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Barnet Clinical Commissioning Group Governing Body Meeting Thursday, 19 March 2020 9:00 to 11:30 Dance Studio, Barnet Youth Zone, Unitas Building, 76 Montrose Avenue, London HA8 0DT
AGENDA
Item Title Lead Action Page Time
1.0 INTRODUCTION
1.1 Welcome and Apologies Chair (Dr Charlotte
Benjamin)
Note Oral 09:00
1.2 Declarations of Interest Chair Note 3
1.3 Declarations of Gifts and Hospitality
Chair Note Oral
1.4 Minutes of the Meeting held on 19 December 2019
Chair Approve 9
1.5 Action Log and Matters Arising Chair Note --
2.0 OVERVIEW AND UPDATES
2.1 Chair’s Report Chair Note Oral 09:10
2.2 Accountable Officer’s Report Frances O’Callaghan
Note 17 09:20
3.0 UPDATES AND OVERVIEW REPORTS
3.1 Patient Story Jenny Goodridge Note Oral 09:30
3.2 NCL CCGs – Progress Update on Merger
Ian Porter Note 25 09:45
3.3 Integrated Quality and Performance Report
Dr Barry Subel Jenny Goodridge
Ali Malik
Note 39 10:10
3.4 Finance Report (M10) Simon Goodwin Note 69 10:25
3.5 2020-21 Budgets Simon Goodwin Approve 77 10:35
3.6 Governing Body Assurance Framework Report
Kay Matthews Note 91 10:50
4.0 ITEMS FOR INFORMATION AND ASSURANCE
4.1 Annual General Meeting (2019) Minutes
Chair Approve 101 11:00
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4.2 Quality and Performance Committee
Dr Barry Subel Note 103 11:05
4.3 Clinical Commissioning, Finance and QIPP Committee Summary
Dr Barry Subel Note
4.4 Primary Care Procurement Committee Summary
Ian Bretman Note
4.5 Patient and Public Engagement Committee Summary
Ian Bretman Note
4.6 NCL Primary Care Commissioning Committee Minutes
Paul Sinden Note 111
4.7 NCL Joint Commissioning Committee Minutes
Paul Sinden Note 121
4.8 NCL Audit Committees in Common Minutes
Simon Goodwin Ian Porter
Note 129
5.0 QUESTIONS FROM MEMBERS OF THE PUBLIC
Questions from the public relating to items on the agenda
An opportunity to ask questions relating to agenda items at this part of the meeting.
11:15
6.0 CLOSING BUSINESS
6.1 Any other Business 11:25
6.2 Glossary of Acronyms Note 137
6.3 Date and venue of next meeting: First meeting of NCL Governing Body to be held on 23 April 2020
6.4 Meeting Closes 11:30
Register of Interests
A register of members’ interests is available for viewing by the public. The register will be available at the meeting and is accessible online at http://www.barnetccg.nhs.uk/about-us/conflicts-of-interest.htm
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Barnet Clinical Commissioning Group Governing Body 2 March 2020 Report Title Governing Body Register of Interests
Agenda Item 1.2
Report Summary
Governing Body members and attendees are asked to review the agenda and consider whether any of the topics might present a conflict of interest, whether those interests are already included within the Register of Interest, or need to be considered for the first time due to the specific subject matter of the agenda item. A conflict of interest would arise if decisions or recommendations made by the Committee could be perceived to advantage the individual holding the interest, their family, or their workplace or business interests. Such advantage might be financial or in another form, such as the ability to exert undue influence. Any such interests should be declared either before or during the meeting so that they can be managed appropriately. Effective handling of conflicts of interest is crucial to give confidence to patients, tax payers, healthcare providers and Parliament that CCG commissioning decisions are robust, fair and transparent and offer value for money. Conflicts of interest guidance to which all CCGs across NCL have adopted is available on the CCG website: If attendees are unsure of whether or not individual interests represent a conflict, they should be declared anyway, either at the meeting or to the Board Secretary beforehand, so that the appropriate course of action can be determined.
Recommendation The Committee is asked:
• To NOTE the Register of Interests which follows
• To DECLARE any existing or new interests in relation to items on the present meeting’s agenda
Conflicts of Interest
The purpose of the Register is to list interests, perceived and actual, of members, that may relate to the meeting
Resource
Implications
Not Applicable
Engagement
Not Applicable
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
The Register of Interests is presented at each Governing Body meeting
3
Appendices
The Governing Body Register of Interests
4
Declared Interest
(Name of the organisation and nature of business)
Fin
an
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Inte
rest
No
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Fin
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Pro
fessio
nal
Inte
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No
n-
Fin
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Pers
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Inte
rest
From
Frances O'Callaghan Accountable Officer No interests declared no no no n/a nil return n/a 24/02/2020
NCL CCGs no yes no Direct Chief Financer for all NCL CCGs 01/06/2017 08/08/2019
East London NHS FT no no yes Indirect wife is a senior manager 01/06/2017 08/08/2019
Everglade Medical Practice yes yes no Direct GP Partner 30/05/2017 14/11/2019
Barnet, Enfield and Haringey Mental Health Trust no no yes indirect Wife is a consultant CAMHS pyschiatrist 01/11/2019 14/11/2019
Primary Care Network (1 Westeros) no yes no Direct Clinical Director 01/07/2019 14/11/2019
Barnet GP Federation yes yes no Direct Shareholder (along with all other Barnet practice partners)
01/05/2017 14/11/2019
Dr Nick Dattani Elected GP Representative Millway Medical Practice yes yes no Direct GP Partner - Personal Medical Services (PMS) Practice. 14/03/2018 05/08/2019
Community ENT Clinic yes no no Direct Milway Medical Practice hosts the Community ENT Clinic
for which it is paid a nominal session rate
14/03/2018 05/08/2019
Nick Dattani Medical Group Ltd Yes yes no Direct Director 14/03/2018 05/08/2019
Barnet Federated GPs yes yes no Direct Shareholder (along with all other Barnet practice partners)
14/03/2018 05/08/2019
Primary Care Network 4 no yes no Direct practice is a member 01/07/2019 05/08/2019
Watling Medical Centre, Burnt Oak yes yes no Direct GP Partner 01/05/2017 09/08/2019
Barnet GP Federation yes yes no Direct Shareholder (along with all other Barnet practice partners)
01/05/2017 09/08/2019
Colindale BurntOak Healthcare Network –the company name of
the network
yes yes no Direct Director 01/05/2017 09/08/2019
Thornhill Clinic Ltd yes Yes No Direct 25% shareholder, a primary care clinic in Luton, there is no
connection to Barnet CCG or patients and no NHS activity
01/05/2017 09/08/2019
Primary Care Network 1W no yes no Direct practice is a member 01/07/2019 09/08/2019
Murtaza Khanbhai Ltd Yes Yes No Direct Director 14/08/2019 09/08/2019
Ravenscroft Medical Centre Yes Yes no Direct GP Principal 01/03/2017 15/08/2019
South Locality Barnet Practices Network Ltd no yes no Direct Member 01/05/2017 15/08/2019
Barnet Federated GPs yes yes no Direct Shareholder (along with all other Barnet practice partners)
01/05/2017 15/08/2019
Primary Care Network 5 no yes no Direct practice is a member 01/07/2019 15/08/2019
CLCH no no yes Indirect Niece is a member speech and language therapist Nov 2018 Nov 2018
St George's Medical Centre Yes Yes no Direct GP Partner 04/07/2003 15/08/2019
JFS Brent No yes No Direct school Governor 01/05/2017 15/08/2019
Chelsea and Westminster NHS FT no no yes Indirect husband is clinical lead for ENT 01/04/2011 15/08/2019
Charing Cross NHS Trust no no yes Indirect husband is ENT consultant 01/04/2009 15/08/2019
Primary Care Network 5 no yes no Direct Practice is a member 01/07/2019 15/08/2019
Barnet Federated GPs yes yes no Direct Practice is a member 15/08/2019
Speedwell Practice. Yes Yes No Direct GP Partner 01/07/1998 12/09/2019
Speedwellness Health Ltd Yes Yes No Direct Director, this is a wholly owned subsidiary company and is
dormant
2013 12/09/2019
Barnet Federated GPs yes yes no Direct Shareholder (along with all other Barnet practice partners)
01/03/2017 12/09/2019
NHS England’s Medical Directorate, and its Transforming
Cancer Services Team
No yes no Direct Member 01/03/2017 12/09/2019
North Central London Cancer Commissioning Board. no yes no Direct Chair 01/03/2017 12/09/2019
National Clinical Review Group for Bowel Cancer, NHS
England.
no yes no Direct GP Member 01/03/2017 12/09/2019
Dr Charlotte Benjamin Elected GP Representative
Dr Clare Stephens Elected GP Representative
To Updated
Name Position (s) held in the CCG i.e.
Governing Body member; Committee
member; Member practice; CCG
employee or other
Type of Interest Is the interest
direct or
indirect?
Nature of Interest Date of Interest
Elected GPs of the Governing Body
Executive Voting Members of the Governing Body
Simon Goodwin Chief Finance Officer
Dr Murtaza Khanbhai Elected GP Representative
Dr Aashish Bansal Elected GP Representative
Dr Barry Subel Elected GP Representative
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Medical Advisory Board (to the pan cancer London
Commissioning board)
No yes no Direct Member 01/11/2017 12/09/2019
All-party Parliamentary Groups for cancer. No yes no Direct By invitation she makes ad-hoc contributions 2013 12/09/2019
International Council for Standardisation in Haematology in
association with the World Health Organisation
No No Yes indirect Father is a Board member 01/03/2017 12/09/2019
Bowel Cancer UK no yes no Direct Member of the Clinical Advisory Board 01/03/2017 12/09/2019
St Michael’s Grammar School, Finchley no yes no Direct Foundation Governor 01/03/2017 12/09/2019
Air Cadets 393 Squadron local group charity no no yes Direct civilian committee member 2012 12/09/2019
Primary Care Network 3 No Yes No Direct Practice is a member 01/07/2019 12/09/2019
East Barnet Health Centre Yes Yes No Direct GP Partner 01/03/2017 11/07/2019
Barnet Federated GPs yes yes no Direct Shareholder (along with all other Barnet practice partners) 01/03/2017 11/07/2019
Barnet Primary Care Network 2 No Yes No Direct Practice is a member 01/07/2019 11/07/2019
Local Medical Council No Yes No Direct Practice is a member 11/07/2019
Dr Louise Miller Elected GP Representative Barnet CCG no no yes indirect Spouse is Secondary Care Consultant Member of the
Governing Body
10/01/2019 12/09/2019
Northwich Park Hospital no no yes indirect Spouse is Secondary Care Consultant 10/01/2019 12/09/2019
Barnet Federated GPs no yes no direct practice is a member 12/09/2019
Primary Care Network 5 No Yes No Direct Practice is a member 01/07/2019 12/09/2019
Citizens Advice Bureau, Barnet no yes no Direct Chair 01/04/2017 14/08/2019
Biomedical Healthcare Ltd no no yes Indirect Son is a senior technical manager in a company offering
an App for people to manage prescription requests and
long-term medication programmes
01/04/2017 14/08/2019
Royal Free London no yes no Direct Member of the Council of Governors 01/04/2019 14/08/2019
Timewise Foundation CiC Group of Companies no no no Direct Provides occasional consultancy services for this social
enterprise that helps organisations make better use of
flexible working.
17/10/2018 14/08/2019
Headway East London (HEL) no yes no Direct Treasurer to HEL, which provides services to people with
acquired brain injury
01/06/2018 03/09/2019
Healthcare People Management Association no yes no Direct Honorary Treasurer 01/10/2018 03/09/2019
Camden CCG no yes no Direct Lay Member for Audit and Governance 01/06/2019 03/09/2019
Our Time no yes no Direct Chair of Trustees for this charity supports children with
parents with mental health issues
12/09/2019
Nursing and Midwifery Council no yes no Direct Registrant Member 12/09/2019
The Guardian no no yes Indirect Spouse is Public Services Editor 12/09/2019
Dr Jon Baker Secondary Care Doctor Phoenix GP Practice in Hendon yes no yes Indirect Spouse is a GP in Barnet 27/09/2017 06/09/2019
Dawn Wakeling London Borough of Barnet
representative on the Governing Body
(Executive Director, Adults and Health)
No interests declared no no no n/a nil return 13/02/2018 12/09/2019
Public Health Barnet no yes no Direct Director of Public Health Barnet, which has a statutory duty
to provide a ‘core offer’ to the CCG
03/05/2018 11/09/2019
Royal Free London Group no yes no Direct Royal Free London Group Director of Public Health 01/09/2019 11/09/2019
Rory Cooper Healthwatch Representative on the
Governing Body
No interests declared no no no n/a nil return 11/09/2019 11/09/2010
Kay Matthews Chief Operating Officer No interests declared no no no n/a nil return 12/09/2019
Matt Backler Deputy Chief Finance Officer No interests declared no no no n/a nil return 29/09/2017 04/09/2019
Colette Wood Director, Care Closer to Home No interests declared no no no n/a nil return 27/10/2017 08/08/2019
Ruth Donaldson Joint Director of Commissioning No interests declared no no no n/a nil return 27/02/2018 03/09/2019
Sarah D'Souza Joint Director of Commissioning No interests declared no no no n/a nil return 10/01/2018 14/08/2019
Jenny Goodridge Director of Quality and Clinical Services Care Sub-Committee for the Joseph Rowntree Foundation (JRF)yes yes no direct Member of the Care Sub-Committee. In the unlikely event
that the JRF bid for any local NHS services, I would be
excluded from the procurement and decision-making
processes.
01/03/2019 03/09/2019
Dr Clare Stephens Elected GP Representative
Ian Bretman Lay Member for Patient and Public
Involvement
Barnet CCG Directors and Attendees of Governing Body Meetings
Non-Voting Members of the Governing Body
Dr Tamara Djuretic Public Health Representative on the
Governing Body
Claire Johnston Governing Body Nurse
Appointed Voting Members of the Governing
Elected GP RepresentativeDr Tal Helbitz
Dominic Tkaczyk Lay Member for Audit and Governance
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Ali Malik Director of QIPP and Performance,
Barnet CCG
No interests declared no no no n/a nil return 01/05/2018 04/09/2019
Andy Simpson Board Secretary No interests declared no no no n/a nil return 03/04/2018 12/09/2019
Ian Porter NCL Director of Corporate Services No interests declared no no no n/a nil return 03/04/2018 13/08/2019
Eileen Fiori NCL Director of Acute Commissioning No interests declared no no no n/a nil return 12/10/2018 12/08/2019
Will Huxter NCL Director of Strategy No interests declared no no no n/a nil return 03/07/2018 08/08/2019
Paul Sinden NCL Director of Performance, Planning
& Primary Care
No interests declared no no no n/a nil return 30/04/2018 16/08/2019
Elizabeth Rippon
Richard Dale Director of Programme Delivery, NCL
STP
No interests declared no no no n/a nil return 20/08/2019 20/08/2019
Andrew Spicer NCL Head of Governance and Risk No interests declared no no no n/a nil return 13/08/2019 13/08/2019
Karl Thompson NCL Senior Head of Corporate
Services
No interests declared no no no n/a nil return 12/10/2018 09/08/2019
NCL Directors and Senior Managers
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Page 1 of 7
BARNET CLINICAL COMMISSIONING GROUP GOVERNING BODY
Minutes of part one of the meeting held from 9:00 on Thursday 19 December 2019
Committee Room 1, Hendon Town Hall, The Burroughs, Hendon, London, NW4 4BG
Present:
Elected Voting Members:
Dr Charlotte Benjamin (Chair) Elected GP Representative
Dr Tal Helbitz Elected GP Representative
Dr Barry Subel Elected GP Representative
Dr Nick Dattani Elected GP Representative
Dr Clare Stephens Elected GP Representative
Dr Louise Miller Elected GP Representative
Appointed Voting Members:
Claire Johnston Nurse Member, Governing Body
Dominic Tkaczyk Lay Member for Audit and Governance, Barnet CCG
Ian Bretman Lay Member for Public and Patient Engagement, Barnet CCG
Helen Pettersen Accountable Officer for Barnet, Camden, Enfield, Haringey and Islington CCGs (NCL CCGs)
Simon Goodwin Chief Finance Officer, NCL CCGs
Non-Voting Members:
Rory Cooper Healthwatch Barnet Representative
Dawn Wakeling Strategic Director of Adults, Communities and Health, London Borough of Barnet
Dr Tamara Djuretic Director of Public Health, Barnet
In Attendance:
Kay Matthews Chief Operating Officer, Barnet CCG
Ruth Donaldson Director of Commissioning, Barnet CCG
Sarah D’Souza Director of Commissioning, Barnet CCG
Colette Wood Director of Primary Care Transformation, Barnet CCG
Matt Backler Director of Finance, Barnet CCG
Ali Malik Director of QIPP, Planning and Performance, Barnet CCG
Andrew Simpson Board Secretary, Barnet CCG (minutes)
Apologies:
Dr Murtaza Khanbhai Elected GP Representative
Dr Aashish Bansal Elected GP Representative
Dr Jon Baker Secondary Care Clinician, Barnet CCG
Jenny Goodridge Director of Quality and Clinical Services, Barnet CCG
1. OPENING BUSINESS
1.1 Welcome and Apologies
1.1.1
The Chair welcomed members and attendees, noted the apologies which had been received and advised that the meeting was quorate.
1.2 Declarations of Interests Register
1.2.1
The Chair invited members to declare any new or existing interests in the context of meeting agenda items.
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Page 2 of 7
1.2.2 1.2.3
Dr Barry Subel stated that the minutes of the August meeting of the North Central London (NCL) Primary Care Co-Commissioning Committee in Common included detail of a decision made in relation to the potential relocation of his practice into Finchley Memorial Hospital. This did not give rise to a conflict of interest at the present meeting, since no discussion or decision was required. No further declarations were made.
1.3 Declarations of Gifts and Hospitality
1.3.1 No new declarations of gifts or hospitality were made.
1.4 Minutes of the Meeting held on 19 September 2019
1.4.1
The Governing Body APPROVED the minutes of the meeting held on 19 September 2019.
1.5 Action Log
1.5.1 1.5.2
There were no open items on the Action Log. In relation to closed item number GB/01-19-002 on work underway to drive improvements to outpatient appointment management, Ruth Donaldson advised that issuing of cancellation letters from Royal Free London (RFL), which did not also offer an alternative appointment had ceased. The Trust’s team was working closely with Barnet CCG (the CCG) and a patient representative to discuss improvements to a range of outpatient issues. The Governing Body NOTED the action log.
2. OVERVIEW REPORTS AND UPDATES
2.1 Chair’s Report
2.1.1 2.1.2
Dr Charlotte Benjamin introduced her Chair’s Report, drawing out the following key points:
Governing Body Members had engaged with member GP practices within their respective constituencies in relation to the draft constitution for the to-be-established NCL CCG. GPs across Barnet gave their support and voted in favour of the constitution;
The Chair was a representative for Barnet CCG at an Assurance and Oversight Group which had been established in order to develop sound governance mechanisms both for the transition to the new CCG and for the CCG itself;
Along with Councillor Caroline Stock, the Chair visited Barnet Youth Zone, where they met with staff members; some of the children who were benefitting from the venture; and some of the volunteers. This included three generations of one family, all giving up their time to support the services and enjoying the experience;
Primary Care Networks (PCNs) in Barnet were developing at pace. Along with Kay Matthews, the Chair had visited the Clinical Director of each PCN in order to better understand their network’s aspirations and support requirements;
The Governing Body NOTED the Chair’s Report.
2.2 Accountable Officer’s Report
2.2.1
Helen Pettersen introduced her Accountable Officer’s Report, reporting the following key points:
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Page 3 of 7
2.2.2
Barnet CCG was leading the way with the NCL’s digital agenda, particularly in relation to the implementation of Health Information Exchange;
Commissioning and primary care teams were working hard to maintain patient safety standards in light of increased activity during the winter months. There had been a 4% increase nationally in A&E attendances, for which work was underway to understand the causes; and
NHS England (NHSE) had accepted the NCL CCG merger application, and its implementation was accelerating. The nomination stage of the process to elect clinical representatives of the NCL CCG Governing Body had closed. Following elections, there would be an assessment stage in January 2020, with successful candidates to be announced before the end of January.
The Governing Body NOTED the Accountable Officer’s Report.
2.3 Patient Story
2.3.1
Due to a technical issue, the video for the patient story on last phase of life care could not be viewed. A link to the video would be circulated to members.
3. GOVERNANCE
3.1
Memorandum of Understanding Between the Partners Forming the Integrated Care Partnership
3.1.1 3.1.2 3.1.3 3.14
Dawn Wakeling introduced a Memorandum of Understanding (MOU) which provided a framework within which partners within NCL could work with the residents of Barnet and its community assets in order to build an Integrated Care Partnership (ICP). The MOU was not legally binding but provided a statement of intent to which partners to the agreement would commit. All listed parties to the agreement had reviewed it, and provided feedback which related in the most part to outcomes, though many of the outcomes which would be agreed would arise from the development of associated work streams, and as such would be included in a further iteration. The following was noted in discussion:
The relationship between the to-be-established NCL CCG and the ICP and other parts of the NCL health and care system was under development, and will be the subject of workshops with representation from all parts of the system;
It would be valuable to take the pledges contained within the MOU to members of the public;
Clinical Directors of PCNs would be included within the list of parties to the agreement in a revision of the MOU;
There would need to be clarity on roles and responsibilities for delivery among the parties;
Work was underway to define the roles of the subgroups listed in the MOU, both in terms of their membership and remits, while ensuring duplication across groups is avoided;
The reference to ‘Barnet CCG’ should be changed to ‘NCL CCG’. The Governing Body APPROVED the Memorandum of Understanding Between the Partners Forming the Barnet Integrated Care Partnership.
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Page 4 of 7
4. OVERVIEW REPORTS AND UPDATES
4.1 Public Health Annual Report
4.1.1 4.1.2 4.1.3 4.1.4 4.1.5
Tamara Djuretic presented the Director of Public Health’s Annual Report, a statutory requirement which serves as an independent and important vehicle for providing advice and making recommendations in relation to population health. The report aimed to highlight the importance of focusing on the positive aspects of healthy relationships; to highlight the voice of local children and young people; and the importance of connecting a community’s voice with evidence in order to determine the ways in which population health could be improved. A set of recommendations were included within the report which focused on how to build further on existing successes. The following was noted in discussion:
Public Health had recommissioned health visitors in recognition of the pivotal role they play in working with children and young people with adverse experiences, something which evidence demonstrates;
Though not directly referenced in the report, Dr Djuretic advised that she would be happy to discuss with Governing Body Members work which would be undertaken in relation to children whose parents have mental health concerns; and
Assurance was given that the scope of work would include the effects of social media on children and young people, particularly in relation to those susceptible to the influence of gangs.
The Governing Body NOTED the Director of Public Health Annual Report.
5. ITEMS FOR ASSURANCE
5.1 Integrated Quality and Performance Report 5.1.1 5.1.2 5.1.3
Anne Walker provided an overview of performance of Barnet CCG-commissioned health and care providers in relation to key quality metrics. As metric scores and trends were given in detail in the report, Ms Walker focused on work undertaken by RFL in relation to its Care Quality Commission (CQC) post-inspection action plan and recently reported ‘never events’. On the action plan agreed between the CQC and RFL were 93 actions, which included 11 ‘must do’ actions and 82 ‘should do’ actions. Monthly meetings of a Clinical Quality Review Group (CQRG) provided a forum in which the CCG sought assurance from the Trust in relation to its progress in implementing the actions and on their mitigation of associated risks. At the November meeting, progress was on target. While the number of open serious incident investigations at the Trust had decreased, the number of those for which resolution was overdue had increased slightly. Since the report circulated for the present meeting was produced, two surgical ‘never events’ had been reported. They were the first surgery related ‘never events’ reported by the Trust in thirteen months. A further serious incident had been reported in relation to the death of a service user in receipt of a jointly funded care package by the CCG and the local authority, more information on which would be provided in part two of the meeting.
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Page 5 of 7
5.1.4 5.1.5 5.1.6 5.1.7 5.1.8 5.1.9
The following key points were also reported:
There had been no improvement in relation to mixed sex accommodation breaches at RFL, with an average of 50 per month being reported, and overnight stays in recovery at the RFL site being a particular concern. Barnet Hospital had divided the intensive care and high dependency units into two separate areas to support the reduction of mixed sex accommodation breaches, which had had a positive impact thus far; and
The format for CQRG meetings at Central London Community Healthcare Trust (CLCH) had changed in order to give focus to the ways in which services could be improved.
Members were reassured by the Trust’s progress in implementation of its CQC action plan, though they raised concern in relation to the number of overdue serious incidents. In response, it was noted that work was underway at the Trust to understand what was driving delays. RFL had to rely upon staff with substantive roles to undertake investigations in lieu of having dedicated investigators, something which tended to be a feature of trusts which were able to resolve more investigations on time. Ali Malik provided an overview of performance of Barnet CCG-commissioned health and care providers in relation to key service access metrics, reporting the following key points:
There were delays in the referral-to-treatment time (RTT) list validation work being undertaken by RFL in light of the data quality issues, which had caused the Trust to temporarily cease reporting RTT performance. The deadline for completion had been put back to October 2020, and to help to mitigate further delays, the Trust had sourced external support for the validation work. Although the Trust was not currently reporting RTT performance, the validation work had highlighted a number of extra 52-week waiters;
RFL performance in relation to the target to begin cancer treatment within 62-days after referral had fallen to 73.7% in September 2019, which was below both the 85% national target and the Trust’s agreed performance trajectory. Work since September to reduce the Trust’s backlog had driven an increase in performance;
RFL remained non-compliant with the six-week diagnostic target in September 2019 following month-on-month decline, though this trend has since changed and further improvements were expected following the recent approval of a business case designed to increase capacity; and
The CCG had seen improvements in its scores against the national Improvement and Assessment Framework during 2019-20. Going forward, a new system-wide framework shared by commissioners and providers was to be adopted in order to facilitate monitoring of system-wide performance.
There was a discussion of the appropriate proportion of extended hours GP appointments in order to help to alleviate winter pressures at trusts. Once the figure had been agreed, the approach would be communicated widely. In response to a question raised, it was noted that work was being undertaken to understand how to reach all groups, including those from overseas, with the message that there are alternative services to use, and that A&E is not the right place for all complaints and concerns. The Governing Body NOTED the Integrated Quality and Performance Report.
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Page 6 of 7
5.2 Month Four (M7) Finance Report
5.2.1 5.2.2 5.2.3 5.2.4
Matt Backler introduced a report which gave a detailed overview of the CCG’s financial position at M7. The position and associated risks had been discussed in detail at the November meeting of the Governing Body’s Clinical Commissioning, Finance and QIPP Committee (CFQ), with the main variances and risks remaining broadly constant for a number of months. A revised year-end position had been agreed with RFL. Achievement of the planned year-end position would be challenging – and with risk – but possible. Simon Goodwin added that the revised position with the Trust should have the effect of reducing the CCG’s potential financial risk, though clarification was required from NHSE in relation to the way in which variances would be allocated across NCL given the system-wide approach to financial monitoring which had been adopted. In response to a question raised, it was noted the replication of Barnet’s ‘embedded team’ approach across NCL would be an effective way of sharing the lessons learned from the CCG’s strong performance in QIPP delivery. The Governing Body NOTED the M7 Finance Report.
5.3 Governing Body Assurance Framework Report
5.3.1 5.3.2 5.3.3
Kay Matthews introduced the Governing Body Assurance Framework (GBAF) Report, advising that it included all four risks with a rating of 15 or over (high) which threatened the achievement of the CCG’s strategic objectives. The following changes were reported:
An increase in the rating of the principle financial risk from 16 to 20;
A decrease in the principle quality and safety risk from 20 to 15. Though two ‘never events’ had been reported recently at RFL, the overall trend was one of a significantly reduced incidence of them, as such the risk rating was felt to remain appropriate.
It was noted that, at the November meeting of CFQ, the Committee agreed to reduce the rating of the principle QIPP risk. Matt Backler undertook to ensure that this would be discussed by the CCG’s senior management team, with a recommendation to be brought to the January meeting of CFQ. The Governing Body NOTED the GBAF Report.
6. ITEMS FOR INFORMATION
6.1 Summaries of Committees of the Governing Body
6.1.1 The Governing Body NOTED the following summaries of its committees.
Quality and Performance Committee meeting held in October 2019;
Clinical Commissioning, Finance and QIPP Committee meetings held in August, September and October 2019;
Primary Care Procurement Committee meeting held in September and November 2019; and
Remuneration Committee (virtual) meetings held in June and November 2019.
6.2 NCL Primary Care Commissioning Committee in Common Minutes
6.2.1 The Governing Body NOTED the minutes of the NCL Primary Care Commissioning Committee in Common meeting held in August 2019.
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6.3 NCL Joint Commissioning Committee Minutes
6.3.1 The Governing Body NOTED the minutes of the NCL Joint Commissioning Committee meeting held in August 2019.
6.4 NCL Audit Committee in Common
6.4.1 The Governing Body NOTED the minutes of the NCL Audit Committee in Common meeting held in May 2019.
6.5 QUESTIONS FROM MEMBERS OF THE PUBLIC
6.5.1
The Chair advised that no questions had been submitted in advance of the meeting. None were raised by visiting observers
7.0 CLOSING ADMINISTRATION
7.1 Any Other Business
7.1.1 7.2.2
The Chair advised that she had been encouraged by the Governing Body’s robust and rich discussions at various forums in relation to performance and outcomes, particularly in relation to QIPP, which was always about making improvements to services for Barnet patients, rather than simply to make cuts. This point was demonstrated in the patient story video which unfortunately was unable to be viewed, but which would be shared with members.
7.2 Glossary of Terms
7.2.1 The Glossary of Terms was NOTED.
7.3 Date of next meeting:
7.3.1 19 March 2020, 9:00, Committee Room 1, Hendon Town Hall.
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16
Barnet Clinical Commissioning Group Governing Body Meeting in Public 19 March 2020
Report Title Accountable Officer’s Report to the Governing Body
Agenda Item 2.2
Lead Director /
Manager
Frances O’Callaghan, Accountable Officer, NCL CCGs
Tel/Email Frances.O’[email protected]
Governing Body Member Sponsor
Not Applicable
Report Summary
This report updates the Governing Body on developments in the local NHS, wider policy issues and key activities since the last Governing Body meeting.
Recommendation The Governing Body is asked to NOTE the Accountable Officer’s Report
Identified Risks
and Risk
Management
Actions
None arising from this report.
Conflicts of Interest
None arising from this report.
Resource
Implications
None arising from this report.
Engagement
Not applicable
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
Not Applicable
Next Steps Not Applicable
Appendices
None – the main report follows.
17
18
Accountable Officer Report
January to March 2020 1.0 Introduction 1.1 This report focuses on the key activities that the senior team, Helen Pettersen and I have
been involved in since the last Governing Body meeting and a summary of the work progressed.
2.0 Coronavirus (COVID- 19) 2.1 The CCG is ensuring that it remains up to date with all advice provided by the Department of
Health and Social Care and Public Health England. We are working with our partners across North Central London (NCL) in collaboration with NHS England and continue to ensure that guidance and key actions are implemented as required. Communication is recognised as being key to ensure that the public, our patients and staff are kept updated and we continue to attend local, regional and national sessions. NCL GP practices have been provided with ongoing support and guidance to ensure they are confident in implementing the latest guidance and we have ensured that all NCL CCGs’ primary care teams have maintained regular and helpful communications. A key area of focus alongside our trusts implementing testing pods, has been to work with community providers to establish home testing.
3.0 Moorfields Update (Outcome of meeting on 12 February 2020) 3.1 The proposal to relocate Moorfields Eye Hospital, University College London (UCL) Institute
of Ophthalmology (IoO) and Moorfield’s Charity to a new site at St. Pancras Hospital in London was approved at a meeting of 14 Clinical Commissioning Group Governing Bodies meeting in common on Wednesday 12th February 2020 and NHS England and Improvement (NHSEI) Specialised Commissioning on 4th February.
3.2 Camden Clinical Commissioning Group, on behalf of those CCGs across England that
commission services from Moorfields City Road site, in partnership with NHSEI Specialised Commissioning (London), consulted between 24 May and 16 September 2019 on a proposal to relocate services from Moorfields Eye Hospital’s City Road site to St Pancras. This new-build centre will bring together excellent eye care, ground-breaking research and world-leading education in ophthalmology.
3.3 During the consultation around 4,600 responses were received, of which 1,511 were
completed consultation surveys. People also gave their feedback in other ways including emails, discussion groups, phone calls, letters and via the virtual assistant on the consultation’s website. You can read the final outcome report at https://oriel-london.org.uk/consultation-documents/ . Overall, the majority of respondents supported the proposal to relocate.
3.4 To further explore and discuss the findings and their impact upon the proposals, the report and
proposals were presented at:
• North Central London’s Joint Health Overview and Scrutiny Committee on 31 January 2020. A link to the papers from this meeting can be found https://www.minutes.haringey.gov.uk/ieListDocuments.aspx?CId=697&MId=9242&Ver=4 .
4.0 Annual Contracting Round Update (2020/21) 4.1 The approach to the annual contracting round for 2020/21 is set within the context of the NCL
Medium Term Financial Strategy (MTFS) and the resulting NCL System Efficiency Plan to achieve financial recovery through collaboration and transparency between commissioners and providers across the NCL Sustainability and Transformation Partnership (STP).
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4.2 A set of principles and priorities were agreed earlier in the financial year, including key financial principles underpinning the approach to system cost reductions, capped levels of acute growth to enable investment in primary, community and mental health in accordance with the planning guidance and Long Term Plan (LTP). The MTFS is also supported by a System Delivery Board, which will make investment decisions to ensure maximum impact of investment to support a more sustainable health economy in NCL.
4.3 Discussions between respective teams are underway to conclude high level agreements
which will be confirmed through a Heads of Agreement and the System Collaboration and Financial Management Agreement (SCFMA). This was recently introduced by NHS England/Improvement, aimed at ensuring that Systems work together to deliver the system financial improvement trajectory.
4.4 This remains very much work in progress and is the basis of good collaboration across the
STP. 5.0 Health Information Exchange Update 5.1 Over 90 practices in NCL have now gone live with the new electronic joined-up health and
care record for patients. This now covers over 700,000 local residents, which is just over 50% of the population of NCL. Ongoing work includes adding community, mental health, social care data as well as more acute and primary care information to the shared care record over the coming months.
6.0 Annual Report and Accounts (ARA) Update 6.1 All NHS bodies have a statutory requirement to produce an ARA as a single document. The
CCG has adopted the template issued by NHSE for the 2019-20 financial year, which contains the following required sections:
1. The Performance Report: an overview and a performance analysis. 2. The Accountability Report: Corporate Governance Report and Remuneration and
Staff Report 3. The Annual Accounts: including financial statements.
6.2 Key dates are as follows:
Date CCG actions
13 March (noon)
CCG to submit a draft copy of the Head of Internal Audit Opinion to allow regional analysis.
16 April (noon) • CCG to submit:
• Draft annual report approved by the Accountable Officer (and passed to appointed auditors for audit)
• Draft HOIA statement as issued to the auditors
• Completed NAO disclosure checklist 2019/20
26 May (5pm) • CCG to submit:
• Full audited and signed annual report, and signed by the AO and appointed auditors as one document
• Full copy of the final HOIA as issued by the CCG’s internal auditors
• Completed NAO disclosure checklist 2019/20
12 June CCG to publish their annual report and accounts on their public website
By 30 September
CCG to hold a public meeting at which their ARA should be presented
6.3 Audit Committee Member review
In light of the NCL CCGs merging on the 1st April, Audit Committee lay members will be given an early opportunity to review a draft copy of the ARA during March.
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6.4 Information disclosure request In line with national guidance, there is a requirement to obtain the authority of individuals who have information disclosed in the remuneration report. We are emailing individuals highlighting their information will be included and asking for them to respond confirming agreement. They will also have the opportunity to amend any factual inaccuracies.
6.5
As part of our preparation and sign-off of the annual report and accounts, whilst the NCL CCG Governing Body has delegated responsibility for the documentation to be signed off at the Audit Committee, each member of the new NCL CCG Governing Body, at the time the Members’ Report is approved in May, will be asked to confirm the following auditor’s statement:
• So far as the member is aware, there is no relevant audit information of which the CCG’s auditor is unaware that would be relevant for the purposes of their audit report
• The member has taken all the steps that they ought to have taken in order to make him or herself aware of any relevant audit information and to establish that the CCG’s auditor is aware of it.
6.6 As a result of the merger on the 1st April, the NCL CCG Governing Body members will be
required to make this statement as the new NCL CCG Audit Committee will also be signing off the ARAs for all five CCGs.
The Governing Body is asked to:
• NOTE the key dates for the ARA process and the requirement for future NCL CCG Governing Body members to respond to the auditor’s member statement in May.
7.0 NHS England National planning guidance Overview 7.1 A summary of the national planning guidance for 2020/21 was presented to the North Central
London (NCL) Joint Commissioning Committee at its seminar on the 6 February 2020. The NHS LTP, published in January 2019, set out the transformation of services and outcomes the NHS will deliver by 2023/24. The NCL LTP was submitted in November 2019, with the plan including financial and performance baselines for 2020/21.
7.2 Local STP plans will be aggregated and published in the National Implementation Plan shortly
after the publication of the People Plan in the coming months. 7.3 Planning guidance for 2020/21 is a milestone for delivery of the NHS LTP, which aims to
• Improve Urgent and Emergency Care (UEC) performance, stabilise and reduce waiting lists for elective care and eradicate waits of 52 weeks or more,
• Improve performance against cancer operational standards including the 62 day standard
• Expand primary and community services continue to transform the way we provide care by working within systems including both NHS and wider partners to take a far more proactive approach on the prevention of ill-health,
• Meet the Mental Health Investment Standard and continue to improve outcomes and care for people of all ages with a learning disability or autism
• Begin to implement the forthcoming People Plan and reduce the impact the NHS has on the environment
• Live within agreed financial trajectories.
• Embed and strengthen the governance of our systems 7.4 NCL will consider the full planning guidance to develop our plans for 2020/21: 7.5 The current main risks to delivering plans for 2019/20 are:
• The need to align CCG and provider operating plans to support a reduction in system costs
• The need to better align system incentives to support delivery of Sustainability and Transformation Plan priorities and to reduce system costs;
• Delivery of system plans within the resource envelopes of both CCGs and providers.
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7.6 Plans for 2020/21 will need to be developed in accordance with the NCL MTFS. The guidance
makes clear the requirement to invest in community, mental health and primary care services. This investment will need to be targeted to help reduce acute hospital and system costs.
7.7 Plans should reflect the priorities identified through engagement with patients and public. Local
CCG engagement timelines will be built into the process for generating plans, as well as being informed by on-going engagement structures.
7.8 Planning for 2020/21 has been previously considered at:
• STP Directors of Finance meetings
• NCL Provider Chief Executive meetings.
7.9 Development of the LTP for NCL has established a finance and performance baseline for 20120/21 and will be co-ordinated through the NCL CCG senior management team.
7.10 Plans for 2020/21 will be developed in accordance with the timetable built into the national
planning guidance. The full version of the guidance can be downloaded from the NHS England website at Planning Guidance
8.0 LTP in North Central London 8.1 To support the next stage of delivery of the LTP in NCL, work is underway to refresh the
approach to NCL wide work and develop a single CCG business plan for 2020/21 ensuring work aligns to the delivery of the LTP and London vision of: Start Well; Live Well; Age Well.
8.2 Each NCL borough now has a borough partnership board in place. This brings together health
and social care partners with a focus on developing shared plans for integrating services to improve the outcomes for local residents. The new single CCG operating model will support the further development of these partnerships.
8.3 Work continues through borough teams to develop and support the primary care networks as
building blocks of the new system. Clinical directors have been appointed and are meeting to support the next stages of this work.
8.4 Work is ongoing with Healthwatch partners in each borough to engage with and refine plans
in areas residents have told us are important to them. To support engagement with the public, staff and partners, case studies have been developed to illustrate the tangible changes integration will deliver. This will be used in coordinated engagement throughout Feb-April 2020.
8.5 The North Central London Directors of Public Health are working on a health inequalities
baseline and framework for outcomes to support partners to mutually agree areas of biggest impact for partnership working at an NCL Level.
8.6 NCL was confirmed funding in relation to the following areas of the LTP for mental health:
crisis funding; mental health liaison; rough sleepers and suicide prevention. 8.7 Community service development plans for 2020 are being shaped in line with the ageing well
ambitions of the LTP. This is being worked on in partnership with the local authorities, to build on best practice locally.
8.8 Mike Cooke has been appointed as independent chair of the STP. He is leading work on the
new partnership board with representation from councils, the new NCL CCG and NHS providers. He will work closely with the new Senior Responsible Officer for the STP, Mr Rob Hurd, who was appointed on the 21 February 2020.
8.9 As part of the emphasis on ever closer collaboration, national and regional regulators are looking to the ‘system’ (in our case, North Central London) to work together to positively impact key areas such as performance, quality, sustainability and transformation of services.
22
The approach of ‘system by default’ represents a level of decentralisation and recognition that local partners, through their ever strengthening collaborations, are best placed to support local systems.
9.0 Integrated Care Partnership (ICP) / Borough Partnership 9.1 Context:
Barnet ICP is made up of Barnet CCG, acute, community and mental health providers, the GP Federation, Barnet Local Authority (LBB) and patient and voluntary sector representatives. To date, local system leaders have met regularly through workshops and meetings to establish governance arrangements, agree a vision, develop high-level outcomes and identify early priority areas. It has been agreed that a population health approach will be followed, which aims to improve physical and mental health outcomes and promote wellbeing across Barnet. The ICP will initially focus on urgent care and over 65s, and the dementia pathway is included as a key priority within this. There is an acceptance that over time, a population health approach will allow us to build up a rich source of data on which to base decisions and enable us to focus more on the wider determinants of health. However, we need to address the immediate issues affecting the local health and social care system and 'build in flight'.
9.2 Priority Areas:
A paper setting out four high-level proposals, to address system wide issues, was presented at the RFL A&E Delivery Board and the ICP Delivery Board in January 2020. The two options with the most support were: 1. Scaling up of frailty and dementia pathway pilots to all primary care networks, with
improved connections to acute Same Day Emergency Care services and Rapid Response; and
2. Increased investment in domiciliary care - dedicated teams of specialist home care workers, working in tandem with community healthcare services and primary care to step people down to lower levels of support would reduce DTOC, and prevent unnecessary residential care admissions or readmission to acute settings.
9.3 The ICP Pathway and Priorities workstream will develop business cases for these areas,
which will go to the NCL System Delivery Board. 9.4 Next Steps:
• Task and finish group to be established
• Develop business cases for scaling up of Frailty and Dementia pathway pilots for all PCNs and enhancing domiciliary care - Align local governance arrangements to NCL ICS ones
• ICP Delivery Board meeting 24 February 10.0 Outcome of Cricklewood Walk-in service decision making
Barnet CCG is the lead commissioner for the Cricklewood walk-in service and Brent CCG is
an associate to the contract. Both Barnet and Brent CCGs’ proposal to close the Cricklewood
walk-in service at the end of its contract on 30 June 2020 was approved by the primary care
committees of Brent and Barnet CCGs at their meetings held in public on 12 and 13 February
2020, respectively.
The CCGs approved this along with a number of other recommendations to support the
implementation of the decision. The full decision-making report with the appendices are
available on the Barnet CCG website which sets out in detail the CCG reasons for proposing
the closure, the various analyses conducted, the results of the engagement process, the
CCGs’ responses and the recommendations made to its respective committees.
The provider of the Cricklewood walk-in service and key stakeholders have been notified of
the decision.
The next steps for the CCG is to address the recommendations set out in the report.
23
Frances O’Callaghan Accountable Officer
27 February 2020
24
Governing Body Meetings 19 March 2020
Report Title NCL CCGs – Progress update on CCG Merger
Agenda Item 3.2
Lead Director /
Manager
Ian Porter, Director of Corporate Services, NCL CCGs
Tel/Email [email protected]
GB Member Sponsor Frances O’ Callaghan, Accountable Officer
Report Author
Luke McCartney, Head of Programme Management, NCL Change Programmes
Tel/Email [email protected]
Name of Authorising
Finance Lead
Simon Goodwin Chief Finance Officer, NCL CCGs
Summary of Financial Implications
No financial implications
Report Summary
This paper provides an update on progress on the programme to merge the five NCL CCGs to form a single CCG from 1st April 2020. The paper summarises the progress made and key next steps to be undertaken for the following priority areas of the merger programme:
1. Governing Body Elections and Recruitment
2. Governing Body and Committee Arrangements
3. HR Transition
4. Clinical Leadership Review
5. Financial Delegation Arrangements and SFIs
6. Communications and Engagement Activities
7. Key next steps
Recommendation The Governing Board is asked to NOTE the updates and progress made across key areas of the programme to deliver the merger.
Identified Risks and Risk
Management Actions
A robust programme management approach has been established for the North Central London Change Programmes, including an approach to risk management and risk register that has been approved and is regularly reviewed by the NCL CCGs’ Assurance and Oversight Group. A summary risk log is provided as part of the report. In addition, a single risk relating to the delivery of the merger is included on the NCL CCGs’ Risk Register for all CCGs.
Conflicts of Interest
Not applicable
25
Resource Implications
Resources are already in place to deliver the merger as part of the NCL
Change Programmes, including leadership from the NCL CCGs Senior
Management Team and the establishment of a single programme team.
Engagement
An extensive engagement process has been conducted at CCG and NCL level to ensure that key partners are aware of, and have had the opportunity to feedback on the merger proposals. A summary of ongoing communications and engagement activity can be found in the report.
Equality Impact Analysis We recognise that any change to the way that CCGs operate has the potential to impact on equalities. For this reason we commissioned an independent Equalities Impact Assessment (EIA) on the impact of merger on our Public Sector Equality Duty. A summary of this report was shared with the Governing Bodies in September. In line with the recommendations of the EIA, work is now underway with the Directors of Public Health across NCL to map and understand the current population health profile of each borough. This will look at inequalities both within and across boroughs. On an ongoing basis, the new CCG will proactively and robustly embrace all aspects of equality, diversity and inclusion in its operating practices and in supporting staff members and officer holders in their roles.
Report History and Key
Decisions
The content for this progress update has been developed with input from Governing Body members, at the following sessions:
Governing Body Meetings in September 2019
Governing Body Seminars in May and October 2019
Monthly meetings between the CCG Chairs and Accountable Officer (since March 2019).
Governing Body Meetings in December 2019
Assurance and Oversight Group on 5th December 2019
Assurance and Oversight Group on 6th February 2020
Assurance and Oversight Group on 4th March 2020
Next Steps The report is being presented to each CCG’s Governing Body members during March. The next steps after this are as follows:
1st April - NCL CCGs Formal Merger
1st April: Implementation of Day 1 merger requirements
Continued regular progress reporting through the NCL CCGs Assurance and Oversight Group
23 April - First Governing Body of NCL CCG Further information on next steps for the programme can be found in the report.
Appendices
No Appendices included
26
North Central London Change Programmes
Update for Governing Bodies
24th February 2020
27
Headlines on our progress to date
Governing Body clinical representative elections completed successfully, Chair confirmed, and process to recruit appointed members underway
Final draft of NCL CCG Constitution submitted to NHS England agreed
Successful completion of NCL Director Level structure recruitment and induction
Next stage of staff transition split into two distinct waves given their complexity. Structure design for Wave 2 completed; and preparation and due diligence for consultations underway with consultations commenced on 25th February
Staff communication and briefings to inform of split between functions and timelines for Wave 2 consultations
30 days consultation to transfer all staff to NCL CCG in accordance with TUPE commenced on 12th February
Clinical Leadership Review complete and timetable for recruitment communicated –with initial roles to be filled by 1st April 2020
Preparations for NCL CCG Day 1 in progress and on track.
28
Progress against our
high-level timeline Oct Nov Dec Jan Feb Mar Apr
Governance
Co
reW
ork
stre
ams
CCG Merger
HR Transition
Working Environment
Transition
ICS Development
Enab
lers
Finance
Comms & Engagement
AOG (10th) AOG (6th) AOG (5th) AOG (8th) AOG (6th) AOG (4th) AOG (6th)
TB (15th) TB (29th) TB (12th) TB (26th) TB (10th) TB (7th) TB (21st) TB (4th) TB (18th) TB (3rd) TB (17th) TB (31st)
TG (22nd) TG (5th) TG (19th) TG (3rd) TG (14th) TG (28th) TG (11th) TG (25th) TG (10th) TG (24th)
NHSE Panel (9th)
Voting (4-18th)Engage on
Constitution
Clinical Leadership ToR
Clinical Leadership Review
Confirm outcome of vote
Mapping GB Member Roles to Committees
Finalise GB Member JDs
GB Member Recruitment / Election GB Induction & Development
NHSE National Committee (tbc)
Meet Chairs
Report
Develop ToR for all NCL CCG Committees Committee ToRs Sign Off
Essential Policies in place
NCL CCG Constitution in place
Next Stage PPE Approach
Develop Benefits Management Framework & Confirm Owners Confirm Baselines & Quantify Benefits Assign Benefits To Owners Develop Monitoring
Wave 1b structure development
Develop Staff Engagement Plan
Finalise Current Staff Structures
Detailed Planning for Waves 2 and 3
Wave 1b Consultation & recruitment
Chair Appointment
Mapping current functions & services
Ch
rist
ma
s a
nd
New
Yea
r
Review Existing Common Policies & Sign Off Essential Corporate Policies for NCL CCG
Develop NCL Wide Health Inequalities Baseline
Wave 1b Complete
TG (17th)
TB (24th)
Wave 2 CCG Structure Design Wave 2 Consultation
AO Recruitment
Confirm NHSE Assurance Outcome
Review existing HR Policies and Consolidate into set of Essential Policies for NCL CCG
Implement new EMT Structure
Wave 1b Appeals
Develop High Level OD Plan for transition
CCG Close-Down Events
NCL CCG Launch Event
Develop 2020-21 OD Plan & Launch Staff ForumOngoing Staff Support Programme incl. HR Drop-In Sessions, Resilience Workshops, Lunch & Learns on New Ways of Working
Finalise Stocktake of Current Position
Develop CCG HQ & Base Strategy Paper
Review at Transition Board
Develop outline view of accom. requirements
Review void space and potential opportunities
Confirm time-dependent decisions (C&B)
High level roadmap for IT, IG, Informatics
Preparations for transfer of assets and contractsDelivery of IT, IG, and Informatics ‘Day 1’ requirements
Establish ICS Partnership Board
Develop ICS / ICP Roadmap
LTP Response Engagement Submit LTP Response (15/11)
ICS Design Principles
Develop NCL Outcomes Framework
Develop Population Health Management Approach
Work on partnership arrangements
Ongoing Engagement w/ SBS
Ledger cleansingDesign of Single Ledger
Agree approach to allocation of financial growth Stress test scenarios for budget delegations with MDs
Define Financial Parameters for Wave 2 Design
Management / transfer of reserves, deficits etc
Letters to all GB Members & Clinical Leads
Determine ledger authority levels & individuals
Clarify with KPMG any changes to year-end accounts closedownSingle Annual Accounts
Develop Approach to Wider Member Engagement
Develop public-facing LTP document
Wave 1b comms Wave 1b comms Wave 2 comms Wave 2 comms
Further development and finalisation of PPE approach
Confirmed approach to member engagementConfirmed PPE Approach
Update C&E Plan Develop C&E ‘Day 1’ products incl. CCG website, staff intranet, branding, newsletters, social media platforms, protocols, & engagement platform ‘Day 1’ C&E products in place
Process to move to single payroll
TG (31st)
Letters to all GB Members & Clinical Leads
Elect GB Chair & Appoint Vice Chairs
Supplier Comms issued
Partner Comms Partner Comms
Programme Plan- Day 1’ DeliveryDeliverable Key Deliverable Decision Point Critical PathProcess MeetingKey:
Wave 1b vacancies (if any)
Wave 2 prep
ICS Next Steps Workshop (22/11)
Wave 2 prep and due diligence
Wave 3 planning and due diligence
NCL AO in Post
TUPE Consultation
Appoint ICS Directors
Paper to new Governing Body on accommodationoptionsFull estimate of 2020-21
accom. requirementsEstates options paper developed for new GB
Explore potential accom. options
‘Day 1’ IT deliverables in place
Transfer order complete
New GB confirmed
Single ledger in place
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Progress on: GB elections and recruitment
Update on Progress
Election process for Governing Body clinical representative members completed on the 26th
of January with 10 members (2 from each existing CCGs) successfully elected
Dr Jo Sauvage appointed NCL CCG Chair and Dr Charlotte Benjamin appointed as Clinical vice-chair
Registered nurse appointed – Claire Johnston
Lay member interviews took place on 20th and 27th February (Deputy Chair (Lay Member) TBC)
Secondary Care clinician to be re-advertised
Clinical lead model for the new Governing Body agreed (see Clinical Leadership Review update)
Informal Governing Body development sessions scheduled for March and April 2020 with the new Governing Body to be ratified in its first meeting on 9th April 2020
Day 1 priorities
• Governing body election and recruitment complete
• Governing body induction and role development complete
• Selection of GB Chair, Deputy-chair & Clinical Vice-Chair
Day 100 priorities
• First Governing Body meeting to establish new ways of working and approve Terms of Reference for committees and key governance documents for new CCG
Year 1 priorities
• Governing Body and CCG committees work together to ensure that the CCG has appropriate arrangements in place to exercise its functions effectively, efficiently and economically and in accordance with its constitution
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Progress on: GB and Committee Arrangements
Update on progress
Terms of Reference for NCL Committees currently being drafted (will be approved via April Governing Body meeting)
Committee Transition being discussed with current Committee Chairs and within Committees:
• Minutes from March meetings to be signed-off by Committee Chairs before 31st
March
• Action Logs to make clear ‘key issues’ that current Committees highlighting as important to be carried forward into new CCG
• Dates being set for Q1 Committee Cycle. Q2 – Q4 to then follow
• Development sessions planned in March and April for new Governing Body Members
Working closely with RSM regarding appropriate carry-forward of outstanding internal audit actions
31
Progress on: HR TransitionUpdate on progress
Single NCL Director level operating Model consultation and selection process completed (Wave 1b)
30 day consultation to transfer all NCL CCGs staff to NCL CCG in accordance with the Transfer of Undertakings, Protection of Earnings(TUPE) commenced on 12th February 2020 in line with the NCL CCGs’ Change Management Policy
Functions in scope of Wave 2 and 3 have been defined and communicated to staff
Review and impact of proposed changes to functions in-scope of Wave 2 currently underway
30 day consultation period for staff in functions in-scope of Wave 2 commenced on 25th February 2020 in line with the NCL CCGs’ Change Management Policy
Monthly formal joint partnership meetings and fortnightly informal meetings with staff side representatives
Ongoing support in place to support staff through change.
Day 1 priorities• Due diligence of all staffing information to transfer to
NCL CCG for TUPE purposes • All HR forms, policies and procedures in place with
reference to NCL CCG and new branding• NCL CCG branding in place for recruitment
(NHS/Health/NEL Jobs) and workforce systems
Day 100 priorities• Move to one NHS electronic staff record (ESR) System• Manage outcome and implementation of Wave 2
consultation • Detailed implementation plan and review of
functions in-scope of Wave 3
Year 1 priorities• New team structures in place and embed new ways
of working• Implementation of strategic organisational
development plan• Form NCL CCG staff forum
32
Progress on: Clinical Leadership ReviewUpdate on progress
Full engagement report produced in December 2019
Set of five strategic recommendations put forward by the Steering Group, focused on 1) Single model for Clinical Leadership across NCL CCG; 2) Consistent and clear clinical lead functions and roles; 3) Single process for recruiting, contracting, and remunerating leads; 4) Framework for development and support of leads; 5) Best practice approach to recruitment & retention
Proposal for set clinical lead roles for 2020-21 agreed (to be reviewed annually)
Communications issued to current clinical Governing Body members and leads on 20 February 2020, setting out outcome and next steps
Recruitment and selection process commenced with aim to recruit to as many roles as possible by 1st April 2020
Remuneration Committee approved remuneration terms for non-Governing Body Clinical Leads
Advert and recruitment information issued to current Governing Body members and clinical leads- 25th February
7
Day 1 priorities
• Core Clinical Leadership requirements for NCL CCG confirmed
• Recruitment to core non-Governing Clinical Leadership roles
• Confirmed model for Clinical Leadership under the new CCG
Day 100 priorities
• Embed new Clinical Leadership roles & begin implementing wider recommendations of the review
• Begin work with partners to consider wider landscape of Clinical Leadership under Integrated Care System
Year 1 priorities
• Continue implementation of recommendations from the review
• Confirm any requirements for ICS focused clinical leadership that may need to be in place from 1st April 2021
• Review CCG requirements for 2020-21
33
Progress on: Financial Delegation Arrangements and SFIsUpdate on progress
Financial principles for NCL CCG developed as part of the CCG merger application
Scheme of Delegation set out in schedule to Constitution
Work underway to develop SFIs - will be approved at first meeting of NCL CCG Governing Body on 9th April 2020
Ongoing development of recommendations to support effective, high quality decision making throughout the new organisation, including at a borough level
34
Ongoing Communications and Engagement
ActivityUpdate on progress
NCL CCG website, intranet, branding, signage, comms platforms and process development
HR Transition – comms materials for staff briefings and newsletters, ongoing FAQ, and consultation launches
External stakeholder merger update letter prepared, information on websites updated
CCG patient rep merger progress letter disseminated, with end of committee information
Future PPE approach in development: CCG engagement leads meeting 6 Feb to develop draft approach; draft PPE/E Committee terms of reference developed; patient rep proposal for NCL CCG committees developed; individual borough partnerships developing PPE approaches; NCL Engagement Ad Board update (6/2)
Member engagement – discussions planned for Feb/Mar member events, and online survey live
Clinical Leadership Review comms support
Governing Body Election comms plan delivered
New Accountable Officer announcement
New Chair announcement
Day 1 priorities
• NCL CCG launch activity• NCL CCG website and intranet• Member Relations approach agreed• New branding rolled out• Enquiries, media, FOI protocols set up
• Office signage
Day 100 priorities
• Vision, Values and OD strategy agreed
• 2020/21 Comms and Eng Strategy agreed
• NCL CCG Comms and Eng Team in place
• Regular updates to key stakeholders & residents on NCL CCG achievements
Year 1 priorities
• Positive staff engagement and support for collaboration across teams in place
• Strong relationship with member practices maintained
• Partnerships with local and NCL stakeholders positively maintained
• Annual Report and AGM delivery
35
The below table provides a summary of the current NCL Change Programmes risk log.
ID Summary Risk description L C Score Mitigation(s) Named owner
R05 CCG Merger process impacts on business as usual for existing CCG functions
3 4 12 • 2020 date for merger to minimise impact on BAU• Wider Leadership Team meeting and director briefings to focus on resilience and
supporting staff through change • New operating model and governance structure rapidly developed• Work underway to review ‘business critical’ functions for Jan-Mar 2020
Accountable Officer /EMDs
R02 Staff leave as they do not feel informed and involved in changes
3 4 12 • 2020 date for merger to minimise disruption for staff • Communications plan in place • HR framework developed and staff support programme in place• Leaderships roadshows led by new CCG EMT
Accountable Officer /Michelle Chadwick
R11 Failure for merged CCG to help tackle health inequalities across north central London
3 4 12 • Firm commitment to make reducing health inequalities a priority for the single CCG• Design of financial principles• Undertaking baseline assessment of current challenges across NCL• Commitment to ongoing close working with local authorities and public health
Will Huxter
R08 New CCG model does not support move to new ways of working for ICS and ICPs
2 4 8 • Design principles developed via ICS group • New governance model is future-proofed and focusses on core functions • Work on borough level Integrated Care Partnerships prioritised by COOs
Ian Porter /COOs
R04 Wider care system stakeholders are not appropriately engaged to enable the delivery of the benefits of merger
2 4 8 • Local engagement with partners through ICP development• Communications plan in place • Senior briefings with Local Authorities • Briefings with NHS Trust Chairs • Briefing with partners including the voluntary sector
Accountable Officer
R06 Merger does not realise potential benefits: • Reduction in transaction costs • Support development of ICPs • Tackling inequalities across our communities
2 4 8 • New operating model and governance structure rapidly developed• Financial and strategic principles and checkpoints to be used throughout process • ICS principles to be developed by ICS design group • Joint programme management office to link to ICS work • Benefits framework developed
Simon Goodwin / Will Huxter
R07 Merger application developed for submission does not meet local & national requirements
2 3 6 • Programme plan and PMO process in place to manage application • Application Development Framework in place• Assurance and Oversight Group in place • Approval of merger application confirmed by NHSE
Ian Porter
R10 Delay in in-Housing of CSU Contracting / POD teams prevents some benefits realised
2 3 6 • Written to CSU MD outlining intensions• Working closely with CSU POD team to keep staff informed
Accountable Officer
Key: L = Likelihood; C = Consequence
Summary of current risks
36
Key next steps
• Letter to NHS England to confirm transfer order arrangements in place
• Recruitment of non-Governing Body clinical leads
• Appoint to remaining Governing Body roles
• Finalise Terms of Reference for new Committees
• Finalise arrangements for patient and public participation and representation
• Implementation of Wave 2 of the HR Transition, and preparation for Wave 3
• Finalise ongoing work on NCL-wide health inequalities baseline with Public Health
• Progress future office accommodation arrangements
• Finalise closedown arrangements for existing five CCGs
37
38
Barnet Clinical Commissioning Group Governing Body 19 March 2020
Report Title Quality and Performance Report Agenda Item 3.3
Governing Body
Sponsor
Dr Barry Subel Tel/Email [email protected]
Lead Director /
Manager
Jenny Goodridge, Director of Quality and Clinical Services Ali Malik, Director of QIPP, Planning and Performance
Tel/Email [email protected] [email protected]
Report Author
Swetlana Wolf, Deputy Director of Quality and Clinical Services Ali Malik, Director of QIPP, Planning and Performance.
Tel/Email [email protected] [email protected]
Report Summary This report provides an overview of performance and quality issues since the last report to the Governing Body on 19 December 2019.
Recommendation To note the contents of this report and the actions that are in place working with our providers to improve performance and quality of care for patients.
Identified Risks
and Risk
Management
Actions
Risks as identified within the report. In addition, there is a specific risk on the GBAF (GBAF 21) in relation to potential quality and patient safety concerns at the Royal Free London.
Conflicts of Interest
Not applicable
Resource
Implications
Not applicable
Engagement
Not applicable
Equality Impact
Analysis
Not applicable
Report History and
Key Decisions
Last presented to Governing Body in 19 December 2019
Next Steps To continue to monitor the performance and quality of the services commissioned by Barnet CCG and highlight any concerns/hot topics to the Governing Body.
Appendices Not applicable
39
40
Quality & Performance Report
Quality & Performance Committee
February 2020
Lead Directors: Jenny GoodridgeDirector of Quality & Clinical Services
Ali Malik Director of QIPP, Planning and Performance
41
2
Note: Acute performance and quality is monitored through North Central London’s Joint Commissioning Committee – latest performance report can be found here: http://www.barnetccg.nhs.uk/about-us/NCL-joint-commissioning-committee.htm. A summary of the key acute performance and quality measures is noted below.
Royal Free London (RFL)
The trust Care Quality Commission (CQC) improvement plan is progressing well and as reported in December 2019 all actions
are on track to meet target deadlines. Approximately 25% of must and should do actions are reported as completed. The Trust is
reviewing the plan internally on a quarterly basis and it was agreed that Progress against the action plan will be monitored via the
Trust’s Clinical Quality Review Group (CQRG).
Pathology issues and waits
A small number of pathology related issues continue to be reported using the Quality Alert system which have been escalated with
the RFL and HSL who are investigating. The results of that investigation will be reviewed at the joint RFL/HSL/CCG meeting in
early February 2020.
Phlebotomy
The Royal Free appointment-based online booking system using Swiftqueue went live in November 2019. The number of
complaints about this service have significantly reduced. A meeting was held in December 2019 to review progress and the
average waiting time was 11 minutes. A further review meeting will be held in the near future.
Mixed Sex Accommodation (MSA) breaches
Monitoring of MSA accommodation breaches continues via the CQRG. In November 2019 the Trust presented a remedial action
plan to reduce the number of patients overnight in recovery by 30% by end March 2020. The CCG have shared a trajectory to
monitor performance and this is to be reviewed at the January CQRG.
Acute UpdateQuality and Performance
42
Acute UpdateQuality and Performance
3
Serious Incidents / Never events
There were 27 open serious incidents (SIs) reported for November 2019, a reduction from 34 in the previous month. Of these,
nine are overdue noting that the number of overdue reports has reduced from 15 the previous month.
The Trust reported two never events in November 2019, both surgery related and wrong prosthesis. One occurred at Chase Farm
and the other at the Royal Free, there was no commonality in staffing or service. Investigations are underway and final reports
will be reviewed by the CCG.
On 16th January 2020 The Royal Free identified a serious incident relating to the automated process responsible for distributing
first and follow up outpatient summary letters. In the period from June 2019 to January 2020 20 8% of letters were not sent, a
total of 27,632. A clinical task and finish group has been established to agree the risk of clinical harm and the process for
distributing the letters not sent. A full stakeholder communication and engagement plan is being developed. The action plan will
be monitored via CMG and the serious incident review and any harm caused via the CQRG.
Non Emergency Patient Transport System (NEPTS)
In September 2019 changes were made to the Patient Transport System with closer management and adherence to the eligibility criteria and changes to the booking system. There have been some initial issues, complaints and incidents raised relating tomissed appointments and availability. To support effective management and oversight of the service, there is a daily call with trust leads and the service provider with a programme board that meets monthly to review performance and quality.
43
4
Cancer
RFL
62 day performance was at 81.8% in December 2019, which is below both the 85% target and the agreed performance trajectory.
The Trust was originally forecasting compliance by October 2019. However, a high backlog in November (103-121 in November)
has made achievement difficult. Over the winter period, it rose to 134 on (12/01/20) There are significant issues with inter-trust
transfers contributing to the backlog through late referrals. Delays in biopsies are also contributing to delays; particularly in the
urology pathway. Additional capacity and outpatient improvements are coming on-stream in January 2020 to address this. In
recent weeks, the backlog has been reducing (108 on 23/2/20). RFL is refreshing its recovery action plan and governance
process, to make it more user friendly and better kept up to date.
The issue with receipt of the root cause analysis (RCA) harm reviews has been resolved and NEL Commissioning Support Unit
(CSU) are receiving them into the correct mail boxes. There is however a further issue that has been identified by the CSU and
NCL Head of Cancer Commissioning in respect of the content and effectiveness of the reviews received. Some breach reports are
missing key information; overall reason for breaches; no root cause identified; lack of actions to address red and amber events;
appropriate sign off and clinical harm caused. The NCL Head of Cancer Commissioning has formally written to the Trust,
requesting to respond to these areas and this will be an area of focus at the January CQRG.
Acute Update Quality and Performance
44
Acute UpdateQuality and Performance
5
Royal Free London (RFL) contd.
Accident and Emergency (A&E)
A&E performance remains below trajectory at 81.2% in January 2020. Attendances & admissions were higher than discharges,
resulting in significant bed capacity issues. Long lengths of stay remains above the local trajectory (40% reduction from the bed
base). A new emergency care model is being developed to improve emergency care admissions patient flow, expected to start in
March 2020. Winter bids, predominantly for escalation and complex assessment beds have been approved by NHS England (E)
and are in place. The 12 hour trolley breaches have increased significantly to 55 in January 2020, from 33 in December 2019.
NHSE requires all acute hospital based Urgent Care Services to become Urgent Treatment Centres (UTC) by December 2020.
This has been in place at Royal Free Hospital since November 2019. At Barnet Hospital, UTC development is progressing well,
with completion expected by March 2020.
Fifteen-minute ambulance handover performance remains non-compliant. The Trust report a lack of space to offload patients and
multiple ambulance arrivals at the same time in peak hours. RFL progressing to embed 'care in a chair' and 'fit to sit' models to
improve performance. Also, a pan-London agreed approach to managing handover delays including the use of hospital led / LAS
paramedic 'cohorting of patients‘ is to be implemented by A&E providers and followed up via their local A&E Delivery boards.
Diagnostics
The Trust remains non-compliant against the 6 week diagnostic target in November 2019, with 6.7% of patients waiting 6 weeks or
more. Non-compliant modalities include endoscopy, non-obstetric ultrasound, and CT. Ultrasound contributes the majority of the
breaches. The Trust have submitted an ultrasound action plan and outsourcing is already in place for 700 examinations per month.
The backlog has reduced by approx. 2,000 from October to December. The Trust is planning to see an elimination of the
ultrasound backlog by August 2020.
Endoscopy and radiology recovery plans are already in place. The Trust are currently outsourcing additional magnetic resonance
imagine (MRI) capacity until all four scanners are fully operational (by April 2020). MRI has maintained an improved performance
of 99.3%. Also the Trust are booking colonoscopies directly into Hadley Wood Hospital which is seeing an improvement in
endoscopy utilisation. The revised diagnostic trajectory shows compliance now expected in Q4 of 2019-20 and is kept under
review. CT has reported compliance in November 2019 for the first time in 2019-20.
45
Acute UpdateQuality and Performance
6
Royal Free London (RFL) contd.
Referral to Treatment (RTT)
RFLceased Referral to Treatment reporting to the national system, whilst it is implementing a new logic to the waiting list and
undergoing a significant data validation exercise. The Trust highlighted that a high volume of unknown activity is being created
either due to staff or system error, which has led to an artificial increase of the RTT waiting list size. The trust are
implementing bespoke departmental staff training for both clinical and administrative staff. Also, technical solutions are in
place to reduce erroneous records being produced.
Operational performance is still challenged in part because of staffing issues in some specialties. This is also impacting on
some of the recovery plans currently in place. The impact on performance will be seen once further progress has been made
on the data validation exercise.
The increased rate of validation is creating pressure on the patient tracking list (PTL) with patient add-ons meaning resources
are being diverted. The RTT Steering Group has been reconfigured to give more robust governance and support from the
whole healthcare system. There has been a reduction in the appointment slot issue (ASI) list size, however, problems persist
with reliability of the data and new plans are in place to further validate and contact patients to book in appointments.
From April to August there were a total of 438 harm reviews undertaken in relation to RTT and all have been classified as low
harm, however, two reviewed in August 2019 require further action to ensure no harm is sustained and this is being managed
by the Trust. There was a death reported in August but this was not related to the wait for surgery. The main services
completing harm reviews remains similar to previous months, with these being trauma and orthopaedics; pain management
and maxillofacial surgery.
46
Non-acute: quality and performance
747
Community & Children (CLCH)
8
• Podiatric surgery did not meet its Dec 2019 trajectory for 18 weeks.
• Continence service is now on target.
• Intermediate care multi and uni-disciplinary (physio & OT) backlog has reduced,
data is now merged with case management and speech & language therapy
(integrated team).
• Musculoskeletal (MSK) The CLCH deep dive concluded it could not deliver the 6
week wait without the transformation. The pathway is no longer an Integrated Care
Partnership priority.
• Podiatry is on target.
• The business case for children’s eye screening has been delayed due to RFL
arguing for TUPE of their ophthalmologist, which will change the financial cost for
CLCH.
• The Orthotics remains a discussion for contract negotiations (high cost appliances).
• The Children’s services have developed a separate scorecard for tracking
performance, which is now monitored at the Children’s CQRG for quality. There are
access concerns for Looked After Children.
• Spirometry performance remains poor against the 6 week wait.
Key points to note
• Podiatric surgery backlog has reduced, a request has been made for CLCH to review
case mix.
• The issue regarding the TUPE of the children’s eye screening ophthalmologist business
case was escalated to commissioners at the Contract Management meeting in Jan 2020.
• MSK will be discussed at the CLCH Operational meeting to see what actions can be
taken now.
• Spirometry capacity will increase via primary care via PCNs, CLCH have also added a
clinic to reduce their wait.
• Looked After Children has been made a standing item on the Children's CQRG agenda.
Actions / next steps
Non-Consultant led services 6 week wait
Consultant led services 18 week wait (Adults)
Current Performance M8 2019/20
Service Line 01/04/2019 01/05/2019 01/06/2019 01/07/2019 01/08/2019 01/09/2019 01/10/2019 01/11/2019
Diabetes - Barnet 94.80% 95.45% 97.44% 98.90% 98.70% 97.99% 98.26% 98.75%
Falls 100.00% 99.32% 98.27% 99.47% 99.43% 100.00% 100.00% 99.55%
Heart Function 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00% 100.00%
ICMSK 99.57% 99.84% 100.00% 99.72% 99.87% 100.00% 100.00% 99.37%
Parkinson's Service 95.00% 96.92% 96.53% 98.45% 99.05% 100.00% 99.33% 100.00%
Podiatric Surgery 44.00% 55.70% 67.88% 73.79% 73.73% 76.27% 79.79% 81.11%
Respiratory/COPD 100.00% 98.05% 100.00% 100.00% 99.54% 100.00% 100.00% 100.00%
Service Line 01/04/2019 01/05/2019 01/06/2019 01/07/2019 01/08/2019 01/09/2019 01/10/2019 01/11/2019
Continence Service 74.67% 69.01% 71.23% 77.78% 94.92% 94.87% 97.06% 96.83%
Planned Care 72.78% 70.90% 66.35% 83.37% 81.60% 87.09% 91.49% 93.04%
MSK Physio 72.65% 69.04% 68.64% 65.34% 71.19% 71.28% 60.19% 50.11%
Nutrition and Dietetics 86.84% 91.21% 91.43% 91.86% 93.00% 85.56% 91.67% 90.79%
Podiatry 90.69% 95.79% 94.31% 94.02% 96.01% 92.63% 87.39% 97.01%
Respiratory/Spirometry 58.82% 46.49% 41.56% 40.93% 44.96% 35.53% 34.78% 30.06%
Stoma Care #N/A 100.00% #N/A #N/A #N/A 100.00% #N/A #N/A
Tissue Viability 95.74% 97.92% 98.28% 96.97% 96.72% 98.48% 97.37% 97.44%
Orthotics 81.63% 82.93% 96.08% 91.38% 88.46% 91.78% 96.10% 88.64%
Orthoptics 70.05% 71.52% 73.85% 70.00% 71.95% 90.63% 95.56% 82.76%
Complex Care #N/A 100.00% #N/A #N/A 100.00% #N/A #N/A 100.00%
48
Community & Children (CLCH)
9
Central London Community Healthcare (CLCH) Adults
The Adult Services CQRG was held December 2019. The meeting was attended by Dr. Matthew Hodson, the Divisional
Director of Nursing and Therapies. Key highlights as below;
• Musculoskeletal Adults Service Deep Dive gave an overview of the services provided and the governance and assurance
systems in place. The service friends and family test indicates 91.7% of users would recommend the service. A number of
service improvements were discussed including drop-in sessions, education groups, telephone assessment and low back
pain start questionnaire.
• Tissue Viability Deep Dive gave an overview of the service and the governance and assurance systems in place. The
service provides specialist community care to enable patients with complex / chronic tissue viability needs to achieve quality
of life and independence. The service sees approximately 350 patients per month and meeting waiting time targets for 97%
of patients. The service is meeting performance and quality targets and monitors three clinical outcomes.
• The clinical audit report provided assurance that the Trust was participating in the mandatory national audits and reporting
these in the Trust Quality Accounts. It was noted positively that there are a number of audits being undertaken by non-
medical staff and these will be presented at future CQRG meetings.
• After a six month period of internal monitoring of the speech and language therapy waiting times performance there are no
reported breaches and enhanced monitoring was stood down.
• The Trust has provided the necessary information requested by the Care Quality Commission in the Provider Information
Return in line with inspection guidance and confirmed that focus groups have commenced. The final inspection date is yet
to be finalised.
• The Trust reported a serious incident on the 6th January in relation to patient referrals to the Barnet single point of access
(SPA) being found in old un-accessed email boxes, affecting speech and language; integrated care therapy and early
supported discharge services. This could result in a potential delay to treatment. Overall 93 patients were affected and
immediate actions have been taken to ensure further incidents cannot occur. All patients / referrals are being actively
managed and a harm review will be undertaken. To date no harm has been identified.
49
Community & Children (CLCH)
10
Central London Community Healthcare (CLCH) Children
The second Children’s service specific CQRG was held November 2019. Key highlights as below;
• Initial Health Assessments (IHA) Looked After Children (LAC) will be a standing agenda item due to a significant drop in
performance.
• The new Children’s Services Report was discussed. Current data are not Barnet specific but will be amended for next
iteration.
• The data presented around staff vacancy rate (clinical), staff turnover rate (clinical) and the sickness absence rate shows
CLCH underperforming against the targets, however Barnet team vacancy rates are not presenting concern.
• CLCH have highlighted as a risk, the demand for continuing care assessment within the complex care team in the children’s
due to limited staffing capacity. Children’s commissioners have requested a demand and capacity study to understand these
issues.
• CLCH reported that they have started the eye screening service mobilisation process, the go-live date is set for the 1 March
2020.
50
11
Royal Free London – Community paediatric services
The CCG have issued a contract performance notice (CPN) to RFL regarding wait times to first appointments and autistic
spectrum condition (ASC) assessments. RFL are developing an action plan to be reviewed by the CCG at performance meetings,
looking at demand and capacity. There has been an improvement of performance against the education health and care plan
(EHCP) 20 week timeline, which has been within the required timeframe for the past 12 weeks.
The CCG have funded additional capacity in Royal Free London and Barnet, Enfield and Haringey (BEH) Mental Health Trust to
address the waiting list for autism spectrum disorder (ASD) assessments for CYP under 7 years old. BEH have taken on the
assessments for 5 – 7 year olds waiting for assessments. The recovery plan started in December 2019 and will be completed by
April 2020.
Following the successful waiting time initiative in Q4 of 2018-19, BEH experienced an increase in referrals for autistic spectrum
disorder assessments. This led to consultant time (as part of the neurodevelopmental pathway) increasing and will continue to be
monitored. As BEH have redesigned access to CYP MH provision, CYP waiting for an ASD assessment would have received an
initial assessment and intervention from BEH.
Post-discharge support is being developed for families where a child has received an ASD diagnosis. This is being developed by
BEH in partnership with a wide range of partners including NHS, voluntary sector and parents.
A successful ASC strategic group was organised by the CCG and held in October; this included providers, parents and
stakeholders and focused on a borough-wide redesign of the ASC diagnosis pathway. The CCG have organised the next ASC
strategic group meeting for the end of January. The CCG, with the council, will be coproducing (with families) a borough wide
ASC strategy. Barnet’s Health & Wellbeing Board is completing a deep dive of supporting people with Autism in Barnet, which will
inform the Children’s Autism Strategy and Children’s / Adults Action Plan planned, to be signed off by May 2020.
Key points to note
Small Contracts: Quality update
51
12
Cricklewood Walk in Centre (WiC)
Key points to note
Small Contracts: Quality update
52
13
Integrated Wheelchair Services (AJM Healthcare) – NHS West London Clinical Commissioning Group is the Co-
ordinating Commissioner
RTT 18 week breaches numbers are expected to reach zero by 31 March 2020.
Performance on 18 week breaches has been steadily improving. The chart shows the proportion of the open waiting list that is
within 18 weeks, split by adults and children. Performance was 91% for children and 78% for adults on 6 January 2020. The
overall waiting list size has also reduced and is within the trajectory to reach the target of 1,700 by 31 March 2020 (down from
2,368 at the end of June 2019). Service users with the longest waits have been prioritised.
AJM submit weekly updates on performance and contractual review meetings are held monthly.
Key points to note
Small Contracts: Quality update
53
14
Inhealth NCL Diagnosis - NHS Camden is the co-ordinating Commissioner
The last contract review meeting took place on 11 Dec 2019 to review Q2 2019-20 data. There were no serious incidents (SIs) or
never events. There was a slight increase in incidents regarding violence or aggression from patients and InHealth have
responded by providing conflict training and a no-blame culture to increase incident reporting from staff. The service continues to
meet their KPI turnaround times, however, there was a slight decline in echocardiography 20 working day investigation time due
to capacity issues which are being addressed.
The current contract with InHealth was extended from June 2019 to March 2020 to allow for the NCL-wide procurement process,
which was taking place. As of Oct 2019, the NCL procurement committee confirmed that the procurement has been abandoned in
view of the changes happening at NCL level and medium term financial strategy. NCL procurement has therefore extended the
current Inhealth service for another year in 2020-21 while the review of NCL service needs is taking place.
Optegra
Optegra and Barnet CCG agreed the contract value and year 2 baseline, and the contract is now signed.
A clinical telephone advice line (office hours) will be launched upon finalisation of this agreement.
There has been one further complaint this quarter - due to the referral process and a delay due to a national eRS failure.
Key points to note
Small Contracts: Quality update
54
15
North East London Foundation Trust (NELFT) – integrated children’s therapies
The following areas were discussed at the Contract Performance meeting held 9 December 2019:
18 week waiting times standards for Initial Health Assessments: The provider has arranged a winter recovery plan using staffing
capacity released during Christmas school holiday time to continue to address the backlog of assessment waiting times.
Waiting times for education, health and care plan (EHCP) assessment. Successful delivery recorded (within 6 weeks) and at
100%, since October 2019 half term.
A CPN was issued at the Q1 2019-20 mid-point contract meeting. It was agreed with the Trust that this will enable commissioners
and the Trust to meet monthly and work jointly on a remedial action plan. Monthly meetings will continue in anticipation that the
performance for waiting times are reduced to within 18 weeks by March 2020.
Contract Change Proposal - The Trust provided an update on the new implementation model, which it had shared initially in June
2019. The proposal has a strong focus on integrated pathway delivery linked to a clinical prioritisation matrix. The workforce
consultation was completed in September 2019, with the aim of full implementation of teams and pathways from September
2019. Details are being regularly reviewed at contract performance meetings and monthly meetings between commissioner and
provider operational lead.
Discussions are ongoing between London Borough of Barnet, NELFT and Barnet CCG regarding the full mobilisation of the
service and timescales, with particular focus on handover of private provider provision. EHCP case list validation was completed
by Education, with 600 cases identified and transferred from Local Authority to NELFT Barnet Children’s Integrated Services in
July 2019. An action plan for the management and integration of these cases is underway. Issues for special and mainstream
schools are being reviewed. A clear communication action plan is in place which includes updates to schools Head teachers and
Special Educational Needs Coordinators [SENCos], updates on the Barnet Local Offer and regular focus groups with
parents/carers.
It was agreed at the Q4 2018-19 contract meeting that mobilising the Social Care Occupational Therapy element of the joint LA &
CCG contract, would formally be paused to enable the service to focus on issues above. This was reconfirmed at the September
Q1 2019-20 contract meeting. The position remains the same.
Key points to note
Small Contracts: Quality update
55
16
Gynaecology Partnership Limited (provider of the community gynaecology service)
The CCG’s last quarterly contract review meeting took place on 6 November 2019. Commissioners have been working with the
service to optimise the reporting of key performance quality indicators (KPIs) which now include performance metrics as well as
additional KPIs. No complaints, incidents or SIs were received in the last quarter and the service continues to be well used and
receives good patient feedback.
The contract value and mechanism for 2019-20 has been agreed and signed by both CCG and provider. The newly implemented
Barnet Community gynaecology service rapid access hysteroscopy service went live in August 2019 for patients with suspected
cancer and the service is reporting good month on month usage.
The clinical lead had raised concerns about the national campaign against painful hysteroscopies to ensure that the service is
ensuring that patients are duly informed about the risks of hysteroscopy and clear about the options for pain relief. The service
has updated their patient leaflet and at the CRM the service provided some recent surveys which showed a noted improvement in
expectation of patients of the procedure before hysteroscopy and their experience after.
Marie Curie Hospice Hampstead (MCHH)
No further quality issues have been reported since the last Governing Body.
Key points to note
Small Contracts: Quality update
56
17
Key points to note
Co-commissioned providers: Quality update
Barnet, Enfield and Haringey Mental Health Trust (BEHMHT)
Mandatory training performance has reduced slightly. This is partly due to a number of new starters and large numbers of staff
coming out of compliance at the same time. The Trust is addressing this and increasing the number of seminars available. An
updated position regarding performance will be provided in February 2020.
There are currently waiting time delays in Enfield IAPT service for second appointments. Patients who are waiting are being
risk assessed. This is not impacting on Barnet.
The Trust has been accepted by the Flow Coaching Academy which aims to improve patient flow and bed management. They
are the first mental health trust to be accepted onto the programme.
An update regarding progress with the CQC inspection action plan is expected to be given at the January 2020 CQRG.
Royal National Orthopaedic Hospital (RNOH)
Many SI investigations are currently not being concluded and reported within the 60-day limit. The RNOH investigation team is
running additional root cause analysis (RCA) training to also improve the quality of reporting. Commissioners are meeting with
RNOH to support improvements.
The RNOH CQRG format has changed to a three month rotational format comprising: a traditional meeting; a teleconference
meeting and a site visit.
57
Mental Health – Improving Access to Psychological Therapies (IAPT)
18
Recovery
Recovery above the 50% target has been sustained throughout 2019/20 except
for May’s performance where only 48% recovery was achieved.
Access
• Access continued to be below target in November 2019 due to lower numbers
of referrals and available staffing.. However, local data for December 2019
and January 2020 shows performance was above the access target
compensating for shortfall earlier in the year.
Out Of Area Placements (OAP)
• There were 495 OAP days for Barnet patients in Nov 2019,
• To support Barnet Enfield and Haringey Mental Health Trust to deliver zero
OAPs by March 2021 (a national ambition), a range of initiatives are
occurring. These include CRHT expansion, and a new ward (Shannon)
opened in Dec 19.
Key points to note
• MIB IAPT service go live Q4 19/20
• Continued expansion of core provision in 2019-20 in line with new investment
provided
Actions / next steps
Current Performance
40%
45%
50%
55%
60%
Recovery
rate
IAPT Recovery Rate Performance
0
100
200
300
400
500
600
700
800
900
Access N
um
bers
IAPT Access Performance – Number Entering Treatment
Access Achieved Access Target
58
NHS Oversight Framework
19
Update on key metrics and changes
59
NHS Oversight Framework
20
The new NHS Oversight Framework is the new method of assessment for CCGs and providers in England. This is replacing the CCG Improvement and Assessment Framework (CCG IAF). It aims to bring together both the provider and commissioner assessment methods to reflect the more combined regulatory structure and also the development of STPs and ICSs.
This approach in 2019-20 is a first iteration of a more joined assessment framework. The aim is to have a new framework for thehealthcare system by 2020/21 that balances system development, performance management and incorporates measures from the NHS Long Term Plan Implementation Framework.
Assessment Metrics
There are now 59 metrics used for the assessment of CCGs, including seven new measures:
The metrics no longer in use are:
.
Metric Description
Reducing the rate of low priority prescribing
Children and Young People, and Eating Disorders investment as a percentage of total mental health spend
Learning disabilities mortality review: The percentage of reviews completed within 6 months of notification
Patient experience of getting an appropriate GP appointment
Overall size of the planned care waiting list
Patients waiting over 52 weeks for planned care
Evidence-based interventions (implementation of the Interventions Policy)
Metric Description
Provision of high quality care: adult social care
Children and young people’s mental health services transformation
Crisis care and liaison mental health services transformation
Mental Health - cardio metabolic assessments
Primary care access - percentage of registered population offered full extended access
Count of the total investment in primary care transformation made by CCGs compared with the £3 per head commitment
Reliance on specialist inpatient care for people with a learning disability and/or autism
60
NHS Oversight Framework
21
Many of the metrics are the same as in the CCG IAF and the measuring is similar. Where there are new measures, they will have to be leads allocated to these areas where appropriate.
Assessment methodology
NHS regional teams and system leaders (where appropriate) will consider a number of factors:
• The extent to which the CCG and/or provider is triggering a concern under leadership capacity and capability, quality of care,
financial management, and/or operational performance.
• Any associated circumstances the CCG and/or provider is facing.
• The degree to which the CCG and/or provider understands what is driving the issue.
• Views of system leadership and governance.
• The CCG’s and/or provider’s capability and the credibility of plans to address the issue.
• The extent to which the CCG and/or provider is delivering against a recovery trajectory.
Based on these, it will be determined what level of support a CCG will require. There are four categories of support offered to
CCGs:
This assessment of required support will run alongside the annual assessment of CCGs for 2019/20 as it is still a legal
requirement. The annual assessment will again be based on performance in each of the indicator areas, balanced against
financial performance and leadership assessment. The latest release of data is summarised in the following slides. This shows
both current performance and the change from the last update.
Category Description of support needs
Maximum Autonomy No actual support needs identified across. Maximum autonomy and lowest level of
oversight appropriate.
Targeted Support Support needed but mandated action is not considered needed.
Mandated Support The CCG has significant support needs and is placed in the dedicated support regime.
Special Measures The CCG is failing or at risk of failure with very serious/ complex issues that mean it is
placed under legal directions.
61
NHS Oversight Framework
22
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period Oct-19 Trend
103aDiabetes patients that have achieved all the NICE-recommended treatment targets
2017-18 37.3% l
107aAntimicrobial resistance: appropriate prescribing of antibiotics in primary care
0.965 2019 08 0.77
107bAnti-microbial resistance: Appropriate prescribing of broad spectrum antibiotics in primary care
10% 2019 08 12.4%
108aThe percentage of carers with a long term condition who feel supported to manage their condition
1 2019 0.49
121a Provision of high quality care: hospitals 19-20 Q1 61.0
121b Provision of high quality care: primary medical services 19-20 Q1 66 l
128b Patient experience of GP services 2019 78.2%
128d Primary care workforce 2019 03 0.91
Primary Care
62
NHS Oversight Framework
23
Mental Health
RefImprovement and Assessment Framework (IAF) Measures
Target / Standard
Latest Measurement Period
Oct-19 Trend
123a Improving Access to Psychological Therapies - recovery 50% 19-20 Q1 53.3%
123b Improving Access to Psychological Therapies - access 4.94% 19-20 Q1 5.0%
123cPeople with first episode of psychosis starting treatment with a NICE-recommended package of care treated within 2 weeks of referral
53% 2019 08 82.1%
123fMental Health Out of Area Placements (inpatient bed days per 100,000 population)
2019 07 315
123g Mental Health - health checks 19-20 Q1 21.8%
123i Mental Health - Investment standard 19-20 Q1 Compliant l
123jMental Health - quality of data submitted to NHS Digital (DQMI)
2019 07 70.3
124bProportion of people with a learning disability on the GP register receiving an annual health check
2017-18 63.6% l
124c Completeness of the GP learning disability register 2017-18 0.38% l
126a Estimated diagnosis rate for people with dementia 66.7% 2019 09 74.8%
126b Dementia care planning and post-diagnostic support 2017-18 78.3% l
63
NHS Oversight Framework
24
Other
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period
Oct-19 Trend
102aPercentage of children aged 10-11 classified as overweight or obese
2015-16 to 2017-18 33.2% l
103bPeople with diabetes diagnosed less than a year who attend a structured education course
2017-18 (2016 cohort)
2.6% l
125c Choices in maternity services 2018 63.4 l
125d Maternal smoking at delivery 6% 19-20 Q1 3.89%
64
NHS Oversight Framework
25
Planned Care
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period Oct-19 Trend
122a Cancers diagnosed at early stage 53.5% 2017 53.0% l
122bPeople with urgent GP referral having first definitive treatment for cancer within 62 days of referral
85% 18-19 Q4 75.6% l
122c One-year survival from all cancers 75.0% 2016 77.0% l
129aPatients waiting 18 weeks or less from referral to hospital treatment
92% 2019 03 89.2% l
133a 6 week diagnostics (new) 1% 2019 09 9.9%
144aUtilisation of the NHS e-referral service to enable choice at first routine elective referral
2019 07 99.9%
65
NHS Oversight Framework
26
Quality
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period
Oct-19 Trend
105bPersonal health budgets (per 100,000 CCG responsible population)
19-20 Q1 87.9
122d Cancer patient experience 2018 8.7
125a Neonatal mortality and stillbirth 2016 4.9 l
125b Women’s experience of maternity services 2018 81.3 l
130aAchievement of clinical standards in the delivery of 7 day services
2017-18 2.0 l
131aPercentage of NHS Continuing Healthcare full assessments taking place in an acute hospital setting
15% 19-20 Q1 11%
132aEvidence that sepsis awareness raising amongst healthcare professionals has been prioritised by the CCG
2018 Green l
66
NHS Oversight Framework
27
UEC
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period
Oct-19 Trend
104aInjuries from falls in people aged 65 and over (per 100,000 CCG registered population)
19-20 Q2 1,668
105cPercentage of deaths with three or more emergency admissions in last three months of life
2017 7.4% l
106aInequality in unplanned hospitalisation for chronic ambulatory care sensitive and urgent care sensitive conditions
18-19 Q2 1,508 l
127bEmergency admissions for urgent care sensitive conditions (per 100,000 registered population)
19-20 Q2 1,510
127cPercentage of patients admitted, transferred or discharged from A&E within 4 hours
95% 2019 03 86.7% l
127e Delayed transfers of care per 100,000 population 2019 09 9.1
127fPopulation use of hospital beds following emergency admission (per 1,000 population)
18-19 Q2 425.1 l
67
NHS Oversight Framework
28
Corporate
Ref Improvement and Assessment Framework (IAF) Measures Target /
Standard
Latest Measurement Period
Oct-19 Trend
141b In-year financial performance 19-20 Q1 Red l
145a Expenditure in areas with identified scope for improvement 19-20 Q1 N/A l
162a Probity and corporate governance 19-20 Q1Fully
compliantl
163a Staff engagement index 2018 3.817 l
163b Progress against Workforce Race Equality Standard 2018 0.2 l
164a Effectiveness of working relationships in the local system 2018-19 69.6 l
165a Quality of CCG leadership 19-20 Q1 Amber l
166aAssessing CCG compliance with statutory guidance standards of public and patient participation in commissioning health care
2018 Amber l
68
Barnet Clinical Commissioning Group Governing Body Meeting 2 March 2020
Report Title Month 10 Finance Report
Agenda Item 3.4
Governing Body
Sponsor
Simon Goodwin, CFO of NCL CCGs
Email [email protected]
Lead Director /
Manager
Matt Backler – Director of Finance, Barnet CCG
Email [email protected]
Report Author
Bev Tipping – Head of Finance, Barnet CCG
Email [email protected]
Report Summary
At month ten (M10) the CCG has held its forecast to the planned £6.7m deficit, however there remain material risks to delivery. As work is being undertaken at Barnet and across NCL to seek mitigations the FOT remains to plan. At M10 the CCG has included a £1.6m mitigation adjustment to bring the position back to plan. The mitigation required has increased since the prior month due to an additional £0.4m of GP@Hand costs. The year-to-date position is an £8.3m deficit (£1.1m adverse to plan). The year to date position is higher than the full year forecast due to phasing impacts. Delivery of the Quality, Innovation, Productivity and Prevention (QIPP) Programme is forecasting delivery £17.5m (96%) of its £18.2m target. The CCG has net risk of £3.6m. Best and worst case analysis has identified a range of circa £6.7m to £10.0m deficit. Due to the level of risk and given the plan does not include any contingency the best case now would be delivery of the planned £6.7m deficit.
Recommendation The Governing Body is to NOTE the 2019/20 Finance position
Identified Risks
and Risk
Management
Actions
The financial risks are set out in the report and are managed through general principles of financial control (reporting, challenge, recovery plans etc). Financial risk is included in the GBAF
Conflicts of Interest
Not Applicable
69
Resource
Implications
Resourcing implications agreed with finance team. These have been be
approved as part of the 2019/20 QIPP Planning Process.
Engagement
The finance report is built up through engagement with budget holders in determining the financial position
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
• The detailed finance report is presented each month to the Clinical Commissioning, Finance and QIPP Committee
• A summary finance report is presented at each Governing Body
Next Steps Continue to monitor the financial position
Appendices
None
70
Finance Report 2019-20Month 10 (January 2020)
Lead Director: Matt Backler
Author: Beverley Tipping
71
Finance Report 10
At M10 NCL CCGs are forecasting a £46.0m deficit (compared to the planned £41.0m deficit).
1
• At month ten (M10) there is an adverse Year to Date (YTD) variance of £5.2m.
• Enfield and Haringey CCG are no longer forecasting achievement of their planned deficits. Enfield is forecasting
£17.9m (compared to a planned £15.4m) and Haringey is forecasting £16.6m (compared to a planned £14.1m).
• Therefore the M10 forecast outturn (FOT) across NCL commissioners is £5.0m adverse to the planned £41.0m
deficit.
• There is an overall net risk of (£6.5m) to the achievement of NCL CCG financial plans
• There is a YTD QIPP variance of £8.5m and a FOT QIPP variance of £9.2m.
NCL M10 summary Financial Position
Source: Non-IFSE return M10
Annual
Plan YTD Var. FOT Var. YTD Var. FOT Var.
19/20
Plan FOT
Barnet (6.8) (1.1) - (0.6) (0.7) (3.6) (6.8) (9.1)
Camden (4.8) 0.0 - (0.7) (0.7) - (4.8) (5.9)
Enfield (15.4) (2.1) (2.5) (2.7) (2.7) (1.6) (15.4) (20.4)
Haringey (14.1) (2.0) (2.5) (2.4) (3.1) (0.3) (14.1) (16.5)
Islington - - - (2.2) (2.0) (1.0) - (3.3)
Total (41.0) (5.2) (5.0) (8.6) (9.2) (6.5) (41.0) (55.2)
Prior month (41.0) (1.3) (5.0) (8.5) (8.5) (6.6) (41.0) (57.3)
Bottom line QIPP Underlying position
Net risks
72
Finance Report 10
At M10 the CCG is forecasting to deliver its planned £6.7m deficit, however in line with previous months there remain material risks to delivery.
2
Executive Summary
Summary
• Forecast: At M10 the forecast is the planned £6.7m deficit, however there remains material risks to delivery. Work is being undertaken locally and across NCL to seek mitigations.
• At M10 the CCG has included a £1.6m mitigation adjustment to bring the position back to plan.
• Year to date: £8.3m deficit compared to a £7.2m planned deficit. The year to date position is higher than the full year forecast due to phasing impacts. This is mainly driven by the mitigation actions as these are phased to occur in the last few months of the year.
• Acute: Forecast to overspend by £2.5m. This is driven by overspends in Royal Free and Whittington offset by underspends in out of sector acute and non-contract activity.
• Non-acute: Non-acute is forecasting a £3.4m overspend driven by overspends in mental health, learning disability high cost placements and prescribing.
• Corporate: Forecasting to be £5.8m below plan. £1.6m of this is the mitigation adjustment referred to above. The remaining variance is due to a number of staffing vacancies and slippage in expected cost pressures.
• QIPP: The CCG is forecasting to achieve £17.5m (96%) of the QIPP target of £18.2m. YTD QIPP delivered is on plan at £14.1m (£0.6m adverse to plan).
Acute performance (£m)
Bud Actual Var Bud FOT Var
£m £m £m £m £m £m
Royal Free 168.7 169.7 1.1 201.3 202.6 1.3
UCLH 23.4 23.5 0.1 27.9 28.0 0.1
Other acute 65.5 65.7 0.2 78.6 79.7 1.1
Total Acute 257.6 258.9 1.3 307.9 310.4 2.5
Prior month 231.3 232.4 1.1 307.8 309.9 2.0
Trust / Service
YTD Full Year
73
Finance Report 10
At M10 QIPP is forecast to deliver £17.5m of the full year £18.2m target.
QIPP
74
Finance Report 10
At M10 the net reported risk for the CCG is £3.6m (prior month £3.2m)
4
Risk & Mitigations
• The value of risk has increased by £0.4m since the previous month due to an increase in GP@Handcosts, this has in turn increased the mitigation required to bring the CCG back to plan.
• The most material risk in previous months related to Royal Free over performance. This has now been mitigated as a year end deal has been agreed with Royal Free which is shown in the position.
• Worst case scenario shows a potential deficit of £10.4m if all the risks materialise, given the level of risk the best case would be the achievement of the planned £6.7m deficit.
RisksPrevious
Month Risk
£'000
Previous
Month Risk
Emergent
Risk at M10
£'000
Emergent Risk
at M10Description
FOT (6,747) (6,747)
Acute over-performance (902) Med (902) Med Out of sector acutes perform above budgeted growth assumptions. This has been a problem historically
however significant levels of growth in line with historical trends have been budgeted to mitigate this
CHC (639) Med (839) Med Continuing Healthcare is an on-going risk, however the risk is lower than in previous years due to detailed
budgeting and additional controls put into place in the second half of 2018/19.
GP at Hand (200) High At M10 NHSE has adjusted the CCG allocation by £0.7m, and the CCG has assumed a further £0.2m will
be taken by year end, which we have shown in the position.
QIPP risk - Low - Low
RTT 52 week waits (40) Low (40) Low Fines relating to 52 week wait breaches reported as risk while we await national guidance on treatment
Prescribing (293) Med (293) Med NCSO Costs
Mitigation Actions (1,200) High (1,600) High There is a risk mitigiations will not be achieved.
Total - risk (3,274) (3,674)
Worst case (10,021) (10,421)
Likely Case (9,476)
Best Case (6,747) (6,747)
75
76
Barnet Clinical Commissioning Group Governing Body Meeting 19 March 2020
Report Title Budget setting 2020/21 Draft Budget
Agenda Item 3.5
Governing Body
Sponsor
Simon Goodwin, CFO Tel/Email [email protected]
Lead Director /
Manager
Matt Backler – Director of Finance
Tel/Email [email protected]
Report Author
Bev Tipping – Head of Finance Tel/Email [email protected]
Report Summary
The report sets out NCL CCGs draft financial planning as at 05 March 2020, including a view of Barnet CCG. The NCL draft budget was submitted to NHSE on 5 March 2020. NCL CCG submitted a budget with a deficit of £59m, Barnet CCG representing £6.6m of this deficit. There may be additional requirements from NHSE/I which may further change the position as the NCL position has not been accepted yet. However this represents the most realistic position and is still very stretching.
Recommendation The Governing Body is asked to APPROVE the 2020-21 Draft Budget
Identified Risks
and Risk
Management
Actions
The value of potential gross risks reported outside of NCL CCG’s financial position total £28.7, offset by £14.6m mitigations, indicating a net risk position of £14.6m.
Conflicts of Interest None arising from this paper.
Resource
Implications
As shown in the budget paper, in particular, please note the cost pressures
and deficit plan.
Engagement
The Budget has been built up with engagement with:
Directorates - cost pressures
Director of QIPP Planning and Performance – QIPP plan and activity trajectories
NCL central team – tariff and other assumptions
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
This is the first draft of the 2020-21 budget
Next Steps To monitor the financial position against the planned budget
Appendices None – the main report follows
77
78
Barnet CCG - 20/21 Budget setting update
Matt Backler Director of FinanceMarch 2020
79
Contents
2
Title Slide #
Section 1 NCL CCGs overview
Overview of 20/21 Planning guidance 4
NCL Draft Budget 5-6
Section 2 Barnet CCG
Movement in the underlying position from 19/20 FOT to 20/21 8
20/21 Budget setting assumptions 9
Bridge from opening underlying position to 20/21 Plan 10
I&E summary 11
80
Section 1: NCL CCGs overview
381
4
20/21 Planning guidance – Areas of Impact for NCLPlanning guidance for 2020/21 is a milestone for delivery of the NHS Long Term Plan, with the NHS planning to deliver the 2020/21 elements of the NHS Long Term Plan commitments, which local systems have developed through their strategic plans.
NCL will have to consider the below areas in further developing plans for 2020/21:
• Delivery of the planning guidance within the NCL medium term financial strategy, and the requirement for delivery of investment standards in community, mental health and primary care services to support a reduction in acute hospital and overall system costs;
• A focus on reducing system costs, noting that 50% of the Financial Recovery Fund will now be tied to overall system financial performance rather than the performance of individual organisations;
• Reducing local bed occupancy levels to 92% from current levels in the high 90’s, with any addition to acute bed capacity based on running an efficient urgent and emergency care system (investing in same day emergency care, rapid response, alternative carepathways to ambulance conveyance to emergency departments and discharge capacity to facilitate bed occupancy reductions);
• The need to maintain waiting list sizes within January 2020 levels by January 2021 and in-year resolution of 52-week waits at Royal Free London including options for mutual aid across NHS Trusts in NCL;
• Increasing capacity in general practice and supporting the development of primary care networks;
• Delivery of existing commitments for 2020/21 set out in the Long Term Plan, including:o Further reductions in inpatient placements and improved coverage of health checks in general practice for people with Learning
Disabilities and Autism; o Extending access to psychological therapies in mental health services
• “System as default” – agreeing STP models for system and provider oversight with NHS London in preparation for the introduction of Integrated Care Systems from April 2020/21.
82
5
Combined NCL positionThe top table shows the NCL draft budget, which was submitted to NHSE on 5 March 2020. The CCG submitted a budget with a deficit of £59.1m.
The forecast outturn (FOT) for 19/20 is a £46.0m deficit, however the underlying position is £10.5m worse than this at £56.5m. As such the 20/21 plan is a deterioration of £2.5m
The CCG is planning to deliver the required investment standards in mental health services, community services and primary care. In addition to this, the CCG is planning to operate within the 2020/21 running cost allocation.
The plan includes assumptions around growth and inflation. Efficiencies are also built into the draft plan.
Borough splitThe bottom table shows the deficit by each of the five existing NCL CCGs. Of the £59.1m deficit Barnet accounts for £6.6m which is the same as the plan for the current year.
NCL CCG Draft 20/21 Budget
83
6
NCL CCG Risk and Mitigations
In addition to the £59m deficit NCL CCG has also identified net financial risks of £14.6m, as highlighted in the above table. The identified risks include:
• Cost pressures within out of sector trusts.
• Growth within prescribing and continuing healthcare.
• Pressures on Primary Medical care contracts.
At present these risks outweigh the mitigations from contingency and possible changes to allocations.
84
Section 2: Barnet CCG
785
8
Movement in underlying position from 19/20 FOT to 20/21
1 1 2 3
A number of these costs and
allocation will repeat but have been
split out for completeness.
Note - cancer is a pass through
payment to the cancer alliance.
Income Costs
Cancer 5,563 5,563
Overseas visitors (252) (252)
GP@Hand (M9) (537) (537)
BCF non-recurrent funding 408 408
Cytology (148) (148)
Other 2,230 2,230
7,264 7,264
Non-recurrent adjustments of £1.0m.
Made up of:
• £1.3m non-recurrent mitigations in
19/20 FOT
• £1.2m for the Royal Free Contract
(up to Cap value)
Both of these were non-recurrent
benefits in 2019/20.
Offset by:
• Assumption of £1.0m of income for
extended access contract
• £0.5m of other individual small
items
1 2 3
Other full year effects of £1.8m.
The main driver of this is £1.2m of
signed off business cases rolled
over from 19/20. These are included
in QIPP plan as rollover with
savings attached.
The CCGs underlying position is a
£9.5m deficit.
4
4
86
9
20/21 Budget setting assumptionsBudget heading 20/21 high level assumptions
Core allocation growth B 4.43%,C 3.2%, E 4.3%, H 4.83%, I 3.72%
Primary Medical allocation B 4.87%,C 4.69%, E 4.44%, H 4.38%, I 4.83%
MHIS 1.7% above core allocation growth
Additional LTP allocations (NCL) £2.2m Mental Health, £13.8m Primary Care, £0.8m Ageing Well, £2.5m Cancer, £1.1m
Other, £20.4m in Total (these allocations are not included in the 20/21 operating plan
return)
CS/PC investment Equivalent to core allocation growth
In sector Acute SLA values as set out in letter from TJ/SG/SM dated 9th January.
2% above 19/20 plan (adjusted for 19/20 alignment gaps and 19/20 agreed in-year contract
variations).
Out of sector acute 2% growth on 19/20 plan (with 1% reserve) less CCG shares of contract challenge,
repatriation and activity management action targets
London Ambulance 5.4% based upon latest information
In sector NHS non-acute 2% uplift on 19/20 plan - subject to investment agreed via System Delivery Board.
Non-NHS Nil uplift
Hospices 2.9% as per national AfC uplift assumption
CHC 5% net of QIPP (assuming 5% QIPP)
GP prescribing 4% net of QIPP (assuming 3% QIPP)
GP LES 1.3% as per draft tariff
Local Authority 2.9% as per national AfC uplift assumption – though writing to LAs to inform nil uplift.
Corporate non-running pay e.g.
clinical/transformation posts
2.9% as per national AfC uplift assumption
GP IT 2.9% as per national AfC uplift assumption
Other incl. Estates 2%
Running costs £5.4m reduction. 87
10
Bridge from opening underlying position to 20/21 Plan
Tariff, growth and allocation as set out
in the assumptions slide. The CCGs
allocation has reduced by £0.7m since
the published version mainly due to
GP@Hand adjustments.
Includes £2.8m of mandated
contingency.
The total cost pressures are £5.4m,
however this is off set by £2.0m of
assumed savings mainly made up of:
• £1.5m out of sector acute contract
challenges assumed per the LTP.
• £0.4m adjustment to In Sector
acute to get to contract envelope.
Net QIPP here refers to return on investment
savings assumed in the LTP.
• Net QIPP here refers to
• £0.4m – additional reduction in running costs
below allocation (per the LTP)
• £0.1m Diagnostics and GP IT.
Assumptions are net of QIPP hence the general plan
is not shown in the bridge
The CCG draft budget submitted to
NHSE on 5 March 2020 shows a
£6.6m deficit. It is expected that
NHSE will not agree this budget.
1
1
1 32 4
2 3
Investment Reserve of £2.2m:
• £1.2m Mental Health
• £0.9m Community
This is uncommitted funding required
to meet the investments standards
and forms part of the investment fund.
5
4
1
5
88
11
I&E summary
Overall CCG positionThe Barnet Borough summary budget is set out in the table.
There is an increase in allocation of £24.1m compared to the underlying 19/20 position, of this:• Acute: £4.3m is increased spend in acute (The acute growth is
so low due to the additional MTFS targets in out of sector set against the “Acute Other” line)
• Non-acute: the overall increase is £13.9m representing the spend based on investments standards and expected growth in areas like prescribing and continuing care.
• Corporate: costs have increase by £3.0m which is driven by re-establishing the contingency
• Deficit: has improved by £2.9m
There may be additional requirements from NHSE/I which may further change the position as the NCL position has not been accepted yet. However this represents the most realistic position and is still very stretching.
Underlying Plan Change
£'000 £'000 £'000
Allocation 587,897 612,028 24,131
Acute - in sector 256,918 261,627 4,709
Acute - out of sector 30,405 31,014 608
Ambulance 14,928 15,734 806
Other 8,162 6,371 (1,791)
Acute Total 310,414 314,745 4,332
Mental Health 54,685 57,527 2,841
Learning Disabilities 5,784 6,128 344
Childrens Services 2,097 2,464 367
Continuing Care 32,626 34,257 1,631
Community Services 62,932 66,006 3,073
Prescribing 49,602 51,578 1,976
Primary Care 58,605 62,135 3,529
Other non-acute 4,208 4,338 130
Non-Acute Total 270,539 284,432 13,893
Programme 8,670 9,324 654
Running 7,780 7,345 (435)
Contingency - 2,787 2,787
Corporate Total 16,450 19,456 3,006
Expenditure 597,402 618,633 21,231
Surplus/(Deficit) (9,505) (6,605) 2,900
(1.6%) (1.1%)
89
90
Barnet Clinical Commissioning Group
Governing Body Meeting
19 March 2020
Report Title Governing Body Board Assurance Framework
Agenda Item 3.6
Lead Director /
Manager
Kay Matthews, Chief Operating Officer, Barnet CCG
Tel/Email [email protected]
GB Member Sponsor
Helen Pettersen, Accountable Officer
Report Author
Chris Hanson, Governance and Risk Lead NCL CCGs
Tel/Email [email protected]
Name of
Authorising
Finance Lead
Not Applicable
Summary of Financial Implications
The GBAF report assists the CCG in managing its most significant financial risks.
Report Summary
This report is the Governing Body Board Assurance Framework (‘GBAF’). It captures the most serious risks that have been identified as threatening the achievement of Barnet CCG’s five strategic objectives. Key risks from the North Central London Primary Care Co-Commissioning Committee in Common (‘NCL PCCC’) risk register, NCL Joint Commissioning Committee (‘NCL JCC’) risk register and NCL Risk Register are reported to the Governing Body to ensure visibility and oversight. Risks from the NCL JCC risk register and the NCL risk register are from an NCL perspective. However, risks from the NCL PCC risk register can be from either a local perspective or a pan NCL perspective depending on the risk. Board Assurance Framework (‘GBAF’) There are 3 risks that reach the threshold of 15 or higher for inclusion on the GBAF. 3 risk scores have remain unchanged, and 1 risk score has reduced below the GBAF threshold. The full version of the GBAF can be found here. Key Highlights: GBAF20: Failure of Royal Free London Hospital to Meet NHS Constitutional Standards Trajectory e.g. A&E, RTT and 62 Day Waits in 2019/20 (Threat). This risk has been defined to refer to the financial year 2019/20 only, however, as an ongoing risk the historical data has been retained to demonstrate performance over time. Performance against cancer targets is variable, however improvements in clinical pathways are being made (particularly lower Gastrointestinal). There is significant risk to the recovery of the Referral To Treatment (‘RTT’) standard in the shorter
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term given suspension of national reporting and operational issues. A&E performance is challenged due to operational capacity. To address these issues Barnet CCG continues to work closely with Royal Free London and is leading on joining up performance management across the system by inviting key stakeholders such as NHS England and NHS Improvement to the Barnet CCG led Performance Review Group meetings. Recovery actions are being linked to wider system transformation plans to ensure sustainable position going forward. The risk remains high despite mitigating actions taken by the CCG. This risk remains rated at 16. GBAF21: Failure to ensure that quality and patient safety are maintained at the Royal Free London (Threat). The never events action plan and associated Contract Performance Notice, approved for closure by the Quality and Performance Committee, was formally closed at the January 2020 CQRG. The Patient Safety Strategy, launched by the Trust, identifies the element of human factors as an area for ongoing review. This will be monitored through the Trust’s audit and be the subject of presentations/updates to the CQRG during 20/21. The CQC action plan is in place to address quality and safety issues and it has been agreed this will be for quarterly review via Clinical Quality Review Group. As of December 2019 Trust reporting that on track to deliver all actions in the CQC action plan. Next review March 2020. The risk remains rated at 15. CRR1: Failure to Deliver 2019/20 Statutory and Other Financial Requirements Set By NHS England (Threat). At Month 10 the CCG has held its forecast to the planned £6.7m deficit, however this includes an assumption of £1.6m of savings / mitigations to get back to the planned deficit. Work is ongoing across Barnet and NCL to seek these mitigations so the forecast remains at planned level. The mitigation adjustment has increased by £0.4m since Month 09 due to an increase in GP@hand costs. The risk remains rated at 20. Risks removed from the GBAF The following risk has reduced below the threshold for the GBAF. It will continue to be monitored below this level: CRR2: Failure to Deliver the 2019/20 QIPP and Transformation Programme (Threat). The 2019/20 QIPP Position at Month 09 reported a net Forecast Outturn achievement of 97% (£17.6). This is broadly in line with the month prior and there has been a few in-year risks with mitigations identified to support expected targets. Monthly RFL-impact NCL QIPP Report Position meetings continue to be held to review monitoring data and ensure reporting consistency. These review meetings are also supported by the Local Delivery Group – where RFL Operational and Transformational leads are in attendance - and locally at the QIPP Delivery Group (QDG) meeting where progress is scrutinised against the key milestones and plans. The 2019/20 NCL QIPP Reporting Template is now being produced by QIPP colleagues further to the NCL training provided. The CCG continues to work closely with NELCSU in supporting the development of the 2020/21 iteration. The risk rating was reduced in January from 15 to 8. This risk continues to be overseen on the CCG’s Corporate Risk Register.
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NCL Risk Register There are 15 risks on the NCL Risk Register with 1 risk having a current risk score of 15 or higher. There is one new risk, and one risk has closed. The full version of the NCL Risk Register can be found here.
Key Highlights: NCL9: Delivering Financial Balance Across NCL CCGs (Threat). For 19/20, the CCGs aggregate financial plan was a combined deficit of £41m, an adverse variance of £33m from Control total with a net additional risk of £22m. The NCL STP is developing a Medium Term financial strategy as part of the STP requirement for the NHS Long term plan. The Medium Term financial strategy will include a plan to bring the NCL STP health economy into balance over the next 3 years with the focus on system-wide schemes that reduce costs of provision. At Month 10, Enfield and Haringey are each reporting a £2.5m adverse variance to plan (£5m in total). The other CCGs are reporting to plan. There is a further risk of deterioration in the reported position but the intention is that this is managed. This risk is rated 20. New Risk The following is a new risk: NCL17: Failure to maintain effective commissioning during Coronavirus outbreak. This is a new risk. Whilst the Coronavirus risk is low to the local population, NCL CCGs are actively supporting London and National responses to the global outbreak. CCGs are supporting Providers responses to reported cases and containment efforts. Whilst there is a risk that this situation, if extended for a significant period of 2020, may impact NCL CCGs' efforts to effect key activities across the CCGs, this situation is under close review. This risk is rated 12. Closed Risks The following risk has now closed: NCL11: Destabilisation as a result of the UK's planned exit from the European Union. A No-Deal withdrawal from the EU no longer a risk further to implementation of negotiated deal on 31 January 2020. NHSE have ceased all assurance requirements. NHSE requirement for ongoing single CCG point of contact in place. Risk now closed. NCL Primary Care Commissioning Committee in Common Risk Register There are 9 risks on the NCL Primary Care Commissioning Committee in Common (‘NCL PCCC’) Risk Register with 2 risk having a current risk score of 15 or higher. There are two new risks. The NCL PCCC Risk Register can be found here. Key Highlights:
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PCCC18: Inadequate support from Primary Care Support England (Capita contract) for general practices (Threat). List Cleaning activities have commenced. There are 6 cohorts being audited: 1. Patients registered over 100 years of age; 2. Under 16 and sole occupant at address following the removal of an adult; 3. Houses of multiple occupancy (10 or more registered residents); 4. Transient Patients; 5. Patients living at an address flagged as demolished on the Post Office Address File; 6. Students who have been registered for four or more years. As of November 2019 Capita are now contacting GP practices/patients for all six cohorts. For cohorts three and four Capita are contacting one third of the population targeting those areas that according to ONS data have high population inflation areas. This includes both Haringey and Camden, but Barnet, Enfield and Islington will not be contacted for cohorts three and four for twelve months. The three-year list reconciliation project began in January 2019 and below are the preliminary dates for NCL CCGs when Primary Care Support England (PCSE) will audit them: • Barnet - 15/06/2020 • Camden - 26/07/2021 • Enfield - 14/06/2021 • Haringey - 07/09/2020 • Islington - 03/08/2020 This risk is rated 16. PCCC26: Failure to manage increased costs due to GP at Hand (Threat). This is a new risk that considers the financial risk to NCL CCG primary care and overall budgets from the introduction of the GP at Hand (Babylon) service. The financial risk accrues from the top-slicing of CCG funds to pay for secondary care services for patients transferring to GP at Hand services, with the funds being transferred to Hammersmith and Fulham CCG as host of the GP at Hand service. The risk to primary care budgets will accrue from any future change to CCG uplifts for any material shift in population from local practices to GP at Hand services. The Committee noted that the establishment of GP at Hand services within NCL is not in accordance with the NCL primary care strategy. Future mitigation of this may include consideration of establishing a local NCL equivalent service. This risk is rated 15. NCL Joint Commissioning Committee Risk Register There are 13 risks on the NCL Joint Commissioning Committee (NCL JCC’) Risk Register with 7 risks having a current risk score of 15 or higher. The NCL JCC Risk Register can be found here. Key Highlights:
JCC13: Failure to manage winter pressures and impact on waiting time standards and capacity for elective pathways (Threat) In addition to mitigations relating to delivery of the four hour A & E waiting time standard, including additional winter funding for most challenged systems, A&E Delivery Boards are delivering plans to improve patient flow:
Plans to reduce extended lengths of stay (over 21 days) by 40% by March 2020 compared to March 2018 with weekly discharge profiles submitted to encourage reducing this patient cohort;
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Delivery of new models for same day emergency care, frailty pathways and discharge-to-assess pathways in line with operating plan priorities;
Plans to reduce ambulance conveyances to emergency departments through alternative care pathways including rapid response, and additional clinical revalidation of low acuity calls to London Ambulance Service;
Additional call handling capacity in the NHS 111 service;
From February 2020 Category 5 (primary care) calls have been transferred from London Ambulance Service to the clinical assessment service run by NHS 111 to help reduce ambulance despatch and increase the use of local alternative care pathways;
Plans to increase GP streaming in emergency departments. This risk is rated 16. JCC28: Failure to support system financial recovery through contracts (Threat) Mitigations include
Agreement of system principles for development of the NCL medium-term financial strategy, and supporting contract principles for 2020/21 with providers;
Triangulation of finance and activity plans within the NCL Long Term Plan with providers supported by the principles above;
Launch event for 2020/21 planning round held in December 2019 sponsored by provider and commissioner system leads;
Cap and collar constructs have been agreed for the contracts with Royal Free London and North Middlesex University Hospital for 2019/20, and a block contract for UCLH in 2019/20 and 2020/21;
Fixed income agreements proposed for 2020/21 with acute providers. This risk is rated 20.
Recommendation The Governing Body is asked to review the GBAF highlight report and provide feedback on the risks.
Identified Risks
and Risk
Management
Actions
The GBAF is a risk management document which highlights the most significant risks to the achievement of the CCG’s strategic objectives.
Conflicts of Interest
Conflicts of interest are managed robustly and in accordance with the CCG’s conflict of interest policy.
Resource
Implications
Updating of the GBAF is the responsibility of each risk owner and their respective directorates. The Governance Team helps to support this by providing monitoring, guidance and advice.
Engagement
The GBAF report is presented to each Governing Body meeting. The Governing Body includes clinicians, lay members and representatives of patients and other key stakeholders.
Equality Impact
Analysis
This report was written in accordance with the provisions of the Equality Act 2010.
Report History
and Key
Decisions
The GBAF was last reviewed by the Governing Body on 19 December 2019 and by the Barnet Senior Management Team (SMT) on 5 March 2020. Risks are kept under review by the risk owners and by the committees of the Governing Body.
Next Steps To continue to manage risk across the organisation in a robust way.
Appendices The following documents are included:
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BAF Risks Highlight Report;
Risk Scoring Key.
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Risk ID Risk Title Risk Owner Strategic Update JUNE SEPT DEC MAR
GBAF 20 Failure of Royal Free
London Hospital to
Meet NHS
Constitutional
Standards Trajectory
e.g. A&E, RTT and 62
Day Waits in 2019/20
(Threat)
Ali Malik Director of QIPP,
Planning and Performance
This risk has been defined to refer to the financial year 2019/20 only,
however, as an ongoing risk the historical data has been retained to
demonstrate performance over time.
Performance against cancer targets is variable, however
improvements in clinical pathways are being made (particularly lower
Gastrointestinal). There is significant risk to the recovery of the Referral
To Treatment (‘RTT’) standard in the shorter term given suspension of
national reporting and operational issues. A&E performance is
challenged due to operational capacity. To address these issues
Barnet CCG continues to work closely with Royal Free London and is
leading on joining up performance management across the system by
inviting key stakeholders such as NHS England and NHS Improvement
to the Barnet CCG led Performance Review Group meetings.
Recovery actions are being linked to wider system transformation plans
to ensure sustainable position going forward.
The risk remains high despite mitigating actions taken by the CCG. This
risk remains rated at 16.
Quality and Perfromance Committee has oversight of this risk.
16 16 16 16 12
GBAF 21 Failure to ensure that
quality and patient
safety are maintained at
the Royal Free London
(Threat)
Jenny Goodridge, Director of
Quality and Clinical Services
The never events action plan and associated Contract Performance
Notice, approved for closure by the Quality and Performance
Committee, was formally closed at the January 2020 CQRG. The
Patient Safety Strategy, launched by the Trust, identifies the element of
human factors as an area for ongoing review. This will be monitored
through the Trust’s audit and be the subject of presentations/updates to
the CQRG during 20/21.
The CQC action plan is in place to address quality and safety issues
and it has been agreed this will be for quarterly review via Clinical
Quality Review Group. As of December 2019 Trust reporting that on
track to deliver all actions in the CQC action plan. Next review March
2020.
The risk remains rated at 15.
Quality and Perfromance Committee has oversight of this risk.
20 20 15 15 8
CRR1 Failure to Deliver
2019/20 Statutory and
Other Financial
Requirements Set By
NHS England (Threat)
Matt Backler- Director of
Finance
At Month 10 the CCG has held its forecast to the planned £6.7m
deficit, however this includes an assumption of £1.6m of savings /
mitigations to get back to the planned deficit. Work is ongoing across
Barnet and NCL to seek these mitigations so the forecast remains at
planned level. The mitigation adjustment has increased by £0.4m since
Month 09 due to an increase in GP@hand costs.
The risk remains rated at 20.
Clinical Commissioning, Finance and QIPP Committee has oversight of
this risk.
15 16 20 20 12
Risk Key
Risk Improving
Risk Worsening
Risk neither improving nor worsening but working towards target
BAF Risks- Highlight Report2019/20
Movement From
Last Report
Target Risk
ScoreCurrent Risk Score
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Risk Key
Risk Improving
Risk Worsening
Risk neither improving nor worsening but working towards target
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Risk Scoring Key This document sets out the key scoring methodology for risks and risk management.
1. Overall Strength of Controls in Place There are four levels of effectiveness:
Level Criteria
Zero The controls have no effect on controlling the risk.
Weak The controls have a 1- 60% chance of successfully controlling the risk.
Average The controls have a 61 – 79% chance of successfully controlling the risk
Strong The controls have a 80%+ chance or higher of successfully controlling the risk
2. Risk Scoring
This is separated into Consequence and Likelihood. Consequence Scale:
Level of Impact on the Objective
Descriptor of Level of Impact on the Objective
Consequence for the Objective
Consequence Score
0 - 5% Very low impact Very Low 1
6 - 25% Low impact Low 2
26-50% Moderate impact Medium 3
51 – 75% High impact High 4
76%+ Very high impact Very High 5
Likelihood Scale:
Level of Likelihood the Risk will Occur
Descriptor of Level of Likelihood the Risk will Occur
Likelihood the Risk will Occur
Likelihood Score
0 - 5% Highly unlikely to occur
Very Low 1
6 - 25% Unlikely to occur Low 2
26-50% Fairly likely to occur Medium 3
51 – 75% More likely to occur than not
High 4
76%+ Almost certainly will occur
Very High 5
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3. Level of Risk and Priority Chart
This chart shows the level of risk a risk represents and sets out the priority which should be
given to each risk:
LIKELIHOOD
CONSEQUENCE
Very Low
(1)
Low (2)
Medium (3)
High (4)
Very High
(5)
Very Low (1)
1 2 3 4 5
Low (2)
2 4 6 8 10
Medium (3)
3 6 9 12 15
High (4)
4 8 12 16 20
Very High (5)
5 10 15 20 25
1-3
Low Priority
4-6
Moderate Priority
8-12
High Priority
15-25
Very High Priority
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Page 1 of 2
BARNET CLINICAL COMMISSIONING GROUP – ANNUAL GENERAL MEETING
Held between 12:00 and 13:00 on Thursday 19 September 2019 at Committee Room 1, Hendon Town Hall, London NW4 4AX
Present:
Elected Voting Members:
Dr Charlotte Benjamin Elected GP Representative
Dr Barry Subel Elected GP Representative
Dr Nick Dattani Elected GP Representative
Dr Aashish Bansal Elected GP Representative
Dr Tal Helbitz Elected GP Representative
Dr Clare Stephens Elected GP Representative
Dr Murtaza Khanbhai Elected GP Representative
Dr Louise Miller Elected GP Representative
Executive Voting Members:
Helen Pettersen Accountable Officer for Barnet, Camden, Enfield, Haringey and Islington CCGs (NCL CCGs)
Appointed Voting Members:
Claire Johnston Governing Body Nurse
Ian Bretman Lay Member for Public and Patient Engagement, Barnet CCG
Dominic Tkaczyk Lay Member for Audit and Governance, Barnet CCG
In Attendance:
Kay Matthews Chief Operating Officer, Barnet CCG
Ruth Donaldson Director of Commissioning, Barnet CCG
Sarah D’Souza Director of Commissioning, Barnet CCG
Colette Wood Director of Primary Care Transformation, Barnet CCG
Matt Backler Director of Finance, Barnet CCG
Ali Malik Director of Performance and QIPP, Barnet CCG
Andrew Simpson Board Secretary, Barnet CCG
Apologies:
Jenny Goodridge Director of Quality and Clinical Services, Barnet CCG
Jon Baker Secondary Care Clinician, Barnet CCG (voting)
Simon Goodwin Chief Finance Officer, NCL CCGs
INTRODUCTION
1. Welcome and Apologies
1.1
The Chair welcomed all to the CCG’s 2019 Annual General Meeting, organised for the purposes of presenting the CCG’s 2018-29 Annual Report and Accounts (ARA) document in public.
2 Key Achievements 2018-19, finances and future plans
2.1
The Chair and the CCG’s senior leadership presented the key highlights from the 2018-19 ARA, including commissioning achievements and financial performance. Detailed updates were also given in relation to work to drive improvements to quality and mental health services and on the development of primary care networks
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Page 2 of 2
The 2018-29 ARA was formally received in public. A quorum of GP practice members was achieved.
3 Questions and Answers
3.1
Visiting members of the public and representatives of member practice raised a number of questions, with waiting times for health visitors and the CCG’s recent consultation in relation to the potential relocation of Ravenscroft Medical Centre to Finchley Memorial Hospital amongst them.
4.0 Any Other Business
4.1 There was none.
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Barnet Clinical Commissioning Group Governing Body Meeting 2 March 2019
Report Title Summary of Meetings of the Committees of Barnet CCG Governing Body
Agenda Items
4.2 – 4.5
Lead Colette Wood (Primary Care Procurement Committee)
Email [email protected]
Jenny Goodridge and Ali Malik, (Quality and Performance Committee)
Email [email protected]
Simon Goodwin (Clinical Commissioning, Finance and QIPP Committee)
Email [email protected]
Vee Scott (Patient and Public Engagement Committee)
Email [email protected]
Report Summary
This paper presents a summary of the business conducted at the following Committees of the Barnet CCG Governing Body:
Item 4.2: Quality and Performance Committee (Chair – Dr Barry Subel)
Item 4.3: Clinical Commissioning, Finance and QIPP Committee (Chair – Dr Barry Subel)
Item 4.4: Primary Care Procurement Committee (Chair – Ian Bretman)
Item 4.5: Patient and Public Engagement Committee (Chair – Ian Bretman)
Recommendation The Governing Body is asked to NOTE the report.
Identified Risks
and Risk
Management
Actions
Not Applicable
Conflicts of Interest
Not Applicable
Resource
Implications
Not Applicable
Engagement
Not Applicable
Equality Impact
Analysis
Not Applicable
Report History and
Key Decisions
Not Applicable
Next Steps Not Applicable
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104
Quality and Performance Committee (4.2)
Summary of the meeting held on 5 December 2019 and 6 February 2020
At its meeting on 5 December 2019, the Governing Body’s Quality and Performance Committee
undertook the following activity:
Review of a report on performance among providers in relation to key infection prevention
and control targets, during which members raised concern over a rise in clostridium difficile
and Escherichia Coli within GP practices;
Review of the outcomes of engagement work undertaken by Healthwatch Barnet in relation
to local health and care services, and the associated recommendations made, which
included the expansion of public awareness raising for cancer screening services and their
effectiveness in reducing mortality;
Review of an integrated quality and performance report which gave an overview of
performance of quality and service access metrics of health and care providers
commissioned by the CCG. Concern was raised over the reporting of two surgical ‘never
events’ by Royal Free London following a period of more than a year during which none
were reported. Members also suggested that issues relating to MRI capacity be raised at
the Trust’s next Performance Review Group meeting;
An overview of Continuing Health Care was provided, which highlighted that performance
in relation to service delivery and financial management were broadly on track, though there
were challenges in relation to the proportion of patients who received their assessment in
hospital which were linked to broader challenges within the acute system of addressing
delayed discharges; and
Members provided scrutiny of the mitigation of the CCG’s identified risks to the achievement
of quality and service access performance targets.
At its meeting on 6 February 2020, the Committee once again discussed provider performance and
in relation to the achievement of quality and service access performance targets, as well as the
following activity:
Review of an Annual Safeguarding Report, which provided an overview of how statutory duties and requirements for the safeguarding of children and adults had been met;
Review of a report on social and nursing care homes in Barnet, which highlighted challenges during the past year and the work underway with the local authority to address them; and
Received an update in relation to work underway to address the number of out-of-area placements for patients of mental health services, something for which Barnet was an outlier.
As 6 February was the final meeting of QPC due to the impending merger of NCL CCGs, the Committee agreed that the quality and performance in the following areas should be given close scrutiny by its equivalent committee under the new NCL CCG Governing Body:
Royal Free London quality and performance issues;
Mental health services; and
Care Homes.
At both meetings, the Committee noted the minutes of the Clinical Quality Review Groups of the
following providers in order to gain assurance in relation to quality:
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Royal Free London
Central London Community Healthcare
Barnet, Enfield and Haringey Mental Health Trust
Royal National Orthopaedic Hospital
The CCGs’ Quality and Performance Subgroup
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Clinical Commissioning, Finance and QIPP Committee Meetings (4.3)
Summary of the Meetings Held in November 2019 and January and February 2020.
At each meeting of the Barnet CCG Governing Body’s Clinical Commissioning, Finance and QIPP Committee (CFQ), clinical and lay members of the Committee:
Provide oversight of the CCG’s financial position and performance in delivery of its QIPP programme;
Receive updates on information management technology developments and business conducted by the CCG’s Programme Oversight and Development Group (PODG);
Review risks from the CCG’s corporate risk register which have a risk rating of 12 or greater and sit within the Committee’s remit;
Review and approve any non-primary care commissioning and investment proposals;
Review any other reports which have been produced in response to members’ requests for assurance on any relevant matter.
At each of the meetings held in November, January and February, committee members discussed the CCG’s financial position, stated in the context of the overall position for North Central London CCGs). The CCG was forecasting to deliver its financial plan of a £6.7m deficit throughout this period, though members noted a number of emerging risks which would increase the deficit if they materialised. Performance in delivery of the CCG’s QIPP programme remained strong with a projected savings of £17.5m at month ten, which represents 96% delivery of the annual plan. Members had the opportunity to review and comment upon the NCL System Efficiency Plan at the November meeting.
Risks to the delivery of financial and QIPP targets are captured on the Committee’s Risk Register, which was given detailed scrutiny at each of the meetings. Following committee agreement and in light of strong performance, the principle risk to the achievement of QIPP targets was decreased, which resulted in the removal of it from the Committee Risk Register, which focuses on those risks rated as 12 or above. Throughout the period, members received an overview of activity undertaken and decisions made by the CCG’s clinically-chaired Programme Oversight and Delivery Group and provided oversight, and provided scrutiny of the progress of the CCG’s digital transformation programme.
At the February meeting – the final meeting before the Committee was to be established –
members:
Approved plans to deliver mental health support teams in Barnet through the Local
Authority and the use of trailblazer funding; and
Received an overview of the budget for 2020-21, which would be approved at the March
meeting of the Governing Body.
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Summary Report of Primary Care Procurement Committee Meeting (4.4)
Summary of the meetings held in October 2019 and February 2020
At its October 2019 meeting the Committee approved the following elements of a business case
designed to establish greater resilience, retention, skills and leadership within the Barnet primary
care workforce
General practice nurse programme
Salaried Portfolio Innovation Doctor scheme
Four trainee nursing assistants;
Members also approved business cases to:
To provide an equitable social prescribing service across Barnet through the recruitment and training of link workers, a service manager and service administrator; and
To fund two senior clinical pharmacists and a primary care network pharmacist peer support and training network for a period of twelve months.
At its February 2020 meeting, the Committee approved locally commissioned services to improve outcomes for diabetes and to support acceleration of the use of Coordinate my Care by GPs within Barnet.
A public part of the meeting was constituted in order for members to make a decision in relation to the future of the Cricklewood Walk-in Centre, with members approving the proposals to decommission the service. More information can be found in the Accountable Officer’s report at agenda item 2.2.
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Patient and Public Engagement Committee (4.5)
Summary of the meetings held in September and December 2019
At the September 2019 meeting, in an update on services provided at Cricklewood GP Health
Centre, the Committee noted that the decision to re-procure the Alternative Provider Medical
Services GP contract was made in August and that a new provider would be in place by March
2020. There was also a discussion about the future of the walk-in service at Cricklewood beyond
March 2020 in light of the national guidelines for non-emergency care. The committee was asked
to consider options for patient engagement on this for discussion at a future meeting
A comprehensive update was given on plans for the merger of the five NCL CCGs into one and
the formation of Integrated Care Partnerships and an Integrated Care System across NCL. The
Committee discussed engagement and communication options with patients and communities and
the need to shape structures with local residents.
There was an update on process to consider the relocation of Ravenscroft Medical Centre to
Finchley Memorial Hospital, and the learning which would can be applied to future consultations.
During partner updates:
Healthwatch Barnet, fed back on the results of a survey carried out on the NHS the Long
Term Plan which identified seven main areas of focus that were important to Barnet
residents. Healthwatch is also conducting a check of GP answerphone messages and
websites for correct and consistent information regarding GP out-of-hours access and
extended access services and will report back at the next meeting;
The Barnet Patient Participation Network expressed a wish to develop links with other
patient participation networks going forward and get the BPPN more involved in the NCL
Change Programme work; and
London Borough of Barnet informed the committee that the London Borough of Barnet’s
Annual Engagement Summit would take place in September.
At its December 2019 meeting, the following activity was undertaken:
There was a discussion of the CCG’s engagement log with particular focus on patient
involvement in the commissioning of services. The attendance of commissioners at
engagement events was considered helpful, though it was felt that rigorous planning
would be required to ensure that residents always have the opportunity to engage with
commissioner in relation to their local health needs;
Members reviewed Barnet’s performance against engagement metrics contained within
the national Improvement and Assessment Framework. The CCG had scored ‘amber’ in
the previous year’s assessment, and work was underway to ensure that this could be
improved upon for the current year;
The Committee received an update on work underway to improve resident engagement.
Suggestion was made that there be a shared vision for local engagement, which could be
socialised Patient Participation Groups (PPGs); and
Members had the opportunity to review the engagement approach adopted in relation to forthcoming orthopaedic and autism service reviews.
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NORTH CENTRAL LONDON PRIMARY CARE COMMITTEE IN COMMON
(Meeting held in public)
Minutes of Meeting held on Thursday 19 December 2019 between 3pm and 4:30pm
Islington CCG – Clerkenwell Rm, 2nd Floor, Laycock Centre, Laycock St, London N1 1TH.
Voting Members Present:
Lay Members
Ms Cathy Herman (Chair) Governing Body Lay Member, Haringey CCG & Chair of PCCC
Mr Ian Bretman Governing Body Lay Member, Barnet CCG
Ms Karen Trew Governing Body Member, Enfield CCG
Ms Lucy de Groot Governing Body Lay Member, Islington CCG (deputised for Sorrel Brookes, Islington CCG)
Ms Kathy Elliot Governing Body Member, Camden CCG (deputised for Glenys Thornton, Camden CCG)
GP Representatives
Dr Dina Dhorajiwala Governing Body GP Member, Haringey CCG
Dr Dominic Roberts Clinical Director, Islington CCG (deputised for Dr Murtaza Khanbhai, Barnet CCG)
Dr Kevan Ritchie Governing Body GP Member, Camden CCG
Dr Janet High GP Clinical Lead, Enfield CCG
Officer Representatives
Ms Colette Wood Director of Care Closer to Home, Barnet CCG
Ms Clare Henderson Director of Commissioning & Integration, Islington CCG
Ms Deborah McBeal
Director of Primary Care Commissioning and Deputy Chief Operating Officer, Enfield CCG
Ms Neeshma Shah Director of Quality & Clinical Effectiveness, Camden CCG (deputised for Simon Wheatley, Camden CCG)
Mr Tony Hoolaghan Chief Operating Officer, Haringey & Islington CCGs (deputised for Paul Sinden, NCL Director of Performance, Planning & Primary Care & Rachel Lissauer, Haringey CCG)
In Attendance
Ms Charlotte Cooley Governing Body Practice Nurse, Camden CCG
Ms Tracey Lewis Head of Finance, Camden CCG
Ms Vanessa Piper Head of Primary Care, NCL Primary Care Commissioning & Contracting Team
Mr Riyad Karim Interim Head of Primary Care Commissioning, Enfield CCG
Mr Greg Cairns Director of Primary Care Strategy, London wide LMCs
Ms Vivienne Ahmad (Minutes)
Board Secretary, Islington CCG
Apologies:
Ms Sorrel Brookes Governing Body Lay Member, Islington CCG & Vice Chair of PCCC
Ms Glenys Thornton Governing Body Member, Camden CCG
Dr Murtaza Khanbhai Governing Body GP Member, Barnet CCG
Ms Rachel Lissauer Director of Commissioning & Integration, Haringey CCG
Mr Simon Wheatley Assistant Director of Primary Care, Camden CCG
Mr Simon Goodwin NCL Chief Finance Officer
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Mr Paul Sinden NCL Director of Performance, Planning and Primary Care
Ms Noelle Skivington Healthwatch Representative, Enfield
1. Welcome & Apologies
1.1 The Chair welcomed members and attendees to the meeting. Apologies were recorded as above.
2
Declarations of Interests Register
2.1 The Chair advised that the Committee Declarations of Interest Register had been circulated with the meeting papers.
3a Declarations of Interest Relating to Items on the Agenda
3a.1
The Chair invited members of the Committee to declare any interests in respect to the items on the agenda. None were declared.
3b Declarations of Gifts and Hospitality
3b.1 There were no declarations declared.
4 Minutes of the meeting held on 17 October 2019
4.1 4.2 4.3
The minutes were APPROVED as an accurate record of the meeting subject to the following amendment: To correct Janet High’s title to ‘Dr’ Janet High. Action:
To correct Janet High’s title to ‘Dr’ Janet High. (Vivienne Ahmad)
5 Actions from the meeting held on 17 December 2019
5.1
The action log was reviewed and updated.
6 Matters Arising
6.1 There were no matters arising.
7 Questions from the public
7.1 There were no questions from members of the public.
ITEMS FOR DISCUSSION
8 Finance Report – Month 7
8.1 8.2 8.3
Tracey Lewis provided a summary of the financial position for Month 7 for delegated primary care budgets. The following key points were reported:
Main risk noted was the GP at Hand year-to-date and forecast. Barnet & Camden had included this in their forecast outturn position (FOT) whereas the
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8.4 8.5 8.6 8.7 8.8 8.9 8.10 8.11
other three CCGs were showing this in their noted risk positions when reporting to NHS England (NHSE).
The FOT was showing break even for all CCGs other than Camden’s planned overspend of £1.9m against their delegated allocation.
The following was noted in discussion of the report:
The Committee asked about GP at Hand and why three CCGs were reporting this differently. It was noted the CCGs were anticipating the risk would disappear in the delegated budget by the end of the year and instead were reporting this as a continued risk within their returns to NHSE.
Members were concerned over the GP at Hand cost pressures with the lack of control on the expenditure and yet it was acknowledged that this had to be accepted as a London-wide adjustment to allocations.
The Committee further asked about the national position as from 1 April 2020. It was noted a consultation had been conducted and were waiting for the outcome.
It was noted the draft 2020/21 budget would come to the next meeting on 20 February 2020.
Action:
To add the draft 2020/21 budget to the PCCC Forward Planner for February 2020. (Tracey Lewis and Vivienne Ahmad)
The Committee NOTED the report.
9 NCL Quality & Performance Report
9.1 9.2 9.3 9.4 9.5 9.6 9.7 9.8 9.9 9.10
In absence of Paul Sinden, Tony Hoolaghan presented the report. The following key points were reported:
The report mentioned Urgent and Emergency care and Inclusion of appointment data.
Record for September 2019 showed that 45% of people received a same day appointment for general practice in north central London which was above the London and national performance.
There was a need to look at differential rates of DNAs in the primary care hubs.
National review of access – closely waiting for the results of this to see the implications for access and the link to primary care networks (PCNs), extended hours, extended access hubs etc.
The Committee discussed whether the NCL Quality & Performance Report was being used in a useful way. The following was noted in discussion of the report:
The report seemed useful especially as CCGs share and learn the information to support their practices. This could be helpful with CQC reviews where those practices were poorly rated. An action review could work out what the early warnings were.
The differential rates of DNAs would be useful across the CCGs.
There was a concern that the report was produced without quality assurance. This would entail reviewing the report and highlighting any issues before the report was issued.
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9.11 9.12 9.13 9.14
There was a need to ensure key issues were stated at the top of the report and to frequently address themes and areas such as complaints and early warning systems.
It was agreed to discuss the future development of the NCL Quality & Performance report at the PCCC seminar in January 2020
Action:
To add to the PCCC Forward Planner, a discussion on the NCL Quality & Performance report for the seminar in January 2020. (Paul Sinden and Vivienne Ahmad).
The Committee NOTED the report.
10 Primary Care Networks (PCNs) in North Central London – PCN and Clinical Director (CD) Development Funding
10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8 10.9 10.10 10.11 10.12 10.13
In absence of Paul Sinden, Tony Hoolaghan presented the paper. The following key points were reported:
Through the NCL Health and Care Closer to Home programme perspective a process was being worked through, with the LMC, to allocate the PCN development funding.
There had been a London wide support for PCNs particularly with clinical directors, working with the local community health service providers, and working out the roles and responsibilities and what the priorities were. However the PCN Directors felt overwhelmed and required some support and guidance.
There was an issue with London weighting for the new PCN roles in inner London. Discussions had taken place at the highest level to resolve this and a recent meeting took place with Tony Hoolaghan and members of NHS England including Liz Wise, Director of Primary Care Transformation and Commissioning and Mark Turner, London Director of Commissioning.
A fuller PCN update would be provided at the next meeting on 20 February 2020. Primary Care Leads presented a short update on their networks. The following was noted in discussion of the report:
Development funding – There was a need to see the progress of this funding by March 2020. This had been a challenge for people with a number of different work streams.
It was useful to understand what had been done across the boroughs, the different approaches taken as well as the lessons learned. It was questioned how the Clinical Directors could be brought together as a network so that they felt supported in some way but still autonomous to drive their own part of the business. It was noted the Clinical Directors had been brought together at NCL level and preferred to meet regularly so that that sessions / master classes could be planned in areas such as premises, partnership working, digital etc. When they were first brought together they realised they had to specialise in different areas.
Barnet CCG produce a weekly Clinical Directors bulletin with key issues and it was agreed to share this with the Committee.
Actions:
To share the Clinical Directors bulletin with the PCCC members. (Colette Wood)
To provide a full PCN update at the next PCCC meeting on 20 February 2020. (Paul Sinden)
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10.14
The Committee NOTED the paper.
11 Barnet – Update on the Ravenscroft proposal to relocate
11.1 11.2 11.3 11.4 11.5
An update on the Ravenscroft proposal to relocate was provided. The following key points were reported:
Unfortunately the relocation could not go ahead because it was a joint application of two practices and the community health provider, with the two providers withdrawing from the process. Legal advice was sought which stated that as the practices had pulled out, this changed the nature of the application. Patients were notified straight away that the relocation could not go ahead.
It was recognised this was a challenging project and a disappointment for the Barnet team.
The Committee NOTED the update.
ITEMS FOR DECISION
Contract Variations
12 All Boroughs – Personal Medical Services (PMS) Contract Changes
12.1 Barnet – East Barnet Health Centre
12.1.1 12.1.2
The Committee was asked to approve the removal of a GP signatory due to their resignation with effect from 31 March 2020. The Practice was offering fewer nurse appointments than was recommended. The NCL Commissioning Team would monitor and provide advice where necessary. The Committee APPROVED the recommendation.
12.2 Haringey – Heathfielde Medical Centre
12.2.1 12.2.2
The Committee was asked to approve the removal of a GP signatory due to their resignation with effect from 1 April 2020. It was noted the practice was offering fewer appointments than were recommended, The NCL Commissioning Team advised the practice of the minimum recommended figures and the practice was working towards these targets. The Commissioning Team would monitor and provide advice where necessary. The Committee APPROVED the recommendation.
12.3 Camden – Daleham Garden Surgery
12.3.1 12.3.2
The Committee was asked to approve the addition of a new GP effective from 1 January 2020 which would bring the PMS agreement up to two contractors. It was noted there was some under provision at this practice in terms of GP and nurse appointments. The practice had been advised to increase these appointments and the Commissioning Team would monitor and provide advice where necessary. The Committee APPROVED the recommendation.
12.4 Camden – James Wigg Practice
12.4.1 12.4.2
The Committee was asked to approve the removal of one GP effective from 1 January 2020 which would leave five remaining partners at the practice. The Committee APPROVED the recommendation.
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12.5 Enfield – Bush Hill Park Trinity Surgery
12.5.1 12.5.2
The Committee was asked to approve the removal of one GP from the PMS agreement effective from 31 March 2020 which would leave one remaining partner at the practice. It was noted there was some under provision at this practice in terms of GP and nurse appointments. The number of GP appointments and sessions would decrease further following the removal of the GP. Any shortfall in clinical capacity was expected to be covered by Medicus Health Partners. The Committee APPROVED the recommendation.
12.6 ENFIELD - (Medicus Health Partnership- MHP) Forest Road Group Practice, Riley House Surgery, Freezywater PCC, Southbury Surgery, Green Street Surgery, Lincoln Road Medical Practice, Enfield Island Surgery and Dean House Surgery
12.6.1 12..6.2
The Committee was asked to approve the addition of a GP signatory with effect from 1 April 2020 to the 8 PMS practices that form part of MHP. It was noted there was some under provision at this practice in terms of GP and nurse appointments. Any shortfall in clinical capacity was expected to be covered by Medicus Health Partners. See item 12.5 above. The Committee APPROVED the recommendation.
12.7 Enfield – Winchmore Hill Practice
12.7.1 12.7.2
The Committee was asked to approve the removal of a GP signatory from the PMS agreement to take effect from a retrospective date of 12 October 2019. This variation would leave three signatories. The Committee APPROVED the recommendation.
12.8 Haringey – Rutland House Surgery
12.8.1 12.8.2
The Committee was asked to approve the addition of a GP signatory. This addition would bring the PMS agreement up to two contractors effective from 1 April 2020. It was noted there was some under provision at this practice in terms of nurse appointments. The new doctor would offer additional sessions and be working closely with the Primary Care Network. The Committee APPROVED the recommendation.
12.9 Haringey – The High Road Surgery
12.9.1 12.9.2
The Committee was asked to approve the addition of a GP signatory to the PMS agreement to take effect from a retrospective date of 1 November 2019. The recommendation could not be brought to October’s PCCC meeting as commissioners required more assurance on the practice’s clinical capacity. The Committee APPROVED the recommendation.
12.10 Haringey – Cheshire Road Surgery
12.10.1 12.10.2
The Committee was asked to approve the removal of one GP effective from 1 March 2020 which would leave two remaining contractors at the practice. It was noted the practice was in the process of recruiting two new salaried GPs to start by the time the GP leaves the PMS agreement. The Committee APPROVED the recommendation.
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13 Enfield CCG – Medicus Health Partners (MHP) – Practice Relocation
13.1 13.2 13.3 13.4 13.5 13.6 13.7 13.8 13.9 13.10 13.11 13.12 13.13 13.14 13.15 13.16
The Committee was asked to approve the relocation of four practices within Medicus Health Partners under 11 conditions. However, during the course of the meeting a further 12th condition was stipulated which was taking into consideration the inflationary uplift to the current market rent, when the district valuer reviews the premises every three years. This case was about the relocation of four practices under two schemes, one was to move to the Alma development (with the following practices to relocate: Curzon Avenue Surgery, Green Street Surgery and Dean House Surgery) and the other move was to the Willow House Surgery which included Southbury Road Surgery. The following key points were reported:
Reasons for relocation - (a) not fit for purpose buildings, (b) to add resilience on a day to day basis for small practices with only 1 or 2 partners operating in the site, (c) the landlord had served notice on one site, and (d) the Alma site was a significant development.
Cost Implication - MHP stated they required no capital and increase in current market rent for both schemes including GP revenue costs. However, they were requesting capital funding for GPIT cabling. 100% of capital costs would be self-funded by MHP and no further costs would be sought from commissioners.
Risks – Commissioners sought assurance from MHP on their financial viability for each scheme.
Impact to patients – For both schemes, the practices were currently located less than 1.2 miles from the sites at which they were to be relocated. MHP was required to hold patient engagement and a small percentage responded from each practice showing patients were in favour of the relocation.
The timeline from build to relocation – the business case was submitted to commissioners in October 2019 and was hoped to be completed by November 2020.
The following was noted in discussion of the paper:
An amendment to the paper was requested by the Committee that MHP was a super partnership of 14 practices comprising of 35 GPs.
The Committee was concerned about the national stipulations around space allocation to practices and the premises cost directions. Discussions had taken place with the estate leads across NCL who were currently using the Department of Health (DoH) Building Note space estimator specifically for new capital schemes.
Nicola Theron, NCL Director of Estates, was aware of the relocation and there had been discussions on the calculations, tools and future proofing.
Work was progressing and the premises cost direction would be updated to reflect the transformation work and the additional capacity for PCNs.
It was noted a recent case at Enfield was going through the IG process and there seemed to be a disjoint between how the practice space requirements were being assessed locally compared to nationally.
This seemed a complicated relocation and it was thought best to discuss in detail outside of the meeting.
Actions:
To amend the summary of the report stating ‘MHP is a super partnership of 14 practices comprising of 35 GPs. (Vanessa Piper)
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13.17 13.18 13.19
A 12th condition needed to be added to the report which was about applying inflationary uplift to the current market rent, when the district valuer reviews the premises every three years. (Vanessa Piper)
To provide an update on the Medicus Health Partners: practice relocation at the next PCCC meeting on 20 February 2020. (Vanessa Piper)
The Committee APPROVED the recommendation.
14 Camden – Queens Crescent Surgery and Prince of Wales Surgery (Matthewman) merger
14.1 14.2
The Committee was asked to approve the merger between two GMS practices, Queens Crescent Surgery and Prince of Wales Surgery (Matthewman), as from 1 April 2020. The Prince of Wales Surgery currently had an inadequate CQC rating. The merger was to provide the contract holder support to stabilise the contract for the Prince of Wales surgery. The Queens Crescent Surgery contract will be retained as part of the merger. The partners deemed it would be a better solution for both practices to operate out of one practice and to close the Prince of Wales site. Both practices had widely engaged with their patients and were gathering their views.
The Committee APPROVED the recommendation.
15 Barnet – Wakeman’s Hill – change in rent following an improvement grant award
15.1 15.2
The Committee was asked to approve the increase in rent following an improvement grant award. The award was for the space in the building by adding an additional room thus making it compliant again. The Committee APPROVED the recommendation.
16 Barnet, Camden & Haringey – Management of practices that close half a day
16.1 16.2 16.3 16.4 16.5 16.6 16.7
The Committee was asked to approve the remedial notices to be issued to five practices. The following key points were reported:
Initially there were 37 practices in north central London that closed half a day and members were notified at the last PCCC meeting on 17 October 2019 that there remained 11 practices that closed half a day. This had now gone down to 8 practices. Following the publication of this paper three practices came back which then left 5 practices that closed half a day which included 3 in Barnet, 1 in Camden and 1 in Haringey.
If the practices failed to meet the remedial actions set, then commissioners would refer the cases back to the PCCC meeting in February 2020. At that stage the commissioners would set out the financial sanction that could be applied and the impact to the PCN extended hours payment. Further legal advice would be sought again on the financial sanction and risks of challenge.
It was noted an up to date paper on management of practices that close half a day would come back to the next PCCC meeting in February 2020.
The following was noted in discussion of the report:
There were concerns in regards to the number of references to the guidance. It seemed the guidance was being used on the basis of contractual sanctions either now or in the future. This was specifically on the subcontracting arrangements. It was pointed out that the guidance did not imply contractual requirement and should not have been used as a basis for contractual action.
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16.8 16.9 16.10 16.11 16.12
Clarity was sought on the process and timescales for moving from remedial action to financial clawback. Once a remedial action was issued, and the practice did not comply, a process would be set out on what the financial clawbacks could be as there would be implications to PCN members.
The remedial notice would require further details which would be added to the sub-contracting arrangements.
What was being flagged was a concern with the way the contractual sanctions were being applied which would seem to be complicated and a risk.
Action:
To provide an update on the management of practices that close half a day at the next PCCC meeting on 20 February 2020. (Vanessa Piper)
The Committee APPROVED the recommendation.
17 NCL – Addition of Medicus Select Care to Enfield Unity PCN
17.1 17.2
The Committee was asked to approve the request for the addition of Medicus Select Care to join the Enfield Unity PCN. Medicus Select Care was the new service for NCL’s special allocation scheme service which commenced contract 4 November 2019. The Committee APPROVED the recommendation.
ITEMS TO NOTE - URGENT DECISIONS TAKEN SINCE 17 OCTOBER 2019
18 No urgent decisions were taken.
ITEMS TO NOTE AND INFORMATION
19 PCCC Risk Register
19.1 19.2 19.3
The Committee discussed the GP at Hand risk and requested that it should be added to the risk register. Action:
To add the GP at Hand risk to the PCCC Risk Register. (Paul Sinden)
The Committee NOTED the risk report.
20 Committee Forward Planner
20.1 The Committee NOTED the forward planner and the next PCCC seminar taking place in January 2020.
21 Any other Business
21.1 None.
22 Date of next meeting
22.1 Thursday 20 February 2020, 3pm to 4:30pm at Enfield CCG, Committee Room, Holbrook House, 116 Cockfosters Road, Barnet, EN4 0DR
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NORTH CENTRAL LONDON (‘NCL’) JOINT COMMISSIONING COMMITEE Minutes of the meeting held in public on Thursday, 3 October 2019, 2.30pm – 4.30pm
Resource for London, Seminar Room 2, First Floor, 354 Holloway Road, London N7 6PA.
Voting Members Present:
Ms Karen Trew (Chair) Governing Body Vice Chair and Lay Member, Enfield CCG
Dr Mo Abedi Governing Body Chair, Enfield CCG
Dr Charlotte Benjamin Governing Body Chair, Barnet CCG
Dr Imogen Bloor Clinical Vice Chair, Islington CCG
Dr Peter Christian Governing Body Chair, Haringey CCG
Ms Lucy De Groot Governing Body Lay Member, Islington CCG/Lay Member Representative, Haringey CCG
Ms Kathy Elliott (Vice Chair) Governing Body Lay Member, Camden CCG
Mr Simon Goodwin NCL Chief Finance Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Dr Neel Gupta Governing Body, Chair, Camden CCG
Dr Fawad Hussain Governing Body Secondary Care Clinician, Enfield CCG
Ms Helen Pettersen Accountable Officer, Barnet, Camden, Enfield, Haringey and Islington CCGs
Dr John Rohan Governing Body Deputy Clinical Chair, Haringey CCG
Ms Sharon Seber Nurse Representative, Haringey CCG
Non-Voting Members Present:
Ms Parin Bahl Healthwatch Enfield
Ms Sharon Grant Healthwatch Haringey
Attendees:
Mr Ed Nkrumah NCL Director of Performance
Mr Ian Porter Director of Corporate Services, NCL CCGs
Ms Sarah Rothenberg NCL POD Director, NELCSU
Mr Paul Sinden NCL Director of Planning, Performance and Primary Care
Ms Jennie Williams Director of Quality and Nursing, Haringey and Islington CCGs
Apologies:
Ms Sorrel Brookes Governing Body Lay Member, Islington CCG
Ms Janet Burgess Councillor, Islington Council
Ms Pat Callaghan Councillor, Camden Council
Ms Alev Cazimoglu Councillor, Enfield Council
Mr Richard Dale Programme Director, North Central London Change Programmes
Ms Tamara Djuretic Director of Public Health, Barnet Council
Mr Will Huxter Director of Strategy, Barnet, Camden, Enfield, Haringey and Islington CCGs
Ms Sarah James Councillor, Haringey Council
Ms Kath McClinton Assistant Director, Islington CCG
Dr Jo Sauvage Governing Body Chair, Islington CCG
Mr Daniel Thomas Councillor, Barnet Council
Mr Dominic Tkaczyk Governing Body Lay Member, Barnet CCG
Minutes
Mr Steve Beeho Board Secretary, Haringey CCG
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1 Introduction
1.1 Apologies for absence
1.1.1 1.1.2
Apologies had been received from Janet Burgess, Pat Callaghan, Alev Cazimoglu, Richard Dale, Tamara Djuretic, Will Huxter, Sarah James, Kath McClinton, Jo Sauvage, Daniel Thomas and Dominic Tkaczyk. Richard Dale had originally been due to attend on behalf of Will Huxter but he had unfortunately also had to give his late apologies.
1.2 Declarations of Interests
1.2.1
There were no additional declarations of interests.
1.3 Declarations of gifts and hospitality
1.3.1
There were no gifts or hospitality offered or received.
1.4 Opening Remarks
1.4.1
The Chair welcomed everybody to the meeting, particularly Lucy De Groot who would be attending future meetings as a Lay Member representative for Haringey CCG, following the departure of Adam Sharples. On this occasion Lucy de Groot was also attending in the capacity of the Lay Member representative for Islington CCG, as Sorrel Brookes had given her apologies.
1.5 Questions from the public
1.5.1
There were no questions from members of the public.
2. Governance
2.1 Minutes of Committee Meeting on 1 August 2019
2.1.1
The Committee APPROVED the minutes of the meeting held on 1 August 2019 as an accurate record of the meeting.
2.2 Action Log
2.2.1 2.2.2
The Committee reviewed the action log. All actions had been marked ‘green’. The Committee requested further information for Action 91 over and above the briefing circulated, setting out how the Evidence Based Interventions and Clinical Standards policy would be monitored including through clinical audits. The Committee request for further information on the Evidence Based Interventions and Clinical Standards policy was set in the context of:
• Feedback from GPs that the process had increased workload for primary care, and from the briefing it was not clear if the policy was robust enough to ensure consistent implementation in the acute sector;
• A request for assurance from a recent workshop with patient representatives in Camden, that any reduction in referrals accruing from the policy for conditions such as
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2.2.3 2.2.4 2.2.5
hips and cataracts would be clinically appropriate and that this would be monitored which is attended by a patient representative;
• The patient perspective in the briefing needed to be enhanced, setting out opportunities for shared decision-making and appealing decisions to ensure application of the policy was equitable, with the volume of appeals part of the performance indicators for the policy. Aligned to this it was suggested that a time-limited Task and Finish Group, including patient representatives, be established to monitor the first year of implementation.
In response the Committee was informed that a three-pronged approach to monitoring was currently being undertaken through:
• Individual CCGs’ Referral Management Services, where QIPP leads review comparative referral trends across practices;
• Individual Funding Request (IFR) panels where appeal trends are monitored by procedure;
• Monthly review of consultant-to-consultant referrals against clinical criteria;
• Monthly reports on the above were received by a clinical sub-group to check consistent application of the policy, with feedback given where necessary.
From the above the following actions were agreed:
• The comments on patient involvement would be fed into the team administering the policy;
• A monitoring paper would be brought to the Committee in February 2020;
• Commissioning an independent evaluation of the implementation of the policy would be considered, with the decision informed by whether any independent national evaluation of the policy had been carried out.
In response to a query on monitoring the impact of the Evidence Based Interventions and Clinical Standards policy on acute contract baselines, it was clarified that at present there was no nationally agreed approach making it difficult to monitor the impact in full.
2.2.6 The Committee NOTED the Action Log.
2.2.7 2.2.8 2.2.9
ACTION: Richard Dale to circulate a briefing on patient involvement before the next meeting in December 2019; ACTION: Richard Dale to consider an independent evaluation of the implementation in the light of any national evaluation undertaken; ACTION: Richard Dale to bring a monitoring paper to the Committee in February 2020.
3. Contracts and Planning
3.1 Finance and Activity Report
3.1.1
An overview of the report was provided to the Committee:
• NCL CCGs were currently forecasting £12.8m over-performance on all acute contracts at the year-end, £12.6m accrued from the four main NCL acute providers;
• The main financial risk accrued from price inflation from the Whittington Health Payment by Results (PbR) contract, where forecast over-performance was £8.9m. In response to local investigations a query notice into counting and coding changes had been issued;
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• NMUH had written to commissioners expressing concern about non-elective activity reducing capacity to carry out elective procedures, although the Trust was maintaining its Referral to Treatment (RTT) performance. Capacity constraints accrued from long length of stay and discharge processes, rather than an increase in admissions. Commissioners were working with the Trust to support their uptake of primary and community services as an alternative to admission and attending the emergency department;
• £2.4m of the £5m cap on over-performance was being utilised in the Royal Free London contract;
• Work with UCLH to improve data quality continued following introduction of the new patient administration system, for both in-year monitoring and planning for 2020/21;
• QIPP delivery remained strong across NCL with 95.5% achievement against plan;
• Locally-corrected data indicated a 1.2% increase in referrals year-on-year, with further information on urgent and routine referral trends being sought through the electronic referral system. Work continued to increase the responsiveness of, and thereby the uptake of, Advice and Guidance services;
• Follow-up activity was reducing across NCL through work with providers in Local Delivery Groups and the Planned Care work programme;
• A&E attendances showed a real year-on-year increase of 4.7% against an increase in GP registrations of 2%. The increase in A&E attendances had not resulted in a corresponding increase in admission, indicating that the increase accrued from lower acuity attendances. There was no suggestion that the 111 services were increasing the number of A&E attendances. This information was being shared with local teams for further action;
• The London Ambulance Service (LAS) contract had not yet been signed following the Trust requesting additional funding related to activity, clinical pathways and staff grading costs. Commissioners did not support the increase in contract value and support for resolution had been requested from NHS England / Improvement.
3.1.2
The Committee then discussed the report:
• Assurance was sought on the re-profiling of consultant time by Trusts in response reductions in outpatient follow-up volumes, in particular to support improving the interface between primary and secondary care;
• Measures of primary care capacity alongside A&E attendance trends would be useful as much of the growth in A&E activity was attributed to primary care presentations. Understanding patient behaviour was pivotal to understanding these activity trends, as attendance at A&E was influenced by cultural issues, as well as access. To support this the Enfield Healthwatch report published on A&E and GP access in relation to NMUH would be shared;
• In response to reinstating GPs at the ‘front-end’ of A&E at NMUH a consistent approach across Trusts, in particular for redirection, should be considered;
• Events to help a common approach across NVCL in preparation for winter were being held through the Urgent and Emergency Care Programme Board, with a focus on mutual aid across Trusts and improving mental health patient experience;
• The introduction of ‘social prescribing’ and clinical pharmacists in general practices would have a positive impact on access, and differential utilisation across practices should be monitored;
• For all the above more effective communications to promote what services were available in a complex urgent and emergency care system should be made available, and to do this an easily-digestible guide, as well as more innovative ways of targeting hard-to-reach communities, was required;
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• The effectiveness of communications would be further enhanced by having a consistent ‘front door’ model across emergency departments;
• It was highlighted that there was sometimes a tension between redirecting primary care presentations away from emergency departments and the demand from some patients for an increasing number of tests;
• Developing the Long Term Plan for NCL would include consideration as to how a consistent clinical approach to urgent and emergency care system access across NCL could be achieved, including taking into account the learning from the Healthwatch reports. This was being through the ongoing work of the urgent and emergency care workstream;
• Variances on activity and price trends were examined and challenged through contract meetings with providers, and this was reflected in the contract challenge process. Learning from this was shared across contracts, as was currently the case with counting and coding changes at Whittington Health;
• Data issues at UCLH following the introduction of the EPIC Patient Administration System needed to be set in the context of both in-year monitoring and setting the baseline for 2020/21. Weekly conference calls were taking place to support the recovery of robust reporting;
• The potential impact of data issues on contracts for 2020/21 would be discussed at the Committee Seminar in November 2019;
• Concern was expressed about the lack of progress in reducing ambulance response times from the improvement plan with London Ambulance Service.
3.1.3 The Committee APPROVED the report.
3.1.4 ACTION: Parin Bahl to share the Healthwatch Enfield reports on A&E and GP access.
3.2 Acute Performance and Quality Report
3.2.1
The introduction to the report informed the Committee that:
• Linked to the acute contract report that provider contract stocktakes were being undertaken and would be brought as work-in-progress to the Seminar in November;
• Performance against the Cancer 62 day wait target had improved with over 80% of patients seen within the standard in July and August, with waiting list backlogs falling making the improvement sustainable. Recovery of the standard was expected by November 2019 against recovery by October 2019 in the operating plan;
• To recover national referral-to-treatment (RTT) reporting Royal Free London was planning to outsource some validation work from October. To address long waits the Trust was receiving support to reduce pain management waits through a capacity alert, talking to ULCH regarding orthopaedic hand capacity, and in discussion with Moorfields Eye Hospital about the transfer of ophthalmology patients waiting in excess of 26 weeks. This mutual aid across providers was facilitated by the NCL RTT Delivery Group;
• The RTT validation process continues at ULCH following the introduction of EPIC. The Trust was aiming to resume diagnostic reporting for September 2019. The Trust was putting on additional ENT clinics to reduce the waiting list backlog;
• The backlog in non-obstetric diagnostics at Royal Free London, exacerbated by new pension rules, was being mitigated by the Trust making use of internal skill-mix and outsourcing to InHealth, with recovery of the standard expected by January 2020;
• Two events were being held to support Emergency Department (ED) performance and winter resilience:
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o A mental health summit was being held on 5 November to agree actions to reduce long waits in ED, with proposed actions including cross-borough working on assessments in ED by mental health professionals, the implementation of the trusted assessor model across the Barnet, Enfield and Haringey and the Camden and Islington Mental Health Trusts, and multi-agency discharge events to improve patient flow;
o On 25 October 2019 provider chief executives would meet to assess opportunities for mutual aid across providers to support winter resilience;
• There were mixed results in reducing long-lengths of stay in hospital beds across NCL. Whittington Health had achieved a targeted reduction of 40% and UCLH are delivering to plan, but Royal Free London and NMUH had yet to reduce long lengths of stay compared to the March 2018 baseline. Progress was monitored through A&E Delivery Boards and a monthly NCL-wide meeting;
• Two ‘never events’ had occurred since the last meeting, including one at Royal Free London;
• The paper set out continuing work at NMUH to improve patient experience, including the Trust working with Homerton and Croydon hospitals for improvement ideas, as areas with similar demographics;
• The report on the recent Care Quality Commission (CQC) inspection at NMUH would be published on 1 November 2019.
3.2.2 The Committee then discussed the report:
• The rate of serious incidents in NCL was similar to other STPs, and future reports would include comparative information to provide assurance;
• Requested a further update on delivery of actions to improve ambulance response times in Barnet, Enfield and Haringey;
• CCGs were supporting UCLH and Royal Free London find alternative pathways for people experiencing long waits at the Royal Free, but often the long waits accrued from specialist pathways with few alternative providers available. A system was in place with all providers to review 40-week waits to ensure that treatment could be carried out within 52 weeks of referral where possible;
• Aligned to this CCGs were monitoring progress at both UCLH and Royal Free London to validate waiting lists for assurance on patient experience and outcomes, internal focus and resourcing by the Trusts, and establishing robust reporting positions;
• Sought assurance that services developed to support system and winter resilience, particularly community rapid response, were being used to capacity and being referred into by London Ambulance Service and acute hospitals as well as by GPs;
• Suggested that the Camden model for “discharge without prejudice” could be considered across NCL to help reduce long lengths of stay in acute hospitals;
• Requested that hear and treat and see and treat models of care by London Ambulance Service be accessible for people where English was not their first language;
• Indicated that future resilience would be supported by a strategic decision on primary care owned front-end to emergency departments;
• Work was underway with Barnet, Enfield and Haringey Mental Health Trust to reduce the use of out of area placements including the introduction of an incentive scheme to repatriate care, book a block of beds with East London Foundation Trust for out of area placements, and ensure the Trust was carrying out multi-agency discharge events to avoid delays as done in acute hospitals. This was in the context that Barnet, Enfield and Haringey mental health patients were 10 times more likely to end up in an out of area placement than Camden or Islington residents;
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• It was noted that the next report would provide more details about mental health bed capacity.
3.2.3 The Committee APPROVED the report.
3.2.4 ACTION: Paul Sinden to confirm work to ensure services such as rapid response were being used to capacity by the broader urgent and emergency care system.
3.3 Transforming Care Programme (TCP) Update
3.3.1 3.3.2
The paper provided an update on the Transforming Care Programme (TCP) and the extension of the remit in the Long Term Plan to cover broader services for people with Learning Disabilities and Autism, with the update focusing on:
• The number of adults in inpatient beds falling to 47, equating to the year-end target set in the Operating Plan. The reduction had been achieved against a backdrop of restricted resources for care co-ordinator posts;
• NCL had received notification from NHS England of £70,000 funding to help increase care co-ordinator capacity. Further funds would follow through Long Term Plan “fair share” allocations, and would be required to deliver more frequent care treatment reviews in line with the planning guidance;
• Community packages of care were being maintained in line with previous patient case studies received by the Committee, with no new admissions or readmissions in June and July 2019. Previous reports had indicated shorter lengths of stay for readmissions;
• Funding from specialist commissioning discharges in 2019/20 was £2.3m, an increase of £0.36m compared to 2018/19. This resulted in a cost pressure of £0.14m against current costs of community packages of care;
• The complexity of the remaining inpatients would make further discharges more difficult to achieve.
The Committee was then informed of changes to the scope of the programme accruing from the Long Term Plan:
• The inclusion of health checks and medication reviews in primary care;
• The continuing focus on mortality reviews;
• Changes to Governance arrangements were being amended to reflect the increase in scope, including the membership of the TCP Board, which has now been renamed the Learning Disabilities and Autism Programme Board with additional primary care membership;
• The prominence given to this population cohort in the LTP was welcomed.
3.3.3 The Committee then discussed the report:
• Questions from the Haringey Severe and Complex Autism and Learning Difficulties (SCALD) reference group on the programme would be sent for response;
• Suggested that expert reviewers be shared across NCL to carry out the more frequent care reviews;
• The work in primary care (health checks and medication reviews) would be led by Borough teams and linked into the NCL programme on a network basis, using the Programme Board to share good practice;
• The broader focus of the programme was welcomed, with future reports reflecting the broader remit;
• The Committee thanked Kath McClinton and her team for the work they were doing with this vulnerable cohort in a challenging financial situation.
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3.3.4 The Committee NOTED the report.
3.3.5 ACTION: Sharon Grant to forward questions from the Severe and Complex Autism and Learning Difficulties (SCALD) reference group to Paul Sinden for response.
4. Risk
4.1 NCL Joint Commissioning Committee Risk Register
4.1.1 4.1.2 4.1.3
Paul Sinden introduced the JCC Risk Register, noting that many of the updates included in the cover sheet had been discussed in the previous items. Concern was expressed about the pressure being placed on the acute sector in Enfield by the lack of hospice beds. It was agreed that Eileen Fiori would circulate details of the work which is taking place on End of Life Care, with a focus on choice and developing domiciliary services. It was confirmed that a Brexit-related risk had been added to the corporate risk register, and that submissions to regulators provided assurance that Trust and CCGs had prepared plans to manage Brexit-related risks.
4.1.5 The Committee NOTED the report and the updates to the risk register.
4.1.6 ACTION: Eileen Fiori to circulate details of NCL work on End of Life Care.
5. Items for Information
5.1 Glossary of Acronyms
5.1.1
The Committee NOTED the Glossary of Acronyms.
6. Any Other Business
6.1
Forward Planner 2018/19
6.1.1
The Committee NOTED the Forward Planner.
6.2 Deadline for Submission of Reports
6.2.1
The Committee NOTED that reports for the next Committee should be sent to Paul Sinden by 21 November 2019.
7. Date of Next Meeting
7.1
The next Committee meeting would held be on 5 December 2019 (2.30pm - 5pm) in Committee Rooms 1 and 2, Civic Centre, High Rd, Wood Green, London, N22 8LE
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NCL CLINICAL COMMISSIONING GROUPS AUDIT COMMITTEE IN COMMON Meeting held on Wednesday 23 September 2019, 14:30 to 16:30 Clerkenwell Room, Islington CCG, Laycock St, London N1 1TH
Present:
Members (voting)
Karen Trew Chair of Enfield CCG Audit Committee; Member of Barnet CCG Audit Committee
Lucy De Groot Chair of Islington CCG Audit Committee; Member of Haringey Audit Committee
Catherine Herman Member of Haringey CCG Audit Committee
Dominic Tkaczyk Chair of Barnet CCG Audit Committee; Member of Camden CCG Audit Committee
In Attendance
Simon Goodwin Chief Finance Officer, NCL CCGs
Arati Das Deputy Chief Finance Officer, Enfield CCG
Ian Porter Director of Corporate Services, NCL CCGs
Karl Thompson Senior Head of Corporate Services, NCL CCGs (part meeting)
Clive Makombera Risk Assurance Director, Internal Audit, RSM
Erin Sims Local Counter Fraud Specialist, Internal Audit, RSM
Sarah Rothenburg North East London Commissioning Support Unit
Charlie Medley External Audit, KPMG
Andy Simpson Board Secretary (Barnet CCG) and Secretary to NCL ACIC (minutes)
Apologies
Sorrel Brookes Member of Islington CCG Audit Committee
Dr Jarir Amarin Member of Enfield CCG Audit Committee
Dr Kevan Ritchie Member of Camden CCG Audit Committee
Ian Bretman Member of Barnet CCG Audit Committee
1. INTRODUCTION
1.1 Welcome and Apologies
1.1.1 1.1.2
The Chair welcomed members and attendees to the meeting, noted apologies received and advised that the meeting was quorate. The Chair advised on the chairing arrangements for the committee following the resignation of Chairs Adam Sharples and Richard Strang. Lucy De Groot had assumed the role of Chair of Haringey’s Audit Committee and Dominic Tkaczyk had assumed the role of Chair of Camden’s Audit Committee. In line with the committee’s terms of reference, they would also assume the ‘additional’ membership of another CCG associated with their new Chair positions. Their membership would thus be as follows:
Lucy de Groot: Chair of Islington and Haringey’s Audit Committees and member of Camden and Enfield’s;
Dominic Tkaczyk: Chair of Barnet and Camden’s Audit Committees and member of Haringey and Islington’s.
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1.1.3 1.1.4
Though this was in line with the terms of reference, there was broad consensus that it would be preferable to ask other CCG lay members to attend where possible in order to limit the number of committees represented by a single lay member at meetings. The agreed arrangement was for the three remaining NCL Audit Committee Chairs each to chair one of the three remaining meetings within the current financial year.
1.2 Declarations of Interests
1.2.1 1.2.2
No new or existing declarations of interests were made in the context of any agenda item. The register would be updated to reflect Lucy De Groot’s position as Lay Member for Audit and Governance at Haringey CCG.
1.3 Declarations of Gift and Hospitality
1.3.1
No declarations of gifts or hospitality were made.
1.4 Minutes of the Meeting held on the 23 May 2019
1.4.1 1.4.2
The Committee in Common approved the minutes of the meeting held on 23 May 2019. The Enfield CCG Governing Body’s Audit Committee approved the minutes of a virtual meeting held in September 2019.
1.5 Action Log
1.5.1 1.5.2 1.5.3
The Committee noted the written updates on the action log and agreed to close all items. In relation to action number 23/05-001 detailing the Committee’s request for the provision of extra information as standard within the Counter Fraud Report, Erin Sims advised that the report format had been amended to include outcomes of cases and to map cases against high risk areas. The ACIC NOTED the Action Log.
2. INTERNAL AND EXTERNAL CONTROLS
2.1 Financial Services Report
2.1.1 2.1.2 2.1.3 2.1.4
Arati Das presented a financial services report which provided detailed North Central London (NCL)-wide performance information on accounts payable and receivable ledger values, and in relation to invoice purchase order compliance. The value range of invoices without approved purchase orders had increased compared with the report presented in January 2019, largely due to the increase number of agency staff required to undertake roles affected by a recruitment freeze. Concern was raised in relation to the significant value of agency payments as a proportion of the total of value of invoice payments made without an approved purchase order. In response to a question raised, it was noted that the reason that agency staff invoices were often paid without a purchase order was that staff often had to be sourced quickly. Members agreed that an update on the NCL approach to addressing this should be considered at the next meeting of the Committee. Ms Das advised that work had commenced to cleanse ledgers ahead of the merger of NCL CCGs. As part of this, there would be analyses of aged external and intra-NCL debt in order to consider collectability. Maximum write-off levels would be agreed.
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2.1.5 2.1.6 2.1.7
Simon Goodwin requested that intra-NCL ledgers be cleansed by the end of March 2020 so that invoices would be paid or written off before the formation of a single NCL CCG. Members agreed with this recommendation as a generally applicable principle, given the potential of risks which could arise as a result of ‘lost corporate memory’ during the transition from five CCGs to one. The Chair requested that the Committee be sighted at the January meeting on values to be written off and paid. The Committee:
NOTED the Financial Services Report;
AGREED to receive an update at its January meeting in relation to final write-off and payment values of aged debt following the ledger cleansing exercise; and
AGREED to receive an update at its January meeting on the NCL approach to addressing the payment of agency staff using invoices without approved purchase orders (Action: 23/09-001 – Arati Das)
2.2 Standing Finance Instruction Tender Waivers Update and Register
2.2.1 2.2.2 2.2.3
Karl Thompson introduced a NCL-wide register of tender waivers, advising that the standard waiver process and template designed with committee input had been implemented across NCL. The following was noted in discussion:
There were a number of gaps in information, such as values, which should be addressed;
There was evident inconsistency in the approach across NCL to approve waivers in relation to GP Federations. A recommendation was made that primary care colleagues across NCL be consulted in order for a standard approach to be developed. An update on progress should be given at the next meeting. Assurance in relation to the effectiveness of the approach should be given in one year’s time, possibly through the internal audit programme;
There were some differences in register format across CCGs, which should be standardised; and
Waivers should also be recorded in Registers of Procurement Decisions. The Committee:
NOTED the Tender Waiver Register; and
AGREED to receive an update at its next meeting on the approach to the management of activity commissioned through GP Federations, particularly in relation to tender waivers, followed by assurance in a year’s time in relation to the effectiveness of this approach (Action: 23/09-002 – Karl Thompson)
2.3 Information Governance Update
2.3.1
Karl Thompson provided an update on information governance activity, reporting the following key points:
NCL’s Senior Management team would shortly consider proposals for Data Protection Officer arrangements for GP practices. The proposed arrangements were detailed within the Committee paper;
The 2019-20 Data Security and Protection Toolkit had been launched. The number of items within the Toolkit for which the provision of evidence was mandatory had increased from 70 to 106; and
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2.3.2 2.3.3
Work to prepare for the merging of NCL CCGs was underway, including the establishment of a single Information Governance Group.
In response to a question raised, the Committed noted that there were no areas of high risk within the Toolkit, though ongoing assurance would be sought in relation to the robustness of cyber security arrangements. The Committee:
NOTED the Information Governance Update; and
AGREED to receive an update on NCL-wide information governance training compliance before the end of the financial year.
2.4 NCL Governance Work Plan Update
2.4.1 2.4.2 2.4.3
Ian Porter provided an overview of progress in delivery of the NCL Governance and Risk Team work plan, reporting the following key points:
An exercise to transfer all risk recording and monitoring information from Datix to NCL-wide Excel templates had concluded successfully;
The team had undertaken work to support merger activity, including drafting a constitution for a single NCL CCG;
The scope of the NCL Governance Work Plan Update would be widened in future iterations to include governance activity designed to support the merger, including the development of Integrated Care Partnerships and Integrated Care Systems;
A draft of the NCL CCG Constitution had been circulated to Governing Body Members for feedback, after which it would be circulated to all NCL GP Member Practices for voting
The following was noted in discussion:
New NCL Standing Orders would be included within the draft of the Constitution which GP practices will vote on. Approval of the NCL Standing Financial Instructions (draft SFI) and Scheme of Reservation and Delegation would be the responsibility of the newly appointed Governing Body of NCL CCG;
Though the Committee had reviewed and endorsed draft SFIs, minor changes were expected, and as such they would be circulated to the Chairs of individual CCG Audit Committees for feedback before final approval;
Though NHS England (NHSE) had confirmed that NCL-wide corporate policies would stand in a new NCL CCG, it would be good practice to ask the new Governing Body’s Audit Committee to ratify them. An internal policy audit would be undertaken to support this;
The impending statutory annual refresh of declarations of conflicts of interest should seek to include information about individuals’ roles and commitments in relation to primary care networks;
The Committee NOTED the Governance Work Plan Update.
2.5 Review of Governing Body Assurance Framework Systems and Processes
2.5.1 2.5.2
Ian Porter provided an overview of work undertaken to develop and implement a single approach for the recording and reporting of risk across NCL, along with a summary of its impact, which included improved scrutiny of principle risks at Committee level and Governing Body level across all CCGs. The Committee NOTED the report.
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3. POLICES
3.1 Whistleblowing Policy
3.1.1 3.1.2
The policy was to be tabled but required further work. The Committee AGREED to review and approve the policy virtually.
3.2 Policy on Joint Working with the Pharmaceutical Industry
3.2.1 3.2.2
The policy was to be tabled but required further work. The Committee AGREED to review and approve the policy virtually.
4. INTERNAL AUDIT
4.1 Internal Audit Progress Report
4.1.1 4.1.2 4.1.3 4.1.4 4.1.5 4.1.6
Clive Makombera provided a progress report on NCL-wide delivery of its internal audit programme, advising that the reports of three internal audit reviews had been finalised since the last meeting, summaries of which were included within the progress report. A number of further reviews remained in progress, for which the final reports would be included within internal audit papers for the January 2020 meeting. The assurance ratings of the three finalised reviews were as follows:
Primary Care Commissioning – reasonable assurance
Cyber Security – advisory
Health Information Exchange (HIE) – reasonable assurance Members noted the issues which led to the ‘advisory’ rating of the cyber security review, which included potential vulnerabilities associated with out-of-date software. Attention was drawn to a summary of the open internal audit actions and recommendations for each of the five NCL CCGs, and a more detailed account of the same within Appendix B of the progress report. The Committee also noted the following:
As the migration of functions provided by the Commissioning Support Unit would now not take place until next year, the review of the migration had been postponed until April 2020;
Since the May meeting of ACIC, internal auditors had updated the Controls Catalogue to incorporate findings from the 2018-19 Service Auditor Report, a summary of which was included with the papers; and
A benchmarking exercise undertaken by internal auditors – which compared NCL CCGs with RSM’s client base – highlighted that NCL CCGs had a higher number of reasonable assurance opinions and lower number of actions than the average.
The following was noted in discussion of the report and its findings:
Members stated that the report should be more explicit that, while NCL CCGs were doing what they could to influence rigorous patient list verification in the interests of accuracy, the contracts were held by NHSE and, as such, CCGs were limited in the action they could take;
Internal auditors were working closely with CCG management to close as many outstanding actions and recommendations as possible before the
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4.1.7
establishment of the NCL CCG. A progress update would be provided at the January meeting as part of the Internal Audit Progress Report; and
Updates would be provided to NCL CCG finance committees on HIE implementation. Assurance in relation to the same could then be provided to ACIC.
The Committee:
NOTED the Internal Audit Progress Report; and
AGREED to receive a progress update in the January progress report on work undertaken to implement and close as many outstanding audit actions and recommendations as possible (Action: 23/09-003 – RSM)
5. COUNTER FRAUD
5.1 Counter Fraud Progress Report
5.1.1 5.1.2 5.1.3 5.1.4
Erin Sims gave an overview of activities undertaken by the Counter Fraud Team, advised progress in relation to the proactive work plan was on track, and provided an update in relation to specific allegations of fraudulent activity. In response to a question raised, members noted that the Counter Fraud Team’s annual report would provide a summary of learning and the ways in which this is incorporated into awareness-raising. Simon Goodwin undertook to discuss with the Counter Fraud Team an issue of incorrect payments at Haringey CCG. The Committed NOTED the Counter Fraud Progress Report.
6. EXTERNAL AUDIT
6.1 External Audit Progress Report
6.1.1 6.1.2 6.1.3
Charles Medley advised that there was nothing new to report. As such the report was taken as read, and attention was drawn to the Annual Audit Letters for each NCL CCG. The following was noted in discussion of the report:
KPMG would review a statement within its report that NCL CCGs were rated as ‘requires improvement’ against NHSE’s oversight framework, following members’ assertion that this should correctly state a rating of ‘good’;
Clarity should be provided in relation to a value for money ‘exception’ statement made only for Islington CCG, as well as on the audit fees for each NCL CCG; and
Three recommendations from the previous year’s report had been included, which should be removed.
The Committed NOTED the External Audit Progress Report.
7. ITEMS FOR INFORMATION
7.1 Committee Forward Planner
7.1.1 The Committee:
NOTED the Forward Planner, which would be updated to reflect items agreed at the present meeting, and to show that full gifts and hospitality registers would be included within papers for the January 2020 meeting;
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REQUESTED that an outline of a NCL-wide plan to standardise finance and procurement systems, procedures, policies and processes be brought forward from March 2020 to January if possible.
7.2 Issues to Report to Governing Bodies
7.2.1 The Committee AGREED that there were no urgent or pressing issues to reporting to NCL Governing Bodies at their next meetings.
8. CLOSING BUSINESS
8.1 Any Other Business
8.1.1 There was none.
8.2 Date of Next Meeting
8.2.1 Wednesday 22 January 2020, 15:00 to 17:00, Committee Room 4, Enfield CCG
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Jargon Buster (Acroynms Guide)
updated February 2019
Acronym Meaning
A
AC Acute Care
ACO Accountable Care Organisation
ADD Attention Deficit Disorder
ADASS Association of Directors of Adult Social Services
ADHD Attention Deficit Hyperactivity Disorder
AHSNC Academic Health Science Networks and Centres
ALB Arm’s Length Body
AoMRC Academy of Medical Royal College
APHR Annual Public Health Report
APMS Alternative Provider of Medical Services
AQP Any Qualified Provider
ASC Adult Social Care
B
BAF Board Assurance Framework
BAU Business as usual
BC Business Continuity
BCCG Barnet Clinical Commissioning Group
BCDR Business continuity and disaster recovery
BCF Better Care Fund
BEHMHT Barnet, Enfield and Haringey Mental Health Trust
BMA British Medical Association
BMEC Black & Minor Ethnic Communities
BNF British National Formulary
BSCB Barnet Safeguarding Children Board
C
C2C Consultant to Consultant
CAF Common Assessment Framework
CAMHS Child and Adolescent Mental Health Services
CAP Common Assurance Process
CBT Cognitive Behavioural Therapy
CCG Clinical Commissioning Group
CCU Critical Care Unit
CG Caldicott Group (Information Sharing)
CD Commissioning Development (National Director)
CDS Commissioning Data Set
CDF Cancer Drugs Fund
CG Caldicott Guardian
CEPN Community Provider Education Network
CHC Continuing Health Care
CHINs Care Closer to home Integrated Networks
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CHM Commission of Human Medicine
CHSG Clinical Harm Steering Group
CIEH Clinical Intake of Environment Health
CIT Clinical Information Technology
CKD Chronic Kidney Disease
CMHT Community Mental Health Team
CMT Controlled Medical Terminology
COPD Chronic Obstructive Pulmonary Disease
CPA Care Programme Approach
CPAG Clinical Priorities Advisory Group
CPRD Clinical Practice Research Datalink
CQC Care Quality Commission
CQOG Clinical Quality Oversight Group
CQRG Clinical Quality Review Group
CQUIN Commissioning for Quality and Innovation
CROMS Clinical Reported Outcomes Score
CRG Clinical Reference Group
CSCN Clinical Senate & Clinical Networks
CSIPS Continuous Service Improvement Plans
CSO Commissioning Support Organisation (and NHS Providers)
CSU Commissioning Support Unit
CVD Coronary Vascular Disease
CHD Coronary Health Disease D
DBS Disclosure & Barring Service
DES Directed Enhanced Service
DH or DoH Department of Health
DNA Did not attend
DOLS Deprivation of Liberty Safeguards (in Hospital)
DPH Director of Public Health
DR Disaster Recovery
DTOC Delayed Transfer Of Care (where patients are ready to return home or transfer to another form of care but still occupy a hospital bed)
DVSG Domestic Violence Strategic Group
E
EA Equality Analysis
ECH Enhanced Care Homes
E&D Equality and Diversity
ED Emergency Department
EDS Equality Delivery System
EIA Equality Impact Assessment
EMT Executive Management Team
EOLC End of Life Care
EQIA Equality Impact Assessment
EPR Electronic Patient Record
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EPRR Emergency Preparedness Resilience Response
F
FACS Fairer Access to Care Service
FBC Full business case
FFT Friends and Family Test
FNC Funded Nursing Care
FoI Freedom of Information
FT Foundation Trust
FRG & Q Financial Recovery Group & QIPP
FTN Foundation Trust Network
G
GBAF Governing Body Assurance Framework
GDP Gross Domestic Product
GIPs Guaranteed Income Payments (Social care)
GMC General Medical Council
GMS General Medical Services
GP General Practice (or General Practitioner)
GPC General practice Committee
GPFV General Practice Forward View
H
HASC Health & Adult Social Care
HCAI Health Care Acquired Infections
HEART Health & Education Access & Resources Team
HEE Health Education England
HES Hospital Episode Statistics
HHSAC Health, Housing & Adult Social Care
HPA Health Protection Agency
HPSS Health and Personal Social Services
HoNOS Health of the Nation Outcomes Score
HRTPF Human Rights Transition Partnership Forum
HSCIC Health and Social Care Information Centre
HSO Health Service Ombudsman
HSSI Higher Severity Service Incident
HWBB Health and Wellbeing Board
HWE Health Watch England
I
IAPT Improving Access to Psychological Therapies
ICAS Independent Complaints Advocacy Service
ICO Information Commissioner's Office
ICP Integrated Care Pathway
ICT Information and Communication Technology
IFR Individual Funding Request
IG Information Governance
IHA Initial Health Assessment
IHM Institute of Healthcare Management
IAPT Improving Access to Psychological Therapies
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IDVA Independent Domestic Violence Advocates
III Institute for Innovation & Improvement
ILDS Integrated Learning Disabilities Services
IMHA Independent Mental Health Advocacy
IPC Integrated Personalised Commissioning
IPCC Inspection Prevention & Control Committee
IRP Independent Reconfiguration Panel
ISBHaSC Information Standards Board for Health and Social Care
ITT Invitation to Tender
J
JCC Joint Commissioning Committee
JCPMH Joint Commissioning Panel for Mental Health
JGPITC Joint GP IT Committee
JHWS Joint Health & Wellbeing Strategies
JSNA Joint Strategic Needs Assessment
K
KPI Key Performance Indicator
L
LAC Looked After Children
LA Local Authorities
LAS London Ambulance Service
LCFS Local Counter Fraud Specialist
LCPW Liverpool Care Pathway
LD Learning Disabilities
LES Locally Enhanced Service
LETBs Local Education & Training Boards
LGA Local Government Association
LHB Local Health Board
LMC Local Medical Committee
LHW Local Health Watch
LINK Local Involvement Network
LQSG Local Quality Surveillance Group
LRO Legislative Reform Order
LSP Local Service Provider
M
MADEs Multi-Agency Discharge Events
MARAC Multi-Agency Risk Assessment Conference
MCA Mental Capacity Act
MD Medical Director
MDT Multidisciplinary team MSKS Musculoskeletal Service
ME Myalgic encephalomyelitis
MHRA Medicines and Healthcare products Regulatory Agency
MSA Mixed Sex Accommodation
MCPs Multispecialty Community Providers
MO Medically Optimised
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N
NAG National Advisory Group
NCLSPG North Central London Strategic Planning Group
NCLs National Clinical Leads
NEL CSU North East London Commissioning Support Unit
NES National Enhanced Service
NHSE NHS England
NHSPS NHS Property Services
NHSE National Health Service England
NHSCB NHS Commissioning Board
NHSI NHS Improvement
NHS IQ NHS Improving Quality
NIB National Information Board
NICA National Integration Centre and Assurance
NICE National Institute for Health and Care Excellence
NIHR National Institute for Health Research
NMUH North Middlesex University Hospital
NPSA National Patient Safety Agency
NQB National Quality Board
NRLS National Reporting & Learning System
NSF National Service Framework
O
OBC Outline Business Case
OBR Office of Budget Responsibility
OOH Out of hours
OP Older Person
OPAU Older People’s Assessment Unit
OPCMHT Older Persons Community Health Team
OT Occupational Therapy
P
PACE Post-Acute Care Enablement
PACs Primary and Acute Care Systems
PAET Patient Assessment Environmental Team
PALS Patient Advice Liaison Service
PAS Patient Administration System
PC Primary Care
PCSB Primary Care Strategy Barnet
PD Physical Disabilities
PDT Programme Delivery Team
PH Public Health
PID Person Identifiable Data
PID Project Initiation Document
PIMHS Patient Infant Mental Health Service
PLACE Patient-Led Assessment of Care Environment
PoLCE Procedures of Limited Clinical Effectiveness
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PPE Patient and Public Engagement
PPI Patient and Public Involvement
PRES Patient Recorded Experience Score
PROS Patient Recorded Outcomes Score
PPG Patient Participation Group
PPV Patient & Public Voice
PROMS Patient Related Outcome Measures
PTL Patient Tracker List
PYLL Probable Years of Life Lost
Q
QIA Quality Impact Assessment
QIC Quality Improvement Care
QIPP Quality, Innovation, Productivity and Prevention
QISTs Quality Improvement Support Teams
QOF Quality Outcomes Framework
QSG Quality Surveillance Group
R
RACI Responsible Accountable Consulted Informed
RAID Rapid Assessment, Intervention and Discharge Service (a mental health service)
RAG Red Amber Green (traffic light rating system)
RCP Royal College of Physicians
RCGP Royal College of General Practitioners
RCT Randomised Controlled Trials
RCN Royal College of Nursing
RDAG Rare Disease Advisory Group
RHAs Referral Health Assessments/Review Health Assessments
RFL Royal Free London NHS Foundation Trust consisting of Barnet, Chase Farm and Royal Free Hospitals
RP Registered Provider
RSL Registered Social Landlord
RTT Referral to Treatment
S
SAB Safeguarding Adults Board
SBS Shared Business Services
SCIE Social Care Institute for Excellence
SHA Strategic Health Authority
SHOT Serious Hazards of Transfusion
SIs Statutory Instruments
SI Serious Incident
SLA Service Level Agreement
SMT Senior Management Team
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SPA Single Point of Access
SPG Strategic Planning Group
SRG System Resilience Group
SSCB Safer & Stronger Communities Board
STP Sustainability and Transformation Partnership
T
NHSTDA NHS Trust Development Authority
TREAT Triage and Rapid Elderly Assessment Team
TSDO Transformation Strategic & Delivery Office
TTA Tablets to Take Away
TUPE Transfer of undertaking protection of employment regulations
TWR Two-week referral
U
UCC Urgent Care Centre
UCLH University College London Hospital
UECP Urgent and Emergency Care Providers
V
VAWG Violence Against Women & Girls
VBC Value Based Commissioning
VSNAG Voluntary Sector National Advisory Group
W
WHO World Health Organisation
2WW Two Week Wait
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Some of the Acronyms Explained:
Acute services
Medical and surgical treatment provided mainly in hospitals.
Care pathway/patient pathway
A care pathway (also sometimes called a patient pathway) is a diagram, drawn by healthcare
professionals, of a patient's journey through care for a particular health condition. The
pathway is developed so that, at each stage, the patient is getting the appropriate care. If that
care does not work, the patient will continue on the care pathway to the next stage. Care
pathways are designed to get the patient to the appropriate care smoothly.
Barnet Clinical Commissioning Group (CCG)
Barnet CCG is an NHS organisation that commissions (plans and buys) healthcare services
for the residents of Barnet. CCGs were established under the government’s Health and
Social Care Act 2012 and replaced Primary Care Trusts (PCTs). Barnet CCG is made up of
all the GP practices in Barnet and is led by a Governing Body.
Commissioning
Commissioning in the NHS is the process of ensuring that the health and care services
provided effectively meet the needs of the population. It is a cycle of work from understanding
the needs of a population and identifying gaps or weaknesses in current provision, to
procuring services to meet those needs.
Commissioning intentions
Commissioning intentions are developed every year. They describe the changes and
improvements to healthcare that the CCG wants to make for the year ahead and what we
expect to commission (or ‘buy’) to achieve these changes. The CCG’s commissioning
intentions are shared widely with providers and stakeholders and are then developed into a
commissioning strategy plan for the year ahead.
Commissioning Support Unit (CSU)
The Commissioning Support Unit (CSU) is an organisation which provides services to CCGs.
CCGs can decide on the services they wish to obtain through CSUs e.g. commissioning, IT
services, information analysis. The CSU providing services to Barnet CCG is NEL CSU.
CQUIN
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CQUIN stands for Commissioning for Quality and Innovation. CQUIN is a payment
framework which allows commissioners like Barnet CCG to link a proportion of providers'
income to the achievement of locally agreed quality improvement goals.
Healthwatch Barnet
Healthwatch Barnet is the organisation established by the Health and Social Care Act 2012.
Healthwatch Barnet is the independent consumer champion for people who use health and
social care services in Barnet. It will ensure local people’s views are heard in order to
improve the experience and outcomes for people who use them.
You can tell Healthwatch what you think about Barnet’s health and social care services.
Healthwatch can also give you advice and information about local health services.
Health inequalities
Health inequalities can be defined as unfair differences in health status or in the distribution
of health determinants between different population groups. For example, differences in
mortality rates between people from different social classes. In Barnet, there are big health
inequalities that exist between people who live in the west of the borough and those who live
in the north. General health and life expectancy is worse in the west than the north and these
are priority issues for the Health and Wellbeing Board.
Health and Wellbeing Board (HWBB)
The Health and Social Care Act 2012 established Health and Wellbeing Boards as forums
where leaders from the NHS and local government can work together to improve the health
and wellbeing of their local population and reduce health inequalities.
Barnet’s Health and Wellbeing Board includes elected members of Barnet Council, the
Strategic Director of Adults, Communities and Health, Public Health, Children’s and Young
People Services, members of Barnet CCG and a representative of Healthwatch Barnet.
Board members work together to understand Barnet’s health and social care needs, agree
priorities and help to ensure that the Council and the CCG plan and buy services in a more
joined up way.
The Board is responsible for carrying out the Joint Strategic Needs Assessment (JSNA) and
developing a joint strategy (the Health and Wellbeing Strategy) for how these needs can be
best addressed.
Health and Wellbeing Strategy
Barnet's Joint Health and Wellbeing Strategy 2015-2020 has been developed by our Health
and Wellbeing Board (HWB). It is our overarching plan to improve the health and wellbeing of
children and adults in our borough and to reduce health inequalities between the least
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deprived and most affluent areas in the borough. Our Health and Wellbeing Strategy sets out
our vision for Barnet and is informed by our Joint Strategic Needs Assessment (JSNA).
Joint Strategic Needs Assessment (JSNA)
A JSNA describes the future health, care and wellbeing needs of local populations and the
strategic direction of service delivery to meet those needs. JSNAs are developed jointly
between the Council and the CCG – providing a framework for health and social care to work
in partnership to identify the needs of the population they serve and to work together in
commissioning services to meet those needs. The JSNA is a key part of the commissioning
cycle and informs the CCG’s commissioning intentions.
Key Performance Indicators (KPI)
These are set out in contracts with our providers and help us to monitor their performance.
Examples of KPIs include length of stay in hospital for a particular treatment or how satisfied
patients are with the care they receive.
Long term condition
We define a long term condition as something that cannot be cured at the moment, but can
be controlled by medication and/or other therapies, including self-care and changes to life-
style. This definition covers lots of different conditions including diabetes, asthma, multiple
sclerosis and Myalgic Encephalomyelitis (ME)( Note: ME is characterised by a range of
neurological symptoms and signs, muscle pain with intense physical or mental exhaustion,
relapses, and specific cognitive disabilities.
NICE guidance
NICE stands for National Institute for Health and Care Excellence. NICE sets standards for
quality healthcare and produces guidance on medicines, treatments and procedures. Visit
their website for more information: www.nice.org.uk
Patient Participation Group (PPG)
A PPG is a group of patients who are interested in health and healthcare issues and who
want to get involved with and support the running of their local GP practice. Most Patient
Participation Groups (PPGs) also include members of practice staff, and meet at regular
intervals to decide ways and means of making a positive contribution to the services and
facilities offered by the practice to its patients. All our GP practices are expected to have a
PPG.
Planned care
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Planned care means services where you have a pre-arranged appointment. This includes
being referred by your GP to see a physiotherapist or consultant or being sent for diagnostic
tests such as an X-Ray.
Primary care
Primary care is the services provided by GP practices, dental practices, community
pharmacies and high street optometrists. Around 90 per cent of people's contact with the
NHS is with these services. Most primary care services are commissioned by NHS England,
not the CCG.
Procurement
The process of specifying and buying (or leasing) goods or services, evaluating bids, and
negotiating contracts with providers.
Providers/Service Providers
We use the term provider or service provider to include anyone who is commissioned to
supply a health or care-based service. For example, GPs are primary care providers. Social
care providers include social workers and home support workers. Hospitals like University
College London Hospital and Royal Free are also providers.
Secondary care
Secondary care is the services provided by medical specialists, quite often at a community
health centre or a main hospital. These services are provided by specialists following a
referral from a GP, for example, cardiologists, urologists and dermatologists.
What is an STP? The Sustainability and Transformation Partnerships (STP) sets out how local health and care services will transform and become sustainable over the next five years, building and strengthening local relationships and ultimately delivering the Five Year Forward View vision
The North London PARTNERS in health and care are a partnership of health and care organisations from the five London boroughs of Barnet, Camden, Enfield, Haringey and Islington. It includes:
Barnet, Camden, Enfield, Haringey and Islington CCGs Barnet, Camden, Enfield, Haringey and Islington Councils Barnet, Enfield and Haringey Mental Health NHS Trust Camden and Islington NHS Foundation Trust Central and North West London NHS Foundation Trust Central London Community Healthcare NHS Trust Moorfields Eye Hospital NHS Foundation Trust
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North Middlesex University Hospital Royal Free London NHS Foundation Trust Royal National Orthopaedic Hospital NHS Trust The Tavistock and Portman NHS Foundation Trust University College London Hospitals NHS Foundation Trust Whittington Health NHS Trust
More information can be found on: http://www.northlondonpartners.org.uk/
Social Prescribing
Social prescribing involves helping patients to improve their health, wellbeing and social welfare by connecting them to community services which might be run by the council or a local charity. For example, signposting people who have been diagnosed with dementia to local dementia support groups. It provides GPs with a non-medical referral option that can operate alongside existing treatments to improve health and wellbeing.
Extended Access
The service is provided through various practices in Barnet, with 48,000 additional appointments a year to its residence, 7 days a week (including all bank holidays). Any Barnet registered patient can book an appointment to see a local GP or nurse, who offer the same care at hub locations as your usual GP. Just phone or visit your usual GP and ask about the Extended Access appointments or call our call centre between 6.30pm and 9pm weekdays and 8am – 8pm weekends 020 3948 6809.
Integrated Care Systems
In an integrated care system, NHS organisations, in partnership with local councils and others, take collective responsibility for managing resources, delivering NHS standards, and improving the health of the population they serve.
Local services can provide better and more joined-up care for patients when different organisations work together in this way. For staff, improved collaboration can help to make it easier to work with colleagues from other organisations. And systems can better understand data about local people’s health, allowing them to provide care that is tailored to individual needs.
Barnet Federated GPs
Barnet Federated GPs CIC is an organisation consisting of 54 general practices in the London Borough of Barnet covering approximately 400,000 patients. A GP federation is a group of general practice surgeries and practices coming together to form an organisation which can provide high quality services to the local area. Practices remain independent but collaborate and share resources to improve day-to-day functioning and patient care. The company was first formed in November 2015 through the coming together of GP surgeries in all 3 localities within Barnet (North, South and West).
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