Borderline LCG Board Meeting
Friday 19th December 2014, 2.00 – 4.30 pm
Sorrento Room, The Fleet, Fleet Way, High Street,
Fletton, Peterborough, PE2 8DL
MINUTES
Attendees:
Dr Gary Howsam (GH)
Dr Oliver Stovin (OS)
Dr Mark Attah (MA)
Dr Cosmas Nnochiri (CN)
Michael Bacon (MB)
David Parkes (DP)
Carole Edwards (CE)
Mary Bryce (MBr)
Cath Mitchell (CM)
Alan Sadler (AS)
Louise Jinks (LJ)
Wanda Kerr (WK)
Chair
Referral Lead
Quality Lead
Cancer Lead (from 2.10 pm)
Patient Representative
Deputy Patient Representative
Deputy Practice Manager Representative
Healthwatch Representative
LCO, Borderline & Peterborough LCGs
Business Manager, Borderline & Peterborough LCGs
Interim Finance System Lead, Borderline & Peterborough LCGs
Deputy Chief Finance Officer, CCG
In Attendance:
Tina Almond (TA)
Mike Caskey (MC)
Alex Gimson (AG)
Sandra Myers (SM)
Dr Arnold Fertig (AF)
C Rowland (CR)
Borderline Administration Support Officer
Chair, Peterborough LCG (until 2.20 pm)
UnitingCare Partnership
UnitingCare Partnership
Project Manager
Action
Agenda Item 3.1 Prime Ministers Challenge Fund was discussed at the start of the meeting.
Uniting Care Partnership (UCP)
Sandra Myers, Alex Gimson and Dr Arnold Fertig attended for this item.
A paper was tabled which showed Neighbourhood Teams. There were 18 proposed
teams which would include Mental Health and Social Care. Conversations were
underway with the local Health Economy.
S Myers informed the Board, UCP were starting to go out to engage
(Hunts/Cambridge had already been visited) to obtain views with regard to general
practice. S Myers was also meeting with Charlotte Black from Cambridgeshire
County Council and Wendy Ogle-Welbourn from Peterborough City Council together
as there was recognition that bits of service were not within their gift. UCP would be
looking to realign to have sensible groupings. It was early stages but had started with
Primary Care.
C Mitchell commented there were other Health Partners which would need to be
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included in conversations and what does Neighbourhood Teams mean. There would
also need to be links into Oundle and Wansford.
M Bacon raised concern via the Patient Forum. Borderline had separate issues to
Peterborough and concern had been expressed that Borderline would be left in the
border.
A Gimson commented links to Social Care was not in procurement but that UCP were
linking. The prime function in teams was to co-locate district nurses, community staff.
Looking to put into West Group and East Group as a starter. There would be a
proportion percentage share of over 65’s and would be weighted on a deprivation
basis, life expectancy and deprivation index.
M Attah asked with regard to structure, what were the functions of the Teams and
how would we access?
A Gimson responded, the teams would include;
• Community Matron
• Administration Support
• District Nurse
• Community Mental Health
• Therapists
Each practice would have 1 named person assigned to the practice. With regard to
access of the teams, core working hours would be extended, although OOhrs would
be very limited.
G Howsam asked what the plan was on day 1, what were the expectations for
practices.
S Myers responded there would be caveats on day 1. Some skill sets would be there,
but not all. We would be looking to up-skill staff. Some staff would already be trained
from day 1 and ready to go and some would require training. We would also be
looking to recruit to vacancies.
M Attah asked for an ease of access example;
A Gimson responded;
• Visit patient
• Phone team member (single point of contact)
• Team member to contact relevant service you require
G Howsam commented Lakeside would morph into UCP which would also link into
the Better Care Fund (BCF). S Myers informed the Board that she would circulate a
copy of the ‘submission statement’ if Board members wished to see.
M Attah asked how vacancies would be dealt with.
A Gimson confirmed vacancies would be recruited to, but this could not take place
until TUPE of current staff was undertaken. Once TUPE of current staff had been
undertaken, then the vacancies would be advertised.
O Stovin asked with regard to the ‘purple’ group within the Neighbourhood table;
Community based service, we will have a named nurse and there would be central
base for the team. How are UCP going to decide where these teams are to be
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based?
S Myers responded that each practice would have their named team and would be
located where the practice/s were able to accommodate. A Gimson said there was a
need to devolve community care to practice level.
M Attah asked with regard to Intermediate Care, how would this fit in. S Myers
responded UCP were looking across the whole CCG at number of beds. UCP would
be looking at how the beds were utilised and whether they were being used
appropriately as well as looking at how to move flow of patients.
C Mitchell commented it was about the right people going into the CCC, being able to
use ‘step up’. There was good turnover within CCC beds. (14 days)
C Rowland asked what the proposals were with regard to next steps.
A Gimson responded the first proposal had been circulated to the CCGs for
comments/feedback and requested Borderline comments be completed by 5th
January 2015.
C Edwards asked about IT solution, as Oundle were currently using EMIS web. S
Myers responded the IT solution was to have a single view of information.
A Gimson informed the Board if they wished to feedback with regard to the
Neighbourhood Teams he would be happy for them to do so. A Gimson also said that
should Borderline & Peterborough LCGs want to cross boundaries, they could as
UCP would like LCGs to have ownership.
G Howsam thanked Alex, Sandra, Arnold and Chris for attending and suggested
Board members feedback to their individual practices.
C Mitchell highlighted a potential issue with regard to re-location of Peterborough
practices. Area Team were pushing with regard to rental services. LCG have pushed
back to Area Team, but there could potentially be conversations around rental
services going forward.
B Fraser said she was concerned about where the staff would come from, as there
were workforce issues.
1.
1.1
GENERAL ISSUES
Apologies
Apologies were received from Dr Rhiannon Nally, Rebecca Powell, Simon Pitts and
Kyle Cliff.
1.2
Minutes of meeting held on 5th December 2014
The minutes from the meeting held on 5th December 2014 were agreed as an
accurate record.
1.3
Action Log – 5th December 2014
Action 031/14 had been completed.
Action 030/14 – PDMA
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Discussion took place with regard to the PDMA. A Sadler informed the Board he had
emailed Matthew Smith. C Mitchell commented Borderline LCG would need to take
hold of the PDMA themselves and should think about what was needed. C Mitchell
highlighted a few options to look at and suggested thinking about what pathways may
need to be changed next year;
• Asthma
• COPD
• Diabetes
G Howsam suggested going back to the very first ‘IDEAL Agreement’;
• would be easier to administer
• engage with UnitingCare Partnership (UCP)
• provider entity
• need face-to-face time
• use money to pay practices to attend meetings (engagement)
O Stovin commented that Referral Leads Meetings/Prescribing Meetings were still
being undertaken and that engagement was good, although attendance rate had
fallen at Jamborees.
G Howsam suggested having 10 meetings, each practice to provide cover on a rota
basis for the Jamborees; payment could then be paid via the PDMA. C Mitchell
commented, could be linked to clinical pathways/QIPP/UCP etc.
C Mitchell and A Sadler to progress PDMA conversations already being undertaken.
Action: CM/AS to progress PDMA conversation already being undertaken.
2.
2.1
GOVERNANCE
Declarations of Interest
No declarations of interest were received.
2.2
Terms of Reference
The Board agreed the Terms of Reference, subject to adding an annex listing all GP
practices within Borderline LCG.
Action: ToR - TA/AS to add Annex listing Borderline LCG practices.
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3.1
COMMISSIONING & STANDING ITEMS
Prime Ministers Challenge Fund
M Caskey attended for this item. Draft letter from M Caskey and G Howsam was
tabled for Board members.
M Caskey informed the Board there had been various conversations with regard to the
‘Prime Ministers Challenge Fund’
• Service Provision (extended opening hours to allow better access to Primary
Care Services)
• Diversification (financial)
• Messages from CMET were good and CCG bids would be encouraged/CCG
Management Team support a bid
• LMC are of the opinion that this should be on a wider scale
Both M Caskey and G Howsam, as Chairs, were trying to engage with the Board with
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CM/AS
TA/AS
regard to co-commissioning of primary care in looking at opportunities available here
and now.
G Howsam commented in terms of CCG direction of travel and with PMS contracts
changing, there was potential to invest. The CCG would take on responsibility with
initial direction of travel. It would be easier to deal with bigger entities rather than 108
practices;
• Vertical integration
• Community based specialist services
• need to keep practices financially viable
• practices already talking to one another to try to find a way forward
• Some practices would become non-viable
• Primary Care Foundation was a good thing and we should take the opportunity
to work with the CCG Management Team to put in a bid
M Caskey said it did not mean practices had to sign up for 8am – 8pm working, but
that practices could sign up to become an ‘entity/federation’. 8am - 8pm could be
delivered in practice but could be slimmed down to a rota basis. Weekends we could
use ED and utilise some of the resource to reinforce Lakeside within ED.
If the Board agree to the letter being circulated, A Sadler could then follow up with
practice managers during the next couple of weeks. Submission would need to be in
by 16th January 2015. This could act as catalyst to bring practices together. We could
federate in March 2015 8am-8 pm and join UCP.
O Stovin commented that geography was the biggest problem. Slightly different in
Borderline.
C Mitchell responded the CCG configured for a different purpose. We could look to
ignore geographic boundaries and challenge the CCG.
O Stovin said he fully supported but would want whole general practice to be viable.
OOhrs had deteriorated.
G Howsam suggested finding a solution around geographic area.
C Mitchell responded with regard to OOhrs/111, procurement of OOhrs was phase 1.
We could have phase 2, was there anything else that could be added.
Board agreed to the circulation of the letter.
Action: TA to circulate letter to Borderline & Peterborough LCGs to include
Practice Managers, GPs, Nurses etc.on behalf of M Caskey and G Howsam.
TA
A Sadler was asked to organise three ‘Prime Ministers Challenge Fund’ meetings to
take place on 5th, 6th and 7th January 2015 from 7 – pm at CCC. Management support
would be required.
Action: A Sadler to organise three ‘Prime Ministers Challenge Fund’ meetings to
take place 5th, 6th, 7th January 2015 from 7 – 9 pm.
AS
Discussion with Uniting Care Partnership took place following this item.
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3.2
BLCG Leadership and PDMA Budget Report
L Jinks presented the financial overview for November 2014 to the Board and
highlighted the key points within the report as below;
•
•
•
•
•
the LCG was reporting a year to date surplus of £11k and forecasting a year end
surplus of £15k on the leadership costs.
an accrual was included at the end of 2013/14 for clinical leadership costs which
had yet to be invoiced for. After all expected outstanding invoices had been paid
it would leave a credit balance of £19k. This gave a year to date total LCG
Leadership underspend of £30k and forecasted a year end underspend of £34k.
to give a true reflection of the work clinical leads were doing, joint clinical lead
costs had been moved between LCGs based on the fair share calculation.
£1k underspend was forecast at year end on the OPP clinical leadership costs.
PDMA costs had been accrued to budget with no variance reported.
C Mitchell informed the Board she had met with M Caskey and G Howsam to discuss
Mental Health Lead. The Clinical Lead post would be re-advertised. Sessions would
be reviewed when advertised.
The Board noted the financial position as at month 8 (November 2014).
3.3
BLCG Monthly Finance Report
L Jinks reported on the Monthly Finance Report for Month 8, November 2014.
LCG Summary – Table 1 on Page 3 of the report
Total LCG Devolved Programme Budget
FOT LCG Devolved Programme Budget
M8
M7
Movement
Deficit £2.544m Deficit £2.063m Deficit + £0.481m
Deficit £4.072m Deficit £4.006m Deficit + £0.066m
• From month 6 the CCG central reserves had been matched to plan. This was to
make the position that each LCG was being asked to manage more obvious and
transparent.
• The areas with forecast overspends were:
• PSHFT over-performance of £2.834m (£2.656m M7), mainly consisting of :
Non-Electives
£0.985m (£1.106m M7) includes MRET
adjustment
Outpatients
£0.588m (£0.499m M7)
Daycases
£0.457m (£0.484m M7)
• CUHFT
£0.104m (£0.171m M7)
• Other Acute:
Leicester
£0.108m (£0.122m M7)
Fitzwilliam
£0.415m (£0.386m M7)
RNOH
£0.113m (£0.091m M7)
• East of England Ambulance £0.162m (£0.162m M7)
• Continuing Health Care
£0.564m (£0.600m M7)
• GP Prescribing
£0.593m (£0.629m M7)
• Prescribing data for 6 months had now been received and the forecast position
had been calculated by MMT using a local profile which continued to be based on
the assumptions of 2.68% growth, £2m CCG Primary Care, QIPP savings and the
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mid year national drug tariff changes.
CCG Summary – Tables 2 and 3 on Page 4 of the report
Local
Commissioning
Group
FOT Devolved
Budget Variance
£'000
FOT Devolved
Budget Variance %
Rag Rated
Borderline Peterborough CamHealth
CATCH
HCP
HH
IOE
W isbech
CCG
(£4,072)
(£2,802)
(£822)
(£2,195)
(£2,844)
(£1,340)
(£3,891)
(£2,655)
(£20,621)
(3.80)%
Red
(2.00)%
Amber
(1.10)%
Amber
(1.10)%
Amber
(2.20)%
Amber
(2.60)%
Amber
(4.00)%
Red
(4.70)%
Red
(2.40)%
Amber
• Year to date Total devolved Programme Budget to LCGs = Deficit £13.401m
• Forecast Year Total devolved Programme Budget to LCGs = Deficit £20.621m.
• Year to date Total Programme Budget after CCG Central Budgets = Deficit
£0.702m.
• Forecast Total Programme Budget after CCG Central Budgets = Breakeven
• The year to date programme budget deficit position of £13.401m was after being
offset by a surplus on running costs of £0.262m. In addition, a Central budgets
surplus of £12.699m was being used to reduce the CCG year to date deficit
position to £0.702m and a forecast year end breakeven position.
• There were three main areas where the CCG would need to focus its attention to
mitigate the financial risk and learning from 2013/14 financial recovery plans;
• A strong focus on QIPP delivery, to be led by LCGs supported by central
CCG Programme Office.
• This would include fortnightly meetings with Project Managers with the
Director of Performance & Delivery in addition to the monthly Confirm &
Challenge meetings and the Financial Recovery Plan Board.
• Active and more consistent contract management, to be led by the LCG
contract teams supported with finance and information leads.
• The running cost budget had been adjusted to reflect the £2m QIPP reduction.
With tight control of appointments etc. it was previously thought it would be
feasible to reach the stretch target of £2.5m. However, due to recent pressures
this stretch target looked more doubtful. Nevertheless, tight control and
management of this area of spend would continue as there was a 10% reduction
in CCG running costs expected for 2015/16.
The Board thanked L Jinks for the update with regard to Month 8, November 2014.
3.4
2014/15 QIPP Update
The Board noted the total QIPP target for Borderline LCG was £3.690m and noted the
QIPP summary as at October 2014 highlighted below for information:
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QIPP SUMMARY - OCTOBER 2014
Urgent Care
RSS/ Clinical Thresholds
MSK
Ophthalmology
Total QIPP Programme
•
•
•
•
Full Year
Plan
£'000
728
411
132
214
1,485
Running Costs
Total 14/15 QIPP
253
1,738
QIPP Reported at CCG Level
Total 14/15 QIPP
1,952
3,690
Plan to Actual to
Date
Date Variance
£'000
£'000
£'000
429
281
-148
245
-149
-394
77
-128
-205
125
73
-52
876
77
-799
148
1,024
299
376
151
-648
QIPP was being monitored monthly via Confirm and Challenge meetings by the
PMO and LCG Management Team.
Work was on-going by the LCG Management Team to investigate performance
and non-delivery of QIPP schemes.
Due to over-performance of the acute contracts and the non-delivery of QIPP
schemes all LCGs were to produce Recovery Plans.
The target was to bring each LCG back to its planned surplus or planned deficit
position. As a minimum it had been agreed that each LCG needed to deliver
50% of their gap and for Borderline LCG as at Month 7 this was £2m. We need
to recognise the targets and then quickly move onto getting real and robust
schemes which get as close to target as possible in the remaining months
available.
Business Case Overview
Urgent Care
Front Door Discharge Team: FY Target £213k, YTD Delivered £154k. Savings were
based on the team avoiding 275 admissions in 2014/15. The number of avoided
admissions was 200 up to the end of October 2014. Savings for the first three months
of the year were based on a fair shares split as we do not have the number of avoided
admissions by practice or LCG. The Admission Avoidance Team was using a new
template from July 2014 to capture data at LCG level and the savings figures now
reflect this.
The FIRM 2: FY Target £363k YTD Delivered £76k. Savings were based on the team
avoiding 480 admissions in 2014/15. The number of avoided admissions was
reported as 99 for April to September 2014 which was 141 below target. Reporting
avoided admissions was still at Trust level despite requests to provide the data at
LCG level. The contract with CCS to provide The FIRM came to an end as at 30th
September 2014.
MDT: FY Target £65k YTD Delivered £48k. These savings were based on a CCG
wide assumption of achieving 3% reduction in non-electives and A&E attendances.
Care Home Scheme: FY Target £55k, YTD Delivered £0. The Care Home Educator
was now in post as from September 2014. Currently working on identifying savings
and these would be included in the report next month.
Carers Prescription Service: FY Target £32k, YTD Delivered £2k. Savings were
based on avoiding 42 admissions in 2014/15. The project had avoided 3 admissions
in June to October 2014 which was 22 below target.
RSS and Clinical Thresholds
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FY Target £411k, YTD Delivered £-149k. The savings calculated was by LCG using
SUS data. In previous months savings had been calculated using an average cost.
From August 2014 the calculation was based on actual costs. Savings could be seen
in knee replacements, knee anthroscopy, carpal tunnel and tonsillectomy. Due to the
overall increases in first outpatient appointments there have been no savings in RSS.
MSK: FY Target £132k, YTD Delivered £-128k. SUS data was now going through
DSCRO and work was ongoing to validate the data. Some discrepancies had been
found within the elective inpatient data and are therefore using an average cost to
calculate savings until this was corrected.
Ophthalmology: FY Target £214, YTD Delivered £73k. An increase in referrals was
reported away from the acute setting and could now start to see some savings in the
reduction in follow-ups, although these were below plan.
Board had discussion around ‘Fair Shares’ and QIPP targets. W Kerr informed the
Board from next year everyone would have the same QIPP targets. There was
currently 4.5% of spend and the notion of ‘Fair Shares’ was changing going forward.
It would be age weighted rather than deprivation weighted.
G Howsam commented with regard to page 2, mitigating financial risk, do you think
we have a chance with regard to QIPP savings. L Jinks responded some savings
were being made and we were moving in the right direction and referred to page 2,
the Recovery Plan. Achievement was being made on contractual measures.
O Stovin said we were still in a position where we were spending more than what we
had.
M Attah raised concern with regard to Ambulatory Care. He was anxious around
synergy groupings. C Mitchell commented S Pitts was working to set up a meeting
with all agencies to try to provide a solution for Ambulatory Care.
G Howsam commented with regard to MDT, we were always going to hit target and
Carers Prescription would be going into the Better Care Fund (BCF) next year. L
Jinks responded, we had achieved with regard to MDT, the figure should be 0 as
unable to validate.
Board discussed ‘follow ups’. M Attah said that K Cliff, who was undertaking a review
of Acute Contracts, had started to see a reduction.
4.
4.1
ANY OTHER BUSINESS
Feedback from COBIC Workshop
Board members gave feedback from the COBIX Workshop;
O Stovin enjoyed the session, but was not sure it was value for money.
B Fraser felt the session was a bit rushed.
M Bacon found the session useful.
G Howsam had the presentation slides which were good, but also felt it was not value
for money.
A Sadler said it was a useful discussion.
M Attach felt that it was useful, but not value for money.
4.2
O Stovin Retirement
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The Board noted it was O Stovin’s last Board meeting due to retirement and thanked
OS for all his hard work/commitment and wished him well in his retirement.
4.3
Meetings
D Parkes asked why the Board held two Board Meetings a month. G Howsam
responded, Borderline LCG had always held two Board meetings a month and
members found the meetings useful.
L Jinks queried when Finance Reports could be taken in the alternative months when
the Board Development Session was being held. G Howsam responded, he was
happy for the Finance items to be reported at the beginning of the Development
Sessions.
Date & Time of Next Meeting:
Friday 9th January 2015, 4.00-5pm, Sorrento Room, The Fleet, Fletton, Peterborough,
PE2 8DL
There being no further business, the meeting closed at 4.15 pm.
Contact Details
Name: Tina Almond
Email: tina.almond@nhs.net
Telephone 01733 704452
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