG requested responses from provider organisations regarding implications and next steps for individual provider organisation at the PEG meeting in February 2018.
2.9 Following discussions and feedback from the PEG and the Board to Board
Summit, members of the System Integration Team are meeting with leaders from individual organisations to discuss implications and impact of the proposals from individual organisational perspectives.
3. WORKSTREAM HIGHLIGHTS 3.1 The workstreams that constitute the programme continue to report on an
exception basis. Workstream leads continue to meet ‘face to face’ to discuss progress, risks and dependencies on a 6 weekly basis. A summary of progress across the ten workstreams that form the programme is provided at Appendix A.
Key highlights to note are as follows:
Workstream 2 - Alignment with the Leeds Plan: Members of the System Integration Team and Leeds City Council Health Partnerships Team attended all ten Community Committees in December 2017 to engage with local Councillors and members of the public about the Leeds Plan and Local Care Partnerships. The presentation, supporting workshops and discussions were well received and provided a wealth of valuable feedback.
Workstream 4 - Commissioning for Population Outcomes: Attended by over 90 people representing 32 individual organisations, a hugely successful workshop was held on the 29th November 2017 to review and refine the draft Outcomes Framework. Reflecting feedback received, the draft outcomes framework will be presented, (along with proposals relating to supporting commissioning and governance approaches) to the Integrated Commissioning executive (ICE) in January followed by the Population Health Management Group and Accountable Care Development Board in February.
Workstream 8 - Procurement & Assurance: Work has continued to engage with legal experts to understand alternative models for the commissioning, provision and procurement of outcomes. This work is also considering the potential benefits of a local System Alliance Agreement to support the local approach.
6
Workforce (Enabler): The draft Primary Care Workforce Strategy, led by the Lead Nursing Officer for System Integration, is currently out for consultation. The strategy sets out the vision and strategic direction for the Primary Care Workforce in the context of the Leeds Plan, increasing system and provider integration and the development of Local Care Partnerships as well as ensuring the key national workforce deliverables are addressed within the Strategy.
3.2 None of the workstreams within the programme are currently reporting
significant slippage against initial delivery timescales. However, there will be a need to review (and where necessary refine) workstream delivery timescales and scope in early February. This will follow decision making regarding the draft outcomes framework, provider responses as well as implications for governance and commissioning approaches.
4. IMPLICATIONS FOR ORGANISATIONS IN THE LEEDS HEALTH AND
CARE PARTNERSHIP 4.1 Following discussions and feedback from the PEG and the Board to Board
Summit, members of the System Integration Team have been meeting with leaders from individual organisations to discuss implications and impact of the proposals from individual organisational perspectives.
4.2 Meetings that have already taken place with PEG members and other senior
leaders from; LTHT, Adults and Health, GP Federations, LYPFT, Third Sector and LCH. They have been a helpful opportunity to clarify the detail and allay some of the concerns that have arisen as the approach has been developing.
4.3 Some of the emerging themes from discussions that have already taken place
are detailed below:
The principles around collaboration and shared objectives are well
supported.
All partners can see the mutual benefits of accountable care and accept
the need to change.
Need to ensure full alignment with the Leeds Health and Care Plan.
The proposed System Alliance approach to collaborative commissioning
and provision has been well received – further work needed to understand
the detail and implications.
There is wide support for the Local Care Partnership neighbourhood
delivery model.
There is support for taking an incremental approach however there are
some concerns around beginning with the frailty population segment with
some feeling that the segment is too large – further work needed to
understand the implications of this.
There is some concern that a common definition of frailty is complex,
however all organisations can identify benefits and opportunities to work
7
differently with this cohort for the overall improvement of population
outcomes.
There are some concerns about the outputs of the financial modelling work
as this has flagged that there is significant current spend on this cohort –
need to make sure that the approach is well communicated.
Concerns have been flagged about ‘dual-running’ of the current and
emerging ways of working, the potential confusion this could cause and
how transformation will be resourced.
There has been clear message that we must continue to focus on long
term transformation and not allow ourselves to detract from this whilst
addressing current risks.
4.4 Each organisation will report back further detail on implications and levels of
support at the next PEG meeting in February. This will be supported by a detailed paper outlining the responses from each organisation, as well as more detail around what the ‘shadow year’ will entail.
5. NEXT STEPS
5.1 The PHM programme continues to make good progress and is on track to
deliver its aims. There are a number of key risks to delivery however actions have been put in place which should mitigate against these risks.
5.2 A key task for the System Integration Team in January / February 2018 will be
to continue to meet with system leaders and offer ongoing support to help organisations understand the impact of the programme from an individual organisational perspective.
5.3 Following the agreement of the outcomes framework and the supporting
approaches to commissioning and governance, there will be a need to review and potentially refine workstream scope and delivery milestones.
6. STATUTORY / LEGAL/REGULATORY / CONTRACTUAL
6.1 The procurement and assurance workstream is reviewing the statutory,
regulatory and legal requirements and consideration in relation to different models of procurement, and contracting. The workstream is in the process of securing legal expertise the provide specialist advice and support in the consideration of options, selection and design of the chosen approach to procurement, contracting and external assurance including the Integrated Service Assurance Process (ISAP).
7. FINANCIAL IMPLICATIONS AND RISK 7.1 This programme seeks to address the triple aim described in the Leeds Plan
and therefore greater sustainability, use of resources and value for money is a key outcome of full implementation. Through the finance workstream, work has been undertaken to quantify existing services (and associated spend) commissioned to support people living with frailty and at the end of life. In
8
addition, a set of draft principles have been drafted to support joint working as well as approaches to financial risk and gain share.
8. COMMUNICATIONS AND INVOLVEMENT
8.1 A Communications and Engagement ‘Plan on a Page’ and public-facing narrative has been developed through the Communications and Engagement Workstream (Workstream 9). The public facing narrative focuses on the neighbourhood delivery model and the development of Local care Partnerships.
8.3 The public engagement will begin in earnest with a deliberative event planned
for Saturday 24th February. A market research company has been engaged to recruit a demographically representative group of members of the public to attend the event where they will be asked to consider how Local Care Partnerships should work and what the engagement messages should be.
9. WORKFORCE
9.1 As outlined above the draft Primary Care Workforce Strategy is currently out
for consultation. The strategy sets out the vision and strategic direction for the Primary Care Workforce in the context of the Leeds Plan, increasing system and provider integration and the development of Local Care Partnerships as well as ensuring the key national workforce deliverables are addressed within the Strategy.
10. EQUALITY IMPACT ASSESSMENT 10.1 The PHM approach means that the needs of diverse groups can be better met
in individual communities in the future and also allows outcomes to be set for the population that take account of specific needs of people with protected characteristics or other minority or groups where identified.
10.2 An Equality Impact Assessment will be carried out as part of the process to
redesign services. 11. ENVIRONMENTAL
11.1 Environmental impact and considerations of the programme will be scoped in
due course.
12. RECOMMENDATION
The Leeds Health Commissioning and System Integration Board is asked to:
a) RECEIVE this report and note the progress made to date in the establishment of the PHM programme and underpinning workstreams and key next steps.
9
Workstream Key Activities Undertaken Key Activities Planned Progress Against Plan
Workstream Risks and Issues
Commissioning Development
Meeting with BDO to scope commissioning development programme open to all commissioners in Leeds (CCG and LA) and 2-3 sessions will be open to providers.
Programme Implementation: Feb-Mar ‘Building Blocks’ (Populations, Outcomes, Integrated Care)
Potential capacity gaps to support commissioning development programme
Alignment with Leeds Plan
Joint presentations on Leeds Plan and PHM programme to 10 Community Committees with Health Partnerships Team.
Work underway to further align communications, engagement and marketing activities
None stated
Segmentation
Support to development of outcomes framework and finance workstreams completed.
Work within initial plan completed. Further discussion required as to whether to undertake detailed analysis for all population segments or commence detailed analysis for second population segment in Q1 18/19.
None stated
Development of Outcomes
Hugely successful and well received workshop session with 97 people from 32 review and refine outcomes framework.
Draft outcomes framework to be presented to ICE in Jan.
Attend and present to ACDB and PHM in Jan-Feb.
Insufficient time to engage with population groups widely and a delay to approvals process and implementation from April could delay shadow year and system learning.
Development of Provider Alliance
Series of three development workshops now complete. Clarity regarding, mission, purpose, values and membership.
Establish protocols for information sharing and understand existing data across providers.
Establish structure, roles and leadership within the team and approach to governance, decision making and accountability.
Partnership working is delayed and/or stalled due to historical cultural differences between orgs.
Progress is slowed due to increased and/or unexpected pressures on the system.
Local Care Partnerships
General Practice leads identified for all 13 LCPs.
Agreement of LCP geographical boundaries.
Detailed scoping around 6,9 and 12 month deliverables and development of LCPs
Capacity to delivery workstream deliverables.
APPENDIX A Workstream Highlights Risks and Progress Update
10
Pro
gre
ss
Key
C R A G NS
Complete Behind and irretrievable
Behind but retrievable
On track Not due to
start
Finance
Financial values for population segments
Further development of Leeds Data Model to support PHM
Development of draft joint working and risk gain share principles
Complete financial modelling from commissioner (price/tariff) perspective and provider cost perspective.
Test high level risk gain share principles and agree joint working principles.
Completion and agreement of financial inputs based on clarification of services ‘in scope’.
Procurement & Assurance
Discussions in various groups, (SMT, ACDB, Provider Alliance) regarding potential approaches to contracting.
Exploration of benefits of a System Alliance Agreement.
Further discussions with Provider organisations and at the ICE regarding the use of a System Alliance Agreement.
Work to scope potential System Alliance Agreement for Leeds to enable further understanding and discussion.
System partners do not agree the contracting approach so work stream cannot continue.
Comms & Engagement
Communications ‘Plan on a Page’ completed.
Significant support to Outcomes Workshop
Deliberative Event planned February 2018.
Engagement support in development of patient reported outcomes & supporting images.
None identified.
Info Gov, Analytics & IT
This enabling workstream supports multiple programmes, including the Leeds Plan. It supports numerous workstreams but does not formally report through the PHM programme.
Agenda Item: LHCB 17/80 FOI Exempt: No
NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Meeting
Date of meeting: 25 January 2018
Title: Chairman’s Summary – Primary Care Commissioning Committees meeting in common 23 November 2017
Lead Governing Body Member: Philip Lewer, Lay Chair
Category of Paper Tick as
appropriate ()
Report Author: Helena Coates, Governance Manager
Decision
Discussion
Information
Approved by Lead Governing Body member (Y/N): Y
EXECUTIVE SUMMARY:
This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Primary Care Commissioning Committees meeting held in common on 23 November 2017.
RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.
Description of key items of business discussed and key outcomes
Please note that this is a brief summary of the items considered and decisions taken at the meeting of Primary Care Commissioning Committees (PCCCs) meeting held in common on 23 November 2017. Further information can be obtained by reference to the minutes of that meeting.
1. Chief Executive’s Update –The Chief Executive provided an update on the accommodation review, an estimated £400k would be saved by reducing the number of offices. It was noted that the Healthy Futures work programme had been agreed and included stroke and arterial fibrillation.
2. Local Primary Care Schemes - Leeds North, Leeds South and East and West CCGs had schemes in place last year and a single scheme was proposed from 2018 which would incorporate a number of key priorities identified across the organisation and would support change at practice level as well as supporting the strategic priority relating to the development of local care partnerships.
2
3. Feedback following Patient Participation Group Event - The event was very well attended and the feedback was very positive. It was recommended to set up a citywide PPG network and steering group to improve the quality of PPGs in Leeds.
4. Chair’s Summaries from Primary Care Operational Group - The Committees discussed the updates from October and November 2017 Primary Care Operational Group meetings. The Committee agreed to have an update regarding GP workforce including local challenges at a future meeting.
5. Application for closure of Green Road Surgery, Meanwood (Branch Surgery of The Avenue, Alwoodley) – Following public consultation the Committee approved the recommendation for The Avenue Surgery to close the branch surgery at Green Road.
6. Primary Care Finance Report - The Committee was presented with a paper providing an update on the overall co-commissioning allocation which included an update on local primary care and prescribing budgets and expenditure. Across Leeds there was a total of c.£900k owed by Leeds practices to the Community Health Partnerships (CHP). This was as a result of increased charges by CHP to reflect market costs. The Committee agreed to contact London CCGs to understand how issues with the increase of practices charges made by Community Health Partnerships was addressed. It also noted the risks around the Estates and Technology Transformation Fund.
7. Chair’s Summary from Joint Quality and Performance Committee - The Chair’s Summary from the meeting of the Joint Quality and Performance Committee of 9 November 2017 was discussed.
8. Primary Care Integrated Quality & Performance Report (IQPR) - The mechanism and process for sharing the IQPR had been agreed and the report was being shared with practices. Through the review of clinical leads, a GP lead had been identified who would further support the review of the data and associated mitigating factors.
9. Primary Care Risk Report - The Primary Care Commissioning Committees were presented with an updated review of the risks shared at the last meeting, which reflected the single risk register for the City. An additional risk had been identified specifically with regard to Highfield in Bramley.
10. Estates and Technology Transformation Fund, St. Martins House – There was a discussion concerning and application which had been submitted to NHS England.
Strategies/Policies approved
None
Items of positive assurance or issues to be raised with Leeds Health Commissioning and System Integration Board
None
Any additional comments
None
Agenda Item: LHCB 17/81 FOI Exempt: No
NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Chair’s Summary – Joint Finance and Commissioning for Value Committee of 18 January 2017
Lead Governing Body Member: Peter Myers Category of Paper Tick as
appropriate
()
Report Author: Helena Coates, Governance Manager
Decision
Discussion
Information
Approved by Lead Governing Body member (Y/N): Yes
EXECUTIVE SUMMARY:
This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Joint Finance and Commissioning for Value Committee held on 18 January 2018.
RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.
Description of key items of business discussed and key outcomes
Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Joint Finance and Commissioning for Value Committee held on 18 January 2018. Further information can be obtained by reference to the minutes of that meeting. 1. Financial performance
Performance remained on target.
2. Quality, Innovation, productivity and Prevention (QIPP)
The Committee was provided with an update on progress in establishing a process to manage QIPP. A summary list of identified QIPPs was discussed, including that related to Leeds Community Healthcare (LCH). The commissioning plans in relation to LCH were further discussed in a detailed presentation about Neighbourhood Teams and Community Beds later in the meeting.
2
3. Database of Commissioning Activity The Committee was updated about the development of the data bank of information which would assist across the CCG, notably for commissioners in commissioning services, and for identifying the impact of changes on different patient groups.
Strategies/Policies approved
None
Items of positive assurance or issues to be raised with Leeds Health Commissioning and System Integration Board
The Committee was impressed by the developments in relation to the data bank, and the amount of work which had gone into establishing this flag ship project.
Any additional comments
None.
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Agenda Item: LHCB 17/82 FOI Exempt: No
NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Chair’s Summary – Interim Patient Assurance Group of 23 November 2017
Lead Governing Body Member: Angie Pullen, PPI Lay Member
Category of Paper Tick as
appropriate
()
Report Author: Helena Coates, Governance Manager
Decision
Discussion
Information
Approved by Lead Governing Body member (Y/N): Y
EXECUTIVE SUMMARY:
This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Interim Patient Assurance Group (PAG) meeting held on 23 November 2017.
RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.
Description of key items of business discussed and key outcomes
Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Interim Patient Assurance Group (PAG) held on 23 November 2017. Further information can be obtained by reference to the minutes of that meeting.
1) The Commissioning Cycle – The Interim PAG had received information about the commissioning cycle and the process for identifying commissioning priorities and decommissioning and the points in that process when engagement took place. It requested that if there were a diagram produced setting out the structure of West Yorkshire, city wide and locality commissioning and decommissioning that this be provided to the members of the Interim PAG.
2) Patient Assurance Group Tracker and Outstanding Action List – The Interim PAG had requested that the PAG Tracker which recorded information about engagements including low level engagements upon which the Interim PAG were not consulted be updated.
2
3) Interim Patient Assurance Group Code of Conduct – The Interim PAG had considered a Code of Conduct and explored whether or not one was necessary. It determined to consider the issue at a forthcoming workshop.
Strategies/Policies approved
None
Items of positive assurance or issues to be raised with Governing Body/Leeds Health Commissioning and System Integration Board
The Interim PAG was assured of public and patient engagement in respect of the following:-
1) Grange Medicare Limited
2) Maternity Homebirth Pathway (Level 2)
3) Maternity Bereavement Pathway (Level 2)
Any additional comments
A workshop was held on 14 December 2017 which assisted the Interim PAG in looking at what a Leeds PAG could look like from April 2018. Prior to the workshop members were given the opportunity to complete a Committee Effectiveness Survey which enabled exploration of:-
how the meetings should be managed and chaired,
the benefit of having suggested questions to aid, but not prescribe, discussion;
views about how wide the debate should be permitted to go, and whether this should focus on the assurance of engagement, and
the different expectations of the members of the Interim PAG as to how long the meetings should run.
Role of the Interim PAG Following discussion, there were no amendments proposed to the Terms of Reference. Code of Conduct Following significant discussion it was determined that there was no need for a Code of Conduct at present. Recruitment to new PAG It was confirmed that existing PAG members would be formally notified of the end of their term of office. This was a formality which was required in order to build the new CCG’s PAG. There was a unanimous view that there needed to be a proper induction for members of the new PAG, supported by a role description and development sessions/team building sessions.
Agenda Item: LHCB 17/83 FOI Exempt: No
NHS Leeds CCGs Partnership Leeds Health Commissioning and System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Chair’s Summary – Clinical Commissioning Forum of 17 January 2018
Lead Governing Body Member: Dr Alistair Walling Category of Paper Tick as
appropriate
()
Report Author: Helena Coates, Governance Manager
Decision
Discussion
Information
Approved by Lead Governing Body member (Y/N): Yes
EXECUTIVE SUMMARY:
This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Clinical Commissioning Forum (CCF) held on 17 January 2018.
RECOMMENDATION: The Board is asked to: (a) RECEIVE the report.
Description of key items of business discussed and key outcomes
Please note that this is a brief summary of the items considered and decisions taken at the meeting of the Clinical Commissioning Forum (CCF) held on 17 January 2018. Further information can be obtained by reference to the minutes of that meeting. 1. Terms of Reference and Role of the Clinical Commissioning Forum
There was a discussion concerning changes to the Terms of Reference. Some changes are proposed for the new organisation. It was recognised that the landscape will probably look very different in the future as the accountable care system develops, and that the Terms of Reference will need to be revisited again later in the year. One of the current challenges was a lack of understanding about the different roles of CCF, Members Meetings, TARGET, Practice Newsletter etc. The CCF was supportive of the changes proposed.
2. Quality Improvement Schemes (QIS)
The Forum considered proposals for changing the QIS. There was a discussion about
2
whether to adopt a more prescriptive approach in terms of outcomes, which reflected feedback which had been given by practices at members meetings. While the CCF were supportive of the indicators being put forwards there was concern and discussion around whether these offer any drive for practices to collaborate and work together. Members discussed the need to look at schemes supporting this as well as schemes which help practices individually.
3. TARGET Looking to the future it was proposed that TARGET report through to the CCF, and no objections were raised to this proposal. The annual TARGET primary care conference would take place on 21 June 2018.
4. Local Care Partnerships There was a presentation about the development of leadership and Local Care Partnerships. Models for the operation of this were discussed. GPs were asked to focus on what their role was and what they needed around them to deliver this. There was agreement of these as a way forwards and discussion around a need to help these develop and allow them to grow. It was discussed how they will vary in capability and also how population needs will vary and a need in future schemes to support this work to give the best impact for the population, working from current baselines.
5. Draft Primary Care Workforce Strategy The CCF was presented with the draft strategy and comments were welcomed. There was until 31 January 2018 to provide a response.
Strategies/Policies approved
None
Items of positive assurance or issues to be raised with Leeds Health Commissioning and System Integration Board
There is a need to clarify the different roles of the clinical groups, e.g. the CCF, Members Meetings, TARGET, Practice Newsletter etc. to ensure that there is not duplication and that the right body is involved in decisions being taken by the CCGs.
Any additional comments
1
Agenda Item: LHCB 17/84 FOI Exempt: No
NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting
Date of meeting: 25 January 2018
Title: Chair’s Summary of Quality & Performance Committee Meeting held on 11 January 2018
Lead Board Member: Dr Steve Ledger, Lay Member, Assurance and Chair – Quality & Performance Committee
Category of Paper Tick as
appropriate
()
Report Author: Dr Steve Ledger
Decision
Discussion
Information
Approved by Lead Board member (Y/N): Y
EXECUTIVE SUMMARY:
1. This report provides the Leeds Health Commissioning and System Integration Board with a summary of items discussed, outcomes and risks identified at the Quality & Performance Committee meeting held on 11 January 2018.
RECOMMENDATION: The Leeds Health Commissioning & System Integration Board is asked to: (a) RECEIVE the report.
Description of key items of business discussed
1. Please note that this is a brief summary of the items considered and decisions taken at the
meeting of the Quality & Performance Committee on 11 January 2018. Further information can be obtained by reference to the minutes of that meeting.
Actions from Previous Meetings 2. At previous meetings the Committee has considered delayed outpatient appointments and
discussions have taken place around the social impacts of delays. Leeds Teaching Hospitals NHS Trust (LTHT) has confirmed that there is a process in place for clinical prioritisation, followed by a validation process. LTHT will present details of the validation process at their next Quality Meeting and will consider any suggested improvements.
3. An update was provided in relation to stroke performance, particularly Early Supported Discharge (ESD). Local trusts and CCGs have been contacted to clarify how they interpret the guidance around ESD, however no response has been received. It was agreed that this should be progressed with colleagues working as part of the STP stroke workstream.
4. Assurance on performance around ESD is currently limited, given a current lack of clarity
2
as to how many stroke patients are having their needs met in the out-of-hospital setting, with some further concerns over recruitment gaps in the relevant clinical teams. Confirmation is also awaited around the level of proposed further investment in this service. Further updates will be provided.
Information Governance 5. The Committee received assurance in relation to the CCGs’ information governance (IG)
arrangements. The newly appointed Data Protection Officer attended the meeting and provided an overview of her role and the General Data Protection Regulations, which come into force in May 2018. The Committee noted that IG training levels were behind target, and it was agreed that there was limited assurance in relation to the oversight and management of workforce related issues within the CCG. It was agreed to escalate this issue to the Board.
Integrated Quality & Performance Report (IQPR) 6. The Committee was informed that the three key areas of underperformance were the 62
day cancer target, referral to treatment times and the A&E four hour standard. It was noted that the 62 day cancer target had not been achieved in Leeds since December 2016, and was being impacted by continued pressures on beds. The Leeds Cancer Strategy has been developed and the Accelerate, Coordinate, Evaluate (ACE) project is being implemented. The aim is to increase early diagnosis and reduce emergency presentations. Any serious harm resulting from delays is reported as part of the Serious Incident framework.
7. Referral to treatment times are being impacted by cancelled elective surgery, and a small number of patients are waiting over 52 weeks. The number of patients waiting over 40 weeks is also increasing.
8. In relation to the A&E standard, demand is at a similar level to the previous year.
Admissions are marginally lower but length of stay has increased. Delayed Transfers of Care have been reviewed and it was found that further action could have been taken in relation to only two patients.
9. Assurance had been sought at the LTHT Quality Meeting regarding the trust’s processes
for patients staying in non designated areas. The CQC have visited to assess this and feedback is awaited. This will be discussed at the next Quality Meeting with LTHT.
10. The Urgent Care Contract Manager presented the Urgent Care Dashboard to provide assurance of the monitoring and oversight of performance in this area.
Quality Surveillance Process 11. The Head of Clinical Governance presented the Quality Surveillance Process, which has
been produced as an interactive tool to provide a coordinated structure to quality monitoring within the CCG. The tool includes four levels of quality surveillance:
1- Routine Surveillance 2- Routine Plus Surveillance 3- Enhanced Surveillance 4- Formal Action
3
12. The Committee was supportive of the process which is designed to be used with all types of provider. It is already in use within the CCG. An example was given as to how its application recently has provided a coordinated approach to supporting a GP practice (in enhanced surveillance) to improve.
Providers Under Enhanced Surveillance 13. The Committee received a summary of the seven providers that were currently under
enhanced surveillance and the actions being taken as a result.
CCG Risk Register 14. The risk register was presented. There was one new red risk, relating to the risk of surges
in demand impacting on system capability and capacity to respond to need. Members discussed the mutual aid approach which had been agreed across organisations. It was acknowledged that the approach was being tested and changed as appropriate.
15. It was confirmed that successful bids had been made to NHS England for additional funding, including £1.2m for LTHT for additional transitional beds, £600k to support the flow of Elderly Mentally Infirm (EMI) patients, and £100k to support additional capacity in primary care.
Safeguarding Update 16. The Deputy Director of Nursing provided assurance of the CCG’s safeguarding
arrangements. The implications of the ‘Working Together to Safeguard Children’ statutory guidance were being considered. Any concerns about the CCGs’ ability to fulfill its new responsibilities would be reported to the Committee.
Ambulance Response Pilot 17. The Director of Commissioning presented an update on the Ambulance Response Pilot,
which has led to an improvement of 8% in the 8 minute emergency target. The programme is now live in all ambulance trusts nationally and a Spring Review is expected from NHS England to finalise the standards.
Patient Experience Update 18. The Committee received an update on the outcomes of the Patient Insight Group, which
reviews patient experience information from a variety of sources. The outcome of the review into patient experience of cancer services in Leeds has been provided to the CCG Programme Manager for cancer. It was agreed to check how this feedback has been used by the commissioning team and an update will be provided to the Committee at the next meeting.
Committee Work Plan 19. The Committee will receive assurance on the Transforming Care Programme in March. It
was agreed that the six monthly safeguarding updates were not required as the Committee receives the minutes of the Safeguarding Committee at each meeting, as well as annual reports from the CCG Safeguarding Team, Leeds Safeguarding Children Board and Leeds Safeguarding Adults Board.
Strategies/Policies approved
The Committee approved the following updated policies:
4
Information Governance Strategy
Information Governance Policy and Framework
Confidentiality and Data Protection Policy
Items of positive assurance or issues to be raised with the Leeds Health Commissioning and System Integration Board
The Committee wishes to highlight the following issues:
Limited assurance in relation to the oversight and management of workforce related issues, including statutory and mandatory training.
Any other Comments
N/A
1
Agenda Item: LHCB 17/86 FOI Exempt: No
NHS Leeds CCGs Partnership: Leeds Health Commissioning & System Integration Board
Date of meeting: 25th January 2018
Title: The Integrated Quality and Performance Report
Lead Governing Body Members: Sue Robins, Director of Commissioning Jo Harding, Director of Nursing and Quality
Category of Paper Tick as
appropriate
()
Report Author: Various
Decision
Reviewed by EMT/SMT/Date: n/a
Discussion
Reviewed by Committee/Date: Quality & Performance Committee, 11h January 2018
Information
Checked by Finance (Y/N/N/A - Date): n/a
Approved by Lead Governing Body member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
N/A
Financial Implications N/A
Communication and Involvement Issues N/A
Workforce Issues N/A
Equality Issues including Equality Impact assessment
N/A
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
N/A
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EXECUTIVE SUMMARY:
This report provides assurance to the organisation that we are delivering against the requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.
The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:
NHS Constitution and Operational Planning
CCG Improvement and Assessment Framework
Quality and Safety
Commissioning for Quality and Innovation (CQUIN)
The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.
NEXT STEPS:
The key actions which will be undertaken in relation to performance are as follows:
To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.
The key actions which will be undertaken in relation to the development of the IQPR are as follows:
To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;
To work with commissioning teams to develop a minimum of three-year work plans as part of a broader commissioning and performance management framework, which will provide strategic milestones for inclusion within the IQPR.
RECOMMENDATION:
The Board is asked to:
a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the current areas of underperformance and mitigating action; and
b) SUPPORT the continued development of the IQPR.
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PURPOSE OF REPORT
1.1 This report provides assurance to the organisation that we are delivering against the
requirements of the NHS Mandate and Constitution which embed the priorities of our local populations. Where performance falls below the expected standards, remedial action is described.
1.2 The narrative provides an update by exception on key themes and current issues and should be read in conjunction with the dashboards. The dashboards provide a high-level view of how the CCG is progressing in delivering is strategic objectives. The dashboards included with this report are:
NHS Constitution and Operational Planning
CCG Improvement and Assessment Framework
Quality and Safety
Commissioning for Quality and Innovation (CQUIN)
1.3 The indicators and metrics in each dashboard have been chosen to provide a balanced view for each sector. Please note that the metrics are flexible and may change depending on sustained performance.
2. SUMMARY OF KEY PERFORMANCE ISSUES
2.1 Planned Care and Long Term Conditions
Referral to Treatment times continues to be below the required standard although performance is improving gradually through a continued focus on outpatient and day case work to offset the difficulties in treating patients requiring beds for overnight stay.
There were 2 Leeds patients who had waited over 52 weeks at the end of September, one of whom had still not been treated at the end of October. Staffing and capacity issues were cited as reasons for delay in both cases. Both breaches have been investigated and some administrative issues identified as part of the investigation. These have been addressed and staff supported to ensure implementation.
Underperformance against the three 62 day cancer targets continues to be a problem although there are some improvements and the numbers for screening and upgrades are low. There are continued pressures on beds, particularly on the St James’s site which have led to some cancellations both for diagnosis and treatments on cancer pathways. Late referrals from other providers continue to impact on overall performance.
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2.2 Unplanned Care
The 4 hour A&E waiting time was delivered in 79.7% of cases at LTHT during November 2017 (against the 95% standard). A&E demand is similar to the same period last year, admissions are marginally lower yet length of stay and bed occupancy has increased. The number of long stays (ie. 30+ and 90+ days) has increased also. Flow out of the hospital is restricting timely flow in to it. A review of delayed transfers of care has been undertaken but it found only two patients had further action that could be taken to extradite discharge. Further work is required to understand why there remains an issue with flow out of the hospital.
In July 2017, the Secretary of State for Health accepted NHS England’s recommendation to implement new ambulance performance standards. These standards are focused on patients’ clinical needs, and will help to ensure consistent, rapid responses to those who genuinely need them, reduce long waits. This change is a result of the Ambulance Response Pilot (ARP) which Yorkshire Ambulance Service (YAS) have been part of since August 2015.
From the 1st April 2018 YAS and all ambulance trust will be measured nationally on the following revised performance measures:
o Respond to Category 1 calls in 7 minutes on average, and respond to 90% of Category 1 calls in 15 minutes
o Respond to Category 2 calls in 18 minutes on average, and respond to 90% of Category 2 calls in 40 minutes
o Respond to 90% of Category 3 calls in 120 minutes o Respond to 90% of Category 4 calls in 180 minutes.
YAS, with support from commissioners have agreed to implement these performance measures from September 2017 at a Trust level.
2.3 Mental Health and Learning Disabilities
Improving Access to Psychological Therapies (IAPT) access continues to be below target. The target for 17/18 is for 16.8% of the prevalent population to be accessing IAPT support by the end of March 2018; the latest performance for Leeds is 7.9% against a year-to-date target of 9.8%. Considerable work is being carried out by providers to increase access. A recovery plan is in place which is monitored by monthly submissions to MH commissioners and quarterly performance meetings.
2.4 Children’s and Maternity
Although the one week waiting time for urgent referrals to the eating disorder service was not met in the 12 months ending in September 2017 for Leeds, this represents one child not being referred within 1 week out eleven. Performance for the city has been at 100% for the last three months (Sept-Nov).
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2.5 Continuing Healthcare (CHC)
We are currently underperforming against the two Continuing Healthcare Quality Premium measures. We are placing a Continuing Care Nurse to work with the Leeds Integrated Discharge Service in LTHT to provide support and determine if further actions can be put in place to facilitate discharge and are developing the Discharge to Assess pathways to ensure potential CHC patients have access.
Following the successful pilot, the Leeds Frailty Unit, situated at SJUH Emergency Department, has reopened. The unit will run weekdays and supported by geriatricians, advanced nurse practitioners and therapists from the LIDS team. During the pilot phase the clinical and system flow outcomes were very positive and this was mirrored in the patient experience measures.
2.6 Neighbourhood Care
There are a total of 227 Community Intermediate Care beds commissioned of which 213 are currently mobilized. Full capacity will be available in January 2018. We are beginning to develop a process for the identification of delayed discharges in conjunction with the bed bureau and adult social care and intend to report these against the delayed transfer of care definitions.
The number of patient contacts in the neighbourhood teams has been below profile since February 2017 although it is thought that the decrease in contacts is due to a positive change in care delivery. Higher numbers of interventions are now being delivered in fewer contacts as the service is delivered more efficiently to patients.
2.7 Proactive Care and Population Commissioning
The rate of uptake of Personal Health Budgets (PHBs) across the city is currently below our trajectory although we remain focused on achieving the mandated target of delivering 540 PHBs by March 2019 (a rate of 62.2 per 100,000). PHBs are currently being offered to those in receipt of continuing healthcare (children and adults) and people with a learning disability. There is also a small pilot underway in mental health (due to end soon).
We are working towards offering personal wheelchair budgets from April 2018; this will enable us to significantly increase our PHB figures. Approximately 500 patients are referred into the wheelchair service per quarter. We are aiming for 100% coverage (i.e. all patients referred into the service will be offered a Personal Wheelchair Budget) from April 2018.
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3. CCG IMPROVEMENT AND ASSESSMENT FRAMEWORK – 2017/18 Q1 UPDATE 3.1 The CCG Improvement and Assessment Framework (CCG IAF) was introduced in 2016/17
and provides a focus on assisting improvement alongside the statutory assessment function of NHS England. It aligns with NHS England’s Mandate and planning guidance, with the aim of unlocking change and improvement in a number of key areas. This approach aims to reach beyond CCGs, enabling local health systems and communities to assess their own progress from ratings published online.
3.2 For 2017/18, a small number of indicators have been added, a number of updates have been made to existing indicators, and some indicators have been removed. The framework includes a set of 51 indicators (a reduction from 60), although data for 10 indicators is currently unavailable.
3.3 The table below lists the measures within the framework where performance is shown to be within the worst quartile nationally for the Leeds CCGs. 2017/18 CCG IAF - Within the ‘worst quartile’ nationally North South/East West
Children aged 10-11 classified as overweight or obese
People with diabetes diagnosed less than a year who attend a structured education course
Injuries from falls in people aged 65 and over
Provision of high quality care: adult social care
Cancers diagnosed at early stage
Improving Access to Psychological Therapies – recovery rate
Improving Access to Psychological Therapies – access rate
People with first episode of psychosis starting treatment with a NICE-recommended package of care treated within 2 weeks of referral
Proportion of people with a learning disability on the GP register receiving an annual health check
Emergency admissions for urgent care sensitive conditions
Population use of hospital beds following emergency admission
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3.4 The table below lists the measures within the framework where performance is shown to be within the best quartile nationally for the Leeds CCGs. 2017/18 CCG IAF - Within the ‘best quartile’ nationally North South/East West
Antimicrobial resistance: appropriate prescribing of broad spectrum antibiotics in primary care
Provision of high quality care: hospital setting
Provision of high quality care: primary medical services
Cancers diagnosed at early stage
One-year survival from all cancers
Cancer patient experience
Improving Access to Psychological Therapies – recovery rate
Maternal smoking at delivery
Neonatal mortality and stillbirths
Women’s experience of maternity services
Estimated diagnosis rate for people with dementia
Dementia care planning and post-diagnostic support
Patient experience of GP services
Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting
Effectiveness of working relationships in the local system
3.5 Actual performance against the measures used in the CCG IAF is displayed in the
indicator tables accompanying this report.
4. COMMISSIONING FOR QUALITY AND INNOVATION (CQUIN) – 2017/18 Q1 UPDATE 4.1 The CQUIN scheme is intended to deliver clinical quality improvements and drive
transformational change. With these objectives in mind the scheme is designed to support the ambitions of the Five Year Forward View and directly link to the NHS Mandate and it now focuses two areas covering Clinical quality and transformational indicators, and supporting local areas by providing consideration to Sustainability and Transformation Plans and local financial sustainability.
4.2 Reducing impact of serious infections – LTHT has partially achieved this CQUIN at Q1. There has been a lot of progress towards providing timely treatment of sepsis in emergency departments and acute inpatient settings however the 90% target for intravenous antibiotics within 1 hour has been identified as a challenge and there is debate nationally about the appropriateness of the 1 hour target. It is recognised that prompt treatment is important but this may not always mean within 1 hour in terms of outcome. Local audits of this measure have shown that the median time to antibiotics is around 1.5 to 2 hours. Mortality for this group of patients is also monitored and is with the ‘expected’ range. This CQUIN will continue to be overseen by the sepsis group.
4.3 Transitions out of Children and Young People’s Mental Health (CYPMH) Services – This CQUIN requires effective partnership working between LCH, provider of CYPMH services and LYPFT as the provider of adult services to collaborate in order to meet the requirements. During Q1 and Q2 efforts have been made by LYPFT to engage with LCH in order to progress this, unfortunately this has not been successful and the requirements
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have not been met in this quarter. However commitment and agreement is now in place to progress this work and ensure that by the end of Q3 the milestones required for Q2 (no milestones specified for Q1 and Q3) will be met and on track to achieve the requirements for Q4. LYPFT acknowledge that this is an unsatisfactory position and that achieving effective, safe, and good quality transfer of young people from CYPHM services to our services is essential in achieving safe clinical care and a positive experience for young people. In recognition of this however LYPFT has had in place with LCH a focus on young people transitioning to our services over many years, this has led to the development of joint protocols to support effective transitions of care. Partnership working and collaboration between clinicians and operational managers is in place along with mechanisms and approaches to review the effectiveness of this. LYPFT has assured the CCG that whilst the CQUIN requirements for this quarter have not as yet been met this is not indicative of the focus and importance the Trust place on achieving successful transfer/transition of care.
5. NEXT STEPS
5.1 The key actions which will be undertaken in relation to performance are as follows:
To continue to closely monitor the commissioner and provider-led actions in relation to areas of underperformance.
5.2 The key actions which will be undertaken in relation to the development of the IQPR are as
follows:
To continue working closely alongside colleagues in local and citywide commissioning teams, Informatics and Quality in the development of the report and identification of local measures;
To work with commissioning teams to develop a minimum of three-year work plans as part of a broader commissioning and performance management framework, which will provide strategic milestones for inclusion within the IQPR.
6. RECOMMENDATION
The Board is asked to:
a) RECEIVE AND REVIEW the IQPR dashboards; discuss the information, note the
current areas of underperformance and mitigating action; and b) SUPPORT the continued development of the IQPR.
Indicator Tables
NHS Constitution and Operational Planning Measures Page 2‐3
CCG Improvement and Assessment Framework Page 4‐5
Quality and Safety Page 6
Commissioning for Quality and Innovation (CQUIN) Page 7
RAG Rating
92.5%
88.0%
85.0%
Interpreting Trends
'Green' performance would be ≥ 92%
'Amber' performance would be 87.4% ≤ x < 92%
'Red' performance would be < 87.4%
Performance measures shown to be 'Amber' should still be interpreted as
underperforming ‐ a RAG rating has only been applied to serve as a visual guide
to understand how close performance is to the expected standard.
They should not be interpreted as being currently within a tolerance level.
Trend analysis is currently based upon comparing the latest performance with
the performance in the previous period.
A green arrow represents an improvement in performance
An amber arrow represents no change in performance
A red arrow represents a deterioration in performance
The Integrated Quality and Performance Report
Report Period: October 2017
Contents
Report Key
Note: The RAG rating applied within this report is based upon calculating a limit
of 5% higher/lower relative to the expected standard/target.
For example, if the expected Standard is a minimum of 92%...
Measure Period Target Leeds
North
Leeds S&E Leeds
West
Leeds Leeds (YTD) Leeds
Trend
NHS Constitution
RTT Incomplete Pathway Oct‐17 92% 92.3% 91.3% 91.5% 91.6% 91.1%
Diagnostic Waiting Times Oct‐17 99% 99.8% 99.9% 99.8% 99.8% 99.6%
Cancer ‐ 2 Week Wait Oct‐17 93% 95.7% 94.0% 95.2% 94.9% 95.1%
Cancer ‐ 2 Week Wait (Breast) Oct‐17 93% 95.3% 89.5% 96.0% 93.6% 95.5%
Cancer ‐ 31 Day First Treatment Oct‐17 96% 97.6% 96.9% 97.8% 97.5% 96.7%
Cancer ‐ 31 Day Surgery Oct‐17 94% 96.0% 92.0% 95.8% 94.6% 95.9%
Cancer ‐ 31 Day Drugs Oct‐17 98% 100% 100% 100% 100% 99.9%
Cancer ‐ 31 Day Radiotherapy Oct‐17 94% 100% 100% 100% 100% 100%
Cancer ‐ 62 Day GP Referral Oct‐17 85% 83.7% 75.0% 82.6% 80.6% 83.5%
Cancer ‐ 62 Day Screening Oct‐17 90% 91.7% 50.0% 62.5% 71.9% 86.3%
Cancer ‐ 62 Day Upgrade Oct‐17 90% 100% 66.7% 90.9% 83.3% 84.1%
A&E
A&E Waiting Times ‐ % 4 hours or less (LTHT) Nov‐17 95% 79.7% 86.1%
Ambulance
Ambulance Calls Closed by Telephone Advice
(YAS Trust Total)Aug‐17 9.2% 8.7%
Incidents Managed Without Need for Transport to A&E
(YAS Trust Total)Oct‐17 30.9% 32.0%
Mental Health
Dementia ‐ Estimated Diagnosis Rate Nov‐17 66.7% 69.7% 81.5% 74.2% 75.3% 74.6%
IAPT Access (YTD) Oct‐17 9.8% 7.1% 7.2% 8.8% 7.9% 7.9%
IAPT Recovery Oct‐17 50% 53.4% 56.8% 53.8% 54.6% 54.6%
IAPT Waiting Times ‐ 6 Weeks Oct‐17 75% 93.5% 98.2% 94.9% 99.7% 96.0%
IAPT Waiting Times ‐ 18 Weeks Oct‐17 95% 100% 100% 99.3% 95.5% 98.9%
EIP ‐ Psychosis treated within two weeks of referral Oct‐17 50% 75.0% 80.0% 80.0% 78.6% 73.2%
Improve access rate to CYPMH 30%
Waiting Times for Routine Referrals to CYP Eating Disorder Services ‐ Within 4
Weeks
12 months to
Q2 2017/1860% 88.5% 91.2% 89.3% 89.8%
Waiting Times for Urgent Referrals to CYP Eating Disorder Services ‐ Within 1
Week
12 months to
Q2 2017/1895% 100% 100% 75.0% 90.9%
Other Commitments
E‐Referral Coverage Nov‐17 80% 71.0% 64.6% 68.3% 67.7%
Personal Health Budgets (per 100,000) ‐ YTD 2017/18 Q225.6
(Leeds)16.7 14.1 15.9 15.5
Children Waiting no more than 18 Weeks for a Wheelchair 2017‐18 Q2 92% 97.1% 98.3% 94.7% 97.6% 95.5%
Extended access (evening and weekends) at GP services Dec‐1750% by
March 0.0% 31.0% 100% 53.0%
LD Patient Projections
Reliance on Inpatient Care for People with LD or Autism ‐ CCGs Nov‐17 18 24
Reliance on Inpatient Care for People with LD or Autism ‐ NHS England Nov‐17 23 20
NHS Constitution and Operational Planning MeasuresPerformance Measures (1 of 2)
No data currently available
Page 2
Measure Period Target Leeds
North
Leeds S&E Leeds
West
Leeds Leeds (YTD) Leeds
Trend
Quality Premiums (QP)
Cancers diagnosed at early stage (detected at stage 1 and 2)*12 months to
Q1 2016/17tbc 53.2% 47.1% 51.2% 50.4%
Overall experience of making a GP appointment Jan‐Mar 17 tbc 74.5% 69.6% 78.7% 74.9%
NHS CHC eligibility decision made within 28 days 2017/18 Q2 >80% 47.0% 56.0% 47.0% 50.0% 50.0%
Full NHS CHC assessments taking place in an acute hospital setting 2017/18 Q2 <15% 14.1% 26.1% 19.4% 20.5% 20.5%
Recovery rate of people accessing IAPT services identified as BAME Sep‐17 tbc 40.0% 42.1% 38.7% 39.0% 15.7%
Proportion of people accessing IAPT services aged 65+ Sep‐177.3%
(Leeds)5.1% 5.7% 3.9% 4.7% 4.7%
Whole health economy ‐ E. coli blood stream infections (12 months) Oct‐17480
(Leeds)139 236 244 619 347
Whole health economy ‐ collection and reporting of a core primary care data
set for all E coli BSI from Q2 2017/18Q2 2017/18 n/a
Antibiotic prescribing for UTI in primary care ‐ Trimethoprim: Nitrofurantoin
prescribing ratio*
12 months to
Sept 20170.67 0.48 0.48 0.42 0.46
Antibiotic prescribing for UTI in primary care ‐ number of trimethoprim items
prescribed to patients aged ≥70 years*
12 months to
Sept 201711,803 2,283 3,077 3,423 8,783
Prescribing in primary care ‐ items per STAR‐PU*12 months to
Sept 20171.161 1.007 1.110 0.977 1.031
Reported to estimated prevalence of hypertension (%) Q2 2017/1857.6%
(Leeds)57.8% 59.5% 54.4% 56.3%
* Average of CCGs
No data currently available
NHS Constitution and Operational Planning MeasuresPerformance Measures (2 of 2)
Page 3
Value Trend Value Trend Value Trend
Percentage of children aged 10‐11 classified as overweight or obese13/14 to
15/160.0% 31.4% 37.0% 33.7%
Diabetes patients that have achieved all the NICE recommended treatment targets: three (HbA1c,
cholesterol and blood pressure) for adults and one (HbA1c) for children2015‐16 0.0% 37.5% 38.2% 39.1%
People with diabetes diagnosed less than a year who attend a structured education course 2014 0.0% 0.8% 0.6% 0.4%
Injuries from falls in people aged 65 and over 16‐17 Q4 0.0% 1,824 2,599 2,462
Personal health budgets ‐ rate per 100,000 17‐18 Q1 0.0% 16 12 14
Inequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care
sensitive conditions16‐17 Q4 0.0% 1,946 2,290 2,273
Antimicrobial resistance: appropriate prescribing of antibiotics in primary care 2017 06 1.161 1.018 1.117 0.984
Antimicrobial resistance: appropriate prescribing of broad spectrum antibiotics in primary care 2017 06 10.0% 6.1% 6.6% 6.4%
The proportion of carers with a long term condition who feel supported to manage their condition
Provision of high quality care: hospital 17‐18 Q1 0.0% 62 61 61
Provision of high quality care: primary medical services 17‐18 Q1 0.0% 67 67 70
Provision of high quality care: adult social care 17‐18 Q1 0.0% 57 58 57
Cancers diagnosed at early stage 2015 0.0% 56.2% 48.0% 52.6%
People with urgent GP referral having first definitive treatment for cancer within 62 days of referral 16‐17 Q4 85.0% 83.6% 81.2% 82.5%
One‐year survival from all cancers 2014 0.0% 72.5% 70.8% 70.5%
Cancer patient experience 2016 0.0% 8.8 8.9 8.8
Improving Access to Psychological Therapies – recovery 2017 06 50.0% 52.1% 48.1% 56.5%
Improving Access to Psychological Therapies – access 2017 07 0.0% 2.3% 2.2% 2.5%
People with first episode of psychosis starting treatment with a NICE‐recommended package of
care treated within 2 weeks of referral2017 08 50.0% 61.5% 72.2% 67.0%
Children and young people’s mental health services transformation
Mental health out of area placements
Mental health crisis team provision
Reliance on specialist inpatient care for people with a learning disability and/or autism 17‐18 Q1 0.0% 67 67 67
Proportion of people with a learning disability on the GP register receiving an annual health check 2015‐16 0.0% 36.5% n/a 30.2% n/a 38.2% n/a
Completeness of the GP learning disability register
Maternal smoking at delivery 17‐18 Q1 0.0% 5.6% 11.9% 10.8%
Neonatal mortality and stillbirths 2015 0.0% 3.63 n/a 5.39 n/a 1.75 n/a
Women’s experience of maternity services 2015 0.0% 80.12 n/a 83.26 n/a 78.93 n/a
Choices in maternity services 2015 0.0% 67.34 n/a 67.73 n/a 63.99 n/a
Estimated diagnosis rate for people with dementia 2017 08 66.7% 70.6% 80.6% 73.3%
Dementia care planning and post‐diagnostic support 2015‐16 0.0% 80.4% 82.1% 81.9%
Emergency admissions for urgent care sensitive conditions 16‐17 Q4 0.0% 2,361.2 3,383 2,786
Percentage of patients admitted, transferred or discharged from A&E within 4 hours 2017 09 95.0% 88.0% 86.6% 86.8%
Delayed transfers of care attributable to the NHS per 100,000 population 2017 08 0.0% 14.4 15.5 15.1
Population use of hospital beds following emergency admission 16‐17 Q4 0.0% 562.5 628.8 584.2
Percentage of deaths with three or more emergency admissions in last three months of life
Patient experience of GP services 2017 0.0% 86.5% 84.7% 89.6%
CCG Improvement and Assessment FrameworkPerformance Measures (1 of 2)
Measure Period Standard /
Target
Leeds North Leeds S&E Leeds West
Better Health
Better Care
Data currently unavailable
Data currently unavailable
Data currently unavailable
Data currently unavailable
Data currently unavailable
Data currently unavailable
Page 4
Value Trend Value Trend Value Trend
Primary care access – percentage of registered population offered full extended access
Primary care workforce 2017 03 0.0% 1.01 0.98 0.97
Patients waiting 18 weeks or less from referral to hospital treatment 2017 08 92.0% 91.6% 91.1% 90.4%
Achievement of clinical standards in the delivery of 7 day services
Percentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting 17‐18 Q1 0.0% 4.1% n/a 11.4% n/a 5.1% n/a
Evidence that sepsis awareness raising amongst healthcare professionals has been prioritised by
the CCG
In‐year financial performance 17‐18 Q1 0.0% Green 0 Green 0 Green 0
Utilisation of the NHS e‐referral service to enable choice at first routine elective referral 2017 06 0.0% 67.2% 50.6% 56.7%
Probity and corporate governance 17‐18 Q1 0.0%Fully
Compliant
Fully
Compliant0
Fully
Compliant0
Staff engagement index 2016 0.0% 3.8 3.7 3.8
Progress against the Workforce Race Equality Standard 2016 0.0% 0.11 n/a 0.12 n/a 0.12 n/a
Effectiveness of working relationships in the local system 16‐17 0.0% 78.6 68.1 72.5
Compliance with statutory guidance on patient and public participation in commissioning health
and care
Quality of CCG leadership 17‐18 Q1 0.0% Green 0 Green 0 Green 0
Assessment Rating 2016/17 Good Good Good
CCG Improvement and Assessment FrameworkPerformance Measures (2 of 2)
Measure Period Standard /
Target
Leeds North Leeds S&E Leeds West
CCG IAF Rating
Data currently unavailable
Data currently unavailable
Data currently unavailable
Data currently unavailable
Better Care
Sustainability
Well Led
Page 5
in period YTD in period YTD in period YTD in period YTD
Patient Safety
Serious Incidents n/aJun17‐Jul
1710 19 9 23 6 12 1 6
Never Events n/aJun17‐Jul
172 5 0 0 0 0 0 1
Mortality Rate (Standardised Hospital Mortality Index) 1.00Apr 16‐
Mar 170.967
MRSA Blood Stream Infection 0 Sep‐17 0 4
Clostridium difficile Infection 119 Total Sep‐17 12 58
Classic Safety Thermometer (Harm Free Care) 94.3% Sep‐17 95.4% No Data 98.5%
Mental Health Safety Thermometer (% feeling safe) 87.5% Sep‐17 82.2%
Patient Experience
Friends and Family Test (% recommended) ‐ A&E 87% Aug‐17 87.0% 85.8%
Friends and Family Test (% recommended) ‐ Inpatient 96% Aug‐17 95.0% 95.2%
Friends and Family Test (% recommended) ‐ Outpatient 94% Aug‐17 93.0% 93.0%
Friends and Family Test (% recommended) ‐ Maternity Antenatal 96% Aug‐17 100% 97.9%
Friends and Family Test (% recommended) ‐ Maternity Birth 96% Aug‐17 95.0% 94.3%
Friends and Family Test (% recommended) ‐ Postnatal Ward 94% Aug‐17 99.0% 98.0%
Friends and Family Test (% recommended) ‐ Postnatal Ward (Community) 98% Aug‐17 100% 98.2%
Friends and Family Test (% recommended) ‐ Mental Health 88% Aug‐17 81.0% 84.0% 100% 78.7%
Friends and Family Test (% recommended) ‐ Community 96% Aug‐17 96.0% 97.0%
Friends and Family Test (% recommended) ‐ See and Treat/Non‐Conveyance (YAS) 98% No Data
Friends and Family Test (% recommended) ‐ Patient Transport Service (YAS) 86% 67% No Data
Complaints ‐ Total Received Sep‐17 23 (Jun) 21 128
Staffing
Staff Turnover Q1 17/18 12.56%11.8%
(YAS)
Sickness Jun‐17 3.80% 5.21% 4.65%5.31%
(YAS)
Performance Measures
Quality and Safety
Measure Target /
Nat Av
Period LTHT LCH LYPFT Other*
Page 6
Improving staff health and wellbeing
Improvement of health and wellbeing of NHS staff 2017/18
Healthy food for NHS staff, visitors and patients 2017/18
Improving the uptake of flu vaccinations for frontline clinical staff 2017/18
Reducing the impact of serious infections
Timely identification of patients with sepsis in emergency departments and acute inpatient settings 17‐18 Q1
Timely treatment of sepsis in emergency departments and acute inpatient settings 17‐18 Q1
Assessment of clinical antibiotic review between 24‐72 hours of patients with sepsis who are still
inpatients at 72 hours.17‐18 Q1
Reduction in antibiotic consumption per 1,000 admissions 17‐18 Q1
Improving physical healthcare to reduce premature mortality in people with serious mental illness (PSMI)
Improving Physical healthcare to reduce premature mortality in people with SMI: Cardio Metabolic
Assessment and treatment for Patients with Psychoses17‐18 Q1 (unavailable)
Improving Physical healthcare to reduce premature mortality in people with SMI: Collaboration with
primary care clincians17‐18 Q1 (unavailable) N/A
Improving services for people with mental health needs who present to A&E
Improving services for people with mental health needs who present to A&E 17‐18 Q1
Transitions out of Children and Young People’s Mental Health Services
Transitions out of Children and Young People’s Mental Health Services (CYPMHS) 17‐18 Q1 N/A
Offering Advice and Guidance
Advice & Guidance 17‐18 Q1
e‐Referrals
e‐referrals 17‐18 Q1
Supporting proactive and safe discharge
Supporting proactive and safe discharge 17‐18 Q1 (unavailable)
Preventing ill health by risky behaviours – alcohol and tobacco
Tobacco screening 17‐18 Q1
Tobacco brief advice 17‐18 Q1
Tobacco referral and medication 17‐18 Q1
Alcohol screening 17‐18 Q1
Alcohol brief advice or referral 17‐18 Q1
Improving the assessment of wounds
Improving the assessment of wounds 17‐18 Q1
Personalised care and support planning
Personalised care and support planning 17‐18 Q1
Ambulance conveyance
Proportion of 999 incidents which do not result in transfer of the patient to a Type 1 or Type 2 A&E
Department17‐18 Q1 (unavailable)
NHS 111 referrals
Increasing the proportion of NHS 111 referrals to services other than to the ambulance service or A&E
departments17‐18 Q1 (unavailable)
End to End Reviews 17‐18 Q1
Mortality Reviews 17‐18 Q1
PTS Patient Portal 17‐18 Q1
Operational Pressures Escalation Levels Framework 17‐18 Q1
High Volume Service Users 17‐18 Q1
Patient Education 17‐18 Q1
Commissioning for Quality and Innovation (CQUIN)National Measures
Measure Period Acute Integrated
Care Prov.
Care HomeCommunity Mental Health Ambulance 111
N/A
The Leeds Alliance
(co‐located services)
Yorkshire Ambulance Service
Unknown until Spring 2018
Unknown until Spring 2018
Unknown until Spring 2018
Local Measures
One Medical Group
(Walk‐in Clinic)
Measure Period
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THIS PAGE IS INTENTIONALLY BLANK
Agenda Item: LHCB 17/86 FOI Exempt: N
NHS Leeds CCGs Partnership – Leeds Health Commissioning & System Integration Board Meeting
Date of meeting: 25th January 2018
Title: Chief Executive’s Report
Lead Board Member: Phil Corrigan, Chief Executive
Category of Paper Tick as
appropriate ()
Report Author: Phil Corrigan, Chief Executive Decision
Reviewed by EMT/SMT: N/A
Discussion
Reviewed by Committee: N/A
Information
Checked by Finance (Y/N/N/A): N/A
Approved by Lead Board member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to:
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
N/A
Financial Implications N/A
Communication and Involvement Issues
N/A
Workforce Issues N/A
Equality Issues including Equality Impact assessment
N/A
Environmental Issues N/A
Information Governance Issues including Privacy Impact Assessment
N/A
2
EXECUTIVE SUMMARY: 1. The Chief Executive’s report informs the Board of: Commissioning 2. The CCG is progressing the implementation of SKYPE for business. This will provide the functionality for teams to interact across sites remotely and support remote working and teleconferencing. In addition teams are thinking about how this medium can support patients care. 3. Winter continues to challenge the Leeds system with increasing numbers of admissions of frail elderly patients. The St James site is particularly pressured. Daily calls occur with all system partners to support the flow of patients out of hospital into community beds and services. Admissions for patients with influenza have risen over the Christmas period, but numbers are not yet deemed to be in excess of what could be expected. 4. Work is progressing to address the issue around EMI – Elderly Mentally Infirm and the services we commission for this vulnerable group. We are seeing an increasing number of complex EMI cases that are increasingly difficult to place in local long term care. The Director of Integrated Commissioning with Adult Social Care is looking into several options to support short and long term care for this group. Communications and Engagement Winter pressures 5. Leeds, like other parts of the country, has experienced an increase in pressure on services. However ahead of the expected winter pressures a communications plan was developed and put into action to look to alleviate some of the pressures being experienced. The main aim has been to encourage people to use appropriate services for common health conditions with a focus on promoting pharmacies and NHS 111 as a first port of call. In addition to this we have been providing alerts linked to health conditions that worsen during periods of colder weather – such as asthma – to ensure people have appropriate self care support in place. Our partners, in particular Leeds Teaching Hospitals NHS Trust, have been undertaking proactive media work to encourage people to think through their options rather than attending A&E where it is not appropriate to do so. 6. We have also been undertaking insight work with members of the Eastern European community with Polish, Romanian, Czech and Lithuanian people to find out more about how they currently access services, their knowledge of what support is available to them should they fall ill and what they would do in certain health scenarios. This is helping to inform a focused health awareness campaign targeting members of these communities. The work has already seen a leaflet drop take place, supported by community ambassadors such as church leaders, at targeted venues most frequented by those belonging to the communities we are looking to help. In late January we will have four language specific webpages set up providing information and advice including videos showing where people should go for common health conditions. The site will be promoted through advertising and social media and language specific media sites.
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Patient engagement 7. Grange Medicare Limited provides GP primary care services at New Cross Surgery (Rothwell), Middleton Park Surgery and Swillington Health Practice. The contract with Grange Medicare Limited ends on 31 October 2018 meaning that we need to look at future plans for the practices. An engagement process to gain the views of patients, the public and stakeholders in relation to the re-procurement of services has been undertaken to understand the primary care needs and preferences of people registered at the three practices and wider stakeholders. An engagement report will be produced and the Primary Care Commissioning Committee will use this, and other information, to make a decision about the future service model of people registered at the three practices. Workshop for Developing Outcomes for People Living with Frailty 8. The CCG Partnership hosted an event on 29 November at Weetwood Hall attended by 97 people from 32 Leeds-based stakeholders and organisations including patients, carers, commissioners, third sector, Leeds Beckett and University of Leeds, Local Authority, primary care, community care, mental health, acute trust and Yorkshire Ambulance Service. Attendees reviewed the Outcomes Framework for people living with frailty and older people at end of life, which is being developed to help test our approach to commissioning and delivering population outcomes. A final draft has been prepared and will be considered by the Leeds Integrated Commissioning Executive at the end of January. The Outcomes Framework is intended to support the delivery of our Health and Wellbeing Strategy and Leeds Health and Care Plan in that it helps bring together commissioners and providers more easily to deliver care around the needs of people, communities and population groups.
Third Sector Health Outcomes Showcase Event 9. The CCG Partnership hosted an event in collaboration with Leeds Community Foundation and New Philanthropy Capital on 8 December at Horizon Leeds. Attended by over 111 people, the event show-cased the third sector health grants programme run by the CCGs’ in Leeds over the course of 2016 and 2017. A full evaluation report of the health grants programme is currently at the printers and will made available to members of the Governing Body as soon as it is available. Draft People and Organisation Development (OD) Strategy: update 10. Between October and December 2017, as part of working towards creating a single CCG for Leeds, we undertook a period of discussion and engagement across the organisation to help us begin to develop our People and OD strategy. This included:
half day sessions for all staff where more than three hundred individual comments and
suggestions were gathered;
further engagement in focus groups on the then three sites; and
opportunities to leave additional comments and suggestions on posters.
11. We received hundreds of comments and views, and every single piece of feedback has been analysed. This will be used to help shape the strategy as feedback shows that as well as incorporating our organisational ambitions, it is important to recognise what the future needs of our people will be as our system changes around us. For example: flexibility, ability to work within change, great management and leadership skills, collaboration, working across boundaries, influencing others and so on.
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12. The strategy is still in early draft form as we are currently awaiting additional information,such as the most up to date joint workforce information. Once outstanding information is included in the draft, everyone will have the opportunity for further comment. Following any updates, the KPI baselines will be proposed in a short paper to SMT and included in the final version along with the proposed targets for the next three years.
West Yorkshire and Harrogate Joint Committee
13. Key messages from the meeting of the West Yorkshire and Harrogate Joint Committeemeeting held on 9 January 2018 are attached at Appendix 1.
RECOMMENDATION:
The Leeds Health Commissioning & System Integration Board is asked to: (a) Receive the Chief Executive’s report.
Notes
The Joint Committee has delegated powers from the WY&H CCGs to make collective decisions on specific, agreed WY&H work programmes, including mental health, urgent care, cancer and stroke. It can also make recommendations to the CCGs. The Committee supports the wider STP, but does not represent all of the partners.
Agenda papers and further information are available from the Joint Committee web pages: http://www.wyh-jointcommiteeccgs.co.uk/ or contact Stephen Gregg, Governance Lead [email protected].
West Yorkshire & Harrogate (WY&H) Joint Committee of Clinical Commissioning Groups
Meeting held in public on Tuesday 9 January 2018
Summary of key decisions
West Yorkshire and Harrogate Cancer Alliance update
The Joint Committee viewed videos about the experience of patients with cancer, highlighting variation in general practice and the need for effective early diagnosis, supported by high quality, timely information.
The Committee noted the Cancer Alliance vision. Partnership working had enabled the Alliance to bid successfully for additional funding, linked to delivery of the 62 day standard for cancer waits. The cancer workstreams were tobacco control, early diagnosis, high quality services, patient experience and living with and beyond cancer.
The Committee noted awareness-raising campaigns to improve early diagnosis and screening take-up. Campaigning involved the NHS and public health working closely together. Cancer work was being co-ordinated with other STP programmes, including primary care and support for healthier lifestyle choices. The Committee noted the need for strong links between the Alliance and place and for effective diagnosis for groups such as young people. The Alliance was only as strong as the weakest place, and all partners needed to work together effectively.
The Committee noted the focus on awareness raising and early diagnosis, but questioned whether the system had the capacity to cope. It heard about the difficulties of early diagnosis and the need to stop people ‘ping-ponging’ around the system. A multi-disciplinary team approach to assessment was more efficient and used resources more effectively. It could reduce demand on general practice by finding the right answers more quickly for cancer and non-cancer patients.
The Committee explored diagnostic capacity, smoking cessation and maximizing ‘every contact counts’ efforts across the acute sector. It heard about the need to understand and support carers and to ensure strong patient engagement. The Committee heard about the important contribution of local authorities to the prevention agenda.
The Alliance was not a separate entity, but consisted of all partners working collaboratively. There was a need to move towards delivery of a common set of agreed outcomes, with stronger system leadership. A key role of the Alliance was to support all partners to make good, evidence-based decisions.
The Joint Committee:
1. Noted Cancer Alliance progress to date:2. Noted that the brief for the Alliance is expanding beyond the scope of the original WY&H
programme objectives due to national expectations and the coordination and leadership needs ofthe local system;
3. Supported the Alliance ambition to develop a stronger system leadership role to drive improvedoutcomes and experience and requested a progress update and options for how this could bedelivered in practice at the development session in February 2018
Next Joint Committee in public
Tuesday 6th
March 2018, Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1GF
Appendix 1
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Agenda Item: LHCB 17/87 FOI Exempt: No
NHS Leeds CCGs Partnership – Leeds Health Commissioning and System Integration Board Meeting
Date of meeting: 25th January 2018
Title: Primary Care Rebates Scheme Policy
Lead Governing Body Member: Dr Simon Stockill, Medical Director
Category of Paper Tick as
appropriate
()
Report Author: Heather Edmonds, Head of Clinical Pharmacy Development
Decision
Reviewed by EMT/SMT/Date: 12th July 2017 Discussion
Reviewed by Committee/Date: N/A Information
Checked by Finance (Y/N/N/A - Date): N/A
Approved by Lead Governing Body member (Y/N): Y
Joint Health & Wellbeing Strategy Outcomes – that this report relates to
1. People will live longer and have healthier lives
2. People will live full, active and independent lives
3. People’s quality of life will be improved by access to quality services
4. People will be actively involved in their health and their care
5. People will live in healthy, safe and sustainable communities
Corporate Impact Assessment: Does the Report have any of the following key implications? - Insert brief commentary or refer to body of report or N/A
Statutory/Legal/Regulatory/Contractual requirements
Yes
Financial Implications Yes
Communication and Involvement Issues No
Workforce Issues No
Equality Issues including Equality Impact assessment
No
Environmental Issues No
Information Governance Issues including Privacy Impact Assessment
Yes
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EXECUTIVE SUMMARY: This paper summarises the key points around Primary Care Rebate Schemes (PCRS), which is being put forward for adoption citywide.
1. The Leeds CCG Partnership is asked to support the principle of accepting PCRS.
2. If The Leeds CCG Partnership is supportive then they are asked to agree to the adoption of the policy attached.
Background Since February 2015 Leeds North CCG has had a system in place for reviewing and accepting PCRS. To date Leeds North has signed up to 2 rebate schemes. One of the schemes has been in effect for about 1 year and the other 6 months. To date this has resulted in a total rebate of £110K paid to Leeds North CCG since September 2016. Leeds CCGs Partnership has been offered a number of schemes. Schemes offered to date would result in a rebate of around £24,000/year to £80,000/year citywide, based on current prescribing. During the summer we consulted with our member practices, who raised concerns about transparency of the process, which we have taken on board and adapted the policy to address these concerns. There is no need for this policy to go to public consultation as this policy is not intended to affect service or treatment. Key facts re PCRS
Are contractual arrangements, usually for 2 years.
These schemes are essentially a financial and transactional relationship between the pharmaceutical industry and CCGs.
They are financial arrangements and are paid retrospectively on the volume of drug prescribed.
CCGs may not solicit, request or tender for rebate schemes for branded medicines but are at liberty to accept such schemes offered by the pharmaceutical industry. The scheme offered is not negotiable.
Pharmaceutical companies offer rebates to CCGs to maintain their market share when there are several drugs within the same class and newer drugs are cheaper than theirs.
The clinical decision about where the drug sits within a clinical pathway should be made first before any rebates are considered – this is highlighted within the policy attached.
Pharmaceutical companies have streamed lined the process to access the rebates and review the prescribing data on behalf of the CCGs so that payments can be sent automatically on a quarterly basis, this minimises the workload on the medicines optimisation team.
All schemes have a clause referring to FOIs within the contract. These contracts are checked by the finance and governance team to ensure they allow the CCG to comply with FOI requests. Contracts to date allow the CCG to:
o Acknowledge existence of the rebate scheme; o Publish the drug name; and
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o Publish the company name. Leeds North CCG has received FOI requests on rebate schemes that have only asked for this information. The Pharmaceutical companies offering the PCRS are happy if we had this information added to our website to reduce FOI requests.
Our proposed policy goes further and includes a more open and transparent approach with us detailing any approved PCRS on our website and in our annual accounts.
Contacts can be terminated usually by giving 3 months written notice by either side.
Other neighbouring CCGs have similar policies and accept similar rebates schemes, e.g. Harrogate and Rural District CCG, Wakefield CCG.
PCRS are separate to Joint/Partnership working with the pharmaceutical industry.
Having a policy for PCRS does not mean you have to accept all rebate schemes offered.
Pros for accepting PCRS
The CCGs get the drugs at a cheaper price, which allows for the rebated money to be off set against prescribing cost pressures, or service improvement/ diagnostic and monitoring equipment.
Increases cost-effective prescribing.
Reduces the time spent by the medicines optimisation to do cost saving switches, so frees the team up to do more quality improvement work, to support improved patient care and outcomes.
Reduces the need to switch patient’s medication, thereby less confusion for patients and/or carers and fewer queries for practice staff.
Cons for accepting PCRS
There is some concern that PCRS only offer short-term savings and could lead to drugs cost to go up long-term. In reality this does not seem to have occurred and has actually resulted in prices coming down e.g. Rivaroxaban.
Risk If we choose not to accept appropriate PCRS there is an increasing risk of prescribing budgets overspending.
NEXT STEPS: Should the policy be approved, then the next steps would be identification of the members of the panel to review rebate schemes that are offered to the CCG and to feedback to SMT on what schemes have been accepted and the financial impact at regular intervals.
RECOMMENDATION: The Board is asked to approve the Primary Care Rebate Schemes Policy.
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Policy for the review, acceptance and monitoring of rebate schemes offered by the pharmaceutical
industry
Version: Version 6
Name & Title of originator/author(s): Heather Edmonds, Head of Medicines Optimisation
Sally Bower, Head of Medicines Optimisation
Helen Liddell, Head of Medicines Optimisation
Name of responsible committee/individual:
Senior Management team and board.
Date issued:
Review date:
Target audience: Medicines management
Finance
Governance
Quality
Senior Management Team
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1. Introduction The Pharmaceutical Price Regulation Scheme (PPRS) is the mechanism by which the Department of Health ensures that the NHS has access to branded medicines at a reasonable price. The PPRS balances setting reasonable prices for the NHS against delivering a fair return for the pharmaceutical industry so that investment and innovation in pharmaceuticals is incentivised. The PPRS does not apply to devices or nutritional products; nor does it apply to generic medicines whose prices tend to be controlled by their Drug Tariff agreed pricing. The view of the Department of Health expressed in the consultation document on value based pricing is that the existing PPRS does not promote innovation or access to medicines, as the freedom of companies to set the price of new drugs results in the NHS often paying high prices which are not justified by the benefits of the drug and/or of having to restrict access to the drug. A number of manufacturers have established ‘rebate schemes’ for drugs used in primary care to support the NHS QIPP agenda. The NHS is charged the Drug Tariff price for primary care prescriptions dispensed, then the manufacturer provides a rebate to the primary care organisation based on an agreed discount price and verified by ePACT data. Primary care rebate schemes (PCRS) are contractual arrangements offered by pharmaceutical companies, or third party companies, which offer financial rebates on GP prescribing expenditure for particular branded medication. These schemes usually reimburse organisations retrospectively with an agreed percentage discount of the total amount of a particular branded medication prescribed and dispensed. PCRS, underpinned by robust assessment and governance procedures, can lead to significant cost savings. This policy describes how the Leeds CCGs will adopt and implement good practice recommendations to ensure a clear and transparent process for the review, acceptance and monitoring of PCRS. Some schemes are straight discounts and are not volume based, whilst others have varying discount rates available dependent upon the volume of drug prescribed. The discount schemes are confidential to the NHS enabling manufacturers to maintain a higher price in global markets. 2. Purpose and scope This policy is designed to ensure that any PCRS that are adopted deliver financial benefits to the CCG and: • are in the best interests of patients • do not adversely influence prescribing behaviour • do not adversely affect other parts of the local health community The NHS faces a significant challenge in achieving efficiency savings. PCRS can contribute to reduce primary care prescribing costs which can be re-invested into service development and quality improvement work or off set against prescribing budget. It has been reported that at least 30% of CCGs accept PCRS, with potential savings of up to £100,000 in some localities. Pharmaceutical companies offer PCRS for a number of reasons:
Pharmaceutical prices are often set by the European office of multinational companies
Reference pricing – advertised prices in the UK may affect prices in other countries.
This may mean that a price set centrally is not competitive in the UK
To manage this through competition law, companies have the option to discount to the purchaser.
This is managed retrospectively as a rebate to the NHS statutory body purchasing at a local level.
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There are examples of similar schemes running within the NHS, such as:
Patient access schemes. These usually relate to high cost specialist drugs, which NICE has approved, allowing for the drug to be prescribed for a patient at a cheaper cost for a specified period of time.
Hospital and dispensing doctors can negotiate prices for medication direct with the manufacturers, either on a local or national level.
There are some concerns regarding PCRS in relation to legislation such as the Bribery Act, Competition Act and Public procurement law. There are also concerns around:
potentially creating incentives to prescribe drugs with PCRS
undermining the Pharmaceutical Price Regularity Scheme - a voluntary agreement to control the prices of branded drugs sold to the NHS
financial governance and audit requirements
administrative burden of the schemes The legal status of rebate schemes has been reviewed by a number of organisations. The London Primary Care Medicines Use and Procurement QIPP Group sought legal advice on such schemes in 2012. Based on this advice, this Group recommended a set of good practice principles for primary care organisations to use to facilitate robust scrutiny and identification, adoption and implementation of PCRS. This policy incorporates those good practice principles. 3. General principles Before entering into a PCRS with a pharmaceutical industry partner, all proposals will be rigorously tested against clear criteria to ensure that they are in the best interests of both patients and the CCG. All proposals will be treated equally and decisions made will need to stand up to scrutiny if questioned:
Any drug where a PCRS is offered will only be considered by Leeds CCGs which has been reviewed by Leeds Area Prescribing Committee (LAPC) and a recommendation given as to the traffic light classification. The recommendation made by LAPC will take into account the clinical need and safety for the medicines and its place in the care pathway. Black light drugs and those classified for safety reasons will not be considered. LAPC is made up of doctors, pharmacists and nurses from the whole Leeds health economy and includes a lay patient representative.
To reduce the effect of influencing prescribing inadvertently. The details of rebates schemes will not be circulated to prescribers, but Leeds CCGs will publish the acceptance of PCRS from pharmaceutical companies on their web site and will include the company name and drug, however total value for the rebates received will be included in the CCG accounts which is available publically.
Any Medicine considered under a PCRS must be licenced in the UK. Leeds CCGs will not accept any rebate schemes for unlicensed or off-licence uses.
All PCRS offered to Leeds CCGs will be reviewed by the assessment process outlined below to ensure a robust process that follows Leeds CCGs governance procedures.
Any PCRS offered that encourages exclusive use of a particular drug will not be accepted by Leeds CCGs.
Leeds CCGs will only accept PCRS where there is a formal contract that is signed by both parties to ensure:
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That the terms of the scheme are clear,
To maximise legal protection.
Leeds CCGs will not accept any PCRS unless it includes a right to terminate on notice with a sensible notice period (usually no more than 3 months).
Leeds CCGs will only accept PCRS that require submission of volume of use level data available from EPACT relating to the drug the rebate scheme refers to. Leeds CCGs will not provide market share data for competitors’ products or patient identifiable data. Patient confidentiality will be maintained at all times.
Any financial gains received as a result of accepting PCRS: o Will not contribute to the Leeds CCGs CCG Prescribing engagement scheme freed up
resources. o Will be used to offset against non-recurrent costs for service/treatment improvement
projects identified and supported by Leeds CCG’s Medicines Optimisation Team’s, which have been approved by the senior management team (SMT).
o Will be used to address any unexpected shortfall in primary care prescribing costs.
In the cases where a PCRS is agreed, Leeds CCGs will ensure that the agreement entered in to states that the pharmaceutical company that is offering the PCRS will not use our engagement in the scheme to promote their company’s activities that are related to this agreement, or in any other promotional activity for their benefit.
4. Freedom of Information Leeds CCG supports the principles of transparency enshrined in the Freedom of Information Act. Rebate agreements often contain confidentiality clauses which may restrict what information may be disclosed under Freedom of Information. The CCG will publish its policy for accepting rebate agreements along with the list of products for which rebate agreements exist on its publically available website. Section 43 of the Freedom of Information Act sets out an exemption from the right to know if: • The information requested is a trade secret, or • Release of the information is likely to prejudice the commercial interests of any person. (A person may be an individual, a company, the public authority itself or any other legal entity.) The UK is a reference pricing country for pharmaceutical and medical device products and any change to publically available UK prices can impact on the international profitability of pharmaceutical and medical device companies. Pharmaceutical and medical device companies often consider their pricing structures to be trade secrets and there are precedents within the NHS in restricting access to pricing information for these products. NICE negotiates a number of patient access schemes as part of the NICE Technology Appraisal programme. The details of the products that are available to the NHS under a patient access scheme (or discount scheme) are published on the NICE website. The commercial and operational details of the individual schemes are not made publically available and are the subject of confidentiality clauses. Greater Huddersfield CCG benefits from many of these schemes through the prices charged to it for PbR excluded drugs. Section 43 is a qualified exemption. That is, it is subject to the public interest test which is set out in section 2 of the Act. Where a public authority is satisfied that the information requested is a trade secret or that its
8
release would prejudice someone’s commercial interests, it can only refuse to provide the information if it is satisfied that the public interest in withholding the information outweighs the public interest in disclosing it. Leeds CCG will consider all Freedom of Information requests on rebate agreements on their individual merits taking into account the public interest and whether the release of information will prejudice other parties to the agreements.
5. Assessment process The assessment process will be in 2 stages: Stage 1 - initial screening (outlined overleaf) Stage 2 - detailed assessment
9
NO
NO
YES
NO
Stage 1 The initial screening process is outlined below:
This initial screening will be undertaken by the Head of Medicines Optimisation, for Leeds CCG, using the Stage One screening questionnaire in Appendix 1. On satisfactory completion of stage one all PCRS proposals will go to stage 2 of the process. PSRC which are deemed to have not fulfilled stage 1 will be rejected and the relevant Pharmaceutical Company will be informed by email. Stage 2 All PCRS that have satisfactory passed the Stage 1 screening process will be assessed by a review panel consisting of;-
Head of Medicines Optimisation/or their deputy
Finance representative
Governance team representative
Quality team representative
Lay member
Does the proposed rebate scheme have a benefit for the whole local health community? i.e. it would not adverse effect another sector such as secondary care with higher prescribing costs, or community pharmacy
Does the proposed rebate scheme require a change in current prescribing practice?
YES
NO
Are the anticipated net (financial or improvement in quality/safety) rewards through the proposed scheme of sufficient value to warrant engagement?
YES
The proposed scheme is accepted and will be progressed by the CCG
The scheme will not be taken any further by Leeds CCGs
NO
NO
Proposal will be taken forward
to the formal review process YES
Will the integrity of Leeds CCG’s be compromised in any way by engaging in the proposed rebate scheme?
YESS|S
YES
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Prescribing lead GP
GP non-exec member
Medical director or deputy
All PCRS will be assessed against the Stage 2 assessment template in Appendix 2. If the PCRS is accepted to be taken forward then the pharmaceutical company will be contacted and arrangements will be made for the contract to be signed by the Director of Finance. 6. Monitoring, compliance and effectiveness Once the PCRS has been signed, the prescribing data will be collected as outlined in the contract by the Medicines Optimisation team and submitted to the pharmaceutical company, if required. Once PCRS have been agreed, prescribing trends of the drugs involved will be monitored on a quarterly basis to detect any unexpected effects on prescribing trends. This will be undertaken by Leeds CCG medicines optimisation team. If any unexpected effects on prescribing trends are seen this will be reported to the Leeds CCG Senior management team. A summary of all PCRS that been offered to Leeds CCG will be submitted to SMT, together with the outcomes every 6 months. Any changes in prescribing practice which necessitates the cessation of a PCRS will be brought to the attention of the director who signed the original agreement or the clinical director and the pharmaceutical company offering the PCRS will be notified as soon as possible following the agreed exit strategy. An example where this may be necessary is when a drug may be withdrawn off the market due to safety concerns.
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Appendix 1
Stage 1 screening questionnaire
Pharmaceutical company offering the scheme and representative.
Name of Medicines Optimisation representative undertaking the screening.
Brand of drug PCRS refers to
Date of initial offer/approach
Does the proposed rebate scheme fulfil all the general principles outlined in the Leeds CCG policy on receiving and handling PCRS?
Yes / No
If No - outline which general principle(s) the PCRS does not fulfil.
If Yes – Progress to stage 2 Date result fed back to Pharmaceutical company.
Date completed
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Appendix 2
Stage 2 detailed assessment questionnaire
PCRS review questionnaire
Date of review panel
Names and designation of review panel
Pharmaceutical Company
Product(s)
Brief outline of proposal
Y/N/ value
Additional comments
1. Has the stage 1 screening questionnaire been completed?
Only progress this stage if the screen questionnaire is positive.
2. Has place in therapy been agreed? Or is it subject to review Only those agreed will be taken forward
3. Has this product been given a traffic light drug?
4. What is the current volume of use?
5. Will this increase or decrease?
6. What is the anticipated financial benefit (£)?
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7. If tied into volume what increase in volume would we need to achieve in order to achieve cost benefit vs use of currently used therapies?
8. What would be the impact on other products currently being used +/- , and would this be beneficial to patients?
9. What is the impact on partner organisations, such as secondary care and community pharmacy?
10. How would the scheme be administered?
11. What data would the organisation need to share with the pharmaceutical company supplier in order to quantify current / future product usage and time commitment?
12. Is there a fixed term to which the organisation has to agree to participate on the scheme?
13. Is there an agreed exit strategy written into the agreement?
14. Impact on supply chain, including risk of failure of supply of available product
Outcome of panel Agree to take forwards Y/N
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Appendix 3
Equality Impact Assessment
Title of the guidance Policy for approving primary care prescribing rebate schemes
Names and roles of people completing the assessment
Heather Edmonds – Head of Medicines Optimisation
Date assessment started/completed 5.7.17 5.7.17
1. Outline
Give a brief summary of the guidance
The policy provides a transparent framework to support evaluation and approval of rebate schemes to ensure that schemes are only approved where they provide good value for money to the public purse and the schemes’ terms are in line with the organisation’s vision, values, policies and procedures
What outcomes do you want to achieve
The objective evaluation of schemes submitted to the CCG and a clear process for approving and scrutinising agreements.
4. Analysis of impact
This is the core of the assessment, using the information above detail the actual or likely impact on protected groups, with consideration of the general duty to; eliminate unlawful discrimination; advance equality of opportunity; foster good relations
Are there any likely impacts? Are any groups going to be affected differently? Please describe.
Are these negative or positive?
What action will be taken to address any negative impacts or enhance positive ones?
Age N
Carers N
Disability N
Sex N
Race N
Religion or belief
N
Sexual orientation
N
Gender reassignment
N
Pregnancy and maternity
N
Marriage and civil partnership
N
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Other relevant group
N
If any negative/positive impacts were identified are they valid, legal and/or justifiable? Please detail.
NA
5. Monitoring, Review and Publication
How will you review/monitor the impact and effectiveness of your actions
Assessment via the Medicines Optimisation Group will be scheduled for 2 years after ratification of policy
Lead Officer Heather Edmonds Review date: TBA
6. Sign off
Lead Officer
Director Date approved:
Key: * Items will only be included on the agenda if there is any information to report
LEEDS HEALTH COMMISSIONING & SYSTEM INTEGRATION BOARD
WORK PROGRAMME 2017-18
ITEM SEP
2017
NOV
2017
JAN
2018
MAR
2018
Notes
STANDING ITEMS
Welcome & apologies X X X X
Declarations of interest X X X X
Minutes of previous meeting X X X X
Matters arising X X X X
Action log X X X X
Patient Voice X X X X
Questions from Members of the Public X X X X
GOVERNANCE ITEMS
Committee Terms of Reference X X
Committee Annual Reports X
Committee Chairs’ Summaries X X X X
Review of governance arrangements X
ASSURANCE
Board Assurance Framework and Risk Register X X X X
STRATEGY
Leeds Health & Care Plan X X
CCG Strategic Objectives X X
System Integration X X X X
CCGs Operational Plan X
Organisational Development Strategy X
COMMISSIONING
Integrated Quality & Performance Report X X X X
Finance Report X X X X
Chief Executive’s Report X X X X
Business Case / Procurement Approvals* X X X X
POLICIES
Policy Approval* X X X X
ITEMS FOR INFORMATION
Director of Public Health Annual Report X
Safeguarding Annual Reports X
West Yorkshire & Harrogate CCGs Joint Committee Minutes / Summary
X X X
EPRR Statement of Compliance X
Agenda item: LHCB 17/89
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WY&H Joint Committee of CCGs – 07/11/2017
Page 1 of 6
West Yorkshire & Harrogate Joint Committee of Clinical Commissioning Groups
Minutes of the meeting held in public on Tuesday 7 November 2017
Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1QF
Members Initials Role and organisation
Marie Burnham MB Independent Lay Chair
Fatima Khan-Shah FKS Lay member
Richard Wilkinson RW Lay member
Dr Akram Khan AK Chair, NHS Bradford City CCG
Dr James Thomas JT Chair, NHS Airedale, Wharfedale and Craven CCG
Dr Andy Withers AW Chair, NHS Bradford Districts CCG
Helen Hirst HH Chief Officer, NHS Bradford City, Bradford Districts and AWC CCGs
Dr Alan Brook ABr Chair, NHS Calderdale CCG
Neil Smurthwaite NS Chief Finance Officer, NHS Calderdale CCG
Dr Steve Ollerton SO Chair, NHS Greater Huddersfield CCG
Carol McKenna CMc Chief Officer, NHS Greater Huddersfield CCG and North Kirklees CCG
Dr Alistair Ingram AI Chair, NHS Harrogate & Rural District CCG
Amanda Bloor ABl Chief Officer, NHS Harrogate & Rural District CCG
Dr Jason Broch JB Chair, NHS Leeds North CCG
Dr Alistair Walling AWa GP Clinical Lead, NHS Leeds South & East CCG
Dr Gordon Sinclair GS Chair, NHS Leeds West CCG
Philomena Corrigan PC Chief Executive, NHS Leeds CCGs Partnership
Dr Phillip Earnshaw PE Chair, NHS Wakefield CCG
Jo Webster JW Chief Officer, NHS Wakefield CCG
Apologies
Matt Walsh MW Chief Officer, NHS Calderdale CCG
Dr David Kelly DK Chair, NHS North Kirklees CCG
In attendance Initials Role
Lou Auger LA Director of Delivery, West Yorkshire, North Region NHS England
Nigel Gray NG Chief Officer - System Integration, NHS Leeds CCGs Partnership Senior Responsible Officer for Urgent & Emergency Care
Ian Holmes IH Programme Director, WY&H STP
Jonathan Webb JWe Director of Finance, WY&H STP
Stephen Gregg SG Joint Committee Governance Lead (minutes)
Karen Coleman KC Communication Lead, WY&H STP
WY&H Joint Committee of CCGs – 07/11/2017
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Tony Jamison TJ Clinical Lead for Medicines, Yorkshire and Humber Academic Health Science Network
Jacqui Crossley JC Head of Clinical Effectiveness and Governance, Yorkshire Ambulance Service
Jonathan Booker JB Senior Analyst, WY&H STP
Linda Driver LD Stroke Project Lead
Keith Wilson KW Programme Manager, Urgent and Emergency Care
Catherine Thompson CT Programme Director, Standardisation of Commissioning Policies and Elective Care
11 members of the public, and 4 observers from STPs in Cumbria and the North East were in attendance.
Item No. Agenda Item Action
20/17 Welcome, introductions and apologies
MB welcomed all to the meeting and reminded everyone of the role of the Joint Committee. Apologies were noted.
MB congratulated Carol McKenna on being appointed as shared Chief Officer for NHS Greater Huddersfield CCG and NHS North Kirklees CCG. Richard Parry had returned to his full time role at Kirklees Council as Strategic Director for Adults and Health. MB thanked Richard for his contribution to the work of the Joint Committee.
21/17 Open Forum
MB invited members of the public to make representations or ask questions about items on today’s agenda.
Q1 Wakefield CCG and N Kirklees CCGs had introduced referrals to opticians for patients who might previously have gone to A&E. How would this impact on referrals and costs?
CMc said that the aim was to ensure that patients were referred to the most appropriate professional. CMc and PE offered to follow up the issue outside of the meeting.
CMc/
PE
22/17 Declarations of Interest
MB asked Committee members to declare any interests that might conflict with the business on today’s agenda. There were no additional declarations.
MB noted the potential conflicts of interest of GP members in relation to the specification for future out of hours services in agenda item 28/17. No mitigating action was needed at this stage, but the Committee would need to ensure that any conflicts that did arise were managed appropriately.
23/17 Minutes of the meeting in public – 5th September 2017
The Committee reviewed the minutes of the last meeting.
The Joint Committee: Approved the minutes of the meeting on 5th September 2017, subject to an amendment to the initials of an attendee.
24/17 Actions and matters arising
SG presented the log, which had been updated. MB requested that, where possible, actions marked as ‘ongoing’ be assigned a specific deadline. There were no matters arising.
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Item No. Agenda Item Action
The Joint Committee: Noted the action log.
25/17 Video presentations
JW introduced 3 video presentations connected to items on the agenda. In the first, Geoff talked about his experience of stroke and stroke services. The second highlighted the importance of work to prevent physical and mental health conditions. In the third, local health leaders talked about the need for services to work differently together to improve services and outcomes.
The Joint Committee: Noted the video presentations.
26/17 Improving stroke outcomes
JW introduced the item, which provided an update on the stroke programme, and included a proposal for the 11 CCGs to work together to reduce the number of people who die from stroke.
AW noted the need to improve stroke outcomes in WY&H. He highlighted the importance of preventative work and summarised progress on modelling work to help determine future stroke services.
He outlined consultation with the Clinical Forum to ensure that development work reflected current best practice. Discussions were ongoing with providers on the future care pathway. Delivering the 7 day standard for services was a key aim. A key part of effective prevention was detecting and treating atrial fibrillation (AF). AW set out an aspiration to detect and treat 89% of people with AF. A focused approach was proposed, working with the Yorkshire and Humber Academic Health Science Network to support practices where there was the greatest potential to make a difference.
FKS asked how the 89% target had been derived and noted the need to improve outcomes across WY&H. TJ said that Public Health England had carried out detailed work to estimate the benefits from addressing AF.
ABr queried the basis for the target and highlighted the need for accurate and robust diagnoses of AF. AW said that the evidence base for the target was strong. He noted the importance of effective treatment with anti-coagulants.
JW said that the ultimate aim was 100% detection and treatment. There had been extensive clinical engagement in developing the proposals, and targeted support could make a real difference. She outlined the risks to the stroke programme and ongoing work to mitigate them. A further report would be brought to the Joint Committee in March.
PC noted the need to address other aspects of the stroke programme, including diagnostics and consultant review. JW advised that these standards would be addressed by the work on 7 day services.
GS asked how the public was being engaged in the programme. LD outlined the engagement work to date and work planned to support the next steps. JC highlighted how Yorkshire Ambulance Service was drawing on the direct experience of patients and staff to help shape future services.
The Joint Committee:
1. Noted progress in developing proposals to determine optimal service delivery models particularly the ‘scenario’ modelling’ exercise;
2. Noted the proposal to develop and implement a standardised care pathway and clinical standards for hyper acute and acute stroke services;
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Item No. Agenda Item Action
3. Supported the proposal to request each WY&H CCG to:
agree an aspiration to detect and treat 89% of patients with Atrial Fibrillation; and
work collaboratively with the Yorkshire and Humber Academic Health Science Network on implementing a targeted and phased approach to working with their local practices;
4. Noted the key risks and actions to mitigate risks related to our work; and
5. Noted the next steps and timelines in the high level project plan.
27/17 Standardisation of Commissioning Policies and Elective Care
JT outlined the aims of the programme and the work streams. He thanked all those who had been involved so far in the programme.
There were four aims:
to improve health through better prevention and supporting healthier choices
create financial efficiency gains
reduce variation and inconsistency
reduce the perception of a ‘postcode lottery’
Supporting healthier choices
The Committee considered an approach in which, before surgery, patients are offered a choice of services to address lifestyle factors. Choice was a key element of the programme, and required effective communication with patients and the public. Work was already underway in each place and there was now an opportunity to agree a common approach.
Clinical thresholds and policies
Orthopaedics and ophthalmology had been identified as providing good opportunities to reduce variation, improve referral to treatment times and achieve productivity gains.
Follow ups and outpatients
There were clear opportunities to redesign approaches and ensure that support was built around patient needs.
Prescribing
This would focus on reducing unwarranted variation and reducing spend on high cost drugs.
JT outlined the risks to the programme and how they were being mitigated. Effective engagement with patients, the public and providers was key. Financial gains could be achieved, but were largely longer term. The work needed to contribute to reducing health inequalities.
HH felt that there was a need to be ambitious and move quickly to influence commissioning intentions, working closely with providers. This was particularly important in relation to reshaping orthopaedic and ophthalmology services.
JT noted the need to ensure that the capacity was in place to support the programme. HH said that this had been recognised at the Accountable Officer’s meeting earlier in the day.
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Item No. Agenda Item Action
SO noted the need to work closely with secondary care clinicians to make changes. JT agreed that there needed to be a mixture of top down and bottom up approaches, building on what worked locally.
RW noted the need to address variation and health inequalities and deliver ‘quick wins’. FKS highlighted the need to change the conversation with the public, engage with clinicians and communicate consistent messages. JWe highlighted the benefits from addressing variation in primary care prescribing.
GS asked how patient choice would be supported, and said that not all patients were prepared to make ‘healthier choices’. CT said that the aim was to support patients, not direct them. The programme would not create barriers to those who did not choose to make healthier choices.
In response to questions from FKS, JT said that engagement with public health colleagues would be important. JT said that local discussion was needed with community pharmacists at place level. CT would investigate the extent to which Community Pharmacy West Yorkshire had been engaged in the programme. –
CT
The Joint Committee: Agreed:
1. The approach to the Elective Care Programme outlined in the report.
2. The approach of ‘patient choice’ and coherent support offer for supporting healthier choices.
3. The standardisation of commissioning policy for procedures of limited clinical value and elective orthopaedic surgery, and the policy – relationships – technology approach to implementation.
4. The development of new approaches to outpatient services in elective orthopaedic surgery and eye care services.
5. That an update on the programme be submitted to the Joint Committee in March 2018.
CT (MW)
28/17 Urgent and emergency care
NG provided an update on the work of the Urgent and Emergency Care (UEC) Programme Board.
He outlined the role of the Board and how it worked with the five A&E Delivery Boards in Airedale and Bradford, Calderdale and Greater Huddersfield, Harrogate and Rural Districts, Leeds and Mid Yorkshire. The Board aimed to ensure that systems were in place for people to get the right care, in the right place. It aimed to improve the patient experience, improve integration and reduce duplication. He noted the pressures that winter placed on the system and the need for services to work together differently to support A&E departments and ensure that the health and social care system was sustainable.
He summarised the current position on key targets in the UEC delivery plan, including NHS 111, ambulance response, GP access, hospital care, hospital to home and mental health. He outlined work to support seven day hospital services. NG highlighted the main risks to delivery of the programme, including workforce, challenges in the care homes sector and increasing demand for services. He outlined how these risks were being addressed.
CMc noted the new national service specification for the provision of an integrated 24/7 urgent care access, clinical advice and treatment service, incorporating NHS 111 call-handling and former GP out-of-hours services.
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Item No. Agenda Item Action
Not all elements of the specification would be commissioned collectively but it would be important to be clear across WY&H on how everything fitted together. It was important that CCG commissioning intentions aligned to inform the future commissioning strategy across WY&H, and included 7 day services.
In response to a question from MB, CMc said that that potential ‘gaps’ between local and STP commissioning intentions would be assessed by the UEC Programme Board.
AB noted ongoing operational activity led by the A&E delivery boards to address winter pressures. Plans covered better signposting, flu vaccination and clinical escalation. AW noted the pressure in the system, and highlighted capacity constraints in primary care.
FKS asked about proposals to change the roles of health professionals. KW said that the aim was to ensure that patients presented at the right place to get the right care for their needs, regardless of the ‘badge’ of the health professional.
JW noted the need to address the seven day service challenge and adapt how different professionals and sectors fitted in to the system. She noted that the workforce strategy would be key to addressing these challenges. JW and KW highlighted the recent success of the STP engagement event with the voluntary and community sectors.
The Joint Committee:
1. Noted the progress on the delivery of the UEC delivery plan.
2. Agreed the risks and mitigating actions.
3. Agreed the proposed way forward to secure a Y&H IUC service specification which involves alignment of CCG commissioning intentions, with a completion date of March 2018
CMc
29/17 Any other business
There was none.
Next Joint Committee in public – Tuesday 9th January 2018, Kirkdale Room, Junction 25 Conference Centre, Armytage Road, Brighouse, HD6 1QF.