Governing Body – In Public Date: 11 October 2018 Time: 10.30–12:30 Venue: Jubilee Room, Aylesbury Vale District Council, the Gateway, Gatehouse Rd, Aylesbury, HP19 8FF Chair – Dr Raj Bajwa No Agenda Item Action Lead Time Page Welcome 1. Introductions, Apologies Raj Bajwa, Chair 10:30 Verbal 2. Declaration of Interests in items for items on this meeting’s agenda. Locations of public registers: https://www.buckinghamshireccg.nhs.u k/public/about-us/how-we-make- decisions/registers-of-interests/ For Noting & Mitigating Actions Raj Bajwa, Chair 10:30 Verbal 3. Review and Approval of Minutes: a. Meeting minutes – 13/09/18 b. Action Log/Matters Arising For Approval Raj Bajwa, Chair 10:35 Paper Pages 3 - 16 4. Questions from the public For Discussion Raj Bajwa, Chair 10:40 Verbal Decisions 5. Executive Committee terms of reference update Ratification only Russell Carpenter, Board Secretary 11:00 Paper Pages 17- 18 Clinical Directors Presentation 6. Communications and engagement - role and work of the steering group For Assurance Dr Karen West, Clinical Director Integrated Care, Paul Henry, Chair CCG Engagement Steering Group 11:05 Power Point 6a: Communications and Engagement Update including 360 degree report For Assurance Kim Parfitt, Communications, Bucks County Council Dr Rodger Dickson, Clinical Locality Lead, Aylesbury Vale North 11:30 Paper Pages 19 - 32 Leadership Reports 7. Accountable Officer’s Report and System Working Update Chair election update For Assurance Robert Majilton, Deputy Chief Officer 11:45 Paper Pages 33 - 38 Pack page 1
Transcript
Governing Body – In Public Date: 11 October 2018 Time: 10.30–12:30
Venue: Jubilee Room, Aylesbury Vale District Council, the Gateway, Gatehouse Rd, Aylesbury, HP19 8FF
Chair – Dr Raj Bajwa
No Agenda Item Action Lead Time Page Welcome 1. Introductions, Apologies Raj Bajwa, Chair 10:30 Verbal 2. Declaration of Interests in items for
items on this meeting’s agenda. Locations of public registers: https://www.buckinghamshireccg.nhs.uk/public/about-us/how-we-make-decisions/registers-of-interests/
For Noting & Mitigating Actions
Raj Bajwa, Chair 10:30 Verbal
3. Review and Approval of Minutes: a. Meeting minutes – 13/09/18b. Action Log/Matters Arising
For Approval Raj Bajwa, Chair 10:35 Paper Pages 3 -
16 4. Questions from the public For
Discussion Raj Bajwa, Chair 10:40 Verbal
Decisions 5. Executive Committee terms of
reference updateRatification only
Russell Carpenter, Board Secretary
11:00 Paper Pages 17-
18
Clinical Directors Presentation 6. Communications and engagement -
role and work of the steering group For Assurance
Dr Karen West, Clinical Director Integrated Care, Paul Henry, Chair CCG Engagement Steering Group
11:05 Power Point
6a: Communications and Engagement Update including 360 degree report
For Assurance
Kim Parfitt, Communications, Bucks County Council Dr Rodger Dickson, Clinical Locality Lead, Aylesbury Vale North
11:30 Paper Pages 19
- 32
Leadership Reports 7. Accountable Officer’s Report and
12. Date and Time of the next meeting (in public): 13 December 2018 Jubilee Room, Aylesbury Vale District Council, the Gateway, Gatehouse Rd, Aylesbury, HP19 8FF
GOVERNING BODY (IN PUBLIC) 13 September 2018, 10:30am
The Misbourne Practice, Church Lane, Chalfont St Peter SL9 9RR
1&2. Welcome & Apologies Lead The Chair Dr Raj Bajwa (RB) welcomed the Governing Body members to the
meeting in public. Apologies noted as above.
Members (14) Name Title/Organisation Dr Raj Bajwa (Chair) GP Clinical Chair RB Present Tony Dixon Lay Member / Chair of Finance Committee TD Apologies Gary Heneage Chief Finance Officer GH Present Dr Graham Jackson Member GP and Clinical lead ICS GJ Apologies Crystal Oldman Registered Nurse CO Present Robert Majilton Deputy Accountable Officer RM Present Dr Rebecca Mallard-Smith Clinical Director Unplanned Community Care RMS Present Louise Patten Accountable Officer LP Present Robert Parkes Lay Member / Vice Lay Chair / Chair of Audit
Committee RP Present
Debbie Richards Director of Commissioning and Delivery DR Apologies Colin Seaton Lay Member, Patient and Public Involvement CS Present Graham Smith Lay Member, Chair of Primary Care Commissioning
Committee GS Apologies
Dr Karen West Member GP/Clinical Director Integrated Care KW Present Dr Robin Woolfson Secondary Care Specialist Doctor RW Present Standing invitees (non-voting, subject to continual review): Name Title/Organisation Nicola Lester Director of Transformation NL Present David Williams Associate Director of Quality and Safeguarding DW Apologies Hannah Mills Director of Contracts, Performance and Assurance HM Apologies Additional people or experts called to attend meetings on case-by-case basis to inform discussions. Name Title/Organisation Gary Passaway Head of Urgent Care (item 5 only) GPa Present Dr Dal Sahota Clinical Commissioning Director- Unplanned Acute
Care DS Present
Minute taker Name Title/Organisation Russell Carpenter Head of Governance/Board Secretary RC Present
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3. Declarations of Interest in items on this meeting’s agenda The Chair Dr Raj Bajwa (RB) reminded the meeting of obligations to declare
any Conflict of interest they may have on any agenda items. RB noted that declarations previously made by members of the Governing Bodies are listed in the CCG’s Register of Interests published on the CCG website. https://www.buckinghamshireccg.nhs.uk/public/about-us/how-we-make-decisions/registers-of-interests/ Material conflicts and mitigations noted as follows:
1. Primary Care Improved Access – award of contract
Funding for Primary Care Improved Access has been provided by NHS England, with an allocation to the CCG baseline of £3 per head of weighted population for 18/19. This has then been awarded as a contract, notified by PIN, to FedBucks (a Buckinghamshire’s GP provider company) as the contracted lead provider on behalf of the Buckinghamshire provider collaborative in order to facilitate implementation in line with the deadline of 1st October 2018. FedBucks are in turn contracting with each of the member practices. GPs who are partners in practices which are in turn population based shareholders of FedBucks have a direct material conflict of interest where also holding roles as CCG GP Clinical Directors, voting member GPs on the Governing Body, and the CCG Clinical Chair. In relation to this meeting where the above conflict applies, they are suggested to remove themselves from discussion and decision in relation to this item. They are free to remain present in the meeting given it is taking place in public. There is no further mitigation required in relation to financial information as this is not detailed within the supporting paper, it is not commercially sensitive and was nationally published. The CCG Clinical Chair will hand over the chair of the meeting to his Lay Vice Chair for the duration of this item.
2a. Amendments to the CCG Constitution CCG Scheme of Reservation and Delegation
3. Review and Approval of Minutes: a. Meeting minutes – 13/09/18 b. Action Log/Matters Arising
First page: Helen Delaitre (HD) to be added to list of additional people or experts called to attend meetings on case-by-case basis to inform discussions. 9. Integrated Care System: delegated authority for spending transformation funds 2018/19 GJ noted this helpful; new future funding will come to ICS through the system and not statutory organisations, likewise for primary care through primary care networks and not to individual practices. LP indicated this was not accurate; end of sentence to be removed. 12. Quality and Performance Report (Month 1)
As regards CHC indicators, RM stated it is disappointing to see low rates of assessment completions, and that it would be better to have rolling figures rather than year to date.
LP asked if this would be addressed later on the agenda. IC confirmed it would be. RC will also add to the action log.
4. Questions from the public None received in advance or on the day
Decisions 5. Winter / Urgent Care
a) Winter planningb) Non-elective Demand Management / Discharge To Assess decisionc) Emergency Preparedness, Resilience and Response (EPRR) 2018/19
assurance process assessment against core standards
a) Winter planning – a supporting presentation was given by GPa.
The meeting was opened to questions on the winter planning presentation. RP commented that the plan is comprehensive, but there may be competition for resources if too wide. GPa replied that key priorities have been identified which the A&E Delivery Board is accountable for clarifying and managing. The aim is about reducing length of stay in hospital to free up capacity. DS added that our clinical priority is also clear to focus on flu and respiratory.
As regards Frimley, we are aware that attending patients are more likely to be admitted and tend to stay longer, so we also have a priority to investigate why some patients with the same co-morbidities are admitted and stay longer than when compared to Buckinghamshire Healthcare NHS Trust.
KW queried how the plan specifically addresses workforce issues. DS replied that our partner trusts are aware of the Alamac system to manage urgent care activity trends and provide a future predictive model. It also helps identify expected seasonal surges. But we also recognise the difficulties in recruitment for GP locums.
We are encouraged that GP streaming is benefiting patients, and this is expected to further benefit us now that the process is embedded. LP noted two specific points on workforce; there is need for clear modelling of workforce needs in hospital, given their knowledge of busy times for non-elective demand, and therefore where elective capacity may need reducing to compensate. The A&E Delivery Board needs to be seeing this evidence, and be assured that providers can effectively move their resources to manage non-elective demand.
CO queried whether flu vaccinations are offered to care home staff, and whether there is a process to monitor care home bed occupancy. GPa replied there is a system wide dashboard in development for this. IC added a system is about to be piloted where we would have all live time capacity data on a dashboard, so it’s available to our procurement teams for example. DS also noted public health have offered all came home staff a flu vaccinations on site. CO queried if the community teams were aware of this. DS was unsure, but
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would liaise with a new public health consultant who is working out a way to target those community staff given recognition that they frequently move around between care homes and other locations across the county. ACTION.
CS referred to schools asthma education and that three were targeted; how was it decided that to target? DS replied that bus hire had to be within budget for a 5 day week only. The service was offered to 10 schools with intent for half a day at each. 5 initially replied, but others subsequently dropped out as the week coincided with 11 plus exams.
However, we also managed to take it to an adult learning difficulty and autism event, which meant benefit to a cohort which would not ordinarily access this type of service. We also ensured county consistency with this pilot with one school each in Beaconsfield, Princes Risborough and Wendover.
RB further queried that the service was targeted at greatest areas of need and inequalities. DS replied it did include Aylesbury and High Wycombe central wards, though some leafy schools also asked for the offer. The aim is that effective education at ages 13-14 will carry through into adult life
RW queried effectiveness of referral pathways from A&E back to community alternatives, especially affected by the times of day they are available. GP replied GP streaming is key to this, though with further work to ensure effective positive re-direction is in place, including through services such as 111. Data tells us that 50-60 patients day are being positively re-directed through GP streaming.
LP requested for next Governing Body meeting an update for information on the winter plan after it has been discussed by the A&E Delivery Board. Further inclusions in the winter plan suggested for next week’s A&E Delivery Board were:
1. Formal evaluation of last winter including measurable outcomes of whatdid and didn’t work, and how that has affected this year’s plan
2. Presentation included no measurements or timescales, and no real linkto what the problem was, i.e. top ten clinical diagnoses analysis; whereoriginating from and time of day, and therefore how approaches andactions within the presentation address the findings.
3. System analysis for forecasting bed need; this needs link to a currencyof bed days – we know how many beds we have in hospitals and carehomes; we need to know how many bed days each project will offer upto the system to benefit patients.
LP added that the presentation given clearly needs to go through HASC and the external bodies and be a little more public facing.
RB added that there is also need to understand impact on urgent care demand from MuDAS, CATS, GP streaming, GP triage, MIIU and 111 in keeping patients out of hospital. What is the impact of 111 in relation to access to pharmacies, GPs and A&E? What is the quality of service? LP replied that the A&E Delivery Board would need to address the detail in relation to the query.
DS added that MuDAS may not be used as effectively as it might, one of the reasons for that relates to referral pathways, the success of which is depended on clinical engagement both in primary and secondary care. We have a forum to discuss this, though some clinicians have interpreted this the creation of an ICS urgent care board which we need further work to address.
DS
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RM mentioned that the presentation had a mixture of measures we have had in place in previous years with evidence to suggest where there are capacity gaps and how these are to be addressed. Super stranded patients on mental health pathways who often experience long delays need also to be addressed. But we must not neglect the wider impact on capacity from improvements needed in cancer and managing related waiting lists. GPa and DS were thanked for their participation, with the winter plan endorsed by the Governing Body.
b) Non-elective Demand Management / Discharge To Assess decision
D2A is primarily about patients having their needs assessed in their usual place of residence, a care home, or own home, or a place of residence close to their own home as soon as they are medically optimised and deemed safe by a consultant to leave hospital. This takes place in tandem with assessment. IC noted a paper had been provided to governing body members, but it did not now reflect the current situation and so was withdrawn. Governing Body was asked to support:
1. CFO committing up to £500,000 in 2018-19 to commission D2A 2. Prioritise Frimley facing capacity and expansion of the Enhanced
Recovery at Home model. 3. CFO and Director of Commissioning and Delivery to identify an agreed
model for a permanent, year round, sustainable solution. IC noted CFO has authority already for £500,000 but due to Financial Recovery Plan this has been brought to Governing Body to seek assurance that this approach is agreed. IC noted a national objective to better utilise resources, especially during winter. This year the local authority is providing more funding into domiciliary care than last year which has led to better preparedness, and increased care home funding in terms of hour being delivered. We also recognise a workforce challenge, especially in the south of the county, in order to ensure the capacity we need. Frimley last year introduced an enhanced recovery service in Hampshire which they are offering to Buckinghamshire, so we are seeking agreement to fund this. We are also seeking flexibility to fund measures we know are effective; we have good opportunities and need some flexibility for how we deliver. GH added options being explored to fund this, including monies from NHSE circa £1m to invest. ICS partnership board agreed £0.5m from ICS transformation funds would be ring fenced for this. The other 50% to be funded by ICS partners, but if not forthcoming by the CCG alone as a crucial part of winter planning. Without this would experience a tough winter and increase patient safety risks. CO noted workforce challenges and whether staff would move from acute to community. IC replied that this would be a principle, though some organisations such as Frimley Health NHS Foundation Trust have better resilience where they pay London/fringe weightings which aren’t applicable in Buckinghamshire. IC added that our contract with Frimley is PBR; our investment would pay for itself in reducing overall lengths of stay. CO further queried where the people resource would come from to treat stranded patients (i.e. those awaiting discharge). RM replied the intent is for a model of care delivered throughout the year and being able to respond to surges with effective planning; not just focusing on winter planning. IC added that there is
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already care home capacity available through building programmes, if we can put capacity into it. As regards nursing capacity, this is more challenging. LP noted the evaluation, activity and clinical, will be a major factor, and there are some valuable precedents elsewhere with therapy and nursing led units to enable different elements of the workforce to support this. CO also recognised the recruitment challenge. IC noted purchase of demand and capacity modelling which will support what LP has described. LP continued that early discharge to assess has led elsewhere to less dependency with lower need supporting packages. It was also made clear that this is to be delivered by Frimley Health NHS Foundation Trust – this is new in Frimley North and is a change in direction, though this has already been done in Frimley South for some years. RMS queried if D2A period has been defined. IC replied these are standards CHC; the time period for this is six weeks. KW added that this will help reduce the cost of supporting CHC packages. RB queried return on investment if this is successful. GH replied the current objective is impact on system performance, particularly the A&E target. GH felt A&E performance would be improved. GB Supported the recommendations 1 – 3 in the paper
c) Emergency Preparedness, Resilience and Response (EPRR) 2018/19 assurance process assessment against core standards
The Governing Body was asked to:
a) NOTE the progress of the Emergency Preparedness, Resilience and Response EPRR) process and assurance on compliance. This report reaffirms the process followed by NHS Buckinghamshire CCG in undertaking the EPRR self-assessment and subsequent approval by NHS England. This year the CCG has completed a self-assessment against the core standards and have rated itself as substantially compliant. There is a further process completion required to review, approve and ratify through the CCG Executive Committee on 27 September 2018 a suite of documents which support the assessment against the NHS Core Standards for EPRR
a. Major Incident Framework/Incident Response Plan b. CCG Business Continuity Plan and c. Surge and Escalation Plan
b) DELEGATE AUTHORITY to the CCG Executive Committee to undertake the above, in order to discharge approval requirements within core standards.
c) NOTE further requirements for reporting to Governing Body within the core standards and additional assurances provided.
RC noted the CCG Business Continuity Plan as broad as it covers all directorates, which may not always be affected by a major incident (whereas the Urgent Care Team would be directly impacted). GP added that there had been a forensic analysis of compliance, with confirmation that confirm and challenge with Buckinghamshire Healthcare NHS Trust would be taking place on 14 September, followed by confirm and challenge with NHS England on 27 September. Substantial compliance is expected through both. NL drew attention to “Duty to risk assess – recording and reporting through the Corporate Risk Register” and suggested that CCG business continuity and
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EPRR were different and therefore should be reflected in separate risks. ACTION RC took an action to develop a separate EPRR risk. NL also felt our reasoning for current score should read as “We don’t provide front line services and so our risk is low” rather than “The risk to major interruption is generally low because the CCG is not CQC registered and does not therefore provide frontline services” as currently stated. LP echoed these points.
RC
6. Primary Care update including Resilience
a) Primary Care Improved Access – award of contract b) Update on Chiltern House Medical Centre and engagement plan for
Wycombe
a) RB handed over the Chair role to RP given material conflict for GPs present.
A full paper was reviewed at the Primary Care Commissioning Committee on 6 September 2018 in public. This has been a short timescale given original live date of April 23019 moved forward to October 2018. There remain some teething issues to address; in only one locality of seven across the county. A line by line review has also taken place at the project steering group which has involved NHS England. Governing Body was requested to:
• Review summary progress report on mobilising Improved Access to General Practice. Full paper reviewed at Primary Care Commissioning Committee (PCCC) on 6th September 2018.
• Receive verbal update on progress to-date in terms of service readiness and comments from PCCC regarding this scheme.
• Note details of contract to be awarded. • Approve contract signature.
NL noted a typo in the conflicts of interest section: The route to procurement for this contract was as Phase 2 of a procurement 24/7 service. It was therefore not subject to a separate formal external tender, rather a 30 day Prior Information Notice (PIN) as required with EU regulations. There were no challenges to this, leading to signing of heads of terms with FedBucks. LP noted we have a formal framework for procurement previously agreed at Governing Body, with requires active collaboration with local providers to ensure true integration and value for patients. This is an AMPS cntract with one provider within our provider alliance. We must recognise that if FedBucks were to leave the provider collaborate then this would put us in a difficult position. NL clarified that the contract is to be awarded to the provider collaborative with FedBucks as the lead provider. LP asked for this to be amended to be really clear. ACTION CO queried patient involvement expected. NL replied there will be a local version of an NHSE communications plan. Part of the contract is very clear on promotion is part of what is required alongside delivery by the contract holder. Because of short mobilisation time, we expect a soft launch on 1 October. RW asked if A&E can divert patients. NL replied 111 can book on the day, but this is not for urgent referrals, rather it is aimed at planned care.
NL
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Requests above of Governing Body were agreed.
b) Chiltern House Medical Centre Practice – update This practice had dissolved its partnership without notice on 9 July 2018. We put in place an emergency decision to contract for up to 12 months with Primary Care Management Services (PCMS), which is proving effective to date. In the meantime, we had to negotiate lease extensions as there were no leaseholders working at the practice. At Temple End, this has gone well with an extension agreed with the new provider. However, at Dragon Cottage, the lease was due to expire on 29 September 2018. Early indications suggested this would be extended, but the landlord changed their mind and we were asked to give vacant possession on 29 September 2018. To allow for repairs/refurbishment we had to vacate by 7 September 2018. However a large scale communications campaign was undertaken explaining the position; to date we have had a few enquiries. We will now undertake a stakeholder participation exercise for up to 12 weeks to help us make a future decision, and we have published an expression of interest to take over on Contracts Finder. LP suggested the cover sheet does not describe the patient involvement that has already taken place, especially PPG groups. LP commended the team for their early interventions. As regards Temple End, LP noted the list size is quite small and, if there were no willing provider, we may have to disperse the list. Is there a liability with us on the extended lease? NL replied there is three months’ notice. The update was noted for assurance.
7. Integrated Care System: memorandum of understanding with NHS England
RM introduced the MOU with NHS England for the Integrated Care System. This is an update as we had a similar document last year. It has been through the ICS Partnership Board and sets out high level priorities and national must do’s required of every system. Discussion across ICS partners is that, in addition to the MOU, will be a covering letter declaring our sign up and commitment to deliver our operational plan. We also have transformation funds to support it. Comments received:
1. RP – there is reference to quarter 2, but it not clear whether this is calendar year or financial year.
2. CO – Primary Care Networks referred to don’t yet exist. NL clarified we refer to them as “clusters”.
3. LP noted until this is signed we don’t get transformation funds. Also helpful would be the version control.
RB queried whether a version earlier in the process would have been helpful. LP replied the model had come from NHS England, and the Partnership Board would then flag any risks to it being signed. A lot has been discussed at Partnership Board and Executive Leadership Group, so LP was able to provide this assurance as CCG lead. The MOU was duly approved and ratified.
Leadership and Governance
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8. Accountable Officer’s Report and System Working Update
RM talked through a number of points within the report provided. The report was received for assurance. RM specifically noted that the development of ICS Programme Boards has been undertaken in order to really focus on in-year delivery. RB queried if we had thanked staff for their participation at AGM; LP replied we had and those involved had a full day in lieu.
9. Finance Report (Month 4)
GH provided a finance update; circa £9m risks which will crystallise into FOT at Month 9. These have been fully mitigated, but we only have £3.5m contingency remaining. This is uncomfortable at only Month 5. We already know our pressures; Frimley Non-elective, QIPP shortfall, Section 117. Since we reported last month we have additional emerging risks discussed at Finance Committee earlier in the week, for example Category M drugs (national pressure £15m a month, £1.1m for the financial year for us). We have also undertaken sensitivity analysis on numbers; we think there will be further pressures on acute. We need to find further QIPP schemes. GH had instigated extension to discretionary spend; this means any uncommitted spend will be further scrutinised to assist in holding the position. We remain committed to hit out yearend plan. We missed our Q1 Commissioner Suitability Fund (CSF) and BHT their Provider Sustainability Fund (PSF), we expect to hit CSF in Q2 and therefore recoup Q1 money. This is circa £5.5m which is much needed. RB queried GH’s optimism in recouping this. At Month 5 we are showing a break even position, which we also expect at Month 6. We have looked at everything we can to ensure this. GH added that, at system level, there has been much challenge through system assurance and we need to do better on our forecast outturn. This is a system not organisational problem; we need to improve performance and finances this year by taking costs out. There will be a prioritisation exercise to look at further schemes. LP queried who is looking at the analysis of what went wrong last year and lessons learned; it is the ICS Executive Leadership Group? GH that it is; supported by joint quarterly forecasting to maximise PSF and CSF. We have missed the A&E target at end of Q2 which means we miss PSF, but we should achieve CSF. LP suggested if we were a larger ICS (like Manchester) we would have greater movement of our system control. LP noted this was important for the Governing Body to understand. RP provided some additional assurance to Governing Body that Finance Committee are putting GH under scrutiny in relation to the position, and monitoring at some depth each step. It is also vital that individuals set measurable objectives. We already know much more about this year than we did at the corresponding stage last year. We must ensure a balance between reflecting on what has already been achieved against what we still need to do to ensure we achieve a break even position. We must be harder and faster in the targets that we set. RB suggested to the brief to those who come to describe their portfolios is just that. We need to know what is making a difference. GH concluded that A&E and non-elective is also an ongoing challenge at BHT – areas that should not still be open are staffed by locums
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which is increasing cost, and there is a high vacancy rate with pressure on locum and agency staff. We also have a challenge with Cost Improvement Plan (CIP) delivery and maintenance costs across the estate. All these issues we are tackling across the system. LP noted that Milton Keynes Hospital, although a smaller contract, also over performs. GH replied that we have a value circa £9m – it is not showing massive variance as yet. As regards Frimley, there had been an aim to sign a block contract, but it is disappointing to note that this will not now happen. However any activity above a capped value of £52.3m we will pay only a 50% marginal rate tariff, with Frimley paying for the other 50% of the tariff. We are also discussing a number of contract challenges, including short stay admissions of less than one hour. .
The Governing Body was asked to NOTE assurance report provided on CCG discretionary spending. This was noted as a contribution to our transparency in reporting our financial position. RP queried whether the report has benefit to the Governing Body. CS queried whether it was mandatory. RC replied that it is for transparency that we are following a process and evidencing rigour. CS suggested there must be a balance. GH noted there has been a previous discussion about transparency and upwards assurance where Executive Committee had taken any decisions on behalf of the Governing Body. RB added that there had also been the same point in relation to discussion at SMT. KW felt it was important to have it here for information. NL felt the detail was better at Executive Committee given inclusion of values of contracts. RB noted some content also relates to Executive Committee members. RM added it also circulates to Finance Committee and this would be better for detail with some inclusion within the Finance Report. LP concluded that GB needed assurance that there is a list and type, no need for the additional description column. RB noted wanting involvement in discussions about clinical roles. It was concluded it would come to GB for information in appendices with no identifiable details.
11. Quality and Performance Report (Month 5)
KW introduced and described elements of the report – cancer, A&E, and Referral to Treatment (RTT), Delayed Transfers of Care (DTOC), mixed sex breaches, IAPT, learning disabilities, safeguarding, and dementia screening. RB suggested this was an example of aiming to manage too many priorities; naturally work is undertaken to meet national priorities but over time there may be less focus. LP replied we shouldn’t lose sight as it is one of many indicators of CCG effectiveness. RW noted reference under 4 hour A&E waits to “Focus on acuity and admissions – 11.83% increase from July 2017 to July 2018”. Is this an increase in acuity or increase in the number of people? RM replied there is a general theme on the right type of information; type 1 A&E attendances are generally down, but it remains important to continue understanding the link through to admissions. Sometimes we may have broad statements which don’t link context. RB continued this would evidence a reduction in acuity, so perhaps acuity is the wrong term to appear here. It should refer to reduction in type 1/volume.
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RW also referred to previous data reported on diagnostics; this is an interesting metric which was not included in this report. KW replied that it can get long when including so much information. RB queried we have considered diagnostics as a means of reducing in-year spend; we may be spending on excess tests. LP noted emphasised diagnostics in relation to cancer targets – KW confirmed these had been included. General diagnostics primary care and hospitals, were not. KW would feed this back. KW also referred to the first ICS Quality Committee having taken place earlier this week; we are looking at having a couple of focus areas at next meeting in November – learning from end of life deaths and winter planning. LP noted difficulties with the report, for example safeguarding was a long list of things we are doing so wasn’t clear why this was included. It confused some of the serious incident monitoring with some of the wider work. She also felt it couldn’t be mapped to the safeguarding board; given our new statutory responsibilities this needs to be looked at for both children’s and adults. There was some ambiguity about some of the bullet points and link to quality – how are we assured? This needs some further clarity, particularly around cancer. LP also queried status of aiming to agree a dashboard across Oxfordshire and Buckinghamshire with links to quality. The CSU helps monitor this and some of the providers; so this would be helpful. KW replied that this is being discussed. LP requested that we aim for end of Quarter 3; and push back to CSU to ensure it is done. LP added that there were figures around GP triage and GP streaming, but not broken down by locality or practice. We seem to have lost this; we just see GP referrals. KW queried this level of detail at Governing Body. LP replied that when it came it was a graph, and DR made link that it seemed to affect behaviours. It definitely should be reported by locality which also should be reported to localities themselves. Part of our responsibility to the system is not just assuring ourselves that BHT have discharged their responsibilities, but that member practices do what they should. RB suggested this was partly a description of the locality dashboard and how well each locality is discharging the functions it is expected to – referrals, acute care, diagnostics, prescribing, 8-8 improved access etc. RB queried where this would be done; NL replied NHSE are developing it (a dashboard). LP added there remains some wider system performance resilience of primary care providers; RM continued stating this had also been discussed at ICS Partnership Board in relation to an ICS dashboard which should also focus at locality level on A&E, cancer and RTT. RMS added that the dashboard needs to include 8-8 etc.
These were noted (refer to agenda for details). Reports provided for information were noted as received. Meeting closed 12:45
15. Next meeting/AOB Date and Time of the next meeting: 11 October 2018
Jubilee Room, Aylesbury Vale District Council, the Gateway, Gatehouse Rd, Aylesbury, HP19 8FF
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Acronyms
A&E Accident and Emergency IFR Individual Funding Request ACHT Adult Community Health Team IG Information Governance ACO Accountable Care Organisation KLOE Key Lines of Enquiry ACS Accountable Care System LMC Local Medical Committee ADSD Attention Deficit Hyperactivity
Disorder LPF Lead Provider Framework
AF Atrial Fibrillation M Million AGM Annual General Meeting MAGs Multi Agency Groups AQP Any Qualified Provider MCA Mental Capacity Act ASD Autism Spectrum Disorder MCP Multi-speciality Community
Provider AT Area Team MK Milton Keynes University Hospital
Foundation Trust AVCCG Aylesbury Vale Clinical
Commissioning Group MCP Multispecialty Community Provider
BAF Board Assurance Framework MusIC Musculoskeletal Integrated Care BCC Buckinghamshire County
Council NHSE NHS England
BCF Better Care Fund NHSi NHS Improvement BAF Board Assurance Framework NOAC New Oral Anticoagulants BHT Buckinghamshire Healthcare
Trust OCCG Oxfordshire Clinical
Commissioning Group BAME Black and Minority Ethnic OOH Out of Hours BPPC Better Payment Practice Code OUH Oxfordshire University Hospitals
NHS Foundation Trust CAMHS Child and Adult Mental Health
Services OPEL Operational Pressures Escalation
Level CCCG Chiltern Clinical
Commissioning Group PACS Primary & Acute Care Systems
CDIF Clostridium Difficile PAS Patient Administration System CFO Chief Finance Officer PB Programme Board CHC Continuing Health Care PBR Payment by Results CIP Cost Improvement Programme PIRLS Psychiatric In Reach Liaison
Service COI Conflict of Interest PLCV Procedures of Limited Clinical
Value COPD Chronic Obstructive Pulmonary
Disease PMS Personal Medical Services
CPA Care Programme Approach POD Point of Delivery CQC Care Quality Commission POG Programme Oversight Group CQRM Contract Quality Review
SCWCSU South Central and West Commissioning Support Unit
QIS Quality Improvement Scheme
Pack page 14
CSIB Children’s Services Improvement Board
QOF Quality & Outcome Framework
CSP Care & Support Planning QNI Queens Nursing Institute CSR Comprehensive Spending
Review PCCC Primary Care Commissioning
Committee CSU Commissioning Support Unit RAG Red, Amber, Green K Thousand RBH Royal Berkshire Hospital DES Directly Enhanced Service RCA Root Cause Analysis DGH District General Hospital REACT Rapid Enhanced Assessment
Clinical Team DOLS Deprivation Of Liberty
Safeguards RRL Revenue Resource Limit
DST Decision Support Tool (CHC) RTT Referral to Treatment EDS Equality Delivery System SCAS South Central Ambulance Service EOL End of Life SCN Strategic Clinical Network F&F Friends and Family SLA Service Level Agreement FHFT Frimley Health Foundation
GB Governing Bodies TOR Terms of Reference GMS General Medical Services TV Thames Valley HASC Health and Adult Social Care
Select Committee TVN Tissue Viability Nurse
HASU Hyper Acute Stroke Unit TVPC Thames Valley Priorities Committee
HETV Health Education Thames Valley
UECN Urgent Emergency Care Network
HWBB Health & Wellbeing Board YTD Year to Date ICS Integrated Care System ICU Intensive Care Unit
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ACTION LOG
MEETING: Item 3b
DATE: 11/10/2018
TITLE: Action LogPrevious Meeting Date (or Date raised /added)
ActionNumber /ID
Minutes Reference
Action Description Responsibility /Owner
Target date Completed date
Status Progress Details/Comments
12/07/2018 1 Quality and Performance Report (Month 1)
As regards CHC indicators, RM stated it is disappointing to see low rates of assessment completions, and that it would be better to have rolling figures rather than year to date.
DR/IC 11/10/2018 Open This was added back onto the action log on 13/09/18. Quality team asked for update
13/09/2018 2 Winter planning DS also noted public health have offered all came home staff a flu vaccinations on site. CO queried if the community teams were aware of this. DS was unsure, but would liaise with a new public health consultant who is working out a way to target those community staff given recognition that they frequently move around between care homes and other locations across the county.
DS 11/10/2018 Open Dr Dal Sahota asked for update - reply from Public Health received; all community dom care staff are encouraged to get their free NHS vaccination. Public Health have written to all the bucks dom care agencies promoting this and outlining an expectation that this forms part of their winter preparedness. They are also prepared to offer flu clinics with in-reach pharmacists were dom care agencies to hold teaching days or meeting etc involving a high number of staff.
13/09/2018 3 Emergency Preparedness, Resilience and Response (EPRR) 2018/19 assurance process assessment against core standards
RC took an action to develop a separate EPRR risk. RC 11/10/2018 18/09/2018 Closed Separate EPRR risk provided to SMT, to be added to verto, but otherwise action closed
13/09/2018 4 Primary Care update including Resilience a) Primary Care Improved Access – award of contractb) Update on Chiltern House Medical Centre and engagement plan for Wycombe
We must recognise that if FedBucks were to leave the provider collaborate then this would put us in a difficult position. NL clarified that the contract is to be awarded to the provider collaborative with FedBucks as the lead provider. LP asked for this to be amended to be really clear. ACTION
NL 11/10/2018 03/10/2018 Closed Cover sheet in GB papers acrhive amended to include "FedBucks is the lead provider for this contract from within the provider collaborative."
Governing Body (in public)
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MEETING: Governing Body AGENDA ITEM: 5
DATE: 13 October 2018
TITLE: Executive Committee terms of reference update
AUTHOR: Russell Carpenter, Head of Governance/Board Secretary
LEAD DIRECTOR: Robert Majilton, Deputy Chief Officer
Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information For Ratification
Summary of Purpose and Scope of Report:
The Governing Body is asked to RATIFY updated terms of reference for the Executive Committee, currently one of its sub-committees. On 14 June 2018, the Governing Body ratified terms of reference for all its sub-committees post-merger.
Each Committee should consider if its ToR remain fit for purpose at least once a year. If Committee members agree that any changes to the Terms of Reference should be made, in line with the CCG’s Constitution these changes should be recommended to Governing Body for formal ratification.
Executive Committee Terms of Reference were subject to further review and revision in July 2018, approved by the CCG Executive Committee on 25 July 2018.
2. Member changes: Director of Performance, Assurance & Contracting added as votingmember, whilst the Clinical Director – Integrated Care replaces the Associate Directorof Quality & Safeguarding) on voting membership
3. Committee/Boards/Groups/Panels accountable to the Executive Committee – alladded.
4. Delegated authority for decisions: list of decisions delegated to the committee nolonger documented within terms of reference and wholly cross referenced to the CCGScheme of Reservations and Delegation.
Authority to make a decision – process and/or commissioning (if relevant)
The Governing Body has power to ratify the terms of reference tor its sub-committees.
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Conflicts of Interest: (please tick accordingly)
No conflict identified Conflict noted, conflicted party can participate in discussion and decision (see below) Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate in discussion (see below) Conflicted party is excluded from discussion (see below) Governance assurance (see below)
Strategic aims supported by this paper (please tick) Better Health in Bucks – to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all
Better Care for Bucks – to commission personalised, high value integrated care in the right place at the right time
Better Care for Bucks – to ensure local people and stakeholders have a greater influence on the services we commission
Sustainability within Bucks – to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation
Leadership across Bucks – to promote equity as an employer and as clinical commissioners
Governance requirements: (Please tick each box as is relevant to the paper)
Governance Element Y N N/A Comments/Summary Patient & Public Involvement
Equality Quality Privacy Financial Risks Statutory/Legal Committee must have terms of reference as a
Through Member GPs as voting members on Governing Body and Executive Committee.
Supporting Papers:
Executive Committee TOR - FINAL v1.0 AMENDED RC July 2018
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MEETING: Governing Body AGENDA ITEM: 6a
DATE: 11 October 2018
TITLE: Communications and Engagement Update
AUTHOR: Kim Parfitt, Communications, Bucks County Council Dr Rodger Dickson, Clinical Locality Lead, Aylesbury Vale North
LEAD DIRECTOR: Nicola Lester, Director of Transformation
Reason for presenting this paper: For Action
For Approval
For Decision
For Assurance
For Information
For Ratification
Summary of Purpose and Scope of Report:
The purpose of this report is to update the Governing Body on the communications and patient/public involvement that has been undertaken over the preceding three months. It outlines the engagement work, the press and media work and the marketing/campaign work we have undertaken. It includes a report on the 360 degree survey as well as a report on the actions of the Engagement Steering Group. This report is intended for information. Conflicts of Interest:
There are no perceived conflicts of interest
Strategic aims supported by this paper (please tick) Better Health in Bucks – to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all
Better Care for Bucks – to commission personalised, high value integrated care in the right place at the right time
Better Care for Bucks – to ensure local people and stakeholders have a greater influence on the services we commission
Sustainability within Bucks – to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation
Leadership across Bucks – to promote equity as an employer and as clinical commissioners
Governance requirements: (Please tick each box as is relevant to the paper) Pack page 19
Governance Element Y N N/A Comments/Summary
Patient & Public Involvement
This report covers patient and public involvement across the board and links to various groups (see report for detail)
This report has been reviewed by Nicola Lester and approved by the Engagement Steering Group
Membership Involvement
Supporting Papers:
None
Pack page 20
1.0 Introduction
The second quarter of the financial year has seen a continued focus on communications, public and patient involvement and engagement. With many changes going live at the start of quarter 3 for Primary Care, the focus has been to promote these changes and involve the public and patients in these changes. Despite the summer months, we have been looking ahead to managing winter and producing a communications plan, in line with that of NHS England and Public Health England’s campaigns. The integrated care system has also seen increased activity over the last quarter.
2.0 Our Objectives
The Communications and Engagement service provides strategic and operational support for the CCG to enable it to work with stakeholders, partners, patients and the public to deliver their commissioning intentions as part of the integrated care system. The service assists the CCG to ensure that it meets its statutory duties to engage and consult and also work to ensure that equality and diversity issues are taken into account throughout delivery of the service.
3.0 Public and Patient Involvement
3.1 From July - September
There has been a number of areas of work where residents in Buckinghamshire have been able to provide their views either through attending events or by surveys, over the last quarter.
Transforming Care – Access all Areas
This inaugural event took place on Thursday 13 September. The aim of the Access All Areas event was to help people aged 14 and over with learning disabilities and autism access all the areas of support and help available. It took place at Stoke Mandeville Stadium.
This is the result of a partnership between Buckinghamshire County Council, Buckinghamshire Clinical Commissioning Group, and many other health and social care professionals and services. It also had the support of generous sponsorship to enable the event to go ahead. Over 200 people attended during the day and there were 36 exhibitors including BuDS, Animal Antiks, Healthy Minds, Adviza, bSHaW, Bucks Safe Places, Autism Bucks. Those attending could
Pack page 21
try fun food tasting, have a go on the smoothie bike, visit the asthma bus, try out the shooting range or make use of the chill out area. Overall, the event was a resounding success.
NHS70 Event and Joint CCG and BHT Annual General Meeting
In July, Buckinghamshire Healthcare NHS Trust and the CCG held a joint AGM. This formed part of the NHS 70 events taking place in Bucks where residents were invited to come along to Stoke Mandeville hospital and go behind the scenes to see how the NHS works. Alongside this there were fun activities and entertainment for all the family. A flyer was created for the public to outline the work of the integrated care system:
A short film of the day was created by BHT - https://youtu.be/S_kyqCjBXFE
Inequalities Advisory Group
The third meeting of this group took place on 27 September. Members of the group were updated on Flu, Cancer Screening, Improved Access and Chiltern House Medical Centre. As a result, the group are now working with Public Health to increase support available to schools including health and wellbeing teaching within their curriculum (initially beginning with four schools in the Wycombe area). The group is also working with the Stroke Association to arrange more health checks in areas of most deprivation to help reduce health inequalities – as outlined in a previous report.
Views were sought on the work undertaken to date on the Outcomes Framework. This piece of work was undertaken by a group of patients working collaboratively with Buckinghamshire Clinical Commissioning Group and has been ongoing over a period of time. The feedback we received from this, whilst only from four respondents, was detailed and feeds into the ongoing work to provide a steer rather than any formal decision. Once a final draft has been further developed, there will be further opportunity to seek the opinion of the public
Chiltern House Medical Centre
a) Closure of Dragon Cottage
The 25 year lease for Dragon Cottage ended on 29th September 2018 and the owner confirmed to the CCG on Monday 13th August that, contrary to earlier discussions, they would not be renewing the lease and will required vacant possession on the 29th September. A Communications Plan was drafted for contacting patients as well as stakeholders with the key messages being:
The Dragon Cottage branch surgery, part of Chiltern House Medical Centre, will bepermanently closing on 7th September 2018 as the lease is not being renewed.
This is unrelated to the changes in practice management at Chiltern House MedicalCentre.
Don’t worry; you don’t need to do anything.
Your GP appointments will now be at the Temple End site, near Morrison’s in HighWycombe.
We are currently reviewing our options for patients in the Holmer Green area and we willmake sure we involve you in these reviews so we understand what is important to you.
We reached patients through:
Direct Mail Practice’s Patient Participation Group
Text message Social Media Press release Websites (CCG and Chiltern House Medical Centre) Display posters and GP Screen in surgery Emails to Care Homes, Parish Councils, local pharmacies, existing suppliers and users of
the Dragon CottageIn addition, we ensured the following were briefed in case patients contacted them:
Health and Adult Social Care Select Committee Healthwatch Bucks Local Councillors MPs PALs CQC Social Care All GP Practices
b) Reprocurement of a provider at Chiltern House Medical Centre
As part of the communications about the closure of Dragon Cottage, we advised patients we would be reviewing our options for patients in the Holmer Green area and we would sure we involve them in these reviews so we understand what is important to them.
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We are currently planning the communication and engagement activities for this and creating a consultation document. This will be aligned with the Equality Impact Assessment to ensure that through targeted communication channels all of the patients at both the Temple End and Holmer Green sites are involved.
Dementia
The Buckinghamshire Dementia Conference was held on 28 September at The Oculus in Aylesbury. We supported with promotional materials and invitations to promote the conference. 120 people attended - largely people who are living with dementia and their carers, to hear talks
from people affected by the condition and to take part in round table discussions to discuss what is working in Bucks and identify areas of service improvement. 3.2 Future engagement
Getting Buckinghamshire involved Steering group
This group will look at plans to involve local people in changes to health and care services in Buckinghamshire. The group will help us make sure we are talking to the right people at the right time and in the right way, so these people can give us their views on the possible changes. In particular, the group will look at how to involve people in the main areas of work of the Buckinghamshire integrated care system (this is a group of local organisations who are joining up to improve health and care services). This work includes:
More work to help people stay healthier for longer Getting the best care possible Improvements to mental health care Buying the best services for the best price Getting all our staff to work together Getting all our systems to link
The group will try and make sure that the integrated care system will:
Involve people as early as possible in any changes Find ways for people to get involved to make things better for everyone Listen and make sure all voices are heard and acted upon Find ways of helping people understand the changes to their health and social care
services Understand what can and can’t be changed Always use plain English and different ways of listening to residents Help local organisations get better at involving local people
The terms of reference have been agreed and the inaugural meeting is currently being organised.
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4.0 Staff Engagement
360 degree survey This report presents the results from Buckinghamshire CCG’s 360° Stakeholder Survey 2017-18. The annual CCG 360° Stakeholder Survey, which has been conducted online and by telephone since 2014, allows a range of key stakeholders to provide feedback on working relationships with their CCG. The results are used to support CCGs’ ongoing development and feed into improvement and assessment conversations with NHS England. 51 practices were contacted 34 [67%] responded. 7 other stakeholders responded though only 1 out of 3 hospital trusts responded. Of the 22 questions, 17 responses were generally good or average compared to national and neighbouring CCG’s. So Bucks CCG was generally felt to be good with regards to its effectiveness as an organisation, the confidence members have in it, its pursuit of quality and value for money. The respondents particularly felt it was a well led organisation with clear and visible aims. They felt able to raise concerns on quality and were effective communicators as a local system leader. Bucks CCG was also thought to be good at working with others 5 out of 22 areas were thought to be less good and clinical executive felt a response was required.
1. Commissioning/ decommissioning involvement – essential all these decisions are brought to clinical executive for scrutiny by locality leads. Localities need to be aware of operation plans and commissioning intentions
2. High quality/value for money – localities require regular financial/performance reports – as a standing agenda item
3. Acting on feedback in regards quality of services – monthly quality reports 4. Influence of members on CCG plans/priorities – this perhaps the one area Bucks CCG
performed least well. We need to pay more than lip service to being a locality led CCG. Portfolio leads need to debate health priorities with localities. Population health based commissioning will reflect the local nature of health need.
5. Patient / Public engagement – more structured engagement events – sharing best practice on public engagement between localities
In essence the three main conclusions from this 360’ survey
Information – performance/financial/quality – in timely way for localities Scrutiny of commissioning plans at clinical executive by locality leads Scrutiny of commissioning plans by a well-informed locality
This section authored by Dr Rodger Dickson, Clinical Locality Lead for Aylesbury Vale North.
ICS Staff Survey
With the introduction of the Integrated Care System in Buckinghamshire, we wanted to find out what staff knew about the system. We also wanted to know how staff across all organisations wanted to be kept up-to-date with the progress. The ICS staff survey ran from 2 July to 22 July and received 420 responses. As a result of the survey, we will be creating an ICS website to keep staff informed and will be introducing an ideas scheme for staff.
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ICS Newsletter
The latest edition of the ICS newsletter was published on 13 September. This included an update from the programme boards and a video of the event to celebrate achievements made in Diabetes. 330 people currently receive the newsletter. Opening statistics went up from 18% in July to 24.6% in September. We are currently planning a campaign to increase subscription and readership of the newsletter.
5.0 Communications
5.1 Traditional Media
Media requests
From July – September 2018, we have handled 10 media requests directly relating to the CCG including enquiries and interview requests. We have drafted 10 press releases, including 3 ‘if asked’ statements that were not required for release. These included:
- Changes to repeat prescriptions- A proposed new building for Meadowcroft Surgery and Berryfields Medical Centre- Meadowcroft Surgery’s running team – staff doing their bit to promote healthier
lifestyles by example- Dissolution of partnership at Chiltern House Medical Centre and updates- Closure of Dragon Cottage branch surgery- Response to NSPCC report on Bucks- Promotion of Annual General Meeting- Bank Holiday pharmacy hours
Media enquiries included:
- Further details on Berryfields plan- Plans for GP Extended Access- Data protection officers for GPs- Availability of GP appointments in Bucks- Further information on GP partnership at Chiltern House Medical Practice- GP numbers in Bucks- MMR vaccinations for pre-holiday- Smoking cessation (Live Well Stay Well)
Public Questions
We are asked to support the drafting of public questions to the Health and Adult Social Care Select Committee for example a response created on behalf of the CCG and BHT in relation to a question about community hubs
Parliamentary Questions
Response collated jointly for CCG/BCC in response to a question about funding at the Healthy Living Centre from MP David Lidington
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5.2 Social Media
Social media remains critical for engaging with the patients and the public. It allows us to target and inform relevant residents either using demographics or by geography. The table below outlines the key channels, Twitter and Facebook, and the relevant key data.
Twitter Facebook
Tweets Visits to Profile
New Followers
Post/Shares Reach
July 2017 5 381 30 2 73 August 4 335 24 14 1369 September 49 1143 34 13 1111 October 51 879 32 36 2223 November 53 1030 48 39 1370 December 33 420 8 21 3686 January 2018 98 1055 21 83 60716 February 97 832 23 68 33834 March 100 734 27 68 34488 April 29 748 14 15 655 May 53 778 30 43 2750 June 52 712 27 41 2569 July 45 644 10 20 2235 August 51 489 23 42 4315 September 40 340 28 44 3369
6.0 Campaigns
Improved Access to GP Services
A communications and engagement plan was developed to implement and promote ‘Improved Access to GP Services’, following the engagement activity detailed in last quarters report. This involved creating a briefing document and a toolkit of materials for practices as well as producing materials centrally for GP screens and posters. There will be a media/social media campaign to promote the new service starting week commencing 22 October.
This campaign was presented to the Inequalities Advisory Group, and as a result we are currently developing some materials in Urdu and Punjabi. These will be used in schools in areas of the most deprivation to promote on our behalf. The aim being that this improved access will help to increase levels of attendance at the schools.
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Repeat Prescriptions
The way repeat prescriptions for medicine in Buckinghamshire changed in August. Patients were asked, where they were able to do so, to order their repeat prescriptions directly from their GP practice - either online or in person. This meant that patients would be less likely to have unnecessary or out-of-date medicine in their homes, improving their own safety, and will also reduce costly medicine wastage. These changes were communicated out to patients through:
GP Practices Pharmacies Social Media Press
release
Text messages Letters CCG Website Leaflet
Prescribing of over the counter medicines
In March 2018, NHS England published guidance about reducing the prescribing of medicines or treatments that are available to buy over the counter. The new guidance which followed a consultation in 2017 says that stopping the routine
prescribing of these medicines will save the NHS around £100 million. The final recommendations from NHS England covers 35 minor, short term conditions, including dandruff, indigestion, mouth ulcers, travel sickness and coughs and colds.
Our Plans in Buckinghamshire
In 2017/18, over £1.5M was spent on prescriptions in Buckinghamshire for items that can be bought over the counter. Therefore, Buckinghamshire is adopting this national guidance which will reduce the spend on around 35 different medicines and treatments for minor conditions and ailments that are usually self-limiting or which lend themselves to self-care. Communicating the changes
We will be advising residents in Buckinghamshire about these changes through: Activity Detail
Briefing to HASC Emailed briefing to members Engagement Steering Group Briefing Written briefing for meeting Healthwatch Buckinghamshire Email plus meeting in person Media release To all media outlets in Buckinghamshire Website content Details with exemptions to be posted on
Buckinghamshire CCG website Social media content CCG Facebook/Twitter
Poster Printed poster for Pharmacies Digital Screen content GPs and other health touch points
BCC digital screens (County Hall and Libraries) Pack page 28
Bulletin Initial briefing and reminders for GP Practices Medicines Management Bulletin Initial briefing and reminders Public newsletters Community and Voluntary Sector groups
Parish councils Local Pharmaceutical Committee briefing Notification to be circulated from Chief Officer Self-Care advice information for 35 conditions
Information formatted to suit and available on Health Help Now
Promote Self Care Week Promoting advice sections
Red bag - pilot
The first stage of a rollout of the Red Bag initiative involves 16 care homes (although this figure may increase). When a resident becomes unwell and is assessed as needing hospital care, care home staff pack a dedicated red bag that includes the resident’s standardised paperwork and their
medication, as well as day-of-discharge clothes and other personal items. It’s a simple change which is proving to have benefits for both patients and the NHS. It facilitates a smoother handover between care home, ambulance and hospital staff with fewer phone calls and follow-ups made by the hospital staff to care homes looking for health information about the resident. It also stopped patients losing personal items such as dentures, glasses and hearing aids worth £290,000 in a year.
With this rollout, we have created a communications plan along with draft versions of promotional materials to circulate to key staff. The key aim is to raise awareness with hospital staff, ambulance staff and care home staff to prepare for a smooth first stage of the roll-out. Intention is currently to launch the scheme November 1, pending buy-in from key staff members and timeline of meetings/ presentations. Communications has supported with presentations to BHT staff and at the Task and Finish Group.
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Operational Plan – summary
Each year, the CCG produces an Operating Plan to outline their activities for the year. This year, we produced a summary of the CCG Operational Plan. This is predominately for use online but can also be used as a poster/flier if needed.
Dementia – Finding Joy
Comms is also supporting with promotional materials for upcoming performance of Dementia-themed show Finding Joy at Aylesbury Waterside Theatre on 19 November. Performance is free to people affected by dementia, nominal charge for professionals (£5).
Cancer
Further support has been provided to the Living With and Beyond Cancer project - proofing reports, redrafting sections, advising on which feedback to include. Support has also been provided in promoting the Be Clear on Cancer campaign through social media channels. Working to support further cancer screening promotion, particularly in Aylesbury and Wycombe areas where uptake is lower.
Flu
Flu is an integral element of the winter campaign and is being worked on jointly as part of the ICS. We are supporting the national NHS Communications Campaign which launches on Monday 8 October, although flu has already been discussed in the media and we have already got some local work underway: During September we have:
Produced a 350 word column for the Bucks Free Press in Cllr Noel Brown’s name www.bucksfreepress.co.uk/news/16879385.councillor-urges-bucks-residents-to-get-flu-jab-ahead-of-the-winter-season/
Produced an article for the Sept MyBucks, which reaches 12,000 people. https://mybucks.buckscc.gov.uk/september-2018/latest-news/protect-yourself-and-your-family-against-flu-this-winter
Produced an article for 15 local newsletters we sent out mid-September www.buckscc.gov.uk/services/council-and-democracy/media-centre/local-newsletters/
Included flu vaccine messaging in internal newsletters and drawn up a comprehensive staff flu vaccination programme.
Included flu vaccine messaging in the County Council update presented at every Local Area Forum update (18 meetings through Sept/Oct).
Developed frequently asked questions to be cascaded to Patient Participation Groups. Pack page 30
During October as the campaign goes live our dedicated Communications Plan will go into full swing. We are:
Writing and circulating press releases, starting w/c 8 October Mirroring the PHE and NHS social media campaigns and supplementing with our own
content too such as a film of the BCC Cabinet Member getting his vaccine ‘before and after’, a ‘myth busting’ graphic and a flu ‘quiz’ for Twitter
Circulating leaflets and hard copy resources to Children’s Centres, nurseries and libraries Writing further articles for Oct and Nov editions of MyBucks and Local Newsletters Including flu vaccine messaging in the schools bulletin Including articles/info in both internal and external newsletters throughout the month
7.0 Report from Engagement Steering Group
The Engagement Steering Group meets each month with its primary purpose to review the communication and engagement activities of the Clinical Commissioning Group. It aims to ensure that wherever possible the CCG is involving the public and patients in changes. It also aims to review the use of language to ensure the CCG talks in plain English without the use of jargon. Over the last quarter, the ESG has worked on:
A detailed review of the 10 Key Actions for Patient & Public Participation in Commissioning and Health Care. The purpose of this activity is to ensure that the CCG meets all the requirements set out by NHSE for patient involvement. This includes the use of language, layout of the getting involved pages of the website, the Engagement Strategy, and feeding back to the public. This work is currently ongoing
Reviewing the Engagement Strategy 2018 -20 with feedback to ensure it meets our 10 key actions
Reviewing the specification for Healthwatch Bucks Reviewed the Healthwatch Bucks quarterly activity report
The following campaigns and engagement activities have been reviewed and input provided to ensure all communities have an opportunity to be engaged. The ESG also supported the crafting of any surveys and ensuring they were written in plain English.
Third party ordering of repeat prescriptions. In particular, the ESG reviewed the leaflet and letters to ensure readability.
The ESG supported and were involved in the creation of Improved Access survey to understand what and where residents want to see for additional appointments (extended hours) being made available.
Reviewed the proposed Patient Participation Group Survey for Healthwatch Bucks. Reviewed the proposed engagement for the South Locality Out of Hours proposed
changes – understanding and considering the best ways of reaching residents and potential impacts of changes.
After discussion about the changes to over the counter medications, the ESG proposed supporting the CCG in producing a letter to practices explaining changes to GPs prescribing medications for hay fever.
Planned and organised a PPG Network event on 13th September. Reviewed and provided guidance on how to explain the arrangements for flu vaccinations
change for the over 65’s. Reviewed and provided guidance on how we ensure all patients with severe mental illness
receive physical healthchecks. Reviewed the Dementia communications and engagement plan. Considered Haddenham PPGs business case for funding a play about dementia. This was
passed and extended to ensure the south of the county also has a similar opportunity. Pack page 31
8.0 Going forward
The focus of attention in the next quarter will be on winter communications for the integrated care system. We will be producing one communications plan for all organisations in Buckinghamshire.
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MEETING: Governing Body AGENDA 7
DATE: 11 October 2018
TITLE: Chief Officer’s Report / System Working Update
AUTHOR: Robert Majilton, Deputy Chief Officer
LEAD DIRECTOR: Lou Patten, Chief Officer
Reason for presenting this paper: For Action For Approval For Decision For Assurance For Information For Ratification
Summary of Purpose and Scope of Report:
Update to Governing Body members
Authority to make a decision – process and/or commissioning (if relevant)
Not applicable – paper for assurance and not decision
Conflicts of Interest: (please tick accordingly)
No conflict identified Conflict noted, conflicted party can participate in discussion and decision (see below) Conflict noted, conflicted party can participate in discussion but not decision (see below) Conflict noted, conflicted party can remain but not participate in discussion (see below) Conflicted party is excluded from discussion (see below) Governance assurance (see below) Not applicable – paper for assurance and not decision
Strategic aims supported by this paper (please tick) Better Health in Bucks – to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all Better Care for Bucks – to commission personalised, high value integrated care in the right place at the right time Better Care for Bucks – to ensure local people and stakeholders have a greater influence on the services we commission Sustainability within Bucks – to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation Leadership across Bucks – to promote equity as an employer and as clinical commissioners
Pack page 33
Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary Patient & Public Involvement
Supporting Papers: Chief Officer Report and System Working Update – September 2018
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Chief Officer Report and System Working Update – September 2018 1. Integrated Commissioning for Buckinghamshire
A seminar session of the Integrated Commissioning Executive Team (ICET) was held on the 30 August to explore future development of Integrated Commissioning within the context of the development of the STP / Buckinghamshire ICS (into an Integrated Care Provider); this included the Executive Management leads and Clinical members of the ICET. The principle of strong, locally based commissioning, accountable to our population sits at the heart of that but we recognise that some things are best done at a wider population footprint so part of the discussion was how we then ensure a strong Buckinghamshire voice in these discussions. This is being written up and will be considered at the next ICET meeting with proposals coming back to the Executive Committee, this will include consideration of areas of CCG commissioning responsibility that could be fulfilled by ICET (or its successor) and proposals around the associated change in governance to enable that. Commissioning at an STP (STP+) scale / Looking at efficient working with Oxfordshire As the system delivery and commissioning arrangements develop we have previously discussed needing to map out the CCG functions, part of this thinking has been picked up through the work above on integrated commissioning within Buckinghamshire. We have asked the national team looking at this to work with Buckinghamshire and Oxfordshire and we are looking at examples of this work from elsewhere. To support this and gather the collective insight of our staff we are holding a joint away day for the Management Team (for Buckinghamshire this is Directors, Deputy Directors, Associate Directors and Heads of Service) on the 5th October. 2. Flu vaccinations - expedited decision for direct award scheme A direct award scheme for flu antiviral treatment has been agreed and implemented for this coming winter. This provides antiviral prophylaxis to care home residents and staff in the event of an influenza outbreak. Direct Awards are enhanced services (in addition to contracted GMS services with primary care member practices) commissioned locally dependent on local needs which are delivered in general practice. These services are voluntary. As a new Direct Award Scheme, a decision on this scheme would otherwise have been required by the Governing Body under its scheme of reservation and delegation. However, it was taken as a Chair’s action decision in August 2018 to avoid any further delay in rollout to member practices. It has the same specification as for practices in Oxfordshire. It is duly reported as having been taken. The Lay Vice Chair agreed to the Chair’s action on behalf of the Governing Body. This is given a material conflict of interest of the CCG Chair as also a partner in a member practice that would benefit financially from the scheme. This was with an additional assurance from the Chief Finance Officer, given current financial recovery, that the cost of the scheme is fully budgeted for (£14,348). 3. Primary Care update including Resilience
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a) Health and Adult Social Care (HASC) Select Committee, 2 October
The link provided above is to the papers for the Health and Adult Social Care Select Committee, 2 October, which includes updates on:
• Primary Care Hubs • Beaconsfield New Build • Chiltern House Medical Centre.
b) Chiltern House Medical Centre Chiltern House Medical Centre (CHMC) is currently operating under an interim APMS contract held by Primary Care Management Solutions (PCMS) for up to 12 months following the dissolution in July 2018 of the former partnership that held the contract. This allows the CCG sufficient time to look at options available regarding long term provision of services to patients currently registered at CHMC and a full options appraisal will be submitted to the Primary Care Commissioning Committee on 6 December. To ensure that the CCG considers valid options, a market sounding survey, inviting expressions of interest from providers, including local GPs, in providing services for the patients registered at CHMC was issued in early September and the outcome will be used to inform the options considered at the PCC. The next stage of the engagement process will start on 8 October, an initial participation phase will run for six weeks until 16 November which will inform the options appraisal to be submitted to PCCC on 6 December. During this phase, the CCG will engage primarily with patients of CHMC, staff and other local stakeholders seeking their views on the options available. We plan to undertake this engagement through meetings, focus groups and a survey. The survey has been drawn up by the CCG’s Communications Team and has been tested with the Engagement Steering Group and the CHMC PPG. The survey asks respondents to consider options available, provide information on what is important to them as patients of CHMC and to indicate their preference on options available.
c) STP Wave 2 funding: draft Outline Business Case - £8.8m capital award for development of primary care hubs
The CCG was previously successful in a bid for £8.8m funding from NHS England in order to develop primary care hubs in three localities. This is a capital funding scheme, the proposal for which is detailed in the above linked report to HASC. An outline business case is being prepared to be submitted to NHS England for their approval before the end of October 2018 in order to draw down the capital funding specified. The CCG’s current scheme of delegation provides authority for the Chief Finance Officer to undertake “Financial monitoring and reporting on all capital scheme expenditure”
The CFO will therefore monitor implementation of the business under the above authority once approved by NHS England. The business case is not therefore subject to separate CCG approval. In relation the CCG having appointed a firm of property and construction consultants to conduct feasibility studies on three schemes, the CFO has authority for “Selection of architects, quantity surveyors, consultant engineers and other professional advisors within EU regulations”. (CCG Constitution v1.13 - APPENDIX F2 Operational Scheme of Delegation as at 1st September 2018, page 88) https://www.buckinghamshireccg.nhs.uk/public/about-us/what-we-do/constitution/ d) Business Case – Beaconsfield New Build
A project is underway to develop a purpose built, fit for purpose Primary Care Centre for Beaconsfield and its wider catchment area, to increase the capacity for primary care services out of hospital with a commitment to providing a wider range of services, improving seven-day access and providing an increased training capacity. The new building would enable both the Simpson Centre and the Millbarn Medical Centre (the only two NHS GP practices in Beaconsfield) to co-locate and work together at greater scale. A fuller outline business case describes the rationale for investment and financial justification. This business case has already been considered by the Primary Care Commissioning Committee in public on 6 September 2018. There were no material conflicts of interest for member GPs given they are not voting members of the Primary Care Committee, nor are any of those with standing invitations partners at the practices concerned with the business case. Primary Care Commissioning Committee has authority for Premises improvement grants and capital developments; (up to £100k only). Governing Body should sign off any new build proposals. Agreement has been reached between the developer and the District Valuer regarding the total development cost of the project of £7.5m (excluding VAT). NHS England’s Estates and Technology Transformation Fund (ETTF) comprises capital funding of £3m (40% of the development cost), with this to be paid at Practical Completion of the new building – forecast to be March 2021. There is also a further £423k capital for IT fit-out. It is proposed that the capital is used to offset the revenue funding associated with rent reimbursement. If the capital is amortised over 25 years, the resulting annual increase for rent will be in the region of £99,970 plus the incremental cost of rates (due to the increased size) of circ. £37,447 – giving a total revenue increase of £137,417 per annum. The term of the lease is over 25 years. (£3.4m excluding any inflationary increase/DCF Discounted Cash Flow). The business case has been:
1) Considered and agreed at the Primary Care Premises Sub-group which is chaired by a GB Lay member (Tony Dixon) and recommended to the Primary Care Committee for approval
2) Approved at the Primary Care Commissioning Committee on the 6 September and recommended for assurance and ratification by the Governing Body
3) Members of the finance committee, directly and through their membership of the Primary Care Commissioning Committee and Premises Sub-group have been briefed on the case
4) The revenue impact is within the authority of the CFO to approve On this basis the Governing Body is asked to be assured on the process followed and scrutiny provided and ratify the decision of the Primary Care Commissioning Committee on approving the business case. Progress of the implementation will be through the Premises sub-group / Primary Care Committee and any financial variations will be approved by the CFO and reported to the Finance Committee in line with current SFIs/ Scheme of Delegation.
LEAD DIRECTOR: Debbie Richards, Director of Commissioning andDelivery/Accountable Emergency Officer
Reason for presenting this paper:
For ActionFor ApprovalFor DecisionFor AssuranceFor Information
For Ratification
Summary of Purpose and Scope of Report:
The Governing Body is asked to: RECEIVE for information the winter planning update provided below.
An early draft of the Buckinghamshire Winter plan was presented to the last GB andcomments received have been incorporated.
Our first draft system plan was submitted to NHSE on 24/09/18 in line with the local timetableand feedback is awaited. It is understood by NHSE that many providers and systems are stillworking through the detail of their plans and testing out these with partner agencies.
Since the last GB Significant work has continued including: A winter exercise was held in Bucks on 14 September 2018 NHS England hosted a system exercise on 27 September 2018 The Buckinghamshire directors on the Bucks A and E Delivery Board reviewed the
submission on 28/09/18 and agreed priorities for action. Second draft provider plans to be finalised 5/10/18 Second draft system plan to be collated week beg 8/10 A&edb on 16/10 to review and agree plan Summary of agreed winter plan to Bucks ICS Exec 5/11 with final version to Health
and Wellbeing Board and Governing Body in December.
Authority to make a decision – process and/or commissioning (if relevant)
n/a – for information
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2
Conflicts of Interest: (please tick accordingly)
No conflict identified
Conflict noted, conflicted party can participate in discussion and decision (see below)
Conflict noted, conflicted party can participate in discussion but not decision (see below)
Conflict noted, conflicted party can remain but not participate in discussion (see below)
Conflicted party is excluded from discussion (see below)
Governance assurance (see below)
Strategic aims supported by this paper (please tick) Better Health in Bucks – to commission high quality services that are safe, accessible to all and achieve good patient outcomes for all
Better Care for Bucks – to commission personalised, high value integrated care in the right place at the right time
Better Care for Bucks – to ensure local people and stakeholders have a greater influence on the services we commission
Sustainability within Bucks – to contribute to the delivery of a financially sustainable health and care economy that achieves value for money and encourages innovation
Leadership across Bucks – to promote equity as an employer and as clinical commissioners
Governance requirements: (Please tick each box as is relevant to the paper) Governance Element Y N N/A Comments/Summary
Patient & Public Involvement
Describe links to specific involvement on groups or any relevant engagement/consultation
Equality Equalities screening/full impact assessment - results should be incorporated into the report.
Quality As above in relation to the three domains of quality (patient safety, clinical effectiveness/patient experience)
Privacy As above in relation to any change planned to the collection, use, disclosure and disposal of information for the work as is described within the summary or supporting papers.
Financial Further increasing non-elective demand leading to financial pressure without appropriate mitigations
