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Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 2nd June 2015 Page 1 of 2

GOVERNING BODY MEETING – A meeting in public

Tuesday 2nd June 2015 Nightingale Room, OMH

2pm

AGENDA

Ref No. No Time Item Papers GB15-16/0016 1. 2.00pm PRELIMINARY BUSINESS

(Dr Sue Wells – Deputy Chair)

1.1 Apologies for Absence 1.2 Chair’s Announcements 1.3 Declarations of Interest 1.4 Comments/questions from

members of the public

1.5 Minutes and Action Points of Last Meeting – held on 5th May 2015 (All)

• Action Points

DRAFT GB Minutes PUBLIC MEETING 05 05

Action Points of WCCG -PUBLIC GB Mee

1.6 Matters Arising

1.7 Patient Story (Lorna Quigley)

GB 15-16/0017

2. ITEMS FOR APPROVAL 2.1 Engagement Strategy

(Lorna Quigley) Cover Sheet

-Experience and Engag FINAL Wirral

Experience Engagemen 2.2 Direct Access Diagnostics (DAD)

(Patricia Clitheroe/Heather Harrington) Coversheet

Recommissioning of Di Recommissioning of

Direct Access Diagnost

PDF - DAD Papers re Gb 02.06.2015.pdf

GB 15-16/0018

3. ITEMS FOR INFORMATION 3.1

3.2 3.3

Vanguard (Jon Develing) Quality Performance and Finance- QPF (Lorna Quigley/Mark Bakewell) Direct Commissioning Update (Sue Wells/Simon Delaney)

Presentation

Coversheet GB - PERFORMANCE AND FI

Performance and Finance GB June 2015-

cover_sheet_Primary_Care_Report_GB_020

Primary_Care_Report_GB_020615.docx

Agenda – Wirral Governing Body Meeting PUBLIC SESSION – 2nd June 2015 Page 2 of 2

Ref No. No Time Item Papers

GB 115-16/0019

4. ITEMS FOR NOTING 4.1

Subgroups (Ratified Minutes):

• QPF meeting of April 2015

RATIFIED QPF Minutes 28 04 2015.do

GB 15-16/0020

5. RISK REGISTER Current Risk Register

Copy of Risk Register - June 15 GB.xlsx

6. ANY OTHER BUSINESS 6.1 7. End DATE AND TIME OF NEXT MEETING

Tuesday 7th July 2015 2pm – 4pm

Nightingale Room OMH Please forward any apologies to [email protected]

Wirral Clinical Commissioning Group – Future Meetings 2015 Day Date Time Venue

Tuesday 4th August 2pm – 5pm Nightingale Room Tuesday 1st September 2pm – 5pm Nightingale Room Tuesday 6th October 2pm – 5pm Nightingale Room

mailto:[email protected]

Minutes of the WCCG –Governing Body Meeting – PUBLIC SESSION – 5th May 2015 Page 1 of 6

WIRRAL CLINICAL COMMISSIONING GROUP GOVERNING BODY BOARD MEETING

Minutes of Meeting – Public Session

Tuesday 5th May 2015 2pm

Nightingale Room, Old Market House Present: Jon Develing (JD) Chief Officer WCCG

Dr S Wells (SWel) Medical Director (Deputy Chair) Simon Wagener (SW) Lay member (Patient Champion) James Kay (JK) Lay Member (Audit & Governance)

Andrew Smethurst (AS) Secondary Care Doctor Lorna Quigley (LQ) Director of Quality and Patient Safety Outcomes Dr P Cowan (PC) GP Lead – Unplanned Care

Dr S Stokes (SS) GP Lead – Long Term Conditions Dr L Ariaraj (LA) GP Lead – Planned Care Dr S Delaney (SD) GP Lead – Primary Care Paul Edwards (PE) Director of Corporate Affairs Mark Bakewell (MB) Chief Finance Officer

In Attendance: Allison Hayes (AJH) Board Support/Corporate Officer WCCG Richard Williams (RW) LMC Representative Heather Harrington (HH) Programme Manager Tricia Clitheroe (TC) Head of Delivery & Contracts Louise Morris (LM) Senior Financial Accountant Steve Riley (SR) Medicines Management Chelsea Worthington (CW) Corporate Administrator

Ref No. Minute GB15-16/0007

Preliminary Business 1.1 Apologies for absence Apologies were received from: Dr P Naylor, Karen Prior, Fiona Johnstone and Graham Hodkinson. Apologies were received from Paul Edwards and Mark Bakewell for the first part of the meeting.

1.2 Chairs Announcements As Dr Naylor, Chair, was attending the Vanguard site visit being held today, SW explained that she would be undertaking the role of Chair in line with the CCG’s constitutional arrangements. SWel welcomed all members to the meeting and also welcomed 5 members of the public who had attended. SWel explained the purpose the Vanguard visit (Wirral is a pilot site for a new a model of Care as outlined in Simon Stevens’ ‘Five Year Forward View’) and that some member of the Governing Body had been required to attend. SWel then introduced the following new Governing Body members: Jon Develing – Chief Officer Dr P Cowan – Unplanned Care Lead Dr S Stokes – Long Term Conditions Lead


Ref No. Minute Dr S Delaney – Primary Care Lead D L Ariaraj – Planned Care Lead 1.3 Declarations of Interest Dr Ariaraj declared his interests (in a pharmacy) with regards to the Pharmaceutical Engagement for Ratification (item 2.1) paper and members were advised that in line with the CCGs governance arrangements SWel ruled that she would be asking Dr Ariaraj to stay in the meeting but not partake in any direct decision making. 1.4 Comments/questions from members of the public There were no comments/questions from members of the public. 1.5 Minutes from previous meeting held on 7th April 2015. The minutes of the previous meeting held on 7th April 2015 were agreed as a true and accurate record notwithstanding grammatical/typographical errors which will be rectified with the following amendments:

• Page 3 (2.2) – Radiography to be changed to Radiology. • Page 5 (2.3) – the following sentence to be included: Following discussion, there was also

an agreement that all relevant previous images and reports must be available at the time of reporting to the Reporter of a Radiology study. (is this the form of words that Andy wanted)?

Action Points – members discussed the action point recorded in the minutes of 7th April. Members requested that AJH is to feedback a request to reinstate an on-going action list. 1.6 Matters Arising There were no matters arising. 1.7 Patient Story LQ presented a number of patient stories relating to patient experiences of being diagnosed with cancer. JK highlighted the importance of monitoring cancer referrals and questioned the technology used to communicate internal issues. Members agreed that advanced communication skills are needed when clinicians are breaking bad news . SW sought assurance regarding the lesson learnt from these patient experiences and SWel assured members of the Governing Body that lesson learnt are noted and acted upon. Members noted the patient story presented at the meeting.

GB15-16/0008

2.0 Items for approval 2.1 Pharmaceutical Engagement for Ratification LQ introduced Steve Riley, Medicines Management to the meeting and SR presented the Governing Body with the CCGs Policy for Joint Working with the pharmaceutical industry. The aim of the policy is to assist NHS Wirral CCG achieve its objectives and delivery of national


Ref No. Minute and local priorities by building effective and appropriate working relationships with the pharmaceutical industry and to inform and advise staff of their main responsibilities when entering into joint working arrangements with the pharmaceutical industry. In conclusion the joint working with the pharmaceutical industry provides the opportunity to the CCG to complement its organisational expertise with partners equally focused upon improving healthcare for patients, and supports the wider whole system approach being taken by the CCG through Vision 2018 towards a patient-centric health and social care system. SW sought clarity regarding relevance in respect of medicines with EU or UK product licences and SR gave a rationale regarding this. Members of the Governing Body approved the policy presented at today’s meeting. 2.2 Direct Access Diagnostics LQ & HH presented a paper in relation to the direction of travel and the work undertaken to date for the re-commissioning of Direct Access Diagnostics (DAD). This is building on the paper that was presented to the April Governing Body with regard to the future model to procure DAD. The paper outlined the outcome of a subsequent patient engagement event. Key areas which were important to patients included:

• Access/Choice • Availability & Facilities • Waiting times • Quality • Contract monitoring • Technology • Communication • Value for Money/Cost

The feedback indicated support for a prime provider model. The Governing Body were asked to consider commissioning options for DAD with a view to approving the recommendation to re-commissioning of these services via a prime provider model in line with patient feedback and approve the next steps.

SW sought further information regarding a Patient Focus Group which was held on 24th April and HH informed members of the details of the meeting. JK suggested that due to timing in relation to a Parliamentary Election, a further discussion will need to take place in June and members agreed to provide an appropriate direction of travel rather than provide approval at this time. AS requested that a risk assessment is included within the paper and highlighted the need to educate patients, the CCG and GPs that Radiology is not a commodity that can be bought off the shelf. Members of the Governing Body noted the paper presented at today’s meeting and provided a direction of travel for HH to further develop the next steps.

GB15-16/0009

3.0 Items for Discussion 3.1 There were no items of discussion.


Ref No. Minute GB15-16/0010

4.0 Items for Information 4.1 Quality Performance and Finance Report Quality Performance LQ gave a presentation on the activity performance for month 11 (February) and the CCGs dashboard and highlighted the positive areas and the improvements in the challenges that were originally presented. Areas included:

• Inpatient and A&E (minor components) friends and family test and response scores • NWAS turnaround • Delivering the same sex accommodation • Diagnostic tests • MRSA & Cdifficile • Referral to treatment (18 weeks) • 4 hour standard t • Health Care Associated Infection

LQ briefed members of recent Cancer screening figures on behalf of Fiona Johnstone. Members reviewed the figures presented in relation to: Breast screening, Bowel screening and Cytology screening and it was agreed that the data is to be discussed in more detail at the next Governing Body in June. Action – FJ to present the Cancer Screening figures at the next Governing Body in June. AS suggested that future reports include performance figures in relation to WUTH. JD confirmed that it was his intention to refine the Performance and Quality reports now that key members of staff are in post. and it was agreed that LQ would include a narrative in future reports. Action – Performance and Quality reports to be developed for GB The Governing Body noted the contents of the Quality and Performance Report. Paul Edwards, Director of Corporate Affairs arrived at the meeting at 15:17pm. Mark Bakewell, Chief Financial Officer arrived at the meeting at 15:28pm. Directors of Adult Social Services Report LQ presented the Directors of Adult Social Services report for the period of January 2014 – December 2014 on behalf of Graham Hodkinson. It was agreed that Graham Hodkinson is to present the report in further detail at the next Governing Body. Action – GH to present the DASS report at the Governing Body meeting in June. Members of the Governing Body noted the Quality & Performance report. Finance Report MB provided information of the Financial performance against budgeted allocation for 2014/15 as at month 12 (March). Key areas included:

• Draft Accounts have been submitted in line with NHS England Deadlines 23rd April • Draft Accounts position - £2.5m surplus in line with revised NHS England control total


Ref No. Minute • External Auditors on site and working paper review has begun • Draft Annual reports, annual governance statement submitted in line with deadlines 24th

April 2015 • Awaiting feedback from VFM opinion discussion with Grant Thornton

Next Steps

• Audit committee – 21st May 2015 to review recommend accounts • Extra- ordinary Governing Body – 26th May 2015 to approve sign off

accounts/Governance Statement

Other Year End Issues The CCG cash balance at the end of March 2015 was £20k. This is in line with current NHS England guidance that CCGs aim towards 1.25% month end cash balance of the drawdown. AS sought clarity regarding the CCGs surplus figure and MB gave a rationale regarding this. Further discussions took place regarding the CCGs prescribing budget and MB provided further details regarding this. The Governing Body noted the CCGs Year End report as at month 12 (March 2015). 4.2 Emergency Planning Response and Resilience Report PE presented the Emergency Preparedness, Resilience and Response (EPRR) Annual Report for 2014/15. The report illustrates the responsibilities of the CCG related to EPRR and how the CCG is meeting the requirements of those responsibilities and discharging its duties as a Category 2 responder. JK asked about future training exercises and PE explained that these are agreed through the Local Resilience Forum (LRF) and Local Health Response Partnership (LHRP). PE explained that Wirral was unique in that it had a different footprint for these groups (LHRP is Cheshire and LRF is Merseyside in this regard). PE went on to say that, with some of the changes at NHS England, he thought it likely that EPRR responsibilities would increase for CCGs through changes in primary legislation. Members of the Governing Body noted the report. Committee Annual Reports PE provided the Governing Body members with an outline of the committees of the CCG and stated that it is a requirement for each committee to produce an Annual Report. The series of reports that follows defines the key duties of each committee followed by a narrative outlining how those duties have been discharged throughout the 2014-15 financial year. The following committee reports were noted by the Governing Body:

• Audit Committee Annual Report • Remuneration Committee Annual Report • Approvals Committee Annual Report • Governing Body Annual Report


Ref No. Minute • Quality, Performance and Finance Annual Report

JK requested that a committee attendance breakdown is provided and it was agreed that the attendance breakdown would be included in the Annual Report and any published versions of the papers. Members congratulated the committees on their work and for demonstrating to the public how the CCG as an organisation operates. The Governing Body noted and acknowledged the contents of the reports.

GB15-16/0011

5.0 Items for Noting 5.1 Subgroups (ratified minutes for noting)

• QPF of March 2015 – noted • Audit committee minutes of Jan 2015 - noted

The Governing Body noted the minutes of the above subgroups. 5.2 Audit Chair’s Report JK provided members with a summary of the Audit Committee meeting held Thursday 9th April 2015. The Governing Body noted the contents of the Audit Committee meeting of 9th April.

GB15-16/0012

6.0 Risk Register Members noted the current risk register presented for noting at today’s meeting.

7.0 Any other Business The Board meeting ended at 16:08pm.

8.0 Date and Time of Next Meeting The date and time of the next meeting is Tuesday 2nd June 2015 in the Nightingale Room, OMH please contact [email protected] with any apologies or agenda items.

Board meeting ended at: 16:08pm


Action Points – Wirral Clinical Commissioning Group, Governing Body Meeting - PUBLIC SESSION – 05.05.2015 1/1

Wirral Clinical Commissioning Group

Governing Body

Action Points re Meeting of 5th May 2015 (Public Session)

Nightingale Room, OMH 2pm

Outstanding Actions from: 07.04.2015

Topics Discussed Minute Action Points Responsibility Action Target date

• There were no outstanding actions • • New Actions from: 05.05.2015

Topics Discussed Minute Action Points Responsibility Action Target date Actions from previous meeting

1.5 • AJH to reinstate action list • AJH • June GB

Direct Access Diagnostics 2.2 • HH to further develop next steps • HH • June/July GB

Quality and Performance 4.1 • FJ to present Cancer Screening figures at the next GB meeting • GH to present the DASS report the Governing Body in June • LQ to include narrative in relation to WUTH performance re CQC inspection

• FJ • GH • LQ

• June GB • June GB • On-going

Risk Register 6.0 • PE to update the CCGs risk register • PE • On-going

Agenda Items for next meeting / Decisions to note for next meeting / Date & time of next meeting

The date of the next meeting is Tuesday 2nd June 2015 at OMH, Nightingale Room. Agenda items and apologies are to be sent to: [email protected]


GOVERNING BODY BOARD REPORT COVER SHEET

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ENGAGEMENT AND EXPERIENCE STRATEGY

Agenda Item: 2.1 Reference GB15-16/0017 Public / Private Public Meeting Date 2nd June 2015

Lead Officer Lorna Quigley, Director of Quality and Patient Safety

Contributors

Link to CCG Strategic System Plan

1 Patient and primary care centric and based on high quality primary care, secondary

and community services 2 Rigorously developed and agreed care pathways working together with patients to

secure their help, understanding, ownership and support of the needed changes 3 Commissioned services which have a sound evidence base

4 Provides greater equality of access to all

Link to current strategic objectives

1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable harm

To approve Y

To note

Summary The purpose of this strategy is to ensure that NHS Wirral Clinical Commissioning Group (CCG) has an effective and robust approach to communications and engagement activity that supports and it statutory duties in regard to consultation and engagement The Wirral CCG Engagement and Experience Strategy refresh is an opportunity to reflect the changes in the CCG’s approach following its amended Constitutional arrangements and internal structures

Comments No additional comments

Next Steps Publish on website and prepare summary version


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What are the implications for the following (if not applicable please state why): Financial

Does the report consider financial impact? No Not applicable

Value For Money Does the report consider value for money? No Not applicable

Risk Is there a documented risk assessment? Yes The Strategy seeks to minimise the risk of challenge by ensuring extensive engagement and illustrated mechanisms that identify key risks through patient experience approaches

Legal Are there any legal implications? Yes The Strategy illustrates how the CCG will comply with its statutory duties in engaging with the patients and public

Patient and Public Involvement (PPI)

Does the report provide evidence whether there could be a positive or negative impact on patients and public? Yes The Strategy illustrates how patients the public will be involved in commissioning processes

Equality & Human Rights

Does the report provide evidence of whether there could be a positive or negative impact on protected groups (statutory duty for new / changes to services) Yes The Strategy describes how the CCG will endeavor to engage with a wide variety of groups

Workforce Does the report provide evidence of whether there could be a positive or negative impact on the CCG or other NHS staff? No Not applicable

Partnership Working Does the report evidence a partnership working in its development? Yes The stakeholder map highlights key partnerships

Performance Indicators

Does the report indicate any relevant performance indicators for this item? No Not applicable

Sustainability Does the report address economic, social and environmental sustainability (should be addressed for new / change projects)? No Not applicable


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Do you agree that this document can be published on the website? (If not, please note that it may still be subject to disclosure under Freedom of Information - Freedom of Information Exemptions

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path i.e. other papers that are directly related to the current paper under discussion.

Report History/Development Path

Report Name Reference Submitted to Date Brief Summary of Outcome Experience, Engagement and Communication Strategy and Policy

GB 13-14/062 Governing Body February 2014

Approved

Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to an x. If you require any additional information please contact the Lead Officer.

http://www.foi.gov.uk/yourRights/exemptions.htm

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Engagement and Experience Strategy Updated June 2015

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1. PURPOSE

This strategy was originally approved by NHS Wirral CCG’s Governing Body in February 2014 and has now been updated to reflect the new CCG structures and governance arrangements following the ‘Capability and Governance Review’ carried out in 2014 by NHS England The purpose of this strategy is to ensure that NHS Wirral Clinical Commissioning Group (CCG) has an effective and robust approach to engagement and understanding patient experience that supports and underpins:

a) Wirral CCG’s statutory obligations as outlined in the 2012 Health and Social Care Act

b) NHS England guidance:

‘A Call To Action’ ‘Everyone Counts Planning 2014/14 to 2018/19’ ‘Transforming Participation in Health and Care 2013’ ‘The Five Year Forward View’

c) Wirral CCG strategic plan 2014 – 2019

d) The Vision 2018 Programme, which is likely to be superseded by Wirral becoming a Vanguard pilot site

2. INTRODUCTION AND BACKGROUND

NHS Wirral CCG has a duty to fulfill its statutory obligations in regard to patient and public engagement so as to ensure effective participation in the commissioning process, thereby ensuring that services provided reflect the needs of the people. In addition, clinical engagement remains a core precept of Clinical Commissioning Groups and hence is central to the CCG’s commissioning activities.

The Wirral CCG Engagement and Experience Strategy refresh is an opportunity to take into account the changes that have resulted from the adoption of the recommendations of the Capability and Governance Review.

3. WIRRAL CCG CONTEXT

Wirral CCG’s stated vision is “To improve health and reduce disease by working with patients, public and partners, tackling health inequalities and helping people to take care of themselves”. Wirral CCG came into existence as part of the reorganisation of NHS structures undertaken in response to the Health & Social Care Act 2012, replacing Wirral Primary Care Trust from 1st April 2013. Under the new legislation Wirral CCG is responsible for commissioning a wide variety of health services for the residents of Wirral, including;

• Most local hospital care for example A&E, Outpatients, Tests and Operations • Most mental health care including both GP based services and hospital based services • Most community services for example district nurses, matrons and physiotherapy

The CCG does not commission all health services. NHS England has the responsibility for the services listed below:

• GPs, Dentists, Opticians & Pharmacists • Specialist Services for example cardiac & neuro surgery or transplant surgery.

However there are opportunities for CCG’s to undertake co-commissioning with NHS England for the above services. Wirral CCG is exploring the level of co-commissioning it wishes to participate in.

http://www.england.nhs.uk/

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4. ENGAGEMENT AND EXPERIENCE PRINICIPLES

Engagement is integral to all Wirral CCG business and to support this we have developed clear engagement and objectives alongside the aforementioned guidance. The following guiding principles should ensure that the ambitions of Wirral CCG and its partners are fulfilled while reflecting the needs of local people at the centre of our healthcare services from planning to delivery.

• Principle 1 Improve patient/public engagement and understand patient experiences by:

o Using and learning from patient stories o Learning from errors (quality and safety) o Understanding the needs of the populations (equality and diversity)

• Principle 2 Develop and Improve Clinical Engagement • Principle 3 Develop and Improve Wider Stakeholder Engagement

These principles have been adopted as objectives and the section below outlines how they will be achieved.

5. OBJECTIVE 1 - IMPROVE PUBLIC AND PATIENT ENGAGEMENT

Patient, carer and public involvement is embedded through all stages of planning, shaping, designing and delivering services, and in setting priorities and commissioning decisions for Wirral. Combined with wider approaches that allow the CCG to understand patient experience, this ensures that local services are developed and delivered with patient experiences, wants and needs at front and centre. Public and patient engagement is an essential part of health and social services development as this:

• Enables better decision making - involving patients in decisions about their own health and care has the potential to improve outcomes and patient experience.

• Increases ability to deliver difficult change – involving patients and public from the outset of proposed service changes can increase the ability to manage risk and deliver the change.

• Getting services right at an early stage – reduced need for further redesigns. Better value for money. • Enables effective service delivery - understanding patient experiences can assist in identifying areas of

inefficiency and how services can be improved and areas of success that best practice can be built on. • Reduces demand - engaging people can help manage demand for services e.g. inappropriate use of

emergency services • Allows greater community support - engaging with communities can help tackle health inequalities and

support behaviour change 5.1.1 Patient Participation Groups Practice based Patient Participation Groups (PPGs) are one of many ways in which we are increasing our engagement with patients and they offer a great opportunity to maximise our contact with patients and carers, whilst supporting their GP practices in supporting services for their practice population. There are a variety of PPGs within general practice, the majority meet face to face while others may have “virtual” groups using electronic means of communicating. These will be the basis of wider patient representation through a Wirral Wide ‘Wirral Patient Voice Group’ that is currently being established, with Terms of Reference being developed by the patient membership. 5.1.2 Friends and Family Test

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Since 1st April 2013 the NHS Friends and Family test has provided an important opportunity for patients to provide real time feedback regarding the care and treatment they have received. Patients have been asked whether they would recommend hospital wards and emergency departments to their friends and family if they needed similar care or treatment. This means every patient in these wards and departments is able to give feedback on the quality of the care they receive, giving hospitals a better understanding of the needs of their patients, enabling improvements and and giving frontline staff a powerful incentive to make practical and timely improvements to the services they provide. The Friends and Family Test has been extended to Maternity services, GP Practices, Mental Health Services and community services. Friends and Family Test data is captured in performance reports which are brought to Wirral CCG’s Governing Body and Quality Performance and Finance committee. The report highlights both positives and negatives, prompting follow up actions and improvements. 5.1.3 Public/Lay Representation in Decision Making Process Each of the CCG committee meetings and the CCG Governing Body include representation from lay members to provide input to the decision making process. One lay member has a specific focus on being the ‘Patient Champion’ 5.1.4 Governing Body - Patient Stories and Engagement reports The CCG Governing Body is held in public and members of the public are encouraged and welcome to attend these meetings. This meeting now includes a standard Patient Story agenda item. These can be in video, letter and social media format and provide a powerful chance for the board members and public attendees to take a step back and reflect on the individuals at the centre of the services we commission and the outcomes they experience. All agendas & papers are publicised on the public facing website and patient stories will also be included together with future papers. Engagement reports are also received by Governing Body in relation to specific activities (e.g. Vision 2018) and as part of the Direct Commissioning Report

5.1.5 Complaints Ensuring good handling of complaints is one way in which CCG’s can help to improve quality of care for patients and learning from complaints enables organisations to continually improve the services they provide and the experience for all patients. Wirral CCG ensures that complaints are managed in accordance with the strategic goals and objectives and sure that all complaints are managed promptly and efficiently, in line with the Health Act 2009 and NHS Constitution. It also ensures that they are adequately investigated and that complainants are treated with dignity and respect. Wirral CCG’s Corporate Affairs team are now responsible for the management of all formal complaints following the transition back from North West Commissioning Support Unit in January 2015. Lessons learnt from complaints are an important tool to assist quality and responsiveness. Where appropriate, lessons learnt from complaints are reported on a monthly basis to the Quality, Performance & Finance Committee, which is a sub-committee of the Governing Body. A further quarterly aggregated report, including data provided from the Provider organisations, is also presented to the Quality Performance and Finance committee

5.1.7 Learning from errors The quality and safety agenda across Wirral is a high priority in order to ensure that patients receive the best care possible and positive outcomes. It is also a way of learning lessons in order to improve the patients experience of health care services. 5.1.8 Clinical Quality Review Meetings

As part of the contractual process, quality review meetings are held with each acute, community and mental health provider organisation. In 2014/15 this has included hospices and independent providers. These are contracting meetings that focus on quality providing an opportunity to review areas for improvement and good practice and to monitor any improvement activities.

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These meetings provide a robust mechanism where commissioners and providers can work together to identify and strive to meet standards that will serve to deliver services and improve quality. Relationships have been established to support local accountability and response to local needs and requirements. 5.1.9 Quality Reviews These are undertaken quarterly within provider organisations and provide intelligence to gain assurance that there are robust measures in place within organisation to ensure that high quality care is in place, or to identify areas where improvement is required. The reviews consist of a small team from the CCG using a defined criteria based on CQC standards to assess the standard of care, staffing and patient experience. 5.1.10 Serious incidents

Making services safe for patients is fundamental to the provision of high-quality care and it is essential that providers of healthcare have good systems in place for staff to report when patients have, or could have been harmed. Open and honest reporting demonstrates a commitment to patients and their safety and is a mark of “high reliability”. The focus on reporting should be on analysing the root cause of the incidents because serious incidents yield important lessons about changing process to reduce risk. It is only through active learning and service improvement from serious incidents that the benefits of experience are actually realised. The definition of a serious incident is any unexpected incident, which has caused serious harm, or with the potential to cause serious harm, and/or likely to attract public and media interest that occurs on NHS premises or in the provision of an NHS of commissioned service. A Never Event is defined by the National Patient Safety Agency (NPSA) as; a serious or largely preventable patient safety incident that should not occur if the available preventable measures have been implemented by healthcare providers. NHS Wirral CCG are responsible for ensuring that when a serious incident or never event occurs, that there are measures and mechanisms in place for safeguarding patients and also to understand and review investigation of why the event occurred. The CCG work together with provider organisations to ensure that measures are put in place to prevent similar incidents reoccurring.

A Serious Incident Review Group is held on a monthly basis within the CCG to review all RCA reports and action plans, and monthly updates are also provided to the Quality, Performance & Finance Committee; a sub-committee of the Governing Body. Each incident and report is scrutinised by the group members which is made up of clinicians and managers. This group also enables Wirral CCG to monitor and ensure that all serious incidents and/or never events are managed appropriately and within a timely manner, whilst also ensuring that root causes and lessons learned are shared across organisations with a view to prevent similar incidents occurring again.

The CCG recognises that work still needs to be undertaken and will seek to pro-actively reach out to diverse communities to increase engagement and feedback with public and patients and will not rely only on those who are already informed and engaged. In particular we will focus on those we have been unable to reach. The CCG will seek input from public and patients on how best to tackle this challenging area – asking the question wherever possible when undertaking engagement and consultation exercises.

5.1.11 Understanding the needs of the population The CCG seeks to break-down barriers to accessing health services to improve health outcomes across our diverse communities. Our equality objectives will support us to do this. Our Equality Objectives are:

• To make fair and transparent commissioning decisions; • To improve access and outcomes for patients and communities who experience disadvantage; • To improve the equality performance of our providers through robust procurement and monitoring

practice • To empower and engage our workforce

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It is crucial that Wirral CCG meet the exacting requirements of the Equality Act 2010 and understand and respect the needs of all the patients and communities we serve so as commissioners we can improve access and outcomes for those who face disadvantage and health inequalities. We need to ensure we have robust consultative and engagement mechanisms in place to communities across protected characteristics

5.1.12 NHS Equality Delivery System (EDS) To help us set our Equality Objectives we used NHS Equality Delivery Systems (EDS) self-assessment. The EDS is an independently evaluated toolkit implemented by the majority of NHS organisations across England. The toolkit helps organisations improve the services they provide for their local communities and provide better working environments, free of discrimination, for NHS workforce, while meeting the requirements of the Equality Act 2010. The EDS helps local NHS organisations, in discussion with local partners including local populations, review and improve their performance for people with characteristics protected by the Equality Act 2010. By using the EDS, NHS organisations can also be helped to deliver on the Public Sector Equality Duty (PSED). The EDS improves local engagement and awareness of equality across the workforce and reports identify areas where lessons can be learnt so that organisations can act on the findings and good practice

6. OBJECTIVE 2 - DEVELOP AND IMPROVE CLINICAL ENGAGEMENT

In line with the Health and Social Care Bill’s aims, clinicians are critical to the improvement of health and healthcare in Wirral, and will be central to all decision making. The aim is to engage with member practices including GP’s, practice nurses and practice managers, in the development and ongoing work of the CCG to ensure they are involved in the core business and related work streams.

Staff and workforce are important stakeholders to engage. There is clear evidence of the link between positively engaged staff and positive patient experiences. It is essential that we seek feedback and views from staff. Responsibility for the quality of care ultimately lies with frontline staff and boards to create the right culture of care. 6.1. Clinical Representation in the Decision Making Process As a Clinical Commissioning Group, Wirral CCG has ensured that Governing Body, other key meetings and decision making committees have strong clinical representation including;

• CCG Governing Body • Quality, Performance & Finance Committee

To strengthen this further, a Clinical Senate had been established as part of the CCG’s amended constitution. This will provide a forum where collective knowledge, advice and recommendation can be provided to the Governing Body. It will also provide a mechanism for the increasing clinical participation across multi professional groups and offer the opportunity for the expression of a unified clinical perspective on important commissioning and delivery issues. The Senate is responsible for ensuring that strategic plans and commissioning projects are clinically driven, reflecting best clinical practice, coordinating and developing clinical pathways, building clinical networks and clinician to clinician relationships with providers and ensuring appropriate representation. In addition, a Membership Council has now been established, allowing GPs to come together regularly to discuss commissioning issues from a primary care perspective and a Provider Forum has also been established to enable GPs and Practice Managers to discuss issues from a provider perspective. The Provider Forum also has representation from the Local Dental Committee, the Local Pharmacy Committee and the Local Optician Committee. Both of these meetings are supported by the CCG providing practice cover to ensure maximum attendance. Alongside these groups, Practice Nurse and Practice Manager fora have also been established to enable wider representation from General Practice and a planned schedule of practice visits has been established

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6.1.2 Clinical Planning The Vision 2018 programme that has been set up to address the 5 year plan for integration across the social and health care economy, has ensured there is clinical representation across the programme board and work-streams that feed into the development and implementation of proposals. Due to the work that has been undertaken with the economy, Wirral has been selected as a Vanguard site, which will build on the work achieved within the Vision programme. 7. OBJECTIVE 3 - DEVELOP AND IMPROVE STAKEHOLDER ENGAGEMENT

The report, ‘Changing care, improving quality’ (June 2013) developed by the Academy of Medical Royal Colleges, NHS Confederation and National Voices, calls for meaningful engagement of key stakeholders. Wirral CCG has a wide range of stakeholders it needs to engage and communicate with in order to achieve its commissioning objectives. As well as patients, public and clinicians CCG Stakeholders include any group, organisation, member or system who affects or can be affected by CCG actions. 7.1 Stakeholder mapping In 2014 the CCG undertook a mapping exercise of stakeholder groups according to their potential interest and influence. This enabled the CCG to determine key relationships to be developed and engagement and communication activity on an ongoing and project basis. This continues to be developed and will be revised as the Vanguard programme develops further. 7.1.2 Stakeholder Engagement Matrix A stakeholder engagement matrix was developed in 2014 to capture detail in terms of the stakeholder groups, focusing on priorities for communication and engagement processes for each of the stakeholder groups. This matrix acts as a guide in ensuring appropriate stakeholders are engaged as appropriate.

Stakeholder Group Groups Identified Engagement & Communication Priorities

All Stakeholders including Patients & Public

General Public Patients and Carers

Reputation management and public affairs Campaigning for health priorities Managing the brand and the market Awareness of key health messages Engagement and involvement in decision-making Access to health services messages Self-care messages

Vulnerable Groups Homeless Population Learning Disability Groups Disability Groups Domestic Violence Older People Black Minority & Ethnic Groups Alcohol Using Population Drug Using Population Gay, Lesbian & Bisexual Population Children & Young People

Through CCG’s extensive reach via its commissioned services and tailored engagement tools, including focus groups Communication through partnerships with community organisations eg VCaW (Voluntary Community Action Wirral)

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Carers People with long term conditions

Use of interpretive tools – translation clarity of language etc.

Media Local Regional National Specialist

Reputation management “Can-do” approach to relationships Preparation of key messages to respond to anticipated issues Clear protocols Media training for key spokespeople

Key Partners Wirral Local Authority Wirral University Teaching Hospital Cheshire and Wirral Partnership Wirral Community Trust Clatterbridge Cancer Centre North West Commissioning Support Unit

Reputation management. Communication of CCG strategic aims and objectives. Regular briefings through established mechanisms (e.g. Health and Wellbeing Board)

Other Partners Third Sector Local Involvement Networks Faith Groups Resident Groups Department of Health National Commissioning Board & Local Area Team Neighbouring CCGS & Local Authorities

Reputation management High quality, timely information to support partnerships Effective engagement and involvement Communications to support their organisation development Communications about access to services

Influencers Local MP’s Councillors Member Practices

Reputation management Timely, regular briefings – written and face to face to build awareness and support the objectives.

Regulators Department of Health NHS England Monitor CQC

Reputation management. Timely and consistent communications

Independent Contractors

GP’s and practice staff Pharmacists Dentists Optometrics Local Professional Committees, including Local Medical Council etc.

Timely and consistent communications Effective clinical engagement to build awareness and support for strategic objectives and delivery Reputation management

Other NHS & related partners

NHS 111 Health Protection Agency Workforce Confederation Healthcare Commission NHS Alliance NICE Business Services Authority

Reputation management Awareness of key messages Effective engagement & involvement

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7.1.3 Centralised stakeholder contact database

In 2014, Wirral CCG undertook a project to create a centralised comprehensive database of stakeholder contacts. Previously the various project leads held separate lists, but these have been brought together to triangulate the data to include details which can be filtered to produce reports on particular services/interests, constituencies etc. enabling it to be used across the whole organisation for all engagement activities.

7.1.4 Identification of protected groups and pro-active engagement

The CCG will seek to proactively work with community, voluntary and faith sector to identify protected groups and individuals and ensure concerns are heard and barriers to access and outcomes are removed. When designing and implementing CCG communications and engagement activities, the diversity of the population served, the potential barriers to communication and involvement some people face will be taken into account. The CCG will aim to capture and assess the quality of care experienced by vulnerable groups of patients and how and where experiences will be improved for those patients.

7.1.5 Wider promotion of the CCG, commissioning plans and participation opportunities The CCG will ensure that a range of communication methods and materials are developed to ensure patients, public, member practices, staff and stakeholders have the information they need to find out about the way the CCG works, its policies, plans and how to get involved. Wherever possible the CCG will seek for this to be a two-way communication allowing opportunity for feedback and the CCG will seek to do this via;

o the establishment of a patient group across the Wirral footprint o using specialist patient/user groups when required for specific work o social media presence (ensuring that CCG responds to comments) o Intranet for staff o Member practice and patient newsletters and meetings o Regular e-bulletins to key NHS partners, providers and virtual patient groups o Information disseminated at meetings, online and via newsletters arranged by local voluntary

and community organisations o Local authority and partner newsletters, circulations and meetings o Information posted locally on noticeboards in GP practices, pharmacies, dental practices etc

7.1.7 Providing a range of opportunities for participation

Historic reliance on single survey approaches delivered a one dimensional view of service recipients. The CCG will seek to gain insight and input from multiple sources. Not everyone is able to or will want to participate in the same way or at the same times and therefore it is important that wherever possible a cross-section of options is provided when engaging on any one matter. There are a wide range of insight and feedback tools available. Each one will be applicable in different situations, depending on which audience you are trying to reach and what information you are trying to obtain. The engagement and consultation guide will provide CCG officers with detailed information about each of the options. Tools could include:

o Large scale surveys and consultations o Paper / online / telephone / iPad or tablet questionnaires o Dedicated events to enable discussion about proposals o Seeking views from the community at local events or venues e.g. attending festivals, markets,

schools, leisure centres, libraries etc. o Understanding the assets within your local community and collaborating to identify and solve

problems together

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o Pro-active work through local voluntary and community sector organisations, including small grass roots organisations in order to collaborate and solve problems together, particularly with communities of interest e.g. mental health charities, homeless organisations.

o Focus groups and in-depth interviews o Social media comments o SMS and mobile apps o Inpatient bedside TV / digital TV o Outpatient / GP kiosks o Mystery Shopping o Complaints, feedback and compliments o Patient stories o Partnership boards, reference groups, citizen panels and policy groups

The CCG will ensure that appreciation is shown for the time and effort that individuals and groups take to feedback to the CCG. Each new contact is valuable and should be captured on the CCG stakeholder contact list for future engagement. It is essential that patients are kept informed of any developments and outcomes that result from their input and participation so that they do not become disillusioned and every engagement should advise how they can be kept informed of progress.

7.1.8 Use of new and established tools and existing data

There are a wide variety of communication and engagement tools available to the CCG which capture data which can be used to inform service developments. The CCG will seek to utilise these in their research and supplement with their own local engagement where gaps are identified. National and local level tools include;

o The GP Patient Survey o Care Quality Commission Inpatient Survey o Social Media such as twitter / Facebook o The Patient and Public Voice Commissioning Support network o NHS England digital participation space online forum o NHS England ‘People Bank’ where citizens and organisations can register participation interest o Friends and Family Test o Feedback websites such as CareConnect, PatientOpinion, Healthtalkonline.org,

youthhealthtalk.org 8. ROLES AND RESPONSIBILITIES

Effective engagement is everyone’s responsibility and the CCG Governing Body, member practices, staff, including clinicians and practice staff, all have a key role in promoting the work of Wirral Clinical Commissioning Group, the services which it commissions and in raising awareness of health campaigns and initiatives which impact on the health of the local population.

The CCG Chief Officer will ensure that all Wirral Clinical Commissioning Group members and staff are well informed and supported to do this.

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Re-commissioning of Direct Access Diagnostics Summary paper including risk assessments

Agenda Item: 2.2 Reference GB15-16/0017

Public / Private Public Meeting Date 02.06.2015

Lead Officer

Contributors Heather Harrington


1 Patient and primary care centric and based on high quality primary care, secondary and community services

2 Rigorously developed and agreed care pathways working together with patients to secure their help, understanding, ownership and support of the needed changes

3 Commissioned services which have a sound evidence base


1 Prevent people from dying prematurely 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care

To approve

To note

Summary Governing Body is asked to weigh up the advantages, disadvantages and risks of each option listed and reach a decision as to which option to take forward.

Comments

Next Steps Following a decision from Governing Body, a detailed procurement timeline will be drawn up (if applicable to decision made). Further patient and provider engagement will also be undertaken. Alongside this, the specification and tariffs will be developed.


Does the report consider the financial impact? YES If YES, please summarise the key issues Opportunity to redesign model as a whole in an attempt to manage diagnostic referrals as some concerns over inappropriate scans being undertaken. This fits with QIPP initiative. If a decision is made to re-commission the service, there is the opportunity to amend tariff to pay National PBR Tariff. This would achieve a cost saving for CCG. If NO, please state why this is not included

Value For Money Does the report consider value for money? YES If YES, please summarise


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Current tariffs are above National PBR tariff therefore achieve better value for money if we adapt to this. Also opportunity to reduce duplication and ensure the service is more efficient as a whole. If NO, please state why this is not addressed

Risk Is there a documented risk assessment? YES If YES, what are the key risks & what is being done to mitigate Please see each risk assessment for detail. If NO, please explain why

Legal Are there any legal implications and has legal advice been obtained? YES/NO If YES, please summarise the key legal considerations CSU have confirmed legal implications relating to awarding activity back to WUTH. ‘Under Regulation 5 of the Procurement, Patient Choice and Competition Regulations (2013), we would need to be satisfied that there are no other providers who could deliver the service in order to award the contract to WUTH. A decision to award the activity back to WUTH could lead to a legal challenge from a provider who could have provided this service. The fact that this service has been let as an AQP contract with 8 providers is evidence enough that there is a multiplicity of providers that could bid for and provide this service. It would be up to CCG to decide if they are prepared to take the risk of challenge under the Procurement, Patient Choice and Competition Regulations (2013).’ If NO, please explain why legal advice was not necessary


Does the report provide evidence whether there could be a positive or negative impact on patients and public? YES The report covers patient and public feedback which will be taken into account when writing the specification. If NO, please explain why Patient and Public views have not been sought


Does the report provide evidence of whether there could be a positive or negative impact on protected groups (statutory duty for new / changes to services) Yes If YES, does the report include equality impact assessment and what are the key issues The paper includes reference to access, location, choice etc. If NO, please explain why


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Workforce Does the report provide evidence of whether there could be a positive or negative impact on the CCG or other NHS staff? YES If YES, please explain and summarise the key issues TUPE implications are referenced within risk assessment and options appraisal. If a Prime Provider route is taken, staff currently working for the current providers may meet requirement to be transferred to new provider under TUPE regulations. For some staff, this may mean transfer from NHS to non-NHS provider. If NO, please state why there are no work force issues

Partnership Working Does the report evidence a partnership working in its development? YES If YES, please describe The report details engagement process with patients & public. If NO, please state why


Does the report indicate any relevant performance indicators for this item? NO If YES, please describe If NO, please explain why At this point the performance indicators have not been set however this will form the next step relating to service specification development.

Sustainability Does the report address economic, social and environmental sustainability (should be addressed for new / change projects)? NO If YES, please describe If NO, please why not This will be considered when writing the specification.




Report Name Reference Submitted to Date Brief Summary of Outcome Re-commissioning GB15- Governing Body 07.04.2015 Approved in principle but awaiting



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of Direct Access Diagnostics

16/0002

results from patient engagement.

Re-commissioning of Direct Access Diagnostics – Update following patient engagement

Governing Body 05.05.2015 The Governing Body welcomed the patient feedback. However due to Purdah and new members to the Governing Body, it was felt that a formal decision could not be made. Further recommendations were made including the suggestion to undertake risk assessments based on each procurement option and bring back to June 2015 Governing Body. It was also agreed that a summary paper will be brought back to support decision making process, especially for new members who were not present at initial Governing Body meeting.


GOVERNING BODY BOARD REPORT

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Report Title Re-commissioning of Direct Access Diagnostics – Summary paper including risk assessments

Lead Officer Heather Harrington Recommendations 1. Provide recommendation on preferred procurement method for Direct

Access Diagnostics 2.Approve next steps

1. INTRODUCTION

1.1 A paper was discussed at April 2015 Governing Body to seek approval to proceed with a

Prime Provider model for re-procuring Direct Access Diagnostics (DAD). Feedback from the Governing Body was that patient engagement relating to the procurement exercise should be undertaken prior to formal approval.

1.2 A subsequent paper was discussed at May 2015 Governing Body to detail feedback from patient groups following focus group and wider questionnaire. The Governing Body welcomed the patient feedback.

1.3 Further recommendations were made including the suggestion to undertake risk

assessments based on each procurement option and bring back to June 2015 Governing Body. It was also agreed that a summary paper would be brought back to support the decision making process, especially for new members who were not present at April’s Governing Body meeting.

2. BACKGROUND

2.1 DAD services were procured via an ‘Any Willing Provider’ model in 2011/12. The

diagnostic services included within this procurement were; Ultrasound, CT & MRI, DEXA, Nuclear, Plain Film X-ray.

2.2 Original tender was carried out to speed up waiting times for both patient appointments and reports. It also facilitated improved access with community based locations and evening and weekend appointments.

2.3 The following providers are currently offering DAD services in Wirral:

Ultrasound CT MRI X-ray DEXA Nuclear

1 Care UK 2 CCC Diagnostics

3 Diagnostic World

4 Diagnostic Healthcare

5 Kleyn Healthcare 6 Priority Links 7 Spire Murrayfield 8 WUTH


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2.4 The above contracts are all due to end September 2015 and therefore a decision is

needed regarding future commissioning arrangements.

2.5 It should be noted that the current providers have been advised that their contracts will be extended to 31st March 2016. This will allow time for a procurement exercise to take place.

2.6 The contract tariff is no longer offering value for money (see section 7 for financial impact

information).

3. PROCUREMENT OPTIONS

3.1 The table below provides an overview of our options. This table includes a further option

at the suggestion of Governing Body so that the full spectrum of options are considered.

Option Advantages Disadvantages Patient Feedback Option 1: Extend current contracts on annual basis and open competitive window An AWP/AQP process requires an annual ‘window’ to enable new providers to join the service.

Simpler procurement process – can be undertaken relatively quickly

Unable to revise specification to improve quality measures, Key Performance Indicators, model

Patients keen to ensure high quality, cost effective service and therefore did not want to be bound by current specification and tariff. Less internal resource

required as cannot amend specification or tariff

Unable to revise tariff – less affordable, efficient service

Maintains current positives e.g. improved patient choice, improved waiting times

Transactional costs associated with annual procurement process to open window

Costs associated with monitoring and management of 8 + contracts

Feedback that current system doesn’t work – duplication caused by lack of IT interface

Additional disadvantages of AQP model as stated in option 2.

Option 2: Re-procure via an AQP This accredits multiple providers as capable of providing services for an initial 3 year contract term. No guarantee of activity and no maximum number of providers.

Maintains and extends patient choice & likely to maintain local provision within primary care setting

CCG time investment to update service specification, model and tariff

Patient feedback was positive around the access advantages that AQP providers facilitate and the flexibility if one provider isn’t performing well. However, majority of

Maintain improved appointment and reporting timescales

Saturation of the market – providers struggling with numerous providers competing for activity


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The DAD services would go out in multiple lots (x5) e.g. lot 1 – Ultrasound

Opportunity for CCG to redesign DAD specification to further improve quality

Confusion for patients and referrers as multiple providers to choose from

patients raised concerns over duplications, too many providers swamping practices with information, lack of actual choice as GP often has preferred provider, concern over cost of annual processes – felt funding is best spent on direct patient care.

Opportunity for CCG to revise tariff – potential to achieve financial saving by applying National PBR tariff

Duplication of diagnostics and missing information – if secondary care cannot view all relevant images, either re-do scans or make diagnosis without all information

Range of providers; if one is struggling to meet demand, others can support

CCG staffing resource requirement to monitor and manage multiple contracts – including mobilisation process

Feedback that GPs are over-ordering diagnostics as readily available – in some instances referring for inappropriate scans

Financial cost of opening annual competitive window to allow new providers to join

Option 3: Re-procure under a framework model The DAD services would go out in multiple lots (x5) e.g. lot 1 – Ultrasound. There would be a maximum number of providers per lot. Could be up to 15 providers if each lot had maximum of 3 providers.

Maintains patient choice however may be to a lesser extent than AQP as potentially less individual providers


As above


Some confusion for patients and referrers as multiple providers to choose from albeit potentially less than AQP







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Option 4: Re-procure under a Prime Provider Model All DAD services would go out within one integrated specification and we would seek a single Prime Provider who would hold the contract. They may choose to partner with other organisation(s) or subcontract some activity.

Maintains patient choice of locations however likely to be less than under AQP and cannot guarantee choice of provider unless prime provider subcontracts

Potential to reduce patient choice of location however would maintain coverage within each constituency area as a minimum

Patient feedback was positive around Prime Provider, many felt that this could achieve a more efficient system and would reduce duplication. Also felt it would ensure consistent service. Additional positive feedback included less providers fighting for same activity and increase control and governance through one large contract. Some concerns were raised around quality assurance for subcontractors and back up plans for poor performance or patient safety concerns. Also felt it was important to maintain patient choice.




Relies on delivery of Prime Provider. If they cannot cope with demand, no alternative.

Deliver integrated service – could mandate the systems interface with secondary care to allow image sharing – this would reduce duplication

Relies on Prime Provider to manage subcontractors – potential loss of control for CCG however contract would stipulate prime provider liabilities and responsibilities for ensuring sub-contract outcomes/quality and safety

Simpler referral process for patients and referrers

Potential impact on local secondary care provider if they do not bid for or are not successful – may reduce ability to provide an effective and efficient inpatient and outpatient diagnostic service

One single contract for CCG to manage and support though mobilisation

Potential risk of challenge from unsuccessful bidders, could delay service commencement

No annual process required and therefore saving to CCG on transactional costs

Reduction in monitoring and management costs as less contracts

Option 5: Award activity to local secondary care provider

Single system – avoids duplication

Ability of secondary care to cope with demand for direct

access diagnostics and subsequent impact of

achievement of constitutional standards for

diagnostics and RTT

Patients were not asked about this option directly but the feedback given relating to provision as a whole is applicable.


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(response to treatment) This includes desire to remove duplication and ensure secondary care clinicians can view scan images. It would eliminate feedback of practices being swamped by providers. The following patient concerns would also be applicable; reduced patient access and failure to meet scanning and reporting timescales.

Removes risk to sustainability of inpatient and outpatient diagnostic services in secondary care

Provider may not offer primary care based access for diagnostic tests i.e. from GP practice premises as per current model. This could be specified within service specification


Significant risk of challenge - Under Regulation 5 of the Procurement, Patient Choice and Competition Regulations (2013), we would need to be satisfied that there are no other providers who could deliver the service in order to award the contract to WUTH. A decision to award the activity to WUTH could lead to a legal challenge from a provider who could have provided this service


Provider may not want to provide full DAD service

Cost saving to CCG as would avoid need for a procurement

Impact of machine failure e.g. MRI scanner as no other provider on pathway

4. RISK ASSESSMENTS 4.1 The following risk assessments have been conducted for each of the main procurement

options; AQP, Framework and Prime Provider. An additional risk assessment has been undertaken for option to award activity to WUTH. (See embedded documents or Appendix 1 – 4).

Appendix 1 AQP risk assessment.xlsx

Appendix 2 Framework risk assess

Appendix 3 Prime Provider risk assessm

Appendix 4 WUTH Award risk assessmen

5. PATIENT ENGAGEMENT

5.1 A questionnaire was sent out to patient groups via the patient council members.

Additionally, a patient focus group was held in April 2015.


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5.2 Detailed patient feedback was discussed at May’s Governing Body and can be found in Appendix 5.

5.3 A further focus group is planned for 11th June 2015 to further inform specification

development. Patient Council members have been asked to discuss with their individual PPG’s in the meantime to enable wider feedback.

6. SERVICE REDESIGN OPPORTUNITIES

6.1 A re-commissioning process for DAD allows us to revisit the service specification and

tariff. This gives us the opportunity to consider an outcomes based contracting approach.

6.2 It also allows us to review the DAD model as a whole.

6.3 DAD expenditure is continuing to rise and there is a concern that some GPs are over ordering diagnostic tests. This could be partly due to the additional capacity and easy access across DAD Providers. The targets specified within the current contracts exceed the National 6 week target for diagnostic tests.

6.4 There is also some evidence to suggest that GPs are not always ordering the most

appropriate diagnostic test. For example, the Musculoskeletal Value Stream Analysis work revealed that some GPs were ordering the wrong type of diagnostic test for some orthopaedic conditions.

6.5 Alongside engagement and specification development, a review could be undertaken of

GP access to diagnostics. This could include considering GP awareness and education, options to restrict certain tests or encourage discussion with a Radiologist prior to request. This could potentially be more easily facilitated with a single provider model.

7. FINANCIAL IMPACT

7.1 Direct Access Diagnostics is part of 2015-16 QIPP plan with the aim of reducing activity

by ensuring appropriate referrals are made and duplication is eliminated.

7.2 There are also potential savings to be made by adopting the National PBR tariff for DAD.

7.3 Finance will conduct a detailed analysis to determine the most appropriate tariff alongside specification development to ensure value for money.

8. NEXT STEPS

8.1 Following a decision from Governing Body, a detailed procurement timeline will be drawn

up (if applicable to decision made). Further patient and provider engagement will also be undertaken. Alongside this, the specification and tariffs will be developed.

9. CONCLUSION


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9.1 Governing Body is asked to weigh up the advantages, disadvantages and risks of each option listed and reach a decision to inform future commissioning of Direct Access Diagnostics services.

10. APPENDICES (Must be copied below or available on request – do not embed)

No. Title of Appendix 1 Risk Assessment – AQP 2 Risk Assessment – Framework 3 Risk Assessment – Prime Provider 4 Risk Assessment – Award to WUTH 5 Patient engagement paper Glossary of terms AQP – Any Qualified Provider (tenders which ‘accredit’ multiple Providers) DAD – Direct Access Diagnostics (diagnostics available for GPs to refer straight into) ITT – Invitation to Tender (documentation including series of questions for providers to answer. The responses will be evaluated and scored to ascertain the bidders who proceed to presentation stage. The scores are used to determine successful bidder). PPG – Patient Participation Group PQQ – Pre-Qualification Questionnaire (series of questions asked prior to ITT to assess if a provider meets the mandatory requirements of the specification. Those successful will receive an ITT). Prime Provider – one provider commissioned to hold a contract with the option to work with partners/subcontractors to deliver the service. Competitive window – requirement under and AQP contract to open a ‘window’ every 12 months to enable new providers to join the service.

DAD AQP PROVIDER MODEL - RISK, ISSUES AND BLOCKERS LOG

Version No:

Date of last update:

Ref Date Raised Raised by

Type (Risk, Issue)

Description of Risk Milestone(s) Impacted

Benefit(s) / Outcomes Impacted

Probability (1-5)

Impact (1-5)

Risk Severity (P x I) RAG Mitigating Action(s) Probability (1-5) Impact

(1-5)Residaul Risk Severity (P x I)

RAGAction Owner Status Comments

e.g. R30 12.08.2014e.g Prevention & Self Care e.g. Risk

e.g. Reduced investment in prevention agenda e.g. All

e.g. All prevention Benefit / Outcomes

4 4 16e.g. Secured funding until 2018

2 4 8 e.g. Joe Bloggs

e.g. Open

1 12.05.2015 Risk

Due to multiple providers, secondary care unable to access previous diagnostics undertaken - less information to support diagnosis

Delivery Efficient patient pathway 4 4 16

Consider use of Vanguard to promote better interfaces between providers however this is more complex if several providers as all likely to use different systems

4 4 16 Heather Harrington

The potential impact of this could be delays in treatment and poorer patient outcomes.

2 12.05.2015 Risk

If secondary care unable to access required diagnostic scans, an additional scan is ordered. This is a poor quality service for the patient, could cause delays to diagnosis and will incur additional charges to CCG

DeliveryEfficient and high quality patient pathway

4 5 20



This has been CCG's experience of current arrangements e.g. issues with software connectivity to share images which is more difficult to resolve with multiple providers.

3 12.05.2015 RiskSaturation of the market, risk of clinics being cancelled if low activity levels - this could cause a delay

Delivery Patient choice and waiting times 3 3 9

Providers to map capacity and demand. Could be monitored through contract meetings.


Already had one AQP provider of ultrasound withdraw as acitvity levels to low to sustain

4 12.05.2015 Risk Inconsistent quality Delivery High quality service 2 4 8

Ensure quality measures explicity detailed within specification for all providers to follow. This will be ensured through robust contract management


5 12.05.2015 Risk Confusion for patients and referrers - too much choice Delivery Choice 3 2 6

Clearly outline list of providers available and locations - utilise local directory of services


Patient feedback that due to large number of providers, GP chooses preferred provider and doesn’t offer choice.

6 12.05.2015 Risk

Ongoing cost commitment for CCG - requirement to open annual competitive window and manage numerous contracts and mobilisations

Delivery Affordability 3 3 9 Ensure included within procurement budget and workplans 3 3 9 Heather

Harrington

0 00 00 00 00 00 00 00 00 00 00 0

Residual Risk after Mitigating Action taken to addressOr Issue impact levelInitial Risk Assessment

DAD FRAMEWORK PROVIDER MODEL - RISK, ISSUES AND BLOCKERS LOG

Version No:



Type (Risk, Issue)



Probability (1-5)

Impact (1-5)







4 4 16

e.g. Secured funding until 2018


e.g. Open

1 12.05.2015 Risk

Due to multiple providers, secondary care unable to access previous diagnostics undertaken - less information to support diagnosis

Delivery Efficient patient pathway 4 4 16

A framework gives opportunity to set maximum number of providers which may be more feasible to encourage systems to interface and share images and reports. However, still likely to be numerous providers across all modalities


2 12.05.2015 Risk



4 5 20



3 12.05.2015 Risk Inconsistent quality Delivery High quality service 2 4 8

Ensure quality measures explicity detailed within specification for all providers to follow. This will be ensured through robust contract management.


4 12.05.2015 Risk

Risk of destabilising the core secondary care service if Acute Trust ceases providing direct access diagnostics

Delivery Delivery of key contracts 2 5 10 Acute Trust will need to manage this

risk internally 2 5 10 Heather Harrington

5 12.05.2015 Risk

Implications to current workforce - TUPE may apply if current providers are unsuccessful in their bid. This may involve NHS staff tranferring to a private provider

Delivery Workforce 3 3 9Ensure ongoing engagement with staff and liaise with HR at earliest point in process


6 12.05.2015 Risk Cost implications of managing numerous contracts Delivery Finance 3 3 0 Build into staff workplans 2 3 6 Heather

Harrington0 00 00 00 00 00 00 00 00 00 00 0

0 0


DAD PRIME PROVIDER MODEL - RISK, ISSUES AND BLOCKERS LOG

Version No:



Type (Risk, Issue)



Probability (1-5)

Impact (1-5)







4 4 16



e.g. Open

1 12.05.2015 RiskFailure to manage capacity and demand may lead to delays if no alternative providers

Delivery

Achieving improved waiting times - appointment and reporting

3 4 12

Robust contract monitoring and management - enforce penalties for breaches and incentivise improvements. Provider use of sub-contractors to share demand.


This risk could be applied to any provider, regardless of model but it is amplified by prime provider model as only provider commissioned to provide this service

2 12.05.2015 RiskReduced control and influence over prime provider and its' subcontactors

DeliveryEnsuring consistently high quality service

3 3 9

Robust contract monitoring and management - requirement for sub contractor information to be provided to CCG including qualifications, references and ongoing performance activity. Contract would stipulate prime provider liabilities and responsibilities for ensuring sub-contract outcomes/quality and safety


The introduction of a prime provider model with partners/subcontractors offers advantages to CCG including reduced contracts to manage and assurance, consistency and integration provided through prime provider

3 12.05.2015 Risk Reduction in patient choice DeliveryEnsuring patient choice is promoted

3 4 12

Patient choice will be maintained as we will specifiy within the service specification that some diagnostic services e.g. ultrasound are provided within each of the 4 consistuency areas as a minimum. Partners/subcontractors can be encouraged, again facilitating patient choice


This was discussed with the patient focus group who felt that access and quality was more important than provider choice. They advised that more common diagnostics should be available closer to home but for more specialist diagnostics e.g. MRI they would expect to travel further

4 12.05.2015 Risk



3 5 15

Ensure it is mandatory for Provider to ensure free access to previous reports and examinations and ensure link to PACS and patient systems. Also consider how vanguard could potentially support this.


5 12.05.2015 Risk

Risk of destabilising the core secondary care service if Acute Trust ceases providing direct access diagnostics

Delivery Delivery of key contracts 2 5 10 Acute Trust will need to manage this

risk internally 2 5 10 Heather Harrington

6 12.05.2015 RiskRisk of challenge by unsuccessful providers - could delay service commencement

Delivery Commencement as planned 3 4 12

Ensure procurement laws/processes followed correctly, ensure evaluators bring relevant expertise e.g. clinical, quality, workforce, finance, etc.


7 12.05.2015 Risk

Implications to current workforce - TUPE may apply if current providers are unsuccessful in their bid. This may involve NHS staff tranferring to a private provider

Delivery Workforce 3 3 9Ensure ongoing engagement with staff and liaise with HR at earliest point in process


0 00 00 00 00 00 00 00 00 00 0


AWARD ACTIVITY TO WUTH - RISK, ISSUES AND BLOCKERS LOG

Version No:



Type (Risk, Issue)



Probability (1-5)

Impact (1-5)







4 4 16



e.g. Open

1 12.05.2015 RiskFailure to manage capacity and demand may lead to delays if no alternative providers

Delivery

Achieving improved waiting times - appointment and reporting

4 4 16

Robust contract monitoring and management - enforce penalties for breaches and incentivise improvements. Provider use of sub-contractors to share demand.


This risk could be applied to any provider. We would need to be assured of the provider's capability to absorb additional activity whilst maintaining standards and outcomes.

3 12.05.2015 Risk Reduction in patient choice DeliveryEnsuring patient choice is promoted

3 4 12

Patient choice could be maintained as we could specifiy within the service specification that some diagnostic services e.g. ultrasound are provided within each of the 4 consistuency areas as a minimum.


This was discussed with the patient focus group who felt that access and quality was more important than provider choice. They advised that more common diagnostics should be available closer to home but for more specialist diagnostics e.g. MRI they would expect to travel further

4 12.05.2015 Risk

Risk of legal challenge - Under Regulation 5 of the Procurement, Patient Choice and Competition Regulations (2013), need to be satisfied that there are no other providers who could deliver the service in order to award the contract to WUTH.

Delivery Delivery of key contracts 4 5 20 4 5 20 Heather

Harrington

The fact that this service has been let as an AQP contract with 8 providers is evidence enough that there is a multiplicity of providers that could bid for and provide this service.

5 12.05.2015 Risk Potential equipment failure causing delays - no other providers to utilise Delivery Delivery of key

contracts 2 5 10 Provider would need to develop service continuity plan 2 5 10 Heather

Harrington

0 00 00 00 00 00 00 00 00 0



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Report Title Re-commissioning of Direct Access Diagnostics Update following patient engagement

Lead Officer Heather Harrington Recommendations 1.Support recommendation to re-commission via a prime provider model

2.Approve next steps

1. INTRODUCTION 1.1 A paper was presented to April Governing Body to request approval to procure Direct Access

Diagnostics via a Prime Provider model.

1.2 Feedback was supportive of the principle however it was requested that patient engagement was undertaken prior to the decision being formally ratified by Governing Body.

2. PATIENT ENGAGEMENT PROCESS

2.1 Following Governing Body feedback, patient engagement was undertaken through:

• Patient Focus Group held Friday 24th April • Information and Questionnaire sent via patient councils

2.2 The focus group and circulated questionnaire included:

• Information on each of the options – extend as is, re-tender via Any Qualified Provider or re-tender via Prime Provider; including summary of advantages and disadvantages of each

• Open opportunity to give view on each option and indicate preference • Opportunity to give feedback on what the most important elements of a good diagnostics

service are • Question as to how best to maintain engagement throughout process • Opportunity to provide any further comments

2.3 Patients receiving the questionnaire and attending focus group will feedback discussions to their

PPG’s. PPG members will then have the opportunity to contribute to the development of the specification and tender process. This can be facilitated by feedback via their PPG chair, completion of additional questionnaires or attendance at future focus groups.

3. FEEDBACK RECEIVED

3.1 The feedback is summarised below: What procurement option would you like us to adopt?: The majority of patients (75%) advised that they would prefer a Lead Provider model over an AQP model. A number of patients stated that they didn’t mind which model was adopted as long as a high quality service is delivered.


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The feedback from both the questionnaire and focus group are shown below. The focus group allowed us to spend time explaining the options and collect qualitative feedback in terms of what is most important to patients.

Extend existing contracts opening competitive window or re-procure via Any Qualified Provider

Re-procure via Prime Provider Positives Concerns Efficient system – 1 single provider who will manage their subcontractors and ensure delivery against specification

Need to ensure subcontractors meet quality requirements and have all necessary qualifications

Reduced duplication Need to ensure back up in place if prime provider fails either in terms of meeting targets or patient safety incidents

Consistency Maintained choice through requiring provider to offer services across Wirral

No requirement to open competitive window Less confusing for referrers Less providers fighting for same activity Increase control and governance

4. OTHER KEY MESSAGES

4.1 The group highlighted what was most important to them in a diagnostics service; these will be fed into the development of the specification. The key themes included:

4.1.1 Access/Choice – patients want to maintain local provision where possible with a minimum of one location in each of the 4 constituency areas. They want to ensure the locations are accessible via car or public transport and would ideally like free parking. The focus group stated that for more complex scanning e.g. MRI they would expect to travel further and wouldn’t necessarily expect provision in each of the 4 constituency areas.

4.1.2 Availability and Facilities – patients expressed that the service needs to be available when needed, including for urgent appointments and all facilities should be of a consistently high quality

Positives Concerns Choice of locations Duplication – patient own experiences. MRI

not accepted by consultant so repeated, patient husband similar experience

Flexibility if one provider not performing well, option to go to another

Too many providers – practices are being ‘swamped’ with information from providers to encourage use of their services

GP practice chosen preferred provider anyway and utilise them – patient not actually given choice

Concern over cost of opening competitive window – time & money


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4.1.3 Waiting times – waiting times should be as short as possible to reduce anxiety. Patients should be given written information to advise the timeframe in which they should be seen (in line with KPI from contract) and what to do if they do not receive an appointment within this timeframe. Waiting time upon arriving for scan should be as short as possible and the results should be with GP rapidly to ensure available for patient’s next GP appointment.

4.1.4 Quality – in addition to above, the service should be high quality overall – this includes

ensuring all providers (including subcontractors) are adequately qualified, the scan reports are accurate to avoid duplication and communication with the patient and other clinicians is seamless. Specification should also include reference to NICE Guidelines.

4.1.5 Contract monitoring – patient feedback centred around the importance of contract

monitoring to ensure high quality standards are being met. This includes monthly reports, feedback on incidents/errors, patient feedback including complaints. Also feel it is important to have exit options if performance poor. Feel a contingency plan is essential for both delays in patients receiving scans and also any patient safety concerns. Specification should also include some standard requirements e.g. ISO9000.

The group suggested an additional monitoring role for patient groups so that if a PPG member raises a concern about diagnostic waiting times, they can request a report from CCG/Provider to detail performance and if breaching contract, information on what has been done to make required improvements.

4.1.6 Technology – one of the key concerns the patient group had was around sharing the

results in an efficient way. The group suggested setting requirements within the specification that the clinical systems should interface and allow image and report transfer back to referrer and also to secondary care providers if referral required.

4.1.7 Communication – this spanned across each discussion. It included communication with

patients regarding expectations and timescales, communication between clinicians and communication at earliest point with patient to identify appointment date and results date.

4.1.8 Value for money/cost – patients keen to ensure the model represents value for money and

directs as much money as possible to patient care rather than procurement/contracting processes e.g. opening competitive window and monitoring numerous contracts.

5. NEXT STEPS

5.1 If Prime Provider approach approved by Governing Body, the next steps will be:

5.1.1 Discussion with current providers to advise on direction of travel and potential contract extensions.

5.1.2 Draft service specification including all modalities each with appropriate response times 5.1.3 Conduct equality impact assessment 5.1.4 Hold further patient engagement to influence specification – discussions within each PPG

and additional focus group to be held May to re-visit recommendations and look at specific elements to influence specification. Give patients opportunity to influence questions asked during tender process.

5.1.5 Hold Provider day(s) to encourage partnership working 5.1.6 Update specification based on stakeholder feedback 5.1.7 Develop tariff for service 5.1.8 Commence PQQ (Pre-Qualification Questionnaire) process 5.1.9 Evaluation PQQ returns 5.1.10 Commence ITT (Invitation to Tender) process


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5.1.11 Evaluate ITT responses and invite successful bidders to interview/presentations 5.1.12 Bring summary paper to Governing Body detailing outcome of the tender process 5.1.13 Award contract to successful bidder 5.1.14 Commence 12 week mobilisation phase with commencement date estimated to be 1st July

2016. 6. CONCLUSION

6.1 Governing Body is asked to consider the patient feedback presented and ratify decision to re-procure direct access diagnostics via a prime provider model.


No. Title of Appendix Glossary of terms AQP – Any Qualified Provider (tenders which ‘accredit’ multiple Providers) DAD – Direct Access Diagnostics (diagnostics available for GPs to refer straight into) ITT – Invitation to Tender (documentation including series of questions for providers to answer. The responses will be evaluated and scored to ascertain the bidders who proceed to presentation stage. The scores are used to determine successful bidder). PPG – Patient Participation Group PQQ – Pre-Qualification Questionnaire (series of questions asked prior to ITT to assess if a provider meets the mandatory requirements of the specification. Those successful will receive an ITT). Prime Provider – one provider commissioned to hold a contract with the option to work with partners/subcontractors to deliver the service.


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Report Title Re-commissioning of Direct Access Diagnostics – Summary paper including risk assessments

Lead Officer Heather Harrington Recommendations 1. Provide recommendation on preferred procurement method for Direct

Access Diagnostics 2.Approve next steps

1. INTRODUCTION

1.1 A paper was discussed at April 2015 Governing Body to seek approval to proceed with a

Prime Provider model for re-procuring Direct Access Diagnostics (DAD). Feedback from the Governing Body was that patient engagement relating to the procurement exercise should be undertaken prior to formal approval.

1.2 A subsequent paper was discussed at May 2015 Governing Body to detail feedback from patient groups following focus group and wider questionnaire. The Governing Body welcomed the patient feedback.

1.3 Further recommendations were made including the suggestion to undertake risk

assessments based on each procurement option and bring back to June 2015 Governing Body. It was also agreed that a summary paper would be brought back to support the decision making process, especially for new members who were not present at April’s Governing Body meeting.

2. BACKGROUND

2.1 DAD services were procured via an ‘Any Willing Provider’ model in 2011/12. The

diagnostic services included within this procurement were; Ultrasound, CT & MRI, DEXA, Nuclear, Plain Film X-ray.

2.2 Original tender was carried out to speed up waiting times for both patient appointments and reports. It also facilitated improved access with community based locations and evening and weekend appointments.

2.3 The following providers are currently offering DAD services in Wirral:

Ultrasound CT MRI X-ray DEXA Nuclear

1 Care UK 2 CCC Diagnostics

3 Diagnostic World

4 Diagnostic Healthcare

5 Kleyn Healthcare 6 Priority Links 7 Spire Murrayfield 8 WUTH


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2.4 The above contracts are all due to end September 2015 and therefore a decision is

needed regarding future commissioning arrangements.

2.5 It should be noted that the current providers have been advised that their contracts will be extended to 31st March 2016. This will allow time for a procurement exercise to take place.

2.6 The contract tariff is no longer offering value for money (see section 7 for financial impact

information).

3. PROCUREMENT OPTIONS

3.1 The table below provides an overview of our options. This table includes a further option

at the suggestion of Governing Body so that the full spectrum of options are considered.

Option Advantages Disadvantages Patient Feedback Option 1: Extend current contracts on annual basis and open competitive window An AWP/AQP process requires an annual ‘window’ to enable new providers to join the service.

Simpler procurement process – can be undertaken relatively quickly

Unable to revise specification to improve quality measures, Key Performance Indicators, model

Patients keen to ensure high quality, cost effective service and therefore did not want to be bound by current specification and tariff. Less internal resource

required as cannot amend specification or tariff

Unable to revise tariff – less affordable, efficient service

Maintains current positives e.g. improved patient choice, improved waiting times

Transactional costs associated with annual procurement process to open window

Costs associated with monitoring and management of 8 + contracts

Feedback that current system doesn’t work – duplication caused by lack of IT interface

Additional disadvantages of AQP model as stated in option 2.

Option 2: Re-procure via an AQP This accredits multiple providers as capable of providing services for an initial 3 year contract term. No guarantee of activity and no maximum number of providers.

Maintains and extends patient choice & likely to maintain local provision within primary care setting


Patient feedback was positive around the access advantages that AQP providers facilitate and the flexibility if one provider isn’t performing well. However, majority of

Maintain improved appointment and reporting timescales

Saturation of the market – providers struggling with numerous providers competing for activity


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The DAD services would go out in multiple lots (x5) e.g. lot 1 – Ultrasound


Confusion for patients and referrers as multiple providers to choose from

patients raised concerns over duplications, too many providers swamping practices with information, lack of actual choice as GP often has preferred provider, concern over cost of annual processes – felt funding is best spent on direct patient care.






Financial cost of opening annual competitive window to allow new providers to join

Option 3: Re-procure under a framework model The DAD services would go out in multiple lots (x5) e.g. lot 1 – Ultrasound. There would be a maximum number of providers per lot. Could be up to 15 providers if each lot had maximum of 3 providers.

Maintains patient choice however may be to a lesser extent than AQP as potentially less individual providers


As above


Some confusion for patients and referrers as multiple providers to choose from albeit potentially less than AQP







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Option 4: Re-procure under a Prime Provider Model All DAD services would go out within one integrated specification and we would seek a single Prime Provider who would hold the contract. They may choose to partner with other organisation(s) or subcontract some activity.

Maintains patient choice of locations however likely to be less than under AQP and cannot guarantee choice of provider unless prime provider subcontracts

Potential to reduce patient choice of location however would maintain coverage within each constituency area as a minimum

Patient feedback was positive around Prime Provider, many felt that this could achieve a more efficient system and would reduce duplication. Also felt it would ensure consistent service. Additional positive feedback included less providers fighting for same activity and increase control and governance through one large contract. Some concerns were raised around quality assurance for subcontractors and back up plans for poor performance or patient safety concerns. Also felt it was important to maintain patient choice.




Relies on delivery of Prime Provider. If they cannot cope with demand, no alternative.

Deliver integrated service – could mandate the systems interface with secondary care to allow image sharing – this would reduce duplication

Relies on Prime Provider to manage subcontractors – potential loss of control for CCG however contract would stipulate prime provider liabilities and responsibilities for ensuring sub-contract outcomes/quality and safety

Simpler referral process for patients and referrers

Potential impact on local secondary care provider if they do not bid for or are not successful – may reduce ability to provide an effective and efficient inpatient and outpatient diagnostic service

One single contract for CCG to manage and support though mobilisation

Potential risk of challenge from unsuccessful bidders, could delay service commencement

No annual process required and therefore saving to CCG on transactional costs

Reduction in monitoring and management costs as less contracts

Option 5: Award activity to local secondary care provider

Single system – avoids duplication

Ability of secondary care to cope with demand for direct

access diagnostics and subsequent impact of

achievement of constitutional standards for

diagnostics and RTT

Patients were not asked about this option directly but the feedback given relating to provision as a whole is applicable.


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(response to treatment) This includes desire to remove duplication and ensure secondary care clinicians can view scan images. It would eliminate feedback of practices being swamped by providers. The following patient concerns would also be applicable; reduced patient access and failure to meet scanning and reporting timescales.

Removes risk to sustainability of inpatient and outpatient diagnostic services in secondary care

Provider may not offer primary care based access for diagnostic tests i.e. from GP practice premises as per current model. This could be specified within service specification


Significant risk of challenge - Under Regulation 5 of the Procurement, Patient Choice and Competition Regulations (2013), we would need to be satisfied that there are no other providers who could deliver the service in order to award the contract to WUTH. A decision to award the activity to WUTH could lead to a legal challenge from a provider who could have provided this service


Provider may not want to provide full DAD service

Cost saving to CCG as would avoid need for a procurement

Impact of machine failure e.g. MRI scanner as no other provider on pathway

4. RISK ASSESSMENTS 4.1 The following risk assessments have been conducted for each of the main procurement

options; AQP, Framework and Prime Provider. An additional risk assessment has been undertaken for option to award activity to WUTH. (See embedded documents or Appendix 1 – 4).

Appendix 1 AQP risk assessment.xlsx

Appendix 2 Framework risk assess

Appendix 3 Prime Provider risk assessm

Appendix 4 WUTH Award risk assessmen

5. PATIENT ENGAGEMENT

5.1 A questionnaire was sent out to patient groups via the patient council members.

Additionally, a patient focus group was held in April 2015.


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5.2 Detailed patient feedback was discussed at May’s Governing Body and can be found in Appendix 5.

5.3 A further focus group is planned for 11th June 2015 to further inform specification

development. Patient Council members have been asked to discuss with their individual PPG’s in the meantime to enable wider feedback.

6. SERVICE REDESIGN OPPORTUNITIES

6.1 A re-commissioning process for DAD allows us to revisit the service specification and

tariff. This gives us the opportunity to consider an outcomes based contracting approach.

6.2 It also allows us to review the DAD model as a whole.

6.3 DAD expenditure is continuing to rise and there is a concern that some GPs are over ordering diagnostic tests. This could be partly due to the additional capacity and easy access across DAD Providers. The targets specified within the current contracts exceed the National 6 week target for diagnostic tests.

6.4 There is also some evidence to suggest that GPs are not always ordering the most

appropriate diagnostic test. For example, the Musculoskeletal Value Stream Analysis work revealed that some GPs were ordering the wrong type of diagnostic test for some orthopaedic conditions.

6.5 Alongside engagement and specification development, a review could be undertaken of

GP access to diagnostics. This could include considering GP awareness and education, options to restrict certain tests or encourage discussion with a Radiologist prior to request. This could potentially be more easily facilitated with a single provider model.

7. FINANCIAL IMPACT

7.1 Direct Access Diagnostics is part of 2015-16 QIPP plan with the aim of reducing activity

by ensuring appropriate referrals are made and duplication is eliminated.

7.2 There are also potential savings to be made by adopting the National PBR tariff for DAD.

7.3 Finance will conduct a detailed analysis to determine the most appropriate tariff alongside specification development to ensure value for money.

8. NEXT STEPS

8.1 Following a decision from Governing Body, a detailed procurement timeline will be drawn

up (if applicable to decision made). Further patient and provider engagement will also be undertaken. Alongside this, the specification and tariffs will be developed.

9. CONCLUSION


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9.1 Governing Body is asked to weigh up the advantages, disadvantages and risks of each option listed and reach a decision to inform future commissioning of Direct Access Diagnostics services.


No. Title of Appendix 1 Risk Assessment – AQP 2 Risk Assessment – Framework 3 Risk Assessment – Prime Provider 4 Risk Assessment – Award to WUTH 5 Patient engagement paper Glossary of terms AQP – Any Qualified Provider (tenders which ‘accredit’ multiple Providers) DAD – Direct Access Diagnostics (diagnostics available for GPs to refer straight into) ITT – Invitation to Tender (documentation including series of questions for providers to answer. The responses will be evaluated and scored to ascertain the bidders who proceed to presentation stage. The scores are used to determine successful bidder). PPG – Patient Participation Group PQQ – Pre-Qualification Questionnaire (series of questions asked prior to ITT to assess if a provider meets the mandatory requirements of the specification. Those successful will receive an ITT). Prime Provider – one provider commissioned to hold a contract with the option to work with partners/subcontractors to deliver the service. Competitive window – requirement under and AQP contract to open a ‘window’ every 12 months to enable new providers to join the service.

PERFORMANCE AND FINANCE REPORT

Agenda Item: 3.2 Reference GB15-16/0018

Public / Private Public Meeting Date 02.06.2015

Lead Officer Lorna Quigley Director Of Quality and Patient safety Mark Bakewell Chief Financial Officer

Contributors Finance and Business Intelligence teams Wirral CCG


1 Patient and primary care centric and based on high quality primary care,

secondary and community services 2 Rigorously developed and agreed care pathways working together with

patients to secure their help, understanding, ownership and support of the needed changes

3 Commissioned services which have a sound evidence base 4 Provides greater equality of access to all


1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable Harm

To approve

To note Yes

Summary Governing body is asked to receive and note the performance report for Quarter 4 and Month 12 (March 2015) and the verbal finance report for Month 1 (April 2015)

Comments

Next Steps

What are the implications for the following (if not applicable please state why):

Financial

Does the report consider the financial impact? No No data available

Value For Money Does the report consider value for money? No No data available

Risk Is there a documented risk assessment? NO No data available

Legal Are there any legal implications and has legal advice been obtained? NO Monthly report to Governing body


Does the report provide evidence whether there could be a positive or negative impact on patients and public? YES Achievement against the NHS constitutional standards


Does the report provide evidence of whether there could be a positive or negative impact on protected groups (statutory duty for new / changes to services) NO Monthly report to Governing body

Workforce Does the report provide evidence of whether there could be a positive or negative impact on the CCG or other NHS staff? NO Monthly report to governing Body

Partnership Working

Does the report evidence a partnership working in its development? YES


Does the report indicate any relevant performance indicators for this item? YES The report shows the CCG s financial performance and performance against the NHS constitutional standards.

Sustainability Does the report address economic, social and environmental sustainability (should be addressed for new / change projects)? NO Monthly report to Governing Body





Report Name Reference Submitted to Date Brief Summary of Outcome Performance report

QPF14-15 QPF 26/5/15 Paper noted

Finance report QPF14-15 QPF 26/5/15 Paper noted


Finance & Performance Update to Governing Body Meeting

Tuesday 2nd June

Performance Update Quarter 4 Month 12


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Direct Commissioning Report

Agenda Item: 3.3 Reference GB15-16/0018 Public / Private Public Meeting Date 2nd June 2015

Lead Officer Dr Simon Delaney, GP Lead for Primary Care

Contributors Iain Stewart, Head of Direct Commissioning


Edit as applicable:

1 Patient and primary care centric and based on high quality primary care, secondary and community services

2 Rigorously developed and agreed care pathways working together with patients to secure their help, understanding, ownership and support of the needed changes

3 Commissioned services which have a sound evidence base 4 Provides greater equality of access to all


Edit as applicable: 1 Prevent people from dying prematurely 2 Enhance the quality of life for people with long term conditions 3 Helping people to recover from episodes of ill health or following injury 4 Ensuring people have a positive experience of care 5 Ensuring people are treated and cared for in a safe environment and protected from avoidable Harm

To approve

To note Yes

Summary This report is the second update for the Direct Commissioning Team and provides summary detail of the range of activities undertaken within the five reporting domains. Key items from a primary care performance dashboard will be included in due course to further enhance the information reported to Governing Body.

Comments The Direct Commissioning team has operated since early January 2015 with a 1.0wte Commissioning Manager vacancy and from the start of May 2015, the remaining 0.8wte Commissioning Manager has commenced a 5 month career break. Approval for the recruitment to both roles was received end of April 2015 and is underway.

Next Steps


Does the report consider the financial impact? NO Report provides summary detail on general activities undertaken across five domains.


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Value For Money Does the report consider value for money? NO Report provides summary detail on general activities undertaken across five domains.

Risk Is there a documented risk assessment? NO Report provides summary detail on general activities undertaken across five domains

Legal Are there any legal implications and has legal advice been obtained? NO Report provides summary detail on general activities undertaken across five domains.


Does the report provide evidence whether there could be a positive or negative impact on patients and public? YES Based upon the first Wirral Patient Voice meeting, there is a strong sense of patients wishing to be more involved in the commissioning process and subsequent decisions taken by the CCG for local health services.


Does the report provide evidence of whether there could be a positive or negative impact on protected groups (statutory duty for new / changes to services) NO Report provides summary detail on general activities undertaken across five domains

Workforce Does the report provide evidence of whether there could be a positive or negative impact on the CCG or other NHS staff? NO Report provides summary detail on general activities undertaken across five domains

Partnership Working Does the report evidence a partnership working in its development? NO Report provides summary detail on general activities undertaken across five domains


Does the report indicate any relevant performance indicators for this item? NO Report provides summary detail on general activities undertaken across five domains However, there is agreement to develop a primary care dashboard that will report to the Quality, Performance & Finance Committee.

Sustainability Does the report address economic, social and environmental sustainability (should be addressed for new / change projects)? NO


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Report provides summary detail on general activities undertaken across five domains




Report Name Reference Submitted to Date Brief Summary of Outcome



Primary Care Report – Direct Commissioning Team Tuesday 2nd June 2015 – Governing Body Dr Simon Delaney – GP Lead for Primary Care Iain Stewart – Head of Direct Commissioning Sarah Lynch – Administrative Assistant

1

Primary Care Quality

• Routine contract monitoring carried out by NHS England (NHSE) • Enhanced Services Reviews completed and QIPP contribution confirmed at approximately £400,000 - approved

by CCG Approvals Committee • PMS Premium Review – Head of DC representing CCG on local NHSE panel – information from Wirral PMS

practices submitted for consideration – outcome expected by October 2015. • On-going monitoring for quality of communications to Primary Care, both internal/external. • Direct Commissioning support to local voluntary sector bid application to the Department of Health for

“Primary Care Connectors” – bid submitted by Community Action Wirral – awaiting outcome. • iPlato SMS messaging service procured as a single Wirral contract to support member practices. • Participation in CCG Programme Prioritisation exercise for related projects. • Bespoke Wirral risk stratification tool ready to rollout to member practices to support management of

unplanned admissions and use of the four Integrated Care Co-ordination Teams (ICCTs) • Patient Online Programme – worked in conjunction with NHSE to ensure increase in the number of member

practices which had enabled their practice systems to meet the contractual requirements from April 2015 to be able to offer patients online appointment booking; electronic prescribing and online access to patients’ own medical records.

• GP IT – worked in conjunction with NWCSU ICT service to initiate clinical system switches from Vision system to EMISWeb system, in response to requests from a number of member practices – all system switches scheduled to be completed by September – this will mean 54 out of 56 member practices operating on EMISWeb and two continuing with the upgraded Vision system.

2

Member Engagement

• Clinical engagement model agreed and dates confirmed for 2015/16: Members Council (to discuss

commissioning matters) and Providers Forum (to discuss service provision matters) will meet quarterly with GP Out of Hours service providing urgent GP cover; each meeting will be a full afternoon to enable an appropriate level of detailed discussion on key matters – Members Council dates are 1st July; 8th October; 7th January; – Provider Forum dates are 5th August; 4th November; 4th February.

• Primary Care Communications has been extended to include alternating weekly “key pointers” on health system management for Unplanned Care/Planned Care/Prescribing matters

• First Wirral Practice Managers Forum met on 28th April 2015 with supporting presentations on Primary Care portal and Think Pharmacy Minor Ailment service – overall positive feedback on opportunity to collectively meet and discuss key challenges facing primary care – concerns raised by managers about the resources available to support primary care in their increasing role as part of Vision 2018 and the desired need to shift appropriate activity from a hospital setting into the community. Practice Managers have agreed to meet in geographical network groups between the formal quarterly Forum meetings and provide key points/questions to the Direct Commissioning team.

• Wirral Practice Nurses have agreed to utilise the same dates for protected learning time (PLT) to create a Wirral Practice Nurse Forum which will meet prior to the training commencement so as to have the opportunity to capture nursing perspectives on the challenges facing primary care and provide structured feedback via the Direct Commissioning team.

• Members section is now available on the CCG website to further enhance communications and engagement.

3

Patient Engagement

• Head of Direct Commissioning (DC) attended several ex-consortia patient group meetings to keep patient

representatives informed and updated on organisational change. • Head of DC has chaired 3 Wirral-level patient meetings, drawing together the ex-consortia patient council

members to discuss and plan how a Wirral-wide patient approach is best developed. • Held the first “Wirral Patient Voice” meeting on 19th May 2015 to test out the model of engagement – overall

the opportunity was welcomed with good feedback from patient representatives – group agreed that further work is needed on the terms of reference to emphasise the focus of the Patient Voice be on individual Patient Participation Group (PPG) representatives being engaged and involved in the commissioning processes and providing informed feedback and questions rather than an informal discussion opportunity.

• Head of DC continues to attend individual Patient Participation Groups by invite, to update patients on CCG and opportunities/ideas for future engagement.

4

Choice

• Think Pharmacy NHS Minor Ailment service campaign developed in conjunction with NWCSU Medicines

Management team – service had a “soft” launch week commencing 11th May in order to enable Wirral pharmacies the opportunity to prepare their stores – printed materials (posters, flyers, information cards) have been supplied to Wirral pharmacies; general practices; A&E; WICs; Council 1 stop Shops; Libraries and a banner campaign is due to commence on local buses and Wirral Merseyrail by end of May 2015 which will run for 8 weeks and be repeated September/October and February/March in order to provide fresh impetus pre and post Winter.

• Directory of Services (DOS) – work has continued to develop a single Wirral DOS – the next phase will involve establishing the most useful method for member practices to be able to quickly access the directory during working surgeries.

5

Education

• Wirral-wide Protected Learning Time education programme confirmed – topics include Stroke

prevention/Atrial Fibrillation; Respiratory disease; and Musculoskeletal conditions – 24th June/24th September/3rd December/9th March

• Secured subscription for member practices to comprehensive online training resource which covers the majority of update and key skills training for member practices’ staff.

• Expressions of interest sought from member practices for a GP Education & Training Lead to work in conjunction with the GP Lead for Primary Care and the Direct Commissioning team in designing and delivering appropriate education and training opportunities for clinical membership.

• Health Education North West funding secured to support a full year programme of primary care nursing training and skills updating.

DRAFT - Minutes of the WCCG QPF Meeting –28.04.2015 Page 1 of 7

WIRRAL CLINICAL COMMISSIONING GROUP

Quality Performance and Finance – informal meeting

Notes & Actions of Meeting

Tuesday 28th April 2015 1pm Room 539, 5th Floor, Old Market House

Present: Peter Naylor (PN) Chair WCCG

Lorna Quigley (LQ) Director of Quality and Patient Safety James Kay (JK) Lay Member (Audit & Governance) WCCG Simon Wagener (SW) Lay Member (Patient Champion)

Mark Bakewell (MB) Chief Financial Officer Andrew Cooper (AC) Head of Strategic Planning and Outcomes

Christine Campbell (CC) Head of Partnerships Paul Edwards (PE) Director of Corporate Affairs

Sue Wells (SWels) Medical Director WCCG Guest Speakers: Minute Taker/Support: Allison Hayes (AJH) WCCG Corporate Officer – Corporate Affairs In attendance Steve Riley (SR) Medicines Management

Ref No. Minute QPF15-16/0001 1.0 Standing Agenda Items 1.1 Apologies for absence

Apologies were received from: John Oates, Mark Green, Iain Stewart, Sue Smith, Laura Wentworth and John Wicks.

1.2 Declarations of Interest

There were no declarations of interests. 1.3 Minutes of Previous meeting from 31st March 2015

The minutes from the previous meeting held on 31st March were agreed as true and accurate record, notwithstanding typographical and grammatical errors. Action - AJH to send ratified minutes from March to GB in May. Actions from the previous meeting – please refer to action sheet. Outstanding Actions Members discussed the outstanding actions from the previous meeting. Matters Arising There were no matters arising.

QPF15-16/0002 2.0 Items for approval 2.1 Draft Quality Accounts – WUTH

LQ presented the draft quality accounts for WUTH. Wirral University Teaching Hospital Trust has a legal duty to send out the annual draft Quality Account to the Clinical Commissioning Group (CCG) for review.


Ref No. Minute The Department of Health requirement states that the CCG and other stakeholders of the Trust have up to 30 days to consider the report and provide a response. Based on the knowledge of the trust, the QPF committee are requested to approve that the quality account is an accurate reflection of the services provided and the Chair of the CCG is to provide a statement to that effect. Members discussed and reflected on the findings detailed within the report and key areas of discussion included:

• Zero tolerance of avoidable new pressure ulcers • Patients receiving appropriate assistance with eating • Emergency admissions and readmissions • 4 hour target • Advancing Quality • Culture/staff survey • Clinical Audit/data • Medications

Action – Chair to write to WUTH reflecting on the services provided given in the quality accounts and the response is to be submitted to the Governing Body at a later date. 2.2 Annual Quality, Performance and Finance Report LQ presented the Annual Quality, Performance and Finance Report. The purpose of this report is to update governing body members with the progress that work of the Quality Performance and Finance Committee (QPF) has made over the previous year and to provide details of how it has, through its terms of reference, ensured the continuing development, monitoring and reporting of performance outcome metrics in relation to quality improvement, financial strategies and management plans: assurances regarding the quality (safety, effectiveness and patient experience) and value for money of all commissioned services in line with the CCG objectives. 2.3 Mersey Internal Audit Agency Advisory Service CHC/Continuing Care: CCG Overview report CC presented a report conducted by MIAA. Mersey Internal Audit Agency (MIAA) was commissioned in 2014 to undertake an advisory review of the Continuing Healthcare (CHC) and Complex Care service provided by the North West Commissioning Support Unit (CSU). The final report has now been submitted to the CCG including recommendations to improve service delivery and address risks, and an action plan has been produced to demonstrate progress made to date, and further actions planned. SW sought clarity regarding placement packages and pieces of equipment identified for patient’s clinical needs and how these are funded. CC explained that standard equipment would be offered that meet the patient’s needs; however if the patient or family wish for a higher specification model of equipment then the CCG would not necessarily pay for this. Other areas of discussion included: • End of life services • Patient reviews • Terms of References regarding CCG & LA panel meetings • CHC placement costs • Funding of Equipment


Ref No. Minute Members of the QPF committee noted the report and it was agreed that the CCG will continue to implement the action plan to mitigate any risks or gaps highlighted within the report. 2.4 PDGs LQ informed members of the authorisation process regarding Patient Group Directives. PGDs provide a legal framework that allows the supply and/or administration of a specified medicine(s), by named, authorised, registered health professionals, to a pre-defined group of patients. The use of PGDs is linked to a number of services commissioned by Wirral CCG and providers engaged to provide services on behalf of the CCG. Following the NHS reforms in 2013 the legislative changes meant CCGs became one the authorising bodies who can legally authorise PGDs. This role was previously the responsibility of the Primary Care Trust. In August 2013 NICE produced good practice guidance relating the use and development of PGDs. The proposed process for CCG authorisation of PGDS is in line with NICE recommendations. SW sought clarity regarding how patients will be involved in the proposed process and further discussions took place in relation to this. The QPF committee were asked to approve the proposed process to ensure appropriate PGDs are authorised by the CCG in a robust and timely fashion, in line with NICE recommendations. Members agreed to the proposed process presented within the paper at today’s meeting.

QPF15-16/0003 3.0 Items for Discussions 3.1 Performance Reports

LQ presented the Key Performance Indicator Report to the group for the period of February 2015 and committee members were asked to note the following: Referral to treatment target (RTT) No issues, all pathways at an aggregate level are meeting the standards for the month. Non Admitted breaches in:

• All treatment functions met 95.1% target • Ophthalmology achieved 88% and Oral surgery 83%

Incomplete Breached: Ophthalmology 86.3% Admitted: T&O achieved 89% and Plastic Surgery 83% Over 52 week waiters No issues – no patients waiting 52+ weeks. Performance will continue to be monitored to identify any future breaches. Over 26 weeks Patients’ waiting 26+ weeks has increased by 13% this month compared to last month with 306 patients waiting. A&E waiting times This has been below target at 88.1% (YTD actual). A&E at Arrowe Park fell short of the target in February; however WIC performance has met the target.


Ref No. Minute C Difficile/MRSA In February there were four new cases at WUTH of CDifficile and 0 new cases of MRSA. Other areas included:

• Same sex accommodation – 0 breach • Family and Friend test results from Maternity, A&E Inpatient WUTH, GP Surgeries,

Mental Health and Community Trust • Reducing Healthcare acquired infections • Emergency Ambulance • Cancer

Members requested that future friends and family tests are communicated to constituent Wirral GP practices. Further discussions took place regarding penalties in relation to Emergency Ambulance services and LQ provided details around this. It was agreed that further discussions are required regarding the contractual arrangements in relation to the service and it was agreed that a consistency of approach is required. Members noted the current performance report. 3.2 Finance Reports MB presented the Finance report to the group. The report sets out the draft financial position for NHS Wirral Clinical Commissioning Group (Wirral CCG) as at the end of March (Month 12) within the 2014/15 financial year and performance against the measures outlined in the CCG Assurance Framework for 2014/15. The draft year end position resulted in a surplus position of £2.501m against resource allocation There were a number of movements within March’s activity position.Prescribing had particularly showed a further adverse movement in month. NHS Wirral CCG’s Quality, Performance and Finance Committee were asked to note:

• The draft CCG year end financial position as at the end of March 2015 subject to audit • Performance against indicators based on the information available.

Members of the QPF committee noted the Financial report presented at today’s meeting. 3.3 Year end Proposals Agenda item covered in year end financial position and contract updates for 15/16. 3.4 Readmissions Audit PN presented a paper in relation to a Readmissions Audit on behalf of LQ. As part of the 2015/16 contract negotiations between the CCG and WUTH it was agreed that an audit would be undertaken to with the following aims; • To improve the quality of patient care by providing care in the right place and uncover any actions by any appropriate agency which could have prevented readmission. The review


Ref No. Minute will also highlight any key reasons and trends that will inform areas for service development and inform the contracting process. • To establish the value of readmissions which the CCG should fund as they are judged unavoidable (including unavoidable as services are currently provided). The audit and its findings will be presented at other CCG committees (e.g. clinical senate) in order to inform clinical practice and commissioning decisions for the forthcoming year and beyond. QPF were asked to note the work that has been undertaken and the implications that this work has for both organisations.

QPF15-16/0004 4.0 Items for Information and Noting 4.1 Contracting Issues

• CWP – CC reported that the contract with CWP is yet to be signed and further

discussions regarding the application of a deflator have taken place. A review of packages of care is to be developed and MB suggested that an integrated approach of working is a potential way forward.

• CT – AC reported that a memorandum of understanding has now been drafted and highlighted the areas of potential risk for the CCG in relation to future contracts. Areas included: GP visits, and DVT services.

• WUTH – MB updated members regarding the current contracting issues in relation to WUTH. Key areas included: coding, investment reductions (maternity) and Care of the Elderly. The CCG are awaiting a response from WUTH.

• Primary Care – There were no updates regarding Primary Care. Members sought clarity regarding the terms of reference for future QPF meetings and PN explained that the Head of Contracts will take this forward. 4.2 Complaints, Ombudsman & MP letters Report (as of 17th April 2015) PE reported on the complaints and MP enquiries received by NHS Wirral CCG. The purpose of this monthly update is to provide assurance to the Quality, Performance & Finance Committee of complaints received (including those escalated to the Parliamentary & Health Service Ombudsman) & MP enquiries received by NHS Wirral CCG as at 17th April 2015.Highlights included:

• CHC complaints and response timescales - The majority of complaints received continue to be regarding Continuing Healthcare (CHC). There are a number of responses outstanding due to staffing issues leading to delays with these responses, which are being monitored by the Corporate Team.

• MP Enquiries - There have been 8 new MP enquiries received within this reporting period and there are 2 MP enquiries with on-going investigations.

• On-going/new/closed complaints (see below) • There were no complaints escalated to the Ombudsman during this period

New complaints

• Within the period of 23rd March to 17th April 2015; 8 new complaints were received. Closed complaints

• Within the period of 23rd March to 17th April 2015; 8 complaints have been closed (some of which were received in the previous reporting period).

All complaints and MP enquiries received will continue to be managed and monitored in line


Ref No. Minute with the agreed policies and procedures by the CCG’s Corporate Team and this update report will continue to be presented at this committee on a monthly basis going forward, together with an aggregated report of learning and themes on a quarterly basis. PE also updated that ‘lesson learnt’ are now be recorded and thanks was given to the Corporate (Complaints) Team for their work. Members noted the complaints update. 4.3 Freedom of Information requests report – Annual Report PE presented an annual report regarding Freedom of Information requests. The purpose of this annual report is to outline details of FOI requests received within the previous year, including outlining any trends and also providing a summary cost of detailing with a request. Key messages included:

• Within the reporting period 285 FOI requests were received • The average cost of managing a routine FOI request within the Corporate Affairs team

equates to £34.58, this is a decrease since the FOI’s were being managed by the Customer Solutions Centre (North West Commissioning Support Unit), of which the average cost within the previous financial year, for a routine request, was calculated at £92.61.

All FOI queries and responses are published on the CCG’s public facing website, as per the publication scheme. An update report will continue to be presented at this committee on a monthly basis going forward. The QPF Committee were asked to review and note the contents of the report. 4.4 Serious Incidents PN provided the committee with details of the new serious incidents reported in March. 22 new serious incidents were reported to the Strategic Executive Information System (StEIS) in March 2015, relating to:

• 8 Wirral University Teaching Hospital Trust. • 4 Cheshire and Wirral Partnership NHS Foundation Trust • 8 Wirral Community NHS Trust • 0 One to One Midwives • 1 Alderhey Children’s Hospital • 1 North West Ambulance Service

As per the serious incident reporting framework, a root cause analysis will be undertaken on the incident, the report and action plan will be monitored at the CCG Serious Incident Review Group. These reports will be discussed at CCG Quality Performance and Finance Committees and copies shared with the CCG Governing Body. Members noted the report. 4.5 Safeguarding Report PN presented the April Safeguarding Update report to members. The paper presented at today’s meeting provides the Quality, Performance & Finance Committee with a summary of the work associated with safeguarding activity with particular reference to updates relating


Ref No. Minute new government publications, serious case reviews, work of the Wirral Safeguarding Boards, safeguarding assurance items and potential risks. The report covers the period January to March 2015. Discussions took placer regarding Safeguarding training targets and it was agreed that further communication is needed to improve the current target and SWels is to work with LQ regarding this. Members reviewed and noted the report presented today. 4.6 Individual Exceptional Funding Requests (IEFR) Service PE presented an activity report which provided information relating to Quarter 4, January to March 2015, on behalf of LQ and members noted the contents of the report presented today.

QPF15-16/0005 5.1 For Noting Sub Groups for noting

• WCCG CWP CMM Minutes of 22.01.2015 • WCCG CWP CMM minutes of 05.03.2015 • WCNT CMM minutes of 09.02.2015

QPF15-16/0006 6.0 Risk Register

Members discussed the current risk register and all items were reviewed and noted accordingly. A key area of discussion centred on the Non-Medical Prescribers Policy. Action - PE is to update the current risk register and provide a report detailing the recommendations made by the QPF committee to the Governing Body. This will be an on-going action from all QPF meetings.

7.0 Any Other Business

Chair thanked members for their attendance and the meeting closed at: 15:45pm. Date and Time of next meeting The date and time of the next QPF meeting is scheduled for:

Tuesday 26th May at 1pm in Room 539 OMH

Please forward any apologies to [email protected]


Master 14-15

Page 1 of 2

Risk ID Date added Source Division Risk Description Organisational Objectives (reference to detail)

Consequence

Likelihood

Matrix Score Key Control Established Key Gaps in Control (reference to evidence)

Assurance on Controls (reference to evidence)

Gaps in Assurance (reference to evidence)

Consequence

Likelihood

Previous Risk Rating

Owner Date of next review

Date of last review

Last review

12-13 A 12-13 Financial Year

CCG Gov Body Impact of 111 Implementation and Various Activity Impacts across primary / community and A&E Attendances. Increased demand for clinical input and lack of influence of national specification

Quality / Patient Access 3 3 9.00 Current provision of primary care / urgent care services - ability to absorb additional activity

Unknown impact of 111 Service Provision. Increased costs for clinical input

Monitoring of Primary Care/ urgent care activity and performance of NHS111 through information flows

Timely impact on monitoring of primary care activity

3 3 9.00 Governing Body - 111 Implementation Team

June 15 QPF

January 15 QPF To be reviewed at September QPF.Updated AP reviewed at September QPF, next due for review at December QPF. AP reviewed, next due at January QPF upon completion. Reviewed at Jan QPF and noted that a review of the host mobilisation is underway. Agreed for next review at June QPF with a full risk assessment due in October 15.

14-15 B Apr-14 CCG Gov Body Safeguarding and the completion of the GP assurance toolkit.

Quality / Patient Safety 3 3 9.00 Process in place for completion of toolkit

Number of doctors trained to complete toolkit from a safeguarding perspective.Non-compliance.

Monitoring of the completion of the GP assurance toolkit

Training has been carried out for doctors to ensure compliance.

4 4 16.00 LQ August 15 QPF

May 15 QPF New risk discussed. To be monitored at Governing Body. Action plan to be agreed with lead. Oct 14 - Work still being undertaken to ensure the completion of the plan, therefore for further review at December 14 GB.

Action discussed at Nov GB and decision made for this to be rescored at the Dec QPF committee.

Updated AP reviewed at Jan QPF and agreed to amend scoring. Safeguarding team to provide a further updated action plan, next due for review at May QPF.

AP reviewed at May QPF & noted the increase in the compliance rate against the toolkit - Noted next due for review in August 2015 upon completion.

14-15G Jun-14 CCG Gov Body A&E 4 hour Target, including quality of care & standards provided to patients

Quality / Financial / Patient Safety

4 5 20.00 On-going monitoring Target not being met by Wirral economy & rated high risk by NHS England and Monitor

Target continues to not be met.

4 5 20.00 LQ June 15 QPF

May 15 QPF New risk discussed at June GB. To be monitored at Governing Body. Action plan to be agreed with lead.

Reviewed at Jan QPF & agreed for likelihood to be amended to 5. Action plan for further review at March GB. Reviewed at March GB & agreed for further review at May QPF.

AP reviewed at May QPF and noted further update due in June 15 - Therefore due for next review at June QPF.

14-15H Jul-14 CCG Gov Body Cdifficile monitoring Quality / Patient Safety 5 4 20.00 Monitoring or performance against targets

Health economy are ahead of tracheotomy for the threshold for Cdifficile

4 4 16.00 LQ June 15 QPF

May 15 QPF New risk discussed at July QPF/ Action plan to be agreed with lead. To be brought back to August QPF. AP reviewed at August QPF and due back for further review upon completion at the December 14 meeting.

Reviewed at Jan QPF & agreed for consequence to be amended to 5. LQ to provide further updated action plan for March GB. Reviewed at March GB & agreed for further review at May QPF upon completion.

AP reviewed at May QPF and updates noted. It was agreed that this risk should remain on the register and the new target should be reflected - LQ to update AP accordingly for review at June QPF.

14-15I Jul-14 CCG Gov Body Supreme Court Judgement Deprivation of Liberty Safeguards (DoLS)

Quality / Patient Safety 4 3 12.00 To work with Provider Organisations.

To work with Local Authority to assess the

impact fully.

Provider Organisations to ensure that this is on their

Risk register also.

Understanding the local impact to Wirral based on

the Supreme Court Judgement Deprivation of Liberty safeguards (DoLS)

Work continues with Provider Organisations and the Local Authority

Currently awaiting national guidance.

4 3 12.00 LQ July 15 QPF May 15 QPF New risk discussed at July QPF/ Action plan to be agreed with lead. To be brought back to August QPF. AP reviewed at August QPF and due back for further review upon completion at December GB meeting. AP reviewed at Jan QPF & it was noted that processes and training are in place to manage the risk. Noted that Supreme Court Judgement has not yet been received. For further review of AP at May QPF.

AP reviewed at May QPF & members requested further information regarding what has been done so far & what work is being done with Provider Organisations and Local Authority - Further update to be included within action plans for July QPF.

14-15K August QPF CCG Gov Body Continuing Healthcare issues re the service provided, the CHC process followed, general performance & quality & inconsistency of complaint response letters

Quality / Patient Safety 5 3 15.00 Action plan in place and on-going monitoring of

performance

Continuing Healthcare service provided, the CHC process followed, general performance & quality &

inconsistency of complaint response letters

5 3 15.00 CC June 15 QPF

May 15 QPF New risk discussed at August QPF. AP to be completed by IS. For noting at September GB & AP to be reviewed at December GB - awaiting AP from lead. Still awaiting AP from lead - Dec 14.AP requested from CC as part of new work plan / structure.AP due for review at May 15 QPF.

AP reviewed at May QPF & members requested for further details to be included within the AP, for further review at June QPF.

14-15N December QPF

CCG QPF Quality of care provided to patients at Wirral University Teaching Hospital NHS Foundation Trust

Quality / Patient Safety / Financial

4 4 16.00 Quality Surveillence Group (QSG) meeting held on 13th February , follow up

meeting to be arranged in 6 months time. Outputs from

QSG to be monitored through WUTH Quality & Clinical Risk committee.

Minutes of the QSG meetings & WUTH

Quality & Clinical Risk committee

To review further in 6 months

LQ July 15 QPF May 15 QPF New risk discussed at December QPF. Scoring to be agreed & action plan to be completed by LQ.

Scoring to be agreed at January QPF.

Awaiting AP from Lead.

Reviewed at Jan QPF & agreed for the risk description to be amended to reflect concerns regarding the quality of care being provided. It was agreed that this risk would be scored at the next GB to be held in Feb 15.

Reviewed & scored at Feb GB, and agreed for further review at March GB. Reviewed at March Gb & agreed for further review at May 15 QPF.

Action plan being reviewed at QSG meeting and also being monitored through WUTH Quality and Clinical Risk Committee.

14-15O January QPF CCG QPF Risk re Non Medical Prescribers policy as out of date.

Quality / Patient Safety 4 4 16.00 New NMP policy ratified at QPF held on 27th Jan,

implementation to commence to all INP's

following small amends.

Increased risk identified due to out of date NMP policy being utilised by

Independent Nurse Prescribers (INP) in General Practice.

Risk visible during implementation phase of

new NMP policy.

Further documentation for GP's & Practice Managers

to be created to support implementation of new

NMP policy

LQ June 15 QPF

April 15 QPF New risk agreed to be added at Jan QPF - Scoring to be agreed at Feb GB. New NMP policy ratified at Jan QPF & implementation to commence to INP's following small amends within the next 4 weeks.

Reviewed at March 15 QPF.

AP reviewed at April QPF and suggested further review at May QPF to confirm if all practices have now signed to say they have received the new policy. SW (Medical Director) to send a reminder message in Connecting Bulletin to remind practices to confirm receipt.18/05 - Update to advise that SS will email prescribers again to request ackowledgement of NMP policy. For further review at June QPF.

14-15P January QPF CCG QPF Financial risk to CCG Financial 4 4 16.00 Regular financial reporting through QPF & GB. Further

detailed monitoring of contractual prescribing &

other commissioning expenditure areas as

appropriate.

Ability to influence activity trends.

Minutes & monitoring of GB / QPF

Timliness of reporting / ability ti implement action

plans directly.

MB June 15 QPF

March 15 GB New overall financial risk agreed to be added at Jan QPF to replace existing financial risks (1415C,D&F) - Further description, key controls & scoring to be agreed at Feb GB.

Unable to score at Feb GB as CFO not present - Therefore agreed to score at March GB.

Scoring agreed at Feb QPF.

May 15 - Financial assumptions are currently being tested against contract values - This is currently being fianlised and once completed will review planning and then be brought back to QPF and GB in June.

14-15Q February GB CCG GB Risk to services bought from North West CSU following failure of CSU to secure place on the Lead Provider Framework.

CCG organisational delivery

3 3 9.00 Transition Board to be established from february 2015 by NHS England.

Lack of clarity on potential options in the short and

long term

Minutes from the Transition Board once

established.

To be reviewed once Transition Board is

established.

PE/LQ/MB July 15 QPF May 15 QPF New risk identified at Feb GB - Scoring to be agreed at Feb QPF.Scoring agreed as appropriate at Feb GB.

May 15 - Scoring agred but action plan for resolution is being co-ordinated ny NHS England with CCG's joiintly, for further review at July 15 QPF.

Insert Rows Above This Line Only

Impact Values On action plan, suggested review in May QPF to see if all practices have now signed to say they have received the new policy. Additional action was f Negligible 1 Minor 2Moderate 3Major 4Catastrophic 5

Probability Values

Rare 1Unlikely 2Possible 3Likely 4Almost Certain 5

Green/Yellow/Red Threshold ValuesGreen - maximum score 4Yellow - minimum score 5Yellow - maximum score 12Red - minimum score 15

Master 14-15

Page 2 of 2

for Sue Wells to do a reminder message in Connecting Bulletin to remind practices to confirm receipt.

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