NHS Barnet Clinical Commissioning Group Finance, Performance and QIPP Committee Thursday 16 February 2017, 08.30 a.m. to 10.30 a.m. Room G2, Ground Floor, North London Business Park, N11 1NP PRESENT Debbie Frost (DF) NHS Barnet CCG Chair Cathy Gritzner (CG) Accountable Officer Bernadette Conroy (BC) Lay Member Governing Body Barry Subel (BS) GP Board Member (South Locality) Roger Hammond (RH) Chief Financial Officer Clare Stephens (CS) GP Board Member (North Locality) Michelle Newman (MN) GP Board Member (West Locality) Swati Dholakia (SD) GP and Governing Body Member (West Locality) Charlotte Benjamin (CB) GP Board Member (South Locality) IN ATTENDANCE Andrew Barber (AB) Head of Delivery and Strategy and Head of PMO (Interim) Neil Snee (NS) Director of Commissioning (Interim) Michael Weaver (MW) Governing Body Secretary (Interim) Richard Pearson (RP) Deputy Director, NCL POD, CSU David Holden (DH) Director of Governance and Corporate Affairs (Interim) Alison de Metz (AM) Deputy Director, IFR, NEL CSU (Item FPQ/058) Leigh Griffin (LG) Director of Strategy and Primary Care (Interim) APOLOGIES John Bentley (JB) GP Board Member (South Locality) Ahmer Farooqi (AF) GP Board Member (North Locality) Jonathan Lubin (JL) GP Board Member (North Locality) OPENING ADMINISTRATION FPQ/052 Introductions and Apologies for absence The Chair, Debbie Frost (DF), welcomed everyone to the meeting. Apologies were received from Dr John Bentley, Dr Ahmer Farooqi and Dr Jonathan Lubin. Finance, Performance and QIPP Committee Thursday 16 February 2017 1
OPENING ADMINISTRATION FPQ/053 Declarations of Interest Debbie Frost asked the committee to note that GP Governing Members were conflicted in relation to item 8.0, Proposal for Locality Commissioned Service for the stratified follow up of prostate patients in primary care. Any discussion regarding commercially sensitive information in relation to financial information would require the exclusion of GP Board Members. It was therefore proposed that commercially sensitive information would be discussed in a Part Two, meeting in Private with no GP Governing Body Members present. FPQ/054 FPQ/055 All members of the committee noted the requirement for GP GB members not to be present during discussion of matters in relation to item 8.0, Proposal for Locality Commissioned Service for the Stratified follow up of prostate patients in primary care. Minutes of the previous meeting The minutes of the meeting held on 22 December 2017 were accepted as a true and accurate record subject to ensuring the record of the decision taken in relation to item FPQ/045 provided a full and accurate record of the votes cast in relation to the action agreed for STP and CCG 2017/2018 Financial Plans. Action Log FPQ/033 Referrals to Moorfields Eye Hospital (MEH) At its meeting on 17 November 2016 members of the committee had asked to know the reasons for an increase in referrals to Moorfields Eye Hospital. At its meeting on 22 December 2016, RP had reported the majority of over performance at MEH in year had been due to high cost drug injections, The majority of high cost drug injection over performance could be seen in Eylea, used to treat age related Macular Degeneration (AMD) and Diabetic Macular Oedema (DMO). The committee had asked RP to undertake an audit against NICE Guidelines to assess compliance and report findings at today s meeting. RP asked the committee to note a report would be prepared for the Islington MDT at its meeting in March 2017. BC asked to receive the information requested sooner than the Islington MDT in March. RP agreed he would circulate the figures earlier and advised the committee that such activity would not have an impact on the current financial year. The committee noted RP would circulate findings from an audit of NICE Guidelines in relation to the treatment of age related Macular Degeneration (AMD) and Diabetic Macular Oedema (DMO). FPQ/035 and FPQ/037 Performance and Quality Report At its meeting on 17 November 2016 members of the committee asked the CCG to provide an action plan that would return Accident and Emergency performance back to trajectory by March 2017. NS asked the committee to note the CCG and Royal Free London NHS Foundation Trust (RFL) had agreed a trajectory of 92% by the end of March 2017. The CCG was discussing the secondment of a member of staff to support the Urgent Care Programme. MW RP Finance, Performance and QIPP Committee Thursday 16 February 2017 2
OPENING ADMINISTRATION FPQ/055 Action Log FPQ/035 and FPQ/037 Performance and Quality Report DF noted action in relation to this item would continue to be discussed at the Urgent Care Board. The committee noted the closure of Action FPQ/035 and FPQ/037 FPQ/040 Declarations of Interest At its meeting on 22 December 2016 the committee agreed the CCG should ask Governing Body members to update their Declarations of Interest. It was confirmed all members of the Governing Body would be invited to review and update their declarations of Interest following approval of the CCGs Conflicts of Interest Policy at the Audit Committee on 2 February 2017. The committee noted the closure of Action FPQ/040 FPQ/044 Performance and Quality Report At its meeting on 22 December 2016 the committee asked to receive a copy of the recovery plan to improve performance against cancer targets for University College London Hospitals NHS Foundation Trust (UCLH). RP asked the committee to note a copy of the recovery plan had been forwarded to the Director of Commissioning (Interim) who had been asked to advise as to who the report the report should be forwarded to. The committee noted closure of FPQ/044 At its meeting on 22 December 2016 the committee asked the CCG to refresh the RAG rating rationale to include a different basket of comparators and revised basket of CCGs. AB confirmed the action had been completed. The revised Rag rating reflected Barnet CCGs performance against its RightCare peer group (new group), London CCGs and England value. The committee noted closure of FPQ/044 FPQ/046 Child and Adolescent Mental Health Services (CAMHS) referrals At its meeting on 22 December 2016 the committee had asked to be informed of the Tier 3 referral criteria in order to inform GP colleagues. NS agreed he would circulate the Barnet, Enfield and Haringey Mental Health NHS Trust Child and Adolescent Mental Health Service (CAMHS) referral criteria. DF asked for information to be circulated in the CCGs GP Bulletin. The committee noted NS would circulate the Barnet, Enfield and Haringey Mental Health NHS Trust Child and Adolescent Mental Health Service (CAMHS) referral criteria and referral information would be included in the GP Bulletin. NS Finance, Performance and QIPP Committee Thursday 16 February 2017 3
OPENING ADMINISTRATION FPQ/055 Action Log FPQ/048 Five areas for activity audit to support Care Closer to Home At its meeting on 22 December 2016 the committee received a report on Five areas for Activity Audit to support Care Closer to Home and asked the CCG to develop an outline business case and prepare a project plan and benefits realisation. NS confirmed five areas of audit were being worked up into business cases and report would be brought to March meeting of the committee. The committee noted the update and asked NS to circulate the current draft business cases that would be reported to the March Finance, Performance and QIPP Committee meeting. NS FPQ/056 Governing Body Assurance Framework Finance, Performance and QIPP Risks At its meeting on 22 December 2016 the committee received a report on Finance, Performance and QIPP Risks on the Governing Body Assurance Framework (GBAF). BC had agreed to meet with the CCGs Risk and Governance Lead to discuss the GBAF. The committee noted BC would arrange a meeting with the CCGs Risk and Governance Lead to discuss Finance, Performance and QIPP Risks on the GBAF. BC FINANCE AND BUDGET FPQ/056 Finance Report Roger Hammond, Chief Finance Officer, presented the month 9 position (December 2016). The CCG was on plan year to date (YTD) and was forecast to deliver its plan for 2016/17. The CCG had planned to deliver an in-year 2.7m surplus to repay the remaining deficit brought forward from previous years and, as agreed with NHSE, post a 1.1m cumulative surplus. Pressures were being seen across CCG expenditure lines and unexpected in year pressures (i.e. funded nursing care, London Ambulance Service) required the CCG to identify further opportunities to offset these pressures. The Executive Team were working to identify and consider opportunities to offset these pressures. RH outlined work underway with local providers to agree a year end deal that included agreement of Commissioning for Quality and Innovation (CQUINs) payments. Clinical Commissioning Groups (CCGs) are required to refresh their financial / activity plans by 27 February 2017. The CCG had been asked to review the submission it made to NHS England (NHSE) on 16 December. Of particular concern was the current level of unidentified Quality, Innovation, Productivity and Prevention (QIPP) that was subject to further discussion with NHSE. BC confirmed she had written to the NHSE National Audit Committee Chair to express her concern over the level of unidentified QIPP. The CCG had received very positive feedback on its current position and future financial planning from NHS England. Finance, Performance and QIPP Committee Thursday 16 February 2017 4
FINANCE AND BUDGET FPQ/056 Finance Report The CCG had been asked to facilitate the balancing of the Service Transformation Plan (STP) control total for North Central London (NCL) and had, in conjunction with other CCGs, identified additional pressures across NCL that would need to be managed collaboratively to secure all organisations achieving their control totals for 2016/17. Whilst noting the current pressures DF stated the need to continue with Care Closer to Home. The committee noted the month 9 (December 2016) financial position reflecting a balanced position and forecast to achieve the financial plan agreed with NHSE. PERFORMANCE AND QIPP FPQ/057 Quality and Performance Report The Quality and Performance Report (QPR) included a range of key measures and narrative across a number of domains, including NHS Constitutional Standards, Access, Quality and contractual activity performance. Each indicator was Red or Green (RoG) rated against the target, standard or threshold with sparkline analysis showing the trend over the previous 12 months. Due to the timing of the Committee meeting, the majority of data reported related to November 2016. The narrative had therefore not been updated from the Governing Body meeting held on 26 January 2017. This month the report contained updated indicator values and new indicators from NHS England s Improvement and Assessment Framework (IAF). Neil Snee, Director of Commissioning (Interim) asked the committee to note non-compliant Cancer Waiting Time (CWT) targets were the 62 day Cancer Waiting Times and 31 Day standard for subsequent cancer treatments - anti cancer drug regimens. The current (un-validated) 62 day CWT was reported to be 83% (aggregate level). With reference to page 18 of the main report NS asked the committee to note there had been marginal improvements in those areas marked as worse than at least two peers i.e. red. AB confirmed he would be monitoring those areas rated as worse than at least two peers. With reference to page 18, IAF ref. 122b People with urgent GP referral having first definitive treatment for cancer within 62 days of referral BC questioned whether the reported position of 79% should be recorded as red. AB noted the 122b should be reported as red as performance had dropped from 84.8%. LG asked to know the process for drilling down behind the IAF measures, NS confirmed all standards were discussed in greater detail at the requisite Clinical Quality Review Group (CQRG) meetings. DF queried IAF measure 105c, Percentage of deaths which take place in hospital that was rated as red, previously reported at 49.3% with a green arrow. DF asked for clarification as to what the target for 105c was. Given the queries that had been raised, members of the committee agreed the status of all reported measures should be reviewed. The committee received and noted the Quality and Performance Report and asked for clarification as to the target for 105c. AB Finance, Performance and QIPP Committee Thursday 16 February 2017 5
PERFORMANCE AND QIPP FPQ/058 North Central London (NCL) Individual Funding Requests panel arrangements Members of the committee welcomed Alison de Metz, Deputy Director, IFR, NEL CSU to the meeting. AM asked the committee to note NCL CCG Chief Officers have agreed to move to a single joint Individual Funding Requests (IFR) panel for NCL CCGs replacing the current arrangements of individual CCG IFR panels. Such an arrangement would ensure that Panel members would be making funding decisions on behalf of all 5 NCL Panels. AM asked the committee to note the proposed membership of the single panel that would include representatives from each of the five NCL CCGs. BC expressed her support for a single IFR panel and noted the Commissioning Support Unit (CSU) had done a good job supporting the existing panels. However, whilst recognising the advantage of a single panel, CCGs had a statutory position that needed to be protected and therefore each CCG would need to make its own decision taking account of its own financial position. Thresholds and limits needed to be agreed. BC asked to know why a clinician couldn t chair the panel. LG agreed with the principal set out in the paper but there needed to be greater clarity as to the statutory responsibilities for the CCG. DF raised questions in relation to the proposed membership of the panel. The statutory responsibility for the CCG would override what was set out in the policy. AM noted the proposed panel may therefore need to make a recommendation to the individual CCGs to review. It may be the role of the Chief Financial Officer to notify the Panel of the CCGs decision. With regards the rationale to appoint a Lay Chair rather than a clinician it was thought a Lay Chair was less likely to be conflicted by the decision to be taken. Any decision taken by the panel needed to be taken on the basis of the clinical need of the patient. BC agreed on the need to consider the clinical need of the patient but there needed to be a financial threshold of 100k. DH asked to know how the panel would choose five voting roles with one representative from each CCG. Panel members would be drawn from the existing pool of members. DH stated the need for clarity on quoracy. The committee noted the proposed changes to the IFR policy and recommendation to set up a single joint Individual Funding Requests (IFR) panel for NCL CCGs with effect from 1 April 2017. The committee raised a number of concerns that required further clarification. Matters requiring clarification included the need for the CCG to fulfil its statutory financial responsibility, the need to clarify membership and quoracy of the panel and an understanding of financial limits that would operate within the panel. The committee asked to receive a written proposal for constituting the membership of the proposed panel and requested to receive an update for its meeting on 23 March 2017. DH / AM Finance, Performance and QIPP Committee Thursday 16 February 2017 6
PERFORMANCE AND QIPP FPQ/059 Proposal for Locally Commissioned Service for the Stratified follow up of prostate patients in primary care. Neil Snee, Director of Commissioning (Interim) introduced a service specification and business case that were developed following approval at the NCL Cancer Commissioning Board. The aim of the service was to provide enhanced support for prostate cancer patients in the community and encourage and facilitate the transition of care of prostate cancer patients stable on treatment out of the acute hospital setting and into primary care. This supported the strategic objectives of improving patient experience, providing a higher quality service and moving care closer to home whilst not increasing the costs to individual CCGs. This would help to provide patients with a more holistic approach to their care, more locally. BC asked to know if there was a process for monitoring performance and outcomes and how often would it be reviewed. NS set out arrangements for monitoring proposed changes in the pathway. The Committee agreed and endorsed the business case and service specification, agreed activity would be taken out of the relevant acute contract through contract variation and agreed activity would be reinvested in a more focused way to reduce specific cancer waiting times. FPQ/060 FPQ/051 Any other business None recorded Date and time of the next meeting Thursday 23 March 2017, Room G2, Ground Floor, North London Business Park, N11 1NP, 08.30 to 10.30. Agreed as a true and accurate record of the meeting Date: Signature: Name: Title: Finance, Performance and QIPP Committee Thursday 16 February 2017 7