The professional voice of general practice in Camden Londonwide LMCs is the brand name of Londonwide Local Medical Committees Limited Registered and office address: Tavistock House North, Tavistock Square, London WC1H 9HX. T. 020 7387 2034/7418 F. 020 7383 7442 E. info@lmc.org.uk www.lmc.org.uk Registered in England No. 6391298. Londonwide Local Medical Committees Limited is registered as a Company Limited by Guarantee Chief Executive: Dr Michelle Drage

CAMDEN LOCAL MEDICAL COMMITTEE MEETING

To be held from 15.00 to 16.00 pm on Tuesday 16 April 2013

The Boardroom, Woburn House Conference Centre, 20 Tavistock Square, London,

WC1H 9HQ

PART 2

Open meeting 15.00 pm to 16.00 pm

AGENDA

1.0 Welcome and apologies

2.0 Declarations of interest Members to declare any conflicts of interest in connection with any items on the agenda or in the light of subsequent debate

3.0 Minutes and matters arising not listed elsewhere on the agenda: 3.1 Minutes of LMC Part 2 meeting on 18 February 2013 (pages 2-6) 3.2 Minutes of final NCL Cluster and LMC Chairs meeting on 26 February 2013 (pages 7-

15)

4.0 Camden CCG Chief Officer report including:

• Financial position • Risk sharing agreement

• Transition

5.0 CCG update including

• Authorisation • Constitution

6.0 Items for discussion: 6.1 6.2 6.2.1

Camden Primary Care Strategy implementation – to receive an update Enhanced services Co-ordinate my Care LES – to receive an update

6.3 Data sharing agreement – to receive an update following the meeting on 22 March 2013 6.4 GP involvement in Camden’s multi agency safeguarding hub – Ms Jackie Dyer

attending to present this item (pages 16-35) 7.0 Date of next meeting:

18 June 2013

8.0 Any other business:

Draft minutes of Camden Local Medical Committee Part 2 meeting held on 19 February 2013 from 3.00 pm to 4.00 pm at Woburn House Conference Centre, 20

Tavistock Square, London WC1H 9HQ

PART TWO MEETING

OPEN Present:

LMC members Dr Ali Alibhai Dr Denise Bavin Dr Abanti Paul Dr Kevan Ritchie (in the Chair) Mr Philip Thompson Dr Farzan Vanat CCG/Borough Dr C Sayer Observer Dr Ravleen Sabharwal Londonwide LMCs

Mr Greg Cairns Ms Helen Musson Miss Nicola Rice Dr Julie Sharman

Item no.

Action

Organisation / person

responsible

1.0 Apologies Apologies were received from Dr Claire Chalmers-Watson, Mr David Cryer, Dr Nitu Gehdu and Dr Marcus Lewis. Dr Ravleen Sabharwal, a GP Registrar, was welcomed to the meeting as an observer.

2.0 Declarations of interest There were no new declarations of interest.

3.0 Minutes and matters arising not listed elsewhere on the agenda:

3.1 Minutes of LMC Part 2 meeting on 20 December 2012 The minutes of the meeting on 20 December 2012 were agreed as a correct record.

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3.1.1 GP2DRS (minute 6.3 refers) Dr Ritchie reported that the LMC had agreed in the Part one meeting that a communication would be sent to Dr Corcoran to advise him that as a system for diabetic retinopathy screening was already in place in Camden and working well that this initiative should not be rolled out at the present time.

3.1.2 Seven day prescribing (minute 6.4 refers) Dr Ritchie advised that the LMC would be contacting the LPC to advise that it agreed with the views expressed by the Medicines Management Committee in relation to seven day prescribing.

4.0

4.1

4.2

Camden Chief Officer update Financial update Dr Sayer advised that Camden CCG’s financial position was strong at the present time and that an underspend was predicted which was related to the fact that some of the investments had taken longer to get up and running than anticipated. It was hoped that in the following financial year some of the cost pressures could be offset with some of the underspend. Dr Sayer reported that the run rate was reasonable although there were still significant overspends by the acute hospital and work was ongoing to drill down those overspends in more detail. Dr Sayer advised that as far as it was known the CCG would not be likely to take on the PCT’s debts or liabilities. Dr Sayer explained that the five NCL CCGs were currently working together to develop a financial risk sharing agreement and noted that any changes in capitation payments such as a move to fair shares could be a cost pressure to Camden so entering into a risk sharing agreement would be beneficial for Camden. Dr Sayer explained that 2% would be top-sliced from each CCG budget and put into a pool but assured the Committee that strict criteria would be put in place in relation to accessing the pool. Transition Dr Sayer advised that work was ongoing to identify what areas would be transferring to the CCG, public health and the NCB. Dr Sayer advised that practices should not notice any changes to payments.

5.0

5.1

5.2

CCG update Authorisation Dr Sayer advised that the CCG had been advised that it had been given authorisation status although it was still waiting to receive confirmation in writing. Constitution Dr Sayer advised that the revised constitution had been sent to

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practices with the amendments highlighted. Dr Sayer explained that among the main areas highlighted was the reference to a procurement committee in chapter 26. Dr Sayer noted that such a committee would be set up to deal with the conflict of interest issue and it had been felt that it would not be desirable to have too many clinicians on that group as the clinical elements of business cases would have been discussed by other groups. Dr Sayer explained that it had been agreed that a Medical Director should be a voting member of that group although he or she would be from outside Camden. Dr Sayer also noted that the Standing Orders had been completely rewritten and the Standing Financial Orders were being redrafted by RMS Tenon. Dr Sayer also noted that Board members were initially elected for 2 years which mean that their current term of office would expire in June 2013. The CCG had proposed that elections be staggered as with the LMC model and that people would be appointed into any vacancies between meetings. Mr Cairns responded to advise that the latest version was a massive improvement but BMA Law had noted that it did not contain an adequate dispute resolution procedure. In addition the wording around LMC engagement in clause 8.3 needed to be strengthened and he undertook to forward suggested wording to Mr Keith Dickinson in relation to those areas. Dr Ritchie also noted that the LMC had some concerns about the make-up of the Procurement Committee and the Programme Review Board. Dr Sayer noted that Dr Aslan was leading on work to track progress against timelines in relation to the Programme Review Board. With regard to the Procurement Committee Dr Sayer reemphasized that a Medical Director would be appointed jointly with Islington and explained that it was felt that having too many clinicians on this committee would run the risk of them trying to remodel the business case. The idea of the Procurement Committee was simply to put a Chinese wall between the developers of business cases and the preferred procurement options. Dr Ritchie also noted that the constitution made reference to the LMC Executive Committee and asked who was meant by this. Dr Sayer suggested that this should also be clarified with Mr Keith Dickenson. It was noted that a meeting for all Camden practices to discuss the constitution would be taking place on 7 March 2013. Mr Cairns undertook to put the LMC’s issues in writing to Mr Dickinson in the meantime.

GC

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6.0 Items for discussion:

6.1 Camden Primary Care Strategy implementation Dr Sayer noted that the CCG had now accepted responsibility for taking forward the implementation of the primary care strategy and advised that Dr Ammara Hughes was taking the lead on this in Dr Koperski’s absence due his being on sick leave. Dr Sayer noted that the provider chairs and vice chairs met more regularly and were feeling more confident and she noted that business cases were starting to be passed through.

6.2 Enhanced services Dr Sayer confirmed that the current local enhanced services would continue and noted that proposals for future services should include options for delivery. Dr Sayer noted that any new LESs would be discussed by the Enhanced Services Steering Group and the LMC and advised that a Clinical Reference Committee which would replace the PEC was in the process of being set up.

6.2.1 Co-ordinate my Care LES It was noted that the LMC request for a CMC LES was due to be discussed at the Enhanced Services Steering Group on 28 February 2013.

6.3 Data sharing issues:

6.3.1 Data sharing agreement Dr Ritchie expressed disappointment that Mr Aftab had not been able to attend this meeting as the LMC still had concerns that the draft communication to GPs did not include vignettes around liability as the LMC had requested. In addition he asked whether patient groups had seen the draft patient leaflet as the LMC considered that it was non specific and needed to be reworded. Dr Sayer understood that the patient leaflet had been seen by patient groups but undertook to clarify this. Dr Sayer expressed concern that the LMC suggestions around the letter to GPs would make it too long and complicated and agreed that she and Dr Chalmers-Watson both needed to be comfortable with what was going to be sent out. Mr Cairns suggested that it would be more pragmatic to have a meeting to discuss this rather than try and resolve the issue by email. Dr Sayer agreed to this approach.

GC

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6.3.2 Summary Care Record The responses to the queries raised by the LMC at the previous meeting were noted.

6.4 Premises Dr Sayer reported that she had met with Mr Hoolaghan of the CSU the previous week to discuss premises. Dr Sayer explained that although the CCG had no specific responsibility in relation to this area it did consider that it needed to support member practices and to understand what the primary care landscape would look like. Dr Sayer advised that she and Mr Hoolaghan had looked at the practices to see whether there were immediate issues and noted that support could be provided to practices in terms of providing business cases. Dr Sayer also advised that the CCG was working with local authority planners to try and identify any opportunities coming up such as in Kings Cross, Gospel Oak and the Somers Town development.

6.5 PMS issues Dr Sayer advised that she had written a letter to Mr Evans on behalf of the CCG to flag up the risks associated with the PMS review and noted that she was due to meet with Mr Tony Hoolaghan and Mr Robert Evans to discuss concerns that practices may be destabilised.

6.6 Sessional GP issues Dr Sayer noted that there were a lot of sessional GPs working in Camden and advised that she was keen to try and link with trainers and GP registrars to offer the latter opportunities to come and spend a day during their training or offer longer secondment opportunities for a week or so. Dr Sabharwal noted that this opportunity would be welcomed.

7.0 Date of next meeting: 16 April 2013

8.0 Any other business There were no items of any other business.

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Minutes of the NCL Cluster and LMC Chairs Group on 26 February 2013 in

Room 5, Friends House, 173 Euston Road, London NW1 NW1 2PL

Present: LMC Chairs Dr Robbie Bunt (in the chair) Dr Martin Harris Dr Manish Kumar Dr Martin Lindsay Londonwide LMCs Mrs Jane Betts Mr Greg Cairns Dr Tony Grewal Ms Jackie Peake Miss Nicola Rice

NCL Cluster Ms Fiona Erne Mr Robert Evans Ms Trish Galloway Mr Michael Hepworth Mr Martyn Hill Ms Caroline Taylor Mr David Thomas

Item no.

Action Organisation/person

responsible 1.0 Apologies

Apologies were received from Dr Claire Chalmers-Watson, Dr Angela Lennox, Dr Yvette Saldanha and Dr Julie Sharman.

2.0 Declarations of conflicts of interest There were no new conflicts of interest.

3.0 Minutes and matters arising:

3.1 Minutes of the NCL Chairs and Cluster Group meeting on 18 December 2012 The minutes were agreed as a correct record.

3.2.1 Procurement of GP practices (minute 3.2.2 refers) Mr Evans reported that the Hurley Group and Turning Point had been selected as the preferred bidders in relation to the procurement of practices in Camden (Brunswick and Kings Cross Road respectively). With regard to the Enfield procurement (171 Ordnance Road) an invitation to tender was being finalised and would be issued shortly, and confirmation as to the successful bidder in relation to the Laurels in Haringey was still awaited.

3.2.2 Appraisal payments for Haringey PMS practices (minute 5.3 refers) Mr Evans apologised that Ms Novak had not contacted Dr Lindsay to

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confirm the position but noted that as part of the validation of PMS practices a review of what had been included in the baseline had been done and his understanding was that the money for appraisals had been included in the Haringey PMS baseline. Dr Lindsay responded to advise that the LMC refuted that as no evidence to this effect had been produced. Dr Grewal noted that unless an agreement about this was reached it could become the subject of a contract dispute and would need to go to tribunal, suggesting that a compromise arrangement might be in the best interests of all concerned. Mr Evans undertook to discuss the issue further with the Finance Director and to contact Dr Grewal and Dr Lindsay outside of the meeting.

3.2.3 PALS conciliation (minute 5.6 refers) Ms Galloway confirmed that the paperwork regarding the agreement that PALS conciliation would be funded would be reviewed and revised and explained that the North West London CSU would be dealing with complaints post April 2013 through an agreement with the NCB. Ms Erne advised that the NCB was looking to get one CSU to deal with complaints for the whole of London. Ms Erne understood that PALS would be picked up by Healthwatch post April 2013 and that conciliation would fall within the remit of the organisation which dealt with complaints. Dr Bunt considered that it would be helpful to write to practices to inform them of what would be happening and Ms Erne confirmed that the NCB was in the process of developing a communication about a whole range of issues.

4.0 Strategic issues:

4.1

Chief Executive update Financial Ms Taylor confirmed that the Cluster and the individual PCTs had reached their agreed control totals. Ms Taylor explained that the three outer PCTs had reached their control totals with help from the money which had been pooled from across the five PCTs and noted that the Barnet, Enfield and Haringey financial positions had improved remarkably. Ms Taylor noted that Barnet, Enfield and Haringey would still have negative run rates in 2013/14 and reminded members that from 1 April 2013 CCGS would not have allocations in respect of public health and primary care and noted that these were the two areas which had been traditionally underspent in the past. Transition Ms Taylor confirmed that the NCL Cluster was in the midst of the final formal handover of responsibilities to CCGs, local authorities, NHS Property Services and Public Health England and this was proceeding reasonably smoothly. In addition the transfer of schemes for contracts, assets and staff was ongoing. Ms Taylor noted that this was the first time that organisations had been

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closed without having successor bodies and advised that there was a large piece of work to be done to clear archives which could not be handed over to successors. Ms Taylor noted that beyond 1 April 2013 a legacy team would be in place to close down the existing organisation which would comprise one member of staff for London and one for each of the Clusters. The last Joint Board meeting of PCT would take place on 21 March 2013

4.2 NCL Cluster Primary Care Strategy Mr Hepworth tabled a list of the business cases which had been considered across North Central London and he noted that Barnet, Enfield and Haringey had the largest tranche of schemes although he noted that more Camden business cases had been received that morning. He confirmed that a lot of work was being done at the current time to ensure that as much of the allocated money was spent as possible. He noted that IT was the largest single item spend at £4.6m and he confirmed that £8.5m would be spent by month 12. It was noted that future discussions about primary care strategy funding and business cases would need to take place on a borough level with the CCGs.

5.0 Operational issues:

5.1 Primary Care QIPP:

5.1.1

PMS reviews

Mr Evans reported that the negotiations were proceeding across NCL London and were still in the consultation phase. He advised that some meetings had been held with negotiation groups and that meetings would be taking place with patient groups and confirmed that the offer would be finalised and circulated on 15 March 2013 and that the PMS contract would transfer to NCB for management. Dr Grewal noted that the Cluster had just moved from a consultation to a negotiation phase. He noted that it was already 26 February 2013 and asked what date it was expected that the contracts were to be signed. Mr Evans advised that the contracts were to be signed by the end of March. Dr Grewal noted that this meant that there would only be a five weeks’ negotiation period which was an unreasonable timescale. Dr Grewal noted that the contract documents had been sent to some practices on 15 February but not all practices appeared to have received them. Mr Evans undertook to take this back as he had understood that “read receipts” had been requested and anybody who did not respond would be followed up with a telephone call. Dr Grewal noted that the contract which had been sent out had a Capsticks front page attached to a Lockharts contract (version 29). Mr Evans confirmed that Capsticks had entered into agreement with Lockharts to use this and confirmed that (as far as he was aware) it had not been amended and the local element was in the process of being

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finalised. Dr Grewal noted that the letter from Suzanne Novak indicated that the localised element was included in Schedule 1 and Mr Evans undertook to check this. Dr Grewal further noted that the letter asked practices to sign and return the contract undated to which Mr Evans confirmed that he would check this also as this was not the intention. Dr Grewal asked for confirmation in writing that version 29 of the contract had not been changed. Mr Evans undertook to arrange this. In response to Dr Bunt’s query as to where ongoing negotiations would happen post April, Ms Erne advised that she would hope that they would continue with the current people in place as part of the legacy arrangements. Dr Lindsay asked whether discussions would continue if people did not sign up until issues were resolved. Mr Evans advised that a decision would need to be taken at the end of March as to what would be considered out of time. Dr Grewal noted that even if an agreement was made he had seen no undertaking from NCB that the agreement entered into would be maintained. Mr Evans advised that the NCL Cluster had been liaising with NCB re the contract offered and if signed contracts would be handed over. Dr Grewal noted that the health service was under such financial pressure and asked what the NCB’s intention was to PMS. Ms Erne advised that the NCB supported the ongoing negotiations between the NCL Cluster and practices. She confirmed that there was no grand master plan to look at PMS as a whole at this stage in London and that discussions about this had not happened and there had been no direction from national policy. Mr Cairns asked whether clause 100 would be invoked for those practices which had not reached agreement by 31 March. Mr Evans advised that the decision had not been taken yet. He further advised that Clause 100 would be the ultimate option and it was hoped that we would not have to go down that path and that it would be the NCB’s decision. He advised that there would be an element of time within which the Cluster would try and reach an outcome. Ms Erne advised that experience would tell whether any outstanding issues were something that were going to be resolved. She suspected that there might be a few snagging issues which needed to be resolved and would not be able to be shoe- horned into by 31 March and advised that the idea of issuing a termination notice was separate to the process of concluding the PMS review. Dr Grewal summed up by noting the implication that the stretch period would depend upon contractor bodies’ assessment of whether issues were solvable.

5.1.2

Enhanced services: GP cover of nursing, residential and intermediate care homes 12/13 LES Mr Evans tabled the LES which he advised had been drawn up by a multidisciplinary stakeholder group which had included Dr Robbie Bunt and Dr Claire Chalmers-Watson. He understood that the finalised document had been sent to Camden LMC for comments and that it had only been commissioned in Camden and Islington.

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Dr Bunt was not sure that Islington LMC had seen this LES specification and noted that he would raise this at the meeting between Islington LMC and the CCG the following day. Dr Grewal expressed concern about the variation/termination agreement which gave a minimum 14 day notice period to the practice. He considered that this was outrageous given the level of work that would be involved with this specification and noted that it did not fit with the agreed Once for London principles. Mr Evans undertook to check this. Development of LESs in Camden Mr Cairns noted that one of the things which was causing a lot of anxiety in Camden was the rules around commissioning enhanced services from practices in the future. He noted that there was an assumption that if a service was worth more than £173k it had to be put out to procurement but he advised that this was not the case. Mr Evans understood that enhanced services were supposed to be reviewed and any which would continue would have to be done in accordance with the NHS contracting process from the following year. Ms Erne noted that there would be some enhanced services which could only be provided by GP providers but advised that decisions would have to be made about how to procure other services. Ms Erne confirmed that enhanced services did not have to go out to public tender if it was not in the public interest.

RE

5.2 IM&T update: Mr Thomas reported that there was £2m revenue money and £4m capital money to be spent on IT this financial year and he confirmed that the Cluster was on track to spend this by 31 March 2013. IPLATO Mr Thomas noted that 193 practices across the Cluster were now using IPLATO with 12 signed up to go live in the next month. He reported that 42 practices had declined to use IPLATO. Docman Mr Thomas advised that 138 practices already have Docman installed and these were largely in Barnet and Enfield. He noted that a further 111 were due be installed. He advised that capital funding was being used for this and reminded members that if capital funding was not spent the money would be lost so his team had been identifying other items that could be purchased in addition to Docman. Mr Thomas confirmed that the funding for Docman included maintenance for two years and that if practices no longer wished to use it post 2015 they would be able to walk away with no extra cost. Dr Lindsay noted that the acute sector made massive savings through practices using Docman and asked whether they would be able to fund the ongoing costs. Mr Thomas advised that discussions were taking place with acute providers via the commissioners and there was an expectation that they would make some funding available and he noted

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that UCLH was making a sum of money available to cover 30% of Islington Docman costs. Dr Bunt suggested that this should be an item on the agendas for meetings between the CCG and the LMCs.

5.2.1 EMIS web Mr Thomas confirmed that 115 practices had gone live with EMIS web, 61 dates for go live were planned and there were 29 practices where a date had still to be agreed. He further noted that 44 Vision practices were due to move to 360 within 6-8 weeks although it was not anticipated that this migration would create may problems. Dr Lindsay advised that the internet was slow and asked what could be done to increase the line speed. Mr Thomas confirmed that N3 upgrades should be happening although his contact at NHS Connecting for Health could not commit to when this would happen. He suggested that he liaise with Dr Lindsay after the meeting regarding problems individual practices were experiencing but wished to assure the Chairs that he was keeping the pressure on EMIS as he was aware that it was not delivering in some areas such as the training. Dr Lindsay also reminded Mr Thomas of the conversation they had following the second theft of cables which had meant that his practice had been without telephones for a week which would have implications when using EMIS web. Dr Lindsay had asked if it would be possible for a practice to have two telephone lines connected to different exchanges and a hard drive to enable back up should there be a power cut at this time. Mr Thomas confirmed that he had spoken to BT and that somebody was leading on the issue regarding hard drives and Mr Thomas undertook to share the results of that work with CCGs and LMCs. Mr Thomas also confirmed that he had been speaking to EMIS regarding Dr Lindsay’s request that they provide indemnity for GPs but he was still awaiting a response and he suspected they were seeking legal advice.

5.2.2 CSU/CCG draft contract/SLA Mr Thomas advised that the GP IT service had asked CCGs to complete a memorandum of understanding in order to obtain some commitment that they would purchase services from the CSU. He advised that a memorandum of understanding had been secured from four CCGS from NCL with the exception of Camden which had decided to run its own service internally. A copy of the draft SLA was tabled and Mr Thomas confirmed that the CCGs had been given a copy of this before Christmas. He noted that it was based on the existing GPSoC document and noted that many CCGs had reported that the 8.30 -17.00 pm call out time was not long enough and so amendments were being made to ensure that it mirrored the opening times of practices. Mr Thomas confirmed that he was in the process of drafting KPIs for

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CCGs to discuss and agree and he undertook to forward a copy to the LMC office.

5.3 Premises:

5.3.1 Improvement grants Mr Evans noted that a total of grants in excess of £0.75m had been approved in relation to the first tranche of bids and schemes were progressing. He was aware that there had been some delay but gave an assurance that schemes would be supported if they were completed by no later than the second week in March. He noted that Barnet and Camden practices had been offered examination couches as a way of using the slippage in relation to the Barnet and Camden spend. He confirmed that a letter had gone out regarding the second wave of improvement grants in relation to which responses had been asked by the end of May. He noted that improvement grants would be done an individual CCG level in the future.

5.3.2 Premises survey Mr Hill confirmed that all the surveys had been completed except for two. He noted that concern had been expressed at the last meeting that the criteria for the survey had not been shared with the LMC office but he had confirmed that this had been discussed with the LMC office at the time. He also advised that he had tried to establish how many practices had received quotes from Oakleaf at the time of receiving the report of the survey and understood that there had been two cases of this about which he had expressed concern. He advised that the Cluster had no control over who GPs used to undertake any work around the adequacy of their premises and noted that while it would not be appropriate if Oakleaf had been touting for work it would appear that practices had approached Oakleaf directly. Dr Grewal accepted Mr Hill’s point about GPs being able to ask who they wanted to do the work but was concerned that an organisation was going into practices giving the impression that these were CQC related visits. He further advised that he would welcome sight of the reprimand given to the two examples identified. Dr Kumar noted that the documentation in relation to the survey had not separated out the HSC regulations and the CQC requirements. Mr Hill advised that two separate documents had been issued in relation to the visits; one relating to the condition of the premises in the form of a six facet survey and the other document set out the CQC premises conditions. He advised that two separate reports had been produced and he noted that this had been made clear in the letters to practices regarding the survey. Dr Grewal reminded Mr Hill that the only guidance which should be applied to health premises standards at present was the 2004 regulations.

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5.3.3 PCT owned premises

Mr Hill referred to the meeting which had taken place between Mr Andrew Ulyett and Dr Robbie Bunt regarding service charges. He considered that it was reasonable that any increase in service charges should only be applicable from the date that the practice received information about the increase. He advised that he needed to confirm this first, however, with the Director of Finance and confirmed that once he had reached that confirmation a message would be sent to practices in similar situations. With regard to the situation for those practices in PCT owned premises which had not yet signed leases Mr Hill noted that a template lease was now available although he considered it unlikely that there would be time for the leases to be agreed and signed by 1 April 2013 and he considered that practices would need to negotiate with NHS Property Services or the Whittington Heath. Dr Bunt noted that when new leases were signed stamp duty and registry fees would have to be made and that these had been reimbursed by PCTs in the past. Ms Taylor noted that the responsibility for such reimbursement in the future would rest with the NCB but considered it unlikely that such a reimbursement would be made. Dr Grewal reminded the group that such payments were discretionary and suggested that these factors needed to be taken into account when negotiating a new lease. He advised that these charges could affect the viability of practices and considered that there were wider issues here which he hoped the GPC would be picking up.

5.4 Payments to practices Dr Bunt expressed concern about problems Islington practices had recently experienced in relation to payments for some enhanced services and expressed concern that the problems were likely to increase under the new arrangements. He also advised that there were a handful of practices which had an SLA to provide community reception services for trusts and asked how practices would receive payments for this in the future. Dr Grewal suggested that practices who were providing such services and who were paid indirectly via the PCT should contact whoever was leading the services and note that the practice would be billing them directly.

6.0 Future engagement between LMCs and the LAT It was noted that there had been one meeting between the LLMC Medical Directors, DPCSs and the Heads of Primary Care for the three LATs to discuss future ways of working. Dr Grewal advised that another meeting was due to take place in April but there was a need for LLMCs to consider how to engage individual borough LMCs in the process.

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7.0 Any other business:

There was no other business.

15

From: Dyer, Jackie [mailto:Jackie.Dyer@nclondon.nhs.uk]

Sent: 13 February 2013 16:12 To: Chalmers-Watson Claire (CAMDEN PCT)

Cc: Wickens Joanne (CAMDEN PCT) Subject: Arranging to presente to LMC GP involvement in Camden's Multi Agency Safeguarding Hub

(MASH)

Hi Claire

You are aware Camden is piloting its Multi Agency Safeguarding Hub (MASH). The hub aims to

enable agencies to securely share information in order to safeguarding vulnerable children and

families and in turn improve quality and decision making.

We began the pilot in December, the team includes the following members :

Agency MASH status

Camden CSF

Core MASH team member

Metropolitan Police Public

Protection Desk

Core MASH team member

Central North West London

Camden Provider Services (health)

Core MASH team member

Camden Youth Offending Service

Satellite member

Camden Probation Service

Satellite member

Camden Housing and Adult Social

Care

Satellite member

Camden Community Safety Satellite member

During the first stage of the pilot it has been agreed to MASH triage MERLINS which involve concerns

about the safety and welfare of a child aged 0-18 who have come to the attention of the police. The

MASH manager (from Family Services and Social Work Team) currently reviews all MERLINS and give

each case an initial RAG rating to see if it meets the criteria for the MASH. In the next stage of the

pilot the plan is to also include all eCafs through this screening system.

Regarding health involvement you will see in the pilot we have a CNWL representative , who can

access RIO records for HV, SN and sexual health services. For the next stage of the pilot we would

like to involve GPs and our acute Trust partners.

I have included some documents above,

1. Letter regarding Engagement NHS London

2. Camden MASH Information Leaflet for Parents

3. Draft Mash Information Sharing Agreement

I would be grateful if you could arrange a slot at the LMC, for myself and Jo Wickens to come and

discuss future development of this process within general practice in Camden.

Thanking You

Jackie

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Jackie Dyer

Designated Nurse for Safeguarding Children

Camden Borough Office

NHS North Central London

4th Floor, East Wing, St Pancras Hospital

St Pancras Way, London NW1 OPE

Tel 020 3317 2758 Mobile 07768886 258

Secure email account jackiedyer@nhs.net *please notify me if you are sending confidential matter to this email address *

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London Strategic Health Authority

Chair: Professor Mike Spyer Chief Executive: Dame Ruth Carnall DBE

Tel: 020 7932 3700

Fax: 020 7932 3800

To Chief Executive Officers Clinical Commissioners GP Clinical Commissioning Groups

13 April 2012 Dear Colleague Development of Multi-Agency Safeguarding Hubs (MASH) for Safeguarding Children in London A safeguarding children initiative being coordinated by the Greater London Authority on behalf of the Mayoral Office is currently underway in London. The overall vision is for a Multi-Agency Safeguarding Hub (MASH) to be established in every London borough to facilitate information sharing for safeguarding vulnerable children and families. I am the current strategic health representative for NHS London. The need for improved and faster information sharing systems has been consistently identified in a series of studies analysing Serious Case Reviews. Utilising a MASH approach was considered a model of best practice and recommended in the Munro Review of Child Protection in 2011. NHS records have been identified as an important source of information and NHS participation is therefore considered to be a major component of a MASH team. The project management for pan London implementation is being coordinated by the Metropolitan Police on behalf of the Mayor. For several months, the Metropolitan Police and Local Authority Directors of Children's Services have been working alongside health partners to devise a model to identify children and families presenting to statutory agencies that may benefit from early help or child protection services. Clarification as to what constitutes a MASH, information sharing standards and job profiles for health staff working in a MASH are currently under discussion. Progress on the work programme is routinely shared with the strategic planning group chaired by the Greater London Association and the London Safeguarding Children Board. A new operational group is also to be established though members are yet to be fully identified. The current implementation programme is scheduled to run from April 2012 through to March 2014 and ideally involves co-location of police, social care and health services to enable a pooling of information that facilitates early identification and intervention. Six London boroughs have commenced pilots and a phased programme for further implementation across all 33 boroughs is in development. Health input to the pilot sites has been led by the safeguarding children designated professionals aligned to the Local Authority area. Issues connected to the NHS reforms and the effect of transition and change to the NHS in London is fully appreciated by the strategic partnership. However it is anticipated that the pace of the MASH project plan will increase over the next six months.

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To enable local engagement as far as it is possible, NHS safeguarding leads and commissioners should familiarise themselves with borough plans and seek the advice of the relevant Designated Professionals about the practical application. This will enable the local NHS to be fully engaged in the planning process and assist with local design in terms of how the MASH functions in practice including how Mash activity will be evaluated and measured. Please do not hesitate to contact us if you wish to further discuss this multi-disciplinary safeguarding children initiative. Yours faithfully

Dr Andy Mitchell Professor Trish Morris-Thompson Medical Director Chief Nurse

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Introduction and purpose of agreement

This is an agreement between the named partner agencies to share information held

by each agency in order to safeguard children in Camden via Camden’s Multi-

agency Safeguarding Hub (MASH).

The key aim of the agreement is to provide a framework for the safe, secure and

lawful sharing of information where there are concerns about a child’s safety and

welfare. In particular, the agreement will:

• explain the legal basis for sharing information

• set out the roles of each agency in implementing the agreement

• describe the sources and type of information to be shared and the reasons for

sharing

• describe the process by which information will be shared and how the

information will be used

• define any limits to information sharing

• explain how agencies will ensure the safety and integrity of information held.

Information about the agreement

Parties

The parties to this agreement are:

Can you check these are the right agencies and names?

The London Borough of Camden, (including Children, Schools and Families

Directorate and the Housing and Adult Social Care Directorate)

• The Metropolitan Police (Camden Borough Command)

• Central North West London NHS Provider Services

• London Probation Trust (Camden and Islington Local Delivery Unit)

Definitions

For the purpose of this agreement:

Under the Children Act 1989:

• Child means any child or young person aged under 18

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• Parent/carer means anyone holding parental responsibility for the child and/or

holds a residence order or special guardianship order in respect of the child

and who has care of the child on a daily basis

Under section 1 of the Data Protection Act 1998:

• Data means any information which is processed within the MASH team.

• Data processing means obtaining, recording, or holding information in order to

carry out any operation and includes retrieval, adaptation, transmission,

disclosure and destruction.

• Data subject means anyone to whom the information to be shared relates.

• Data controller means the person or organisation who determines the purpose

for which and the manner in which data is processed.

• Data processor means the person (other than an employee of the data

controller) who processes the data on behalf of the data controller.

• Personal data means information from which the data subject can be

identified (ie: names, addresses etc).

• Sensitive personal data as defined by section 2 of the Data Protection Act

means information about the data subject relating to their:

o racial or ethnic origin

o political opinions

o religious or other beliefs

o trade union membership

o physical or mental health

o sexual life

o criminal history or any criminal or court proceedings in which they are

involved.

Management oversight and review

The implementation and operation of the agreement will be overseen by the MASH

steering group, a multi-agency meeting that is convened regularly to manage the

business of the MASH.

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An annual review of the agreement will be carried out by the steering group to

ensure its smooth implementation and continued relevance. However, the steering

group will authorise any changes needed to the agreement during the course of the

year in order to resolve any operational difficulties.

Each agency will designate a senior officer with responsibility for ensuring the

smooth implementation of the agreement on a daily basis and can advise MASH

officers on matters relating to information sharing.

Scope

The agreement relates to information shared by the named parties about children

under the age of 18 normally resident in Camden for whom there are concerns about

their safety and welfare and who are the subject of any referral to Family Services

and Social Work.

Dates

This agreement will come into effect on:

The agreement will be reviewed on:

Information about the MASH

Children are one of the most vulnerable groups in society and the need to protect

them is recognised in the legal duties placed on a number of agencies to co-operate

in order to ensure their safety and promote their welfare.

One of the key areas of inter-agency co-operation is information sharing by key

agencies working with the child and their family. Good information sharing can help

social workers build up a picture of the child’s life, allow them to assess levels of risk

to the child and make good decisions on what interventions and services are likely to

successfully protect the child and support parents.

Camden’s MASH is a partnership between local agencies who have a statutory duty

to safeguard children and who have agreed to set up a multi-agency team in order to

share information on children and families that is held by individual agencies.

The purpose of the MASH is to facilitate lawful information-sharing between

agencies where there are concerns about a child’s welfare in order to build an

accurate picture of the child’s life and informing better and timelier decisions on

intervention.

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The MASH is a co-located team with workers from each partner agency able to

interrogate their agency data and share this in a safe, secure and sterile environment

that enables information to be shared in controlled circumstances and balances the

rights of families to privacy against the need to protect children.

The MASH will deal with all safeguarding referrals into Family Services and Social

Work and will share information about:

• individual children and families where there are concerns or risk of significant

harm to the child

• risks posed by individuals and their potential victims

• community-wide risks requiring a multi-agency response.

Purpose and legal basis for information sharing

The Data Protection Act 1998

The Data Protection Act restricts the sharing of sensitive personal information unless

at least two of the following conditions are met.

• the data subject has consented to disclosure;

• the information is already in the public domain;

• the information must be disclosed under a legal duty;

• the agency is lawfully excluded from the restrictions; (Section 29 of the Act

provides the Police with an exemption for the purposes of preventing or

detecting crime or the apprehension or prosecution of offenders).

• disclosure is necessary to protect the interests of the data subject or others

where consent cannot be obtained or has been unreasonably withheld;

• disclosure is necessary for medical purposes;

• disclosure is necessary for the purpose of legal proceedings or the

administration of justice.

The Human Rights Act 1998

The Act would normally restrict information sharing, as Article 8 protects the right to

privacy and a family life. However, this is a qualified right that public authorities may

infringe in order to uphold the law and protect the rights and freedoms of others.

This will include the need to protect children from harm.

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Common law

Where a common-law duty of confidentiality is owed by a professional to a service

user, as in the case of social workers and health workers, information given to them

in confidence by a service user must not be disclosed to a third party without the

service user’s consent.

The exceptions to this are where the disclosure is in the public interest , for example

there is an overriding need to protect a child’s welfare, or a serious crime has been

committed, or by order of the court.

The Children Act 1989

The Children Act 1989 places a duty on local authorities to safeguard and promote

the welfare of children living in the borough.

• Section 17 places a duty on local authorities to provide services and support

for children in need, defined as “children who are unlikely to meet a

reasonable standard of health and development, or whose health and

development would be significantly impaired, unless provided with services, or

children who are disabled”. Information sharing must be by consent of

parents.

• Section 47 places a duty on local authorities to carry out enquiries to decide

on what action to take to protect a child whom it is thought is suffering or at

risk of suffering significant harm. During enquiries, there is a duty on statutory

agencies to co-operate with the local authority in order to assist with these

enquiries, including sharing information, which may be without consent of

parents.

The Children Act 2004

Section 10 of the Act places a duty on statutory agencies to safeguard and promote

the welfare of children in relation to the 5 outcomes;

o being healthy

o staying safe

o enjoying and achieving

o making a positive contribution

o achieving economic wellbeing

This includes making arrangements for joint working practices that supports the

safeguarding agenda and the delivery of integrated services, including the basis for

information-sharing agreements.

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The Crime and Disorder Act 1998

Section 115 of the Act allows for disclosure of information by a relevant authority (eg:

the police, local authorities, health and probation) for the purposes of preventing or

detecting serious crimes.

The NHS Act 2006

Section 82 of the Act places a duty to co-operate upon NHS bodies and local authorities ‘to secure and advance the health and well-being of people of England and Wales’, including sharing information.

MAPPA Guidance 2009 Section 5 of the statutory guidance to support the Multi-Agency Public Protection Arrangements (MAPPA), covering arrangements for managing sexual and violent offenders, allows for information sharing that is essential for the purposes of public protection.

Consent

Consent must be sought on cases unless there are child protection concerns or in

order to prevent or detect crime. Where consent is sought, the service user must

have a clear explanation of the issues and what they are consenting to so that

consent can be informed. Consent must also be explicit, being specifically requested

rather than implied.

Consent must be given by the individual to whom the information relates and they

must be deemed competent to give consent. Where there are concerns an adult is

not competent to give consent, for example due to mental health issues, consent

should be sought from their next of kin.

Young people aged 16 and over are competent to give consent; young people aged

between 12-15 may be competent if it is thought they understand the issues.

Children under 12 cannot give consent and their parents must do so on their behalf.

Where consent will not be sought or is withheld, the professional must consider the

proportionality of disclosure against non- disclosure; is the duty of confidentiality

overridden by the need to protect a child?

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Information sharing in the MASH

The purpose of information sharing in the MASH is to make timely decisions about

sharing information with other agencies in order to refer families on for services or

interventions.

Information gathered by partner agencies is likely to be sensitive in nature and

obtained for different purposes, but must only be shared for the purpose of

safeguarding children.

Information may be lawfully shared within the MASH only where there are concerns

that the child is at risk of significant harm and that a child protection enquiry under

section 47 of the Children Act is likely to be convened in order to protect the child.

For referrals relating to a child who is in need as defined by section 17 of the

Children, or for families who need early intervention in order to support parenting,

consent must be obtained from families before any information sharing or referral on

can take place.

To ensure information sharing is carried out in a lawful way and that partner

agencies are confident that this is the case:

• The MASH team will be co-located, operating separately from their originating

agencies within a sterile, secure environment.

• Information shared within the MASH will not be passed outside the MASH;

only a summary of information shared will be passed on to any agency to

which the case is referred. The amount of information shared with the agency

will be proportionate to the agency’s “need to know”.

• Each case referred to the MASH will be given a RAG rating depending on the

level of risk of harm to the child, as assessed by the MASH manager. These

are:

o Red: Child appears to be at risk of immediate and/or serious harm.

o Amber: Child appears to be at risk of harm but not imminently and

possibly less serious.

o Green: Concerns about the wellbeing of the child which if not

addressed may lead to poor outcomes.

• Only cases that have been identified by the MASH manager as involving risk

of harm to a child and given a RAG rating of Red or Amber will be subject to

MASH information sharing processes. Green rated cases will require consent

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to be obtained from the service user before referral is made to an early help

service.

• MASH partners agree to share only relevant information relating to the

assessment of risk to the child and that the information will not be used for

any other purpose.

• Information from agencies will only be shared with third parties with the

consent of the agency providing the information.

• Agencies may request that information they provide is not shared with third

parties where a referral is made and there are sound legal or operational

reasons for withholding the information. For example, the police may ask that

details of an on-going investigation are not shared.

• The MASH team will follow the MASH operational protocol describing the

steps for information sharing at all times.

Full details of MASH processes can be found at the following link.

Z:\Children schools & families (social care)\Children and Families\Social Work policy

folder\Multi-Agency Safeguarding Hub (MASH)\MASH protocol Dec 12.pdf

Information to be shared

The list needs to be checked with individual agencies and services for accuracy

Agencies will only share information that is relevant in order to identify any risk of

harm to the child and will be proportionate in relation to the level of risk posed and

concerns held.

The information to be provided by each agency is listed in appendix 1 to this

agreement. Information will be presented using the MASH risk assessment template

(see appendix 2). Information systems will only be accessed by named personnel

who have been authorised to interrogate the system for the purposes of information-

sharing in the MASH.

Each agency will provide basic personal information about the child and family

members, including names, dates of birth, ethnicity and any information needed to

facilitate communication with and participation by the family, for example first

language, communications difficulties.

The child’s NHS number will be used as the unique identifier, but once processed by

the MASH team, the Framework I case number will become the unique identifier and

main method of cross-referencing cases between agencies. The case number will

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also the MASH to trace cases that are referred to Family Services and Social Work

in order to monitor outcomes.

Duties relating to data protection

• All parties agree to process information in accordance with the provisions of

the Data Protection Act 1998 and related statutory instruments.

• Access to data systems will be controlled using usernames and passwords to

increase security and ensuring that only authorised personnel have access to

systems. Personnel will receive adequate training and will have a satisfactory

DBS check carried out prior to being given access.

• Information will be transferred in a secure manner using secure email systems

approved by all parties.

• Information shared within the MASH will be recorded using the template

shown at appendix 2 and held on Framework i.

• As Data Controller, the London Borough of Camden will ensure that

information shared by the MASH is used only for the purposes of

safeguarding children and will not use the information for any other purpose.

• MASH information will only be shared with third parties for the purposes of

protecting children or supporting families, and only with the consent of parents

unless this would place the child at further risk.

• Information produced by the MASH will only be held for as long as required

and in accordance with Camden’s Children, Schools and Families retention

schedule.

Duties of partner agencies

Partner agencies will ensure:

• individual agencies comply with the requirements of the Data Protection Act

1998 in relation to their own gathering, storing and processing of information

held;

• information is shared in accordance with their legal duties under the Data

Protection Act 1998 and the Human Rights Act 1998, and any common law

duty of confidentiality owed to a service user;

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• staff recognise the importance of keeping information confidential and seek

consent before sharing information unless there are legal grounds to share

the information without consent;

• information supplied via the MASH is used solely for the purposes of

safeguarding children and assessing risk of harm and that it is relevant and

proportional, up to date and accurate;

• information will only leave the MASH when referring a family on to relevant

services and interventions, and that only a summary of the information shared

is made available to staff members who need to know and who are aware that

the information is highly confidential;

• information is only shared with third parties with the consent of the agency

providing the information;

• information is recorded in line with agreed procedures set out in the MASH

operational protocol and sent only via secure CJSM email;

• records are retained only as long as needed and that records are disposed of

in a safe and secure manner;

• staff operating within the MASH are authorised to do so and have received

suitable training and induction relating to information sharing so that they

understand their role in the MASH;

• that staff working within the MASH are suitably supervised by their agency

and that a senior staff member from their agency is available to provide

guidance on information sharing issues, including a Caldicott guardian for

health workers;

• information passed to the agency by a partner agency is kept secure and any

breaches of security of information are reported, with each partner agency

having in place procedures for the investigation of any breaches;

• individual agencies have proper procedures in place for seeking a service

user’s explicit and informed consent for disclosure to a third party and that

these procedures are followed at all times;

• individual agencies have a complaints procedure in place to address

complaints relating to the operation of the MASH and the disclosure of

information via the MASH and will co-operate with each other to assist in

resolving any issues.

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Agreement and signatures etc….

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Appendix 1: Information to be shared within the MASH

Agency Information to be shared System/Source Name of officer

authorised to interrogate system on behalf of the MASH

Nature of information (Personal or sensitive information)

London Borough of Camden

Family Services and Social Work

Previous involvement with the family; services and interventions provided; historical concerns, allegations etc

Framework i Personal and sensitive

Youth Offending Service

Information about the service’s involvement with the young person, historic and current; details of any current programme, ie:bail supervision or community sentence

YOIS Personal and sensitive

Housing and Adult Social Care

Details of social care tenancies, details of tenant’s history including rent arrears, reports of domestic violence and anti-social behaviour

Northgate Personal

Integrated Early Years Service

Provision of nursery place or supported child-minding place; attendance; presentation; details of any concerns held

Synergy Personal and sensitive

Education Name of school, educational history, exclusions; attendance and truancy

Impulse Personal

Camden Police Names of household members and relationship to child; information relating to adults who pose a list; details of offences and criminal history of carers; presence of risk factors, ie: domestic violence;

Police National Computer

Personal and sensitive

Central North West London NHS

Children’s health information; information held by GPs; information from hospitals on admissions and outpatient care; information from the London Ambulance Service

RIO/EMIS Personal and sensitive

Probation Information on person’s posing a risk who are known to the family and have contact with the child; family members subject to MAPPA

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Appendix 2:

MASH risk assessment matrix

Information on this record is highly confidential and restricted to use within the MASH

only. If agencies are giving information that they do not wish to be shared outside the

MASH, this should be specified on the form. Housing and education staff should only

complete the relevant information boxes unless they have direct contact with the

family, in which case staff should complete all boxes.

Name of worker:

Agency:

Date completed:

Framework i number:

NHS number:

Agency involvement/contact with child and family

Reason for involvement/contact; services provided or actions carried out; dates; level of

engagement from parent/carer; any patterns of repeated presentation or service request;

Child’s circumstances:

Child’s presentation; relationship with main carer; evidence of neglect, abuse, exploitation or

trafficking; degree of vulnerability due to age, disability or learning difficulties; living with

adults other than parents; emotional difficulties or self-harming behaviour;

Family’s circumstances:

Family composition and relationship to child; quality of family relationships; evidence of

domestic violence or family dysfunction; quality of housing; state of home; level of income;

immigration status;

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Parent/carer’s circumstances:

Relationship with child; parenting capacity and ability to meet the child’s needs; own

presenting issues; attitude towards agencies; history of violence or offending;

Presence of risk factors:

Substance misuse; learning difficulties; mental health issues; domestic violence; criminal

activity; presence of people who pose a risk to children;

Information from housing:

Name of landlord; status and stability of tenancy; rent arrears; housing history; reports of

domestic violence or anti-social behaviour; information about the child

Information from education:

Name of school; educational history; exclusions; level of attendance and any truancy;

Information not to be shared

Please give details of any information that must not be shared with the family or other

agencies

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Keeping children and young people safe and supported Information for parents and carers

Children and young people come to our attention in a variety of ways:

• Schools may have a concern about your child’s attendance or behaviour

• Health professionals may be involved

• A family worker or social worker may be working with your child

• Your family may have problems with housing or where you live

• Police and youth offending may be involved

Wherever the concerns may start, we believe that if a positive difference is going to

be made, we need to understand ‘the whole picture’ and work together – with you.

That’s why we’re bringing together the key professionals who deal with concerns

about children and young people’s safety and support into one team.

One team in one place

The new team will be based at the Crowndale Centre in Eversholt Street NW1. It will

include the police, health, social services and youth offending, with help on call from

a wider group including schools, probation services and housing. We call it a multi-

agency safeguarding hub or MASH.

This team will work to get a better understanding of the different issues that may be

affecting your child’s safety and welfare. Where necessary, this could mean sharing

the information they hold about your family.

Understanding the ‘bigger picture’ can help the team to assess the best way to make

a positive change and to offer your family the right support at the right time.

How does it work?

Whenever anyone is worried about a child, for example a teacher or health visitor,

they will make a referral to the MASH team.

If the MASH team believe the child would benefit from extra help, or that the parents

need support to help care for the child, they will refer the family to the appropriate

support.

However, if the team consider that the child is at risk of harm or abuse, they will each

share the information their agency has about the family and decide what action

needs to be taken to keep the child safe. For example, the team may refer the family

on to Family Services and Social Work for a child protection service.

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It’s my information; what are my rights?

• Any information shared is only used to protect children and it will not be used

for any other purpose. Information held by the MASH team will be kept secure

and no-one but team members will be able to see this information.

• If professionals are referring your child to the MASH team for support, they will

need to ask for your permission first.

• If professionals are referring your child to the MASH team because of child

protection concerns, they do not need your permission. They will let you know

about the referral unless they believe this may put your child at more risk.

• When your family are referred on to another service, only relevant information

will be passed on to them. The MASH manager will explain to you what

information is being passed on and why.

Will I find out what’s happening?

The MASH team manager will contact you to let you know the outcome of any MASH

enquiry once a decision has been made.

What if I’m not happy?

If you’re unhappy about the way the MASH team deals with any referral about your

family, raise this first with the MASH team manager. He or she will explain why

information was shared and how decisions on your case were made.

If you are still not happy, you can make a complaint using Camden’s complaints

system or you can contact the Information Commissioner if you are unhappy about

the way Camden has used your information.

Camden CSF Complaints Children Schools and Families London Borough of Camden FREEPOST RRAR-KKUL-RCEZ 218 Eversholt Street London NW1 1BD

Information Commissioner Wycliffe House Water Lane Wilmslow Cheshire SK9 5AF

Phone: 020 7974 6673 Freephone: 0800 393 561 Fax: 020 7974 1439 Email: children.complaints@camden.gov.uk

Phone: 01625 545 745 Fax: 01625 524 510 Email: mail@ico.gsi.gov.uk

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