Governing Body Meeting
Date of Meeting
Title of Paper
28 January 2016
Clinical Effectiveness Committee Update
Presented By
Author
Dr Sandeep Prakash, GP Director
Mr Glenn Mather, Evidence and Effectiveness Lead
Clinical Lead
Dr Sandeep Prakash, GP Director
Confidential
No
Executive Summary
This report provides an update from the Clinical Effectiveness Committee meeting held on
13 January 2016.
Clinical Policy Development Update
The Committee was provided with an update on progress made on the review of clinical
policies. A development tracker is now in place and will be monitored through Covalent.
There are currently 9 policies where a review still needs to commence across Lancashire.
In the first instance, this has been raised with the chair of the Pan Lancashire Policy
development Group.
Engagement Plan on Draft Clinical Policies
A process has been developed by the Communications and Engagement Team on how
the CCG engages with members of the public when developing clinical policies.
Statement of Principles /
General Policy for Decision Making for Individual Funding Requests (IFR) /
Policy for Considering Applications for Exceptionality to Commissioning Policies
The Committee received three documents or consideration and recommendation to the
Governing Body for approval. Each document is based on existing overarching policies
within the CCG, but updated to reflect latest information. The Governing Body will be asked
to ratify the three policies.
Process for Managing the Individual Funding Requests
The Committee considered the draft process developed by the Commissioning Support
Unit. It was agreed for Committee members to provide their detailed comments by the end
of February. In turn, these would be fed into the Pan Lancashire engagement exercise
which should result in the finalised process being available for consideration at the March
Governing Body meeting.
Clinical Effectiveness Committee Update
NHS Greater Preston CCG Governing Body Meeting
28 January 2016
Do Not Attempt Cardio Pulmonary Resuscitation (DNACPR)
A report was provided detailing an action plan to enable the unified DNACPR to be
adopted by Chorley and South Ribble CCG. The Committee approved the action plan and
the time frames outlined.
Commissioning for Quality and Innovation (CQuIN) Development
The Committee received a report on the work underway to collect ideas and themes for the
2016/2017 contracting round. The potential ideas will be shared and discussed with
providers for consideration and development prior to sign off in March 2016.
Minutes of the Medicines Management Group
The minutes of the Medicines Management Group were noted by the Committee.
Recommendations
The Governing Body is asked to note the content of the report.
Links to CCG Strategic Objectives
Improve Quality through more efficient, safer services which deliver a
better patient experience
Commission care so that it is integrated and ensures an appropriate
balance between in-hospital and out of hospital provision
Be an integral part of a financially sustainable health economy
☐
SO4
Ensure patients are at the centre of the planning and management of their
own care and their voices are heard
☒
SO5
Be seen as a well-run clinical commissioning group and the system leader
☒
SO1
SO2
SO3
Governance and Reporting
(list committees, groups or other bodies that have discussed this paper)
Meeting
Clinical Effectiveness Committee
Clinical Effectiveness Committee Update
NHS Greater Preston CCG Governing Body Meeting
28 January 2016
Date
13 January
2016
Outcome
☒
☒
Implications
Quality/patient Experience
implications
Potential) Conflicts of Interest
Yes ☒
No ☐
N/A ☐
Yes ☐
No ☒
N/A ☐
Equality Impact Assessment
Yes ☐
No ☒
N/A ☐
Privacy Impact Assessment
Yes ☒
No ☐
N/A ☐
Are there any associated risks?
Yes ☐
No ☒
N/A ☐
Yes ☐
No ☒
N/A ☐
Are the risks on the CCG’s risk
register
If Yes, please include risk
description and reference number
Assurance
Assurances will continue to be provided on delivery to the Clinical Effectiveness Committee
Clinical Effectiveness Committee Update
NHS Greater Preston CCG Governing Body Meeting
28 January 2016
Clinical Effectiveness Committee
Minutes
Wednesday, 14 October 2015, Board Room - Chorley House, Lancashire Business
Park, Centurion Way, Leyland PR26 6TT at 1.30 pm
Present
Mrs Anne Bowen, Governing Body Nurse - NHS Chorley and South
Ribble CCG and NHS Greater Preston CCG
Dr Stephen Cairns, Secondary Care Doctor - NHS Chorley and South
Ribble CCG and NHS Greater Preston CCG
Mr Glenn Mather, Quality and Clinical Effectiveness Team - NHS
Chorley and South Ribble CCG and NHS Greater Preston CCG
Ms Clare Moss, NHS Midlands and Lancashire Commissioning Support
Unit
Mr David Noblett, Lay Member - NHS Greater Preston CCG
Mr Geoffrey O'Donoghue, Lay Member - NHS Chorley and South
Ribble CCG
Dr Matthew Orr, GP Director - NHS Chorley and South Ribble CCG
Dr Sandeep Prakash, GP Director - NHS Greater Preston CCG
Dr Anthony Sudell, Lancashire County Council - Public Health
Consultant
In Attendance
Mrs Sandra Cameron, Minutes
1
Welcome and Apologies for Absence
Dr Prakash welcomed everyone to the meeting, especially Mrs Wells, Effectiveness and
Innovation Manager. Part of Mrs Wells’ responsibilities is to support the effectiveness
agenda within the CCG and she was therefore in attendance to hear the debates
surrounding the policies.
Apologies were noted from Ms Karen Sharrocks.
2
Declarations of Interests
There were no conflicts of interest outside those noted in the reports.
3
Minutes of Previous Meeting
The minutes of the CEC meeting held on 8 July 2015 were confirmed as a true record of
the discussions.
4
Matters Arising
All actions listed had been completed.
Minutes of Clinical Effectiveness Committee
14 October 2015
5
Clinical Policies
5i
Endoscopic Knee Procedures
Mr Mather outlined the content of the report and asked the Committee to approve that a
typographical error be correct in the text; the committee agreed to the proposal. The
Committee approved the amendment.
5ii
Policy for Commissioning of Excision of Uterus (abdominal or vaginal) - Request
for Rollover of Clinical Policy
At the July CEC meeting, the request had been made to roll over the revision of a
number of policies, however this policy had been omitted from the list. In answer to a
question regarding whether the review included comments from patient, Mr Mather
reported that although a scoping exercise had been undertaken no patient comments had
been sought. Mr O’Donoghue felt that any delay in reviewing the policy could prove
upsetting for patients. The Committee approved the roll over.
5iii
Unified Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) Adult Policy
At the Clinical Policy Committee held in July, it was discussed what actions needed to be
taken to implement the reviewed policy. Mr Mather gave the following information:
It was agreed that should the policy be adopted the following would be required:-
-
Give time during PETT sessions to give an overview of proposed process
Training to be given in January 2016
In her role as Lead Nurse, Jane Brennan would lead on competencies
Link in to the End of Life Care Agenda
Mr Mather advised that once the Governing Body had approved the policies, training
would need to be undertaken. He also pointed out that it could possibly take 4 weeks to
complete the printing process of the documentation. It was felt that as there was a timing
issue, the launch should take place prior to the training. It was generally agreed that this
policy was moving in the right direction and will improve the current process.
Action:
Governing Body asked to approve the Policy
Mrs Helen Curtis
6
Clinical Policy Implementation
Mr Mather outlined the content of the report, adding that the Pan Lancashire Sub Group
continue to meet.
Individual Funding Request Procedure
Terms of the general policy has been accepted in principle with the CCGs and legal
advisors across the country had been asked for comments.
The Committee asked whether people from different backgrounds were likely to be
disadvantaged by the process. Dr Sudell explained that he had undertaken audit work to
look at this issue and he confirmed that there were no major trends.
Action:
The audit work undertaken by Dr Sudell to be included at the January 2016 Clinical
Effectiveness Committee meeting as an Agenda item.
Dr Anthony Sudell
Process for Framework Development/Process for Policy Development
Appendix 1 outlined the development process in order to highlight any deficiencies.
Policy for Commissioning of Cosmetic Procedures
Minutes of Clinical Effectiveness Committee
14 October 2015
The Committee was updated regarding legal advice resulting in more substantial
changes to be made to the policy. The policy will be re-submitted to the Pan Lancashire
Sub-group for review.
Policy for Commissioning of Assisted Conception Services
Dr Sudell thanked everyone who had completed the survey and reported that the
response rate was very good with the paper well into development.
Mr O’Donoghue felt that the level of knowledge needed to complete the survey was
outside the range of his experience and he was therefore concerned with using the
findings as a basis for the policy. Dr Sudell explained that the purpose of the survey was
not intended to be scientific but to support preliminary ideas for the 1st draft with
stakeholder holding a vast amount of technical and clinical views which would help in the
drafting process. The three groups who were asked to play a valuable part in this survey
were; General Practitioners, Governing Body members and staff members. The
Committee felt that in future this needed to be made clearer at the start of the process.
Mr Noblett added that it would be of value to involve the Patient Advisory Group.
Pan Lancashire Clinical Policy Development Tracker
In answer to a question regarding the lack of information on dates in the tracker, Mrs
Wells confirmed that this was a draft tracker which the Pan Lancashire Sub-group are
tasked with developing further.
Action:
To complete the tracker with a time line for each stage.
Mrs Wells
6i
Procedures of Limited Clinical Value (PoLCV) Update
Mr Mather reported that the prior approved process for Procedures of limited clinical
value will be implemented for a number of procedures from the 1 November 2015. This
process is currently in draft form and outlined in Appendix 3. Mr Mather stated that there
should be a reduction in the procedures as a direct impact. There will be a review after 3
months to look at the affect the process has had.
There was a discussion concerning the current waiting lists for these procedures. Mrs
Curtis stated the intention was to assess patients currently on the waiting list against the
criteria within the Clinical Policies and remove patients from the list if they did not meet
the criteria. Mrs Bowen felt there was a need for a mechanism for those who will be taken
off the lists, which Mrs Wells confirmed was being addressed by the Communications
Team and/or the Planning and Delivery Team who are working on a package to support
patients.
Action:
To liaise with the Planning and Delivery Team regarding current waiting lists.
Mrs Helen Curtis
Mrs Bowen asked if there would be KPI’s developed for the Referral Management Centre,
however Dr Orr explained that as the E-Referral gave an overview on what has happened
through the Referral Management, which is triaged, there was no control over the data.
He was unsure whether the future system could be a hybrid of the two systems however it
would go through RMC.
7
Effectiveness Report
Mr Mather outlined a proposal to launch an Effectiveness Forum and sought the
Minutes of Clinical Effectiveness Committee
14 October 2015
Committee’s views. It was generally felt that there was a need for a quicker
response to new NICE guidance, as it was currently considered difficult to see
what progress was been made with providers on this . It was generally considered
that a smaller group of people could be more effective and the committee
therefore approved the proposal.
8
Research Strategy
8 & 9 Research Strategy and Innovation Strategy
The two papers would be discussed together.
Mr Mather reported that the Effectiveness Team had developed draft strategies
which required feedback from the CEC and he asked if this was what the
committee would wish to see going forward. It was agreed that aspirations for
Research and Innovation should be built into the overarching strategy for Quality
and Performance. Mrs Wells confirmed that she was in discussion with
Universities to understand how we can work better together to provide the right
clinical services across the health economy based on up-to-date and relevant
evidence.
Action
Research and Innovation to be built into the Quality & Performance Strategy.
Mr Glenn Mather
9
Innovation Strategy
Discussed as part of Item 8
10
Research and Innovation Activity
Mr Mather presented the report for information. Dr Prakash pointed out the lack of
innovation funding currently within the CCG. A discussion followed around ideas to
promote innovation and funding with a number of initiatives proposed:
 Mr Mather pointed out that there had been an idea put forward based on the
Dragon Den; however funds prevented this from going ahead.
 Mr Noblett agreed to look into funding streams available.
 Mrs Bowen suggested looking at links into education and Mrs Wells proposed
organising a meeting to see how we can draw on this resource.
Action:
Mr Noblett to look into the funding streams
Mr David Noblett
Action:
Mrs Wells to organise a meeting to discuss ways to draw on resource
Mrs Tracey Wells
11
Commissioning for Quality and Innovation (CQuIN) Development Process
2016/17
Mr Mather reported that work is underway looking at the CQuIN Scheme for 2016/17.
There is no guidance out at this time on the National Schemes, however the CCG plans
to involve the Peer groups and the Membership Council to gain thoughts and ideas for
local implementation.
Mr Mather explained that CQuIN was for enhanced services. Several suggestions were
Minutes of Clinical Effectiveness Committee
14 October 2015
discussed to utilise CQuINS, including:
 using a CQuIN for discharge summaries whichcould be used to ask for
additional information
 the community and voluntary sectors had been considered last year, and
this exercise could be repeated.
12
Clinical Policy Working Group
The Committee noted the minutes.
13
Medicines Management Group
Mrs Moss highlighted the recommendations from the MMG:-

Patches for pain not been finalised

NICE Guidance gone through and rag rated.
The Committee noted the minutes.
14
Any Other Business
Date of next meeting: Wednesday, 13 January 2016
Signed as an accurate record ………..…………………….
Minutes of Clinical Effectiveness Committee
14 October 2015
Date ……………………...
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