CARLISLE LOCALITY BOARD
23 November 2011
ITEM 3
MINUTES OF CARLISLE LOCALITY BOARD
HELD ON WEDNESDAY, 23 NOVEMBER 2011 AT 13:30 AT BOTCHERBY COMMUNITY
CENTRE
PRESENT:
Dr Peter Weaving, Lead GP (Chair)
Dr Andrew Hollings, GP Brampton & Longtown
Dr Alan Edwards, GP, North Carlisle Health Centre
Dr Colin Patterson, GP, Brunswick House Practice
Dr Iain Grainger, GP, Eden Medical Practice
Tim Evans, Cumbria Partnership Foundation Trust
Sue Bowman, Service Delivery Manager, Adult Social Care
Jane Muller, Associate Director of Public Health
Julie McCrone, Practice Manager, Spencer Street Surgery
Ms Amy Clements, Communications Officer
Lesley Angell, Medicines Management Lead (Carlisle & Eden)
Mr Ian Gordon, Non Executive member, Cumbria PCT
Mrs Anna Scamans, Public Engagement Lead (Carlisle & Eden)
Mrs Eleanor Hodgson, Locality Director
Mrs Jane Muller, Associate Director of Public Health
Mr Terry Jones, LINk member
Mrs Lisa Sewell, Business and Performance Manager
IN ATTENDANCE:
Viola Kirkley, Administrator, Carlisle Locality (minutes)
ACTION
1.
APOLOGIES FOR ABSENCE
No apologies received.
2.
DECLARATIONS OF INTEREST
There were no declarations of interest expressed.
3.
MINUTES OF THE LAST BOARD MEETING (28/09/2011)
The minutes of the last meeting of the Carlisle Locality Board were accepted as a
correct record.
4.
MATTERS ARISING
4.1 Dabigatran prescribing
LA reported that NICE will be publishing their guidance on use of Dabigatran for the
prevention of stroke and systemic embolism in atrial fibrillation in December, following
recent publication of the Final appraisal determination. The FAD recommends
Dabigatran as an option, a change from the Initial appraisal determination (IAD) which
proposed warfarin would remain first line treatment. Information will be sent out to GPs
once the guideline is available, but the current APC guidance stands until then.
http://www.cumbria.nhs.uk/ProfessionalZone/MedicinesManagement/PrescriptionPad/
PrescriptionPadNo15.pdf
It was recognised that there will be a pressure on GPs to prescribe, and whilst it is
recognised as cost effective therapy, there is an issue of affordability, with a
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substantial potential extra cost to the prescribing budget of £1000 per patient. LA and
PW will send a letter to GPs once the NICE guideline is available and the APC have
discussed it.
5.
LA/PW
EXECUTIVE UPDATE
Dr Weaving gave the following update:
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On 13 December, the Carlisle Locality alongside Adult Social Care will be hosting
a visit from the Health Select Committee as part of a visit to the North West. They
will focus on joint health and social care commissioning and will meet the STINT
team, carers and visit Extra Care Housing project.
The Merger and Acquisition of the acute trust - both bidders will have to put
forward financial packages as to how to run both hospitals. Following that, the
NCUHT Board will make a decision about the best candidate. As part of this
process Neil Goodwin, Acting CE has put in place a modernisation programme at
the Trust.
Nationally the PFI scheme in North Cumbria has been recognised as needing
additional financial support.
The repatriation of interventional cardiology unit will allow for funding of additional
activity locally.
Discussion followed about the legal responsibility of the Board as a commissioning
body. It was noted that legal responsibility stayed with the CCG, with locality lead GPs
being responsible for the funds delegated to locality level. As part of the CCG
responsibilities, the lines of responsibility will be part of the authorisation process.
Safeguarding concerns at Blackwell Vale Nursing Home were discussed. AE reported
that there was a serious untoward incident at BV NH related to the Home’s inability to
take appropriate action following a CQC report. A panel was convened to look into
issues and plan for the future. The Four Seasons Health Care were asked to
acknowledge the depth of the problems and review their senior management
structure. The medical care was satisfactory but the organisation around care plans
was poor and the Home was running at half capacity. The Home did not follow
appropriate advocacy procedures relating to the capacity for long term decisions about
patients’ future.
6.
FINANCE AND PERFORMANCE REPORT
LS reported that the locality was showing £1,817k overspend for PbR at Month 6. This
was a better position than last month. Prescribing was showing an underspending of
£177k on the full year budget. The figures for the first five months showed that PbR
was 9.3% above plan. The non elective admissions and outpatient follow ups were still
the hotspots for the locality despite the capping arrangement negotiated with the
Trust.
For non elective activity variance against plan, the majority of practices showed
overperformance compared to plan. Grosvenor House (Dr Adam and Dr Ward) and
Brampton showed the most significant overperformance in activity and cost. St Paul’s
had the lowest non elective activity variance against plan.
Sharing good practice between practices was suggested as a topic for a presentation
at a future PLT session and approach to be agreed by the Clinical Executive..
In terms of the locality targets, the methodology for setting next years targets was
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discussed to ensure Clinical ownership and deliverability.
Quarterly CHOC Performance Report for Q2 was discussed. The following issues
were highlighted:
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7.
Possible opportunities to further look at patients who have been referred to A&E,
hospital or ambulance and find out what proportion of admissions are generated
with clinical assessment of patients.
Find out more details around complaints or adverse incidents that could be used LS
as learning for the locality. Lisa to action.
Present case numbers which are shown by practice to show as a rate per LS
thousand population. Lisa will provide CHOC with practice list sizes. (please note
LS
that the figures are shown on page 2 of the report distributed)
MEDICINES MANAGEMENT REPORT
There is a forecast underspend for the locality of £176,870 at year end. Four practices
are forecast to overspend.
The QIPP Comparator report contains information for the five QP indicators from
which the practices have chosen three areas to work on for their QOF QP indicators.
Discussion followed about some practices having difficulties with achieving expected
targets in all clinical areas.
8.
IT UPDATE
Lisa Sewell updated the meeting on the following developments:
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9.
COIN has been approved and will be implemented from April 2012. It will make the
deployment of EMIS web in primary care more efficient.
Discharge summary across the Acute Trust – a pilot is running across three
hospital wards. Chris Corrigan is the Clinical lead for this project. The roll out
across the CIC site is planned for December but will more likely be in January.
There is good progress with sharing primary care records with A&E. It is hoped to
deliver this in December.
There is work around giving CHOC access to primary care records via a mobile
solution.
Electronic transfer of prescribing will go ahead next month. St Paul’s is a pilot site.
ESTATES STRATEGY UPDATE
There is an ongoing review of infrastructure across the locality and the intention to
develop an estates investment strategy. The aim is to present a draft estates strategy
to the January 2012 locality board meeting. The strategy will support any future
business cases for new builds.
It was noted that SMC new practice scheme has received planning permission from
the County Council and the business case will be put forward to the SHA in
March/April. Eleanor will check the exact timeline for this process and let Dr Edwards EH
know.
Discussion followed about the estates strategy and how it linked to improvement
grants. Some schemes in Carlisle require improvements. Any future business case will
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have to be part of a costed clinical strategy and demonstrate savings. Eleanor will find
out about improvement grants details and access to them.
EH
10.
EXERCISE ON REFERRAL
Jane Muller sought the Board’s agreement to contract with Carlisle Leisure to provide
Exercise on Referral for further 3 years (July 2011 – June 2014) and financially
support the funding of the service. The cost of the contract is £10k per annum to see a
maximum of 200 new patients each year. The total cost will be £30k for 3 years.
Carlisle Leisure have been providing EOR for the last 12 months across the locality
and the scheme has been very successful.
It was suggested to train patients’ champions/advocates and incorporate them into the
community network. J Muller was in discussion with Keith Gerrard (Carlisle City
Council) about implementing this idea.
The Board agreed to fund the EOR programme with Carlisle Leisure Ltd for the next 3
years.
11.
CPFT PROVIDER QUALITY REPORT
Tim Evans provided an update on the following developments:
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12.
Community rehabilitation service established in line with provider plan following
formal consultation with staff.
Housebound criteria scheme for existing patients commenced recently. The
scheme is being monitored to ensure robust individual transition plans, no adverse
feedback to date.
Reiver House - the Acute Trust has given notice on the lease and the service at
Reiver house with the plan to re-locate the resource into the main CIC site in April
2012 (to be confirmed). It is planned to review the service model with the
Partnership Trust and ensure that the service continues to be community
focussed. Meetings ongoing with Acute Trust to discuss the minimum
specifications and financial modelling to enable the move to occur. It was felt that
Reiver House did not provide a cheaper alternative to admissions avoidance and
any new model will need to fulfil these criteria and be linked to PCAS. It was
agreed that Tim will review the new model of care with the Acute Trust. Dr
TE/PW
Weaving will be a nominated clinician to work with Tim.
The industrial action on 30 November - the Trust anticipates some level of
disruption, but will maintain the essential services. Some routine work will be
postponed. Some exemptions have been agreed with the unions.
YOUTH ZONE REPORT
Jane Muller gave an overview of Carlisle Youth Zone activities for young people. CYZ
is an independent charity and is open to young people aged 18 – 21 when schools are
closed. It is a good resource for young people in terms of offering a breadth of
activities and integrated sexual health/contraceptive services, smoking cessation etc.
Public Health contributed £75k funding last year, but will not be able to commit this
funding for next year. Jane advised that the locality might be approached for a funding
contribution.
13.
PUBLIC ENGAGEMENT REPORT
Anna Scamans presented the Public Engagement report. She focussed on the
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Locality’s two areas of engagement:
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Engagement for board accountability
Engagement to inform commissioning development.
The locality has a good system for public engagement via the Stakeholders Group
which meets regularly. The recent hot topics of the group were Merger and Acquisition
and End of Life Care. The range of attendees was good. However more correlation
was needed between the group and the business of the Board.
The locality should nominate individuals to act as liaison with local authorities,
Cumbria LINk and the Third Sector. Some links already exist, e.g. Jane Muller is
involved with the Healthy Communities and Older People group and Anna Scamans
maintains links with the local Third Sector groups.
It is a requirement that all business cases should have a communication and
engagement plan and an equality impact assessment.
The locality works well with the Overview and Scrutiny Committee and makes good
use of the Assessment Tool to judge the impact of service changes. In the future the
OSC role will be overtaken by the Health & Wellbeing Board.
14.
STAKEHOLDER REPORT
There was nothing to report.
15.
HEALTH AND WELL BEING BOARDS
Dr Patterson enquired about the links between the Health and Wellbeing Boards and
the locality. It was understood that they will facilitate communication between local
authorities and Clinical Commissioning Groups.
Jane Muller advised that there already was an interim Health and Wellbeing Board in
Cumbria working with 6 district councils. It will become a Shadow H&WBB in April
and will have its own delegated budget. The H&WBB will be responsible for leading on
the production of JSNA of local health across health care, social care and public
health. This will be the basis for Joint Health and Wellbeing strategy which will provide
a framework for local commissioning plans.
Jane advised that the first JSNA was developed in 2009 but will be updated and
owned by H&WBB.
In terms of the locality there is a good statistical base for producing JSNA which is
regularly updated in conjunction with the ongoing work with the City Council. Some
Board members are involved in the City Council work, especially in relation to the
Healthy City initiative. Jane was trying to ensure more engagement in terms of
commissioning plans, but did not anticipate major changes to what the locality was
already providing. The main focus will be prevention and reducing health inequalities.
16.
ANY OTHER BUSINESS
111: A single point of access for urgent care
The government is to introduce a 111 non emergency number for the NHS across the
country and the North West pilot of 111 is anticipated to begin in Cumbria next year
until the service is commissioned in 2013. Visitors to Cumbria will be steered towards
calling 111 to access services and see a GP within a set timeframe. Each practice will
need to take a view on whether they are willing to accept 111 referrals from non
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resident patients. There will be an opportunity for practices to opt out of seeing non
resident patients although one practice opting out will have an impact on other
practices.
17.
DATE AND TIME OF NEXT MEETING
Thursday, 26 January 2011 at 1:30 pm at Rosehill, Carlisle
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