Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Minutes
V0.2 (22 May 2014)
Present
Name
Role/ organisation
Initials
Dr Fiona Butler
GP Principal, Redcliffe Surgery; Governing Body GP
member, Chair
FB
Dr Iain Blake
GP Partner, Colville Health Centre (Blake, Mok & Dias);
Governing Body GP member
IB
Dr Naomi Katz
GP Partner, The New Elgin Practice; Governing Body GP
member, Vice Chair
NK
Kim Rose-Grosso
Practice Manager, Rosary Gardens
KRG
Dr Michael Pryce
GP Partner, Portobello Medical Centre
MPR
Dr Niki Dhanjal
GP locum, Colville Health Centre (Chung)
PD
Amanda Lord
Practice Manager, Medical Centre RHCP
AL
Debbie McCarthy
Practice Manager, The Elgin Clinic
DM
Dr Richard Hooker
GP Partner, Holland Park Surgery; Governing Body GP
member
RH
Alastair Gilchrist
Lay member
AG
Dr Shazid Karim
Salaried GP, Scarsdale Medical Centre; Governing Body
Salaried GP member (job share)
SK
Dr Imran Sajid
Sessional GP, The Surgery (Stanhope Mews West)/
Knightsbridge Medical Centre; Governing Body Salaried GP
member (job share)
IS
Dr Philip Mackney
GP Principal, The Elgin Clinic; Governing Body GP member
PM
Yvonne Fraser
Managing Partner Practice Manager, The Portland Road
Practice; Governing Body Practice Manager representative
YF
Dr Clare Corbett
GP Principal, The Abingdon Medical Practice
CC
Dr Seok Mee Chua
GP Partner, The Abingdon Medical Practice
SMC
Dr M Tahir
GP Principal, Barlby Surgery (AT Medics)
MT
Prithipal Bhambra
Practice Manager, Barlby Surgery (AT Medics)
PB
Dr Oisin Brannick
GP Salaried (Lead GP), Beacon Medical Centre
OB
Dr Akber Ali
GP Principal, Brompton Medical Centre
AA
Dr Catherine Mok
GP Partner, Colville Health Centre (Blake, Mok& Dias)
CM
Dr Andrew Rose
GP Principal, Dr Rose’s Surgery
AR
Valerina Langton
Dr Rose’s Surgery
VL
Dr Puvana Rajakulendran
GP Principal, Earls Court Medical Centre; Governing Body
GP member
PR
Page 1 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Name
Role/ organisation
Initials
Dr Orietta Emiliani
Locum GP, Earls Court Surgery
OE
Dr Maria Pankhurst
GP Principal, Emperor’s Gate Health Centre
MPA
Dr Nirmalan Ramasamy
GP Partner, The Golborne Medical Centre (Ramasamy)
NR
Karen Randle
Practice Manager, The Golborne Medical Centre
(Ramasamy)
KR
Dr Elizabeth Sinclair
GP Principal, The Good Practice
ES
Dr Jasjeet Dua
GP Principal, Kensington Park Medical Centre
JD
Dr Mark Sweeney
GP Principal, Kensington Medical Centre
MS
Dr Michael McKeown
GP Principal, Kynance Practice
MMc
Dr Joseph Gonzalez-Garcia
GP Partner, Lancaster Gate Medical Centre
JGG
Clarise Buncombe
Practice Manager, Milne House Medical Centre
CB
Dr Kuljeet Takhar
GP Partner, Milne House Medical Centre
KT
Dr Simon Ramsden
GP Partner, The Pembridge Villas Surgery
SR
Ray Read
Practice Manager, Portobello Medical Centre
RR
Ashley Ramsay
Practice Manager, The Redcliffe Surgery
AR
Dr Tim Lebens
GP Partner, Scarsdale Medical Centre
TL
Dr Penny Burgess
Salaried GP, Scarsdale Villas Surgery
PB
Dr Susan Malhas
GP Partner, Scarsdale Villas Surgery
SM
Dr A Garfield
GP Partner, Shirland Road Medical Centre
AG
Name
Role/ organisation
Initials
Carolyn Regan
Managing Director
CR
Simon Hope
Deputy Managing Director
SH
Kerry Doyle
Head of Corporate Services
KD
Sarah Wheeler
Head of Finance
SW
Katrina Mindel
Senior Primary Care Strategy Manager
KM
Sonia Richardson
Patient representative
SR
Emily Nicholls
Corporate Services Administrator
EN
Peter Stirling
Interim Governance Manager
PS
Katie Beach
Delivery Manager
KBE
Jude Channon
Locality Manager
JC
Angela Wilson
Locality Manager
AW
In attendance
Page 2 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Tessa Sandall
Deputy Managing Director, Hammersmith & Fulham CCG
(item 2.1)
TS
Kate Brady
Project Manager, St Charles redevelopment
KBR
Sarah Hamilton
Safeguarding Nurse
SH
Item
Action
1
Introduction
1.1
Welcome
The Chair welcomed members to the meeting.
New Governing Body members, Dr Shazid Karim & Dr Imran Sajid (salaried GP/ Job share); Dr Andrew
Steeden, GP member, were welcomed. The membership was advised that the CCG was asking for a
Practice Nurse representative to be on the Governing Body, as the Practice Nurse representative had to
step down.
The Chair advised the meeting that the Managing Director, Carolyn Regan, would be leaving the CCG at
the end of May 2014. The Managing Director was thanked for her work and her leadership of the
organisation during its formative stages. It was noted that the new Managing Director, Louise Proctor,
would join the CCG at the end of May.
Achievements in 2013/14, including starting IT migration, setting up Patient Participation Groups and
Community Health Networks, using the St Charles site and working in collaboration with CCGs across
North West London and gaining pioneer status for Whole Systems were noted.
The CCG’s objectives for 2014/15 were outlined:
-
Empowering patients to take more control of their health and wellbeing through delivery of the
‘whole systems integrated care’ programme;
-
Securing high quality services and improved outcomes for patients;
-
Putting in place the infrastructure to deliver high quality commissioning;
-
Building relationships with local authorities and Health and Wellbeing Boards to deliver the Better
Care Fund plan, and developing and delivering joint plans with other CCGs across North West
London;
-
Delivering the Out of Hospital Strategy and acute hospital changes as set out in the Shaping a
Healthier Future Strategy;
-
Delivering our statutory and organisational duties.
The Chair thanked the members and team for their work to date in improving care for patients,
including the new community diabetes service, community cardiac services and greater access to
services (seven day working, paediatric hub development, recruiting Primary Care Navigators and
contributing to Whole Systems).
It was noted that making primary care sustainable for the future would underpin the CCG’s work, and
that there was support in place to achieve this:
-
PM Challenge Fund;
-
Whole Systems development;
Page 3 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Item
Action
-
IT migration to SystmOne;
-
CQC visits (pilot starting 14 May 2014).
The Chair thanked members for their continued contribution to the CCG’s work, and said that it would
not be possible without strong clinical leadership. It was noted that the CCG would be recruiting clinical
leads for:
-
Dementia;
-
Dermatology;
-
Diagnostics;
-
End of Life;
-
Ophthalmology;
-
Vascular (including cardiology & stroke);
-
Governing Body Practice Nurse representative.
It was confirmed that there would be buddying support for new clinical leaders.
The meeting was invited to stay for the briefing session on the PM Challenge Fund, to which members
had been invited previously.
Finally, the Chair asked members to complete their practice based budgets and also requested that
practices let the CCG staff know how they wished to communicate with them so that the CCG could
further develop its links with members and support them to deliver change. Input from members
throughout the meeting was welcomed.
2
Clinically led commissioning
2.1
Primary care transformation
The Chair welcomed the Deputy Managing Director, Hammersmith & Fulham CCG, and Senior Primary
Care Strategy Manager to the meeting.
LES/OOH Transition
It was noted that the work on Locally Commissioned Services was being developed across the CWHHE
collaboration, so that primary care could be transformed to take on work previously undertaken in
hospitals with a consistent price and contracting structure. It was noted that the Governing Body had
delegated some responsibilities to the CWHHE Investment Committee to prevent conflicts of interest.
The enhanced circulated income guarantee was outlined, and the meeting was advised that 2014/15
was a year of transition, with the difference in activity income being paid for in 2014/15. It was noted
that this would allow practices time to adjust in case there would be a change in income in 2015/16.
The Chair thanked the Deputy Managing Director, Hammersmith & Fulham CCG, for her presentation
and advised the meeting that the aim of this work would be to keep resources in primary care, while
demonstrating transparency and good value.
Page 4 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Item
Action
PM Challenge Fund
The meeting was advised that the application from North West London practices had been successful,
and that the award would be used for network development, better technology and workforce
development to transform patient choice and access to general practice. It was noted that there would
be more information at the briefing session at 3.00pm.
Co-commissioning primary care
The Chair confirmed that the CWHHE CCGs had been successful in agreeing to commission primary care
services with NHS England. It was noted that the Secretary of State for Health and the new Chief
Executive of NHS England supported the plans, which would enable the CCG to commission whole
patient pathways across providers, align incentives across the health system, secure investment in and
support for primary care and commission GP networks.
Network development
The meeting discussed how this would support CCGs and practices in ensuring continuity of care, and
implementing Whole Systems. Work to support establishing networks, including the legal framework
and providing backfill for members to lead the work was discussed. It was noted that there would be
support to make the networks operational.
The scale and model needed to make networks successful in improving services for patients were
considered. It was agreed that in order for out of hospitals services to succeed, the networks would be
determined by scale, frequency and, above all, patient need.
CQC visits
The Senior Primary Care Strategy Manager presented the update to the meeting.
Key areas for visits to practices, including safety, being caring and responsive, effectiveness and
leadership were outlined. It was noted that the visits would focus on six population groups: older
people, those with long term conditions, vulnerable people, mental health, working age and recently
retired and mothers and babies.
It was confirmed that the CCG team had received information from the CQC shortly before the meeting,
and that information was shared via the weekly newsletter and extranet. Member practices were asked
to share experience, through Practice Manager and CLS meetings, so that learning practices could learn
from each other.
The meeting discussed the status of the visits and it was noted that it was a pilot, and that the report,
but not the ratings, would be published on the CQC website. It was confirmed that the CQC planned to
visit all practices in England by the end of 2016, and this would include a small number of unannounced
visits.
2.2
Whole Systems update
The Chair welcomed Dr Mark Sweeney, Dr Iain Blake and Sonia Richardson (patient representative) to
the meeting.
The Chair thanked members for their interest in the bid, and it was confirmed that every practice in the
CCG had expressed an interest.
It was noted that there were two bids: one for all patients over 75 and one for serious enduring mental
Page 5 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Item
Action
illness. The meeting was advised that budgets would be allocated to an organisation that provided
services for a cohort of patients, and the University of Buckinghamshire would be joining the bid.
Members were informed that Whole Systems working would be achieved through collaborative working
with other providers, including Chelsea & Westminster Hospital, Imperial College Healthcare, Central
London Community Healthcare and Central North West London, which was unique to this CCG. It was
noted that there was a high level of input from GP and other providers, including GP, lay, patient and
social care representatives, and that the steering group leading the work was accountable to the CCG.
It was confirmed that a project manager had been appointed to support this work.
Reduction in hospital admissions was discussed, and the meeting agreed that keeping patients over 75
out of hospital and increasing independence for patients with serious mental illness was the aim.
Developing a model of care for patients, so that community health delivered what was needed for
patients to remain independent was described as an objective for the Whole Systems project.
Members were advised that GP engagement and input were required.
2.3
Development of North & South Locality Hubs - progress and next steps
The Managing Director and Project Manager, St Charles redevelopment presented the progress report.
The purpose of a hub in providing primary care, out of hospital and community/ voluntary services was
outlined.
The meeting noted progress to date with developing the North hub at the preferred site (St Charles),
and the Strategic Service Delivery Plan that would translate the CCG’s ambition into reality were
outlined. It was confirmed that a lay member chaired the project board, which ensured impartiality
and prevented any conflict of interest.
Members were advised that the Children’s Services pilot in the North, with Imperial College Healthcare,
was based at five GP practices, and would be rolled out to the South of the CCG with Chelsea &
Westminster Hospital. It was noted that there were plans for the diabetes service, with consultant led
triage, to move to St Charles.
Options for developing a hub in the South were discussed. It was noted that the potential
redevelopment of some of the site at the Earls Court exhibition centre was in 3-5 years. The possibility
of moving towards local services for list sizes of up to 20,000 was noted, having been discussed by the
Governing Body.
The meeting was advised that a range of options to support development of a hub in the South was
being looked at, including:
-
Options for Local Authority support;
-
Use of space in Earls Court in the interim;
-
Royal Brompton Hospital changes;
-
Access to Section 106 monies secured as part of planning process, e.g. Earls Court, Imperial West.
Physical layout needed for hubs to work was described, and members were informed that scheduled
and unscheduled care would be close together. It was confirmed that patient pathways would show
how services could be best developed to meet patient needs and support the CCG’s out of hospital
strategy.
Ideas and input from GP practices were welcomed. It was confirmed that a session or GPs in the North
of the CCG was being arranges for the week commencing 2 June 2014.
Page 6 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Item
Action
3
Delivering our statutory and organisational duties
3.1
Changes to Constitution
The Managing Director presented the proposed changes to the meeting. Members were advised that
any proposed change must be presented to them for approval before submission to NHS England.
It was noted that the purpose of the proposed amendments was to ensure that the CCG was effective in
carrying out its functions, and that the Constitution supported the CCG in meeting all its objectives
through ensuring that the CCG’s responsibilities, working arrangements and governance structure were
clearly defined and accessible.
Members were informed that the changes were endorsed by the Governing Body at its meeting in
public on 6 May 2014, and were described as follows:
Committee structure
-
To remove terms of reference from the appendices to the Constitution (Appendix I);
-
To remove the St Charles Redevelopment Project Board from the list of Committees reporting to the
Governing Body (6.4.1 and 6.6.3). Members were advised that the Project Board would report to
the Out of Hospital Committee;
-
To change the name of the Out of Hospital Implementation Steering Group to Out of Hospital
Committee (6.4.1 and 6.6.3).
Quoracy
To amend the text at 3.6.1 in Appendix C to read:
-
A quorum will be reached when a third of the voting members are present. This must include a
minimum of three elected members (including Chair or deputy), at least one officer and at least one
lay member.
Transparency
To add the following text at 6.8:
-
The CCG aims to publish papers for Governing Body meetings in public one week in advance of the
meeting. In exceptional circumstances, late papers may be circulated.
-
Dates of Governing Body meetings in public are available via the CCG website. In exceptional
circumstances, dates may be changed or additional meetings arranged to ensure that the CCG is
able to meet its responsibilities in a timely manner.
-
CCG members will be consulted at plenary meetings, where the CCG will share information and
progress on key developments and hold dialogue with practices. At these meetings, the CCG will
request endorsement or approval of any matters that require agreement from the membership.
Next steps were outlined:
-
To amend the Constitution in line with approval/ recommendations from the Governing Body and
CCG membership in preparation for submission;
Page 7 of 8
Plenary meeting
Tuesday, 13 May 2014, 1.00-3.00pm
Tabernacle, 35 Powis Square, London W11 2AY
Item
Action
-
To submit changes to NHS England before 1 June 2014.
The membership approved the proposed amendments. There were no further recommendations or
dissenting comments.
3.2
Financial strategy & Commissioning Support Unit updates
The Head of Finance was introduced to the membership.
Financial strategy
Members were advised that the CCG was the most over-capitated in the country, and that it would
receive below average allocation growth in the coming years to move funding per head towards the
national target position. It was noted that the CCG’s current financial position was very strong with
significant non-recurrent reserves for investment.
It was confirmed that funds would be used in the best way possible to safeguard the CCG’s position for
the future. The meeting noted that the agreed financial strategy comprised three parts:
a) Pooling of CCG and NHS England non-recurrent funds to support non-recurrent SaHF costs (national
requirement)
b) Utilising CCG carry forward surpluses to enable Out-of-Hospital implementation across NWL, by
placing all CCGs on a common footing.
c) Creation of SaHF Out-of-Hospital recurrent investment fund to support investment in primary care
and community services.
Members were advised that the strategy would be reviewed on an annual basis, and that the CCG had
an investment fund of £15m for 2014/15.
Commissioning Support Unit (CSU)
Members were advised that an update about the North West London CCGs’ plans to move most
services from the CSU to in-house from 1 October 2014, when the current contract expired, was
included with the meeting papers.
Future meetings
Meetings in public
1 July 2014
2 September 2014
Governing Body Development
sessions
Plenary meetings
8 July 2014
17 June 2014
8 July 2014 (following plenary)
Page 8 of 8