Assistant Director of Quality Improvement and Clinical Assurance

Transcription

1 : Primary Care Commissioning Committee Meeting Part 1 Date Wednesday 19 th April 2017 Time 10: pm Venue Rooms 5.3, 15 Marylebone Road, London, NW1 5JD Present Membership Dominique Kleyn DK Governing Body non-audit Lay Member (Chair) Voting Dr Neville Purssell NP CLCCG GP GB Chair Non-voting Jules Martin JM CLCCG Managing Director Voting Dr Niamh McLaughlin NM CLCCG GB Member Non-voting Chris Neill CN CLCCG Interim Deputy Managing Director Non-voting Nick Sodhi JS Deputy Head of Primary Care (NWL) Non-voting Chris Corfield CC Head of Medicines Management (Clinician) Voting Liam Edwards LE Assistant Director of Quality Improvement and Clinical Assurance Non-voting Julie Sands JS Head of Primary Care (NWL) Non-voting Elke Taylor ET Head of Finance (from item 5) (representing Keith Edmunds) Voting Holly Manktelow HM CLCCG Senior Delivery Manager Non-voting Katie Bramall- Stainer KBS Local Medical Committee Non-voting Carena Rogers CR Healthwatch Central West London Non-voting Peter Buckman PB Deputy Chief Finance Officer (from item 5) Non-voting In Attendance Emma Sewell ES CLCCG Engagement & Corporate Affairs Officer (minutes) Non-voting Natalie Osanque NO CLCCG Corporate Affairs Officer Non-voting Apologies Michael Morton MM Governing Body non-audit Lay Member (Vice-Chair) Voting Jonathan Webster JW Nurse GB Member Voting Mary Mullix MMu Nurse GB Member Non-voting Keith Edmunds KE Chief Finance Officer Voting Minutes 1.0 Welcome, introduction and apologies for absence Welcomes and introductions were made to this first meeting of the newly-constituted Primary Care Commissioning Committee, with apologies noted as above. The recruitment of non-conflicted clinicians to sit on the Committee is taking place at a NWL level as the decision has been made that these clinicians should not practice within NWL. In the meantime, CC has kindly agreed to join the committee as a non-conflicted clinician. 2.0 Declarations of interest NP and NM declared an interest in the PMS review. Page 1 of 5

2 3.0 Minutes of meeting Minutes from the 15 th March 2017, the final meeting of the previous Joint Co-commissioning Committee, were reviewed and deemed accurate by those members of this Committee who were previously present. It was noted that the extended access engagement plan previously discussed will be provided within the next four weeks. 4.0 Covent Garden Medical Centre HM explained that the CCG was working jointly with NHS England to support Covent Garden Medical Centre following concerns raised by a CQC review. Following publication of the CQC rating, NHS England visited the practice for a meeting; this was followed by a formal request for further information to be provided that day. Next steps are to be agreed depending on an ongoing assessment of the information provided, possibly including contractual or remedial action. DK asked about the implications and timeline for action. NS advised that because there are no immediate patient safety concerns it is unlikely that any decision will be required ahead of the next PCCC meeting. The CCG have now made two visits to the practice, the first was to understand the position and impact of the CQC rating, and the second visit focused on the out-ofhospital services provided by the practice, predominantly phlebotomy. Some assurance on quality was given by the practice but more scrutiny is required. The CCG is taking a supportive stance. DK enquired if peer support had been offered to the practice and HM confirmed that this is the case through the GP Federation. It was acknowledged that the practice is engaging well with the CCG, the Federation and the LMC. 5.0 Specialist Homeless Practices NS advised there is an ongoing review of needs for specialist homeless practices. Current contracts with Great Chapel Street Medical Centre and The Dr Hickey Surgery may need to be extended whilst a new specification is agreed. A task and finish group has been established to agree the consultation process and deliver proposals for a new model of service. DK asked about the variation expected in the new model of service and was advised that this is not yet known, however assurance was given that it is intended to use established pathways with a local focus where possible, whilst seeking to gain efficiencies of scale. It was acknowledged that great pace is needed for this work because Westminster has a greater homeless population and it should not be held up pending completion of all other work relating to homeless health needs. Local knowledge from CLCCG will need to feed into the review and Great Chapel Street Medical Centre is on board with the process. It was highlighted that this was a positive opportunity to learn from practices and review the current system to provide a suitable specification going forward. The scope and shape of the review is currently being drafted and this, along with the timescale, will come back to the Committee before the review is started. User input will be included at each stage of the review. Page 2 of 5

3 6.0 PMS Review HM explained that the PMS Review paper and recommendations were a culmination of work that had been undertaken by the CCG and local PMS steering group since January. The Governing Body had considered and agreed that these recommendations align with the CCG s commissioning intentions and the Finance and Performance Committee would consider the economic case next week. Any questions or concerns will come back to this Committee as all other committees are conflicted and cannot therefore approve anything relating to the PMS review. The Equality Impact Assessment has been revised and updated, with two services, complementary therapies and dermatology, likely to be decommissioned. The Committee agreed that the direction of travel was appropriate and in line with the rest of NWL but requested improved clarity and detail of the specification and the KPIs. KBS asked whether the outcomes are realistic, considering the challenges that practices and GPs are facing. HM welcomed further discussion with the LMC to talk through their concerns. The Committee expressed its appreciation of the work that has gone into this review and appreciated that practice stability will be assisted by offering a contract for more than one year of commissioning. It was advised that the framework is sufficiently flexible that the CCG can review in years 3, 4, 5 and tweaks can be made. In discussion, it was confirmed that all PMS monies will be reinvested into primary care even if practices do not achieve their targets and therefore forfeit their payments. A balance is needed so there is an incentive to deliver the service, not a disincentive. It was noted that PMS funding cannot be carried forward year on year but assurance has to be given to NHS England that the money is being invested in primary care - as the PMS contracts will run 1 st October to 31 st September the CCG will have from October to March to reinvest money into practices before the end of the financial year. If there is a surplus the CCG could invest this in services it may otherwise not be able to afford. It was suggested that quarterly monitoring may be ambitious and that annual payments may be more realistic. Several concerns were explored. In terms of individual services being decommissioned, concerns were raised over withdrawing the complementary therapies but assurance was given that the 4.2% referred to in the paper related to the practice patients rather than the Central London population. Taking this into account the committee were prepared to agree to this service being decommissioned. Concerns were raised over the evidence for an outcomes-based approach. Some of the Vanguard models are providing limited evidence but only for population demographicsvery different to Central London s. Luton was suggested as a comparable. Concerns were raised that practices may be de-stabilised by the review and this would also affect the CCG. Assurance was provided that individual practice Page 3 of 5

4 reviews would continue and the CCG would be introducing other new models of care in support. In conclusion, the Chair asked the voting members of the Committee whether they agreed to use PMS premium monies to commission improvements in access and improvements in the quality of care for people with long term conditions via an outcomes framework approach. The voting members approved this recommendation. The Chair asked the voting members of the Committee whether they agreed to a contract length for these commissioning intentions that spans all four years of transition. The voting members approved this recommendation. The Chair asked the voting members of the Committee whether they agreed to the principle of pooling of locality incentive scheme monies with monies available from the PMS premium for reinvestment to enable a flat commissioning offer over the whole of the four year transition period and the use of short-term nonrecurrent funding from additional CCG budgets in years 1 and 2 of the contract to enable a flat commissioning offer. Confirmation was provided that the funding was available to meet these recommendations. Concern was raised that the recommendation was to invest 1.8m with savings of only 900k. Assurance was given that if approved in principle, further information would be provided to the Finance and Performance Committee for scrutiny. It was added that the decision will be taken in consideration of the wider health system, as this underpins the CCG s STP. It was also noted that the 1.8m is protected for practices. Taking these points into consideration the voting members approved these recommendations. ALL The Chair asked the Committee to consider the approach endorsed by the NWL PMS Steering Group for the calculation and provision of transition funding. A paper was tabled at the meeting detailing the modelling. Option 1*A had been recommended to the Committee by the PMS Steering Group for agreement, and it was noted that the all the CCG leads have considered the options and agreed option 1*A. It was acknowledged that there will be some high level practices that will be affected and will need support. This support will be in many forms, including working on business model with practices. The voting members of the Committee approved option 1*A The Chair thanked the Committee for their input and suggested any other considerations should be fed back to HM with comments. The Chair asked the Committee to endorse the specification that had been presented to them and the Committee agreed to this endorsement. 7.0 Questions from the Public There were no questions received from the public. 8.0 AOB None. Page 4 of 5

5 Next meeting Wednesday 17 th May 2017, 10:30-11:30am Room 5.3, 5 th Floor, 15 Marylebone Rd, NW1 5JD Page 5 of 5