Paper 11.0
Summary Sheet for Papers: Central London CCG Governing Body Meeting
Date
Wednesday, 9 July 2014
Title of paper
Managing Director’s Report
Presenter &
organisation
Author
Kiran Chauhan, Deputy Managing Director CLCCG
Responsible director
N/A
Clinical lead
N/A
Matthew Bazeley, Managing Director CLCCG
The Governing body is asked to:
Note.
Summary of purpose and scope of report
This report provides the Governing Body a short summary of operational issues for the CCG and
an update on key strategic issues from the perspective of the CCG management team. It is
intended to support accountability and oversight by the Governing Body of the work of the
Managing Director and CCG officers.
Quality & Safety/ Patient Engagement/ Impact on patient services:
N/A
Financial and resource implications
N/A
Equality / Human rights / Privacy impact analysis
N/A
Risk
N/A
Supporting documents
N/A
Governance and reporting (list committees, groups, or other bodies that have discussed the
paper)
Committee name
Date discussed
Outcome
N/A
Managing Director’s Report
July 2014
This report provides the Governing Body a short summary of operational issues for the CCG and an update
on key strategic issues from the perspective of the CCG management team. It is intended to support
accountability and oversight by the Governing Body of the work of the Managing Director and CCG officers.
Key successes:
We have 20 practices now using SystmOne (70%)
We are supporting one practice, Cavendish, to pilot the use of Skype consultations and improve
access to patients. We intend to share this learning across the CCG and other CCGs.
We have identified one General Practice which will submit IAPT data on behalf of all practices and
this will help us to record previously unrecorded local IAPT activity
Patient and public engagement:
The CCG is continuing in the work we are doing with patients and public engagement including the
development of local Patient Participation Groups, engaging with young people, embedding engagement
throughout the commissioning cycle and developing links between the CCG’s User Panel and other patient
and service user organisations.
In particular, following feedback from the Governing Body, the MD has met with Healthwatch with the aim
of reflecting on what is working well in our organisations and how we can develop and further improve
outcomes for patients and involvement of residents. Specifically on the issue of alignment, we agree there
is a need to work more closely together as statutory organisations and I am pleased to say that
Healthwatch now sits on one of the sub-committees of the Board. We will continue to support discussions
between Healthwatch and the CCG’s User Panel to ensure there is alignment where it is required.
Member practice engagement:
We are increasing our engagement with member practices and further strengthening the role of our
locality coordinators and locality meetings to achieve better engagement in clinical commissioning whilst
also supporting the improvement of quality in primary care; for the first time we are bringing summaries of
locality meetings to the Governing Body. The Managing Director will also visit every practice once a year.
So far, we have visited 18 out of 37 practices to discuss key strategic issues such as integrated care
and delivering out of hospital services. An example agenda for these visits is attached and we have visited
the following practices since the last meeting:
Wellington Health Centre
St. John’s Wood Medical Practice
Westminster and Pimlico Health Centre
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Crawford Street Surgery
Newton Medical Centre
Harley Street Surgery
Victoria Medical Centre
Imperial College Health Centre
Crompton Medical Centre
Commissioning/contract issues:
A critical focus for the CCG team has been our work in contract negotiations as host commissioner for
CLCH, in addition to the other smaller (albeit strategically important) contracts with primary care
organisations. Since the last Governing Body, we have signed the full contract with CLCH and I include as
an appendix a summary update on this community providers agreed in-year service developments.
We continue to be actively involved in every main provider contract and have good clinical and managerial
input to these meetings. CSU colleagues are reporting to this Governing Body about the outcomes from
the contracting round across all providers, including the outcomes for patients and member practices
which is where our focus needs to be.
CCG team:
We would like to thank a number of colleagues who are leaving Westminster for pastures new. We would
like to wish Hannah Pearson, Tom Cornwell and Ed Cox in the future. Also, Rory Hill has been successful in
gaining a 6-month secondment leading on information governance for CWHHE. We wish them all well.
However, we would like to share with the Governing Body the key work objectives that has been agreed by
the Chair for the Accountable Officer and what this then means for the priorities of the Senior Management
Team. This is included as an appendix.
Project issues:
In the last month, we have presented our plans for integrated care generally and a Whole Systems
Integrated Care model specifically to the Health and Wellbeing Board and there is broad agreement to the
development of our proposed model of care. In addition, the CCG presented the plans to an expert panel,
including international experts in integrated care systems, and we received helpful and constructive
feedback. We will continue to develop this model with partners to get the detail we need to be able to
implement in shadow form in 2015/16.
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Other:
Ruth and I attended the Westminster Adults, Health & Public Protection Committee (or what was known as
the Health Overview and Scrutiny Committee) where we discussed the challenges and what we can do to
respond to obesity. In addition we talked about the changes in the primary care landscape in Westminster.
To support the IFR policy in North West London, we led a number of panels to review complex
commissioning cases.
We have worked closely with our procurement partners, Westminster City Council, on the Specialist
Housing Strategy for Older People as they are in the final stages of a review of the submitted bids for care
home provision.
We had our fourth and final (for the 2013/14 year) quarterly external assurance review with NHS England.
NHS England continues to be assured across all 6 CCG domains as described in the summary attached. Full
papers from the CCG and NHS England are available on request.
Working with our collaborative CCGs, we supported the recruitment of a CWHHE Diabetes Clinical lead with
both managerial and patient input to the panel and welcome Dr Tony Willis into that role.
We continue to put a lot of work into the development of out of hospital hubs including the plans for
Church Street and Fitzrovia specifically.
We have worked with colleagues in other CCGs to develop the current commissioning support contracting
teams.
The MD and other CCG representatives have given feedback to the organisation commissioned by CWHHE
to review Board effectiveness.
The CCG team attended an event to support Carers Week which included a speaker, one of the CCG GPs,
who is one of the RCGPs Carers Champions. This event was designed to educate CCG officers in the specific
needs of carers and will help us in the development of our commissioning intentions.
The Governing Body is asked to:
Note the contents of the report;
Feedback, if required, on the contents of the MD’s report.
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Appendix 1: Practice Visit Agenda
Agenda: Practice Visit with Matthew Bazeley
Date
Venue
1st of July 2014
Time
14:00 – 16:00
Imperial College Health Centre, 40 Princes Gardens, London SW7 1LY
Practice Team
GPs: Dr Irene Weinreb
Dr Sarah Freedman
Dr Mark Daniels
Dr Chris Allen (Anticoagulation Lead)
Practice Manager: Jacquie O'Connor
Item
1
Description
Introductions and why the visit
2
Discussion of challenges currently faced by the practice
What services do you provide
Local issues
Contractual issues you would like assistance with
Updates and feedback on Commissioned Services
Acute Services
Community Services (i.e. CLCH)
Care Navigators
Wellwatch
Primary Care Plus (PCP)
Patient Referral Service (PRS)
Updates and feedback on Out of Hospital Services
New specifications (2014-15)
7 day opening
Updates and feedback on CCG Commissioning Strategy
Commissioning Intentions
Whole Systems Integrated Care (WSIC)
Prime Minister’s Challenge Fund (PMCF – survey coming out next week)
Hub development
Feedback on the CCG
What is working for you and what is not?
Would you like to be more involved in commissioning?
What would you want at future plenaries, locality meetings? E.g.
education/training etc.
Any Other Business
3
4
5
6
7
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Appendix 2: CLCH Service Development Update
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Appendix 3: CCG 2014/15 objectives
CL CCG Corporate aim and objectives
1. Empowering patients to take more control of their
health and wellbeing through delivery of the ‘whole
systems integrated care’ programme.
BY delivering the out of hospital strategy and the whole
systems programme. This will include:
• co-designing services with patients
• giving patients access to their medical record
• commissioning more services in people’s homes
• patient education and increased self-management
linking to public health agenda.
2. Securing high quality services and improved
outcomes for patients
BY commissioning providers to deliver improved quality
of care and transformation as set out in their contracts.
3. Putting in place the infrastructure to deliver high
quality commissioning.
BY successfully bring in-house the services that are
provided by the CSU and building very good internal
relationships, especially between our governing bodies
and members.
4. 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.
BY focusing on relationships between the CCG and local
authorities and developing the Health and Wellbeing
strategy to deliver the Better Care Fund plans. To work
more closely with the other CCGs in NW London to
develop and deliver shared plans.
MD and senior management team objectives
For CL CCG to increase and improve our work around
patient and public engagement, specifically addressing
the join-up of the User Panel and Healthwatch. To
increase member engagement in all our work and to
prioritise time spent with practices, the work of locality
meetings and with Council of Members. To support
the Governing Body and ensure that all vacancies on
the Governing Body are recruited to and improve the
working relationship between the GB and CCG
management team.
Specifically for CL CCG, to agree an SDIP with the
provider in line with the agreements at the March
Strategic Alignment Meeting and to improve the model
of District Nursing and local CCG initiatives in
particular.
Specifically for CL CCG to in-house the CLCH contract
team, improve working relationships with that
provider, deliver expected outcomes of 14/15 contract,
produce a proposal for 15/16 commissioning intentions
that is agreed by the Tri-Borough Governing Bodies.
Also, to deliver effective and efficient contract
management of GP provider networks and the reprocurement of CLH services in particular. For the CCG
to deliver the agreed procurement of planned care
services.
Specifically for CL CCG, to improve the Tri-Borough
management arrangements including better
operational control of joint commissioning teams.
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5. Delivering the Out of Hospital Strategy and acute
hospital changes as set out in the Shaping a Healthier
Future Strategy.
6. Delivering our statutory and organisational duties.
BY delivering a number of priority areas including:
• completing and delivering the LES review
• implementing the plans funded by the Prime
Minister’s challenge fund
• developing Primary Care networks
• exploring co-commissioning of primary care
• specific projects in each CCG to support care delivery
in community settings.
BY delivering our business as usual activity including:
• all CCGs remaining compliant with all statutory duties:
finance and QIPP; quality; safeguarding; and
performance
• focusing on ensuring that we meet the local targets
that we set ourselves.
Specifically for CL CCG, to deliver a WSIC model of care
and full SystmOne rollout to practices.
Specifically for CL CCG, we will aim to have a team
restructure to best organise the capacity and capability
of our people, to better align our projects (and QIPP
programme specifically) to clearly align with clinical
and financial case for change, to successfully deliver
any aspect of CCG re-authorisation and/or assurance
and to continue team development for both
managerial and GB team.
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Appendix 4: NHS England Assurance summary
Focus
Domain 1
Assurance
level
Assured
Domain 2
Assured
Achievements
Issues
Further action required
All Providers in CWHHE achieved All Type A&E standard
for Q4 with all R&IPs in place and published. T1
performance discussed and highlighted as an area of
focus for NHS England.
Cancer performance at Imperial discussed with recent
progress acknowledged. NHS England has also visited the
trust to discuss performance and actions that were taken
to improve against the standards. All 8 cancer standards
meet for March
CCG also highlighted contracting support provided to
other CCGs regarding out of area providers for example
Camden CCG and UCLH.
CCG highlighted positive work around patient and PPI
feedback including that patients had actually taken part
in contract negotiations this year, this was put forward
nationally as good practice. Locality or village working
also highlighted as a success by the CCG. Confirmed that
Patient Experience Strategy was now signed off by CCG.
Also advised of Whole Systems Integration work which
has transformed patient and public engagement with lay
members having a majority vote on the CoCommissioning Board. Also updated on work under way
regarding SystmOne rollout across CWHHE and benefits
this will bring for patients.
RTT performance at Imperial/C&W discussed
with the CCG agreeing a recovery trajectory of
August 2014 for performance to be sustainable.
111 raised as an issue with LCW performance
below standard currently, CCG are closely
monitoring the situation and will serve an
improvement notice on the Provider should
performance not improve before July.
Close monitoring of performance
standards via monthly CQG
meetings with CCG flagging any
perceived issues with NHS England
at earliest opportunity.
None applicable.
None applicable.
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Domain 3
Assured
Financial targets & plans exceeded (higher than planned
surpluses).
CCG updated on performance against local priorities
stating that their Care Plan indicator was highlighted as
achieved.
Recent IAPT event across NWL was discussed and agreed
as successful with CCGs awaiting learning from work with
BHH CCGs. CCGs agreed to plan positively for 2014/15
and 2015/16 being as ambitious as possible.
Domain 4
Assured
Domain 5 &
6
Assured
CCG updated on new significant work on FGM regarding
child safeguarding. CCG also updated on good progress
against Winterbourne work and early warning systems.
CCG confirmed that nurse staffing levels were being
discussed at all CQGs in June/ July and agreed to report
back at a later date.
Discussed CCGs 360 degree feedback with CCG
highlighting comparatively strong response rates, the
CCG are working to process feedback including the pace
of change and ability to keep up to date. Advised that an
action plan is under development which would feed into
CCG OD plan, CCG agreed to feedback on developments
at a later date.
The CCG will not deliver on their MMR priority
but highlighted Performance has been strong and
mitigating circumstances have affected
performance. NHS England agreed that the spirit
of the indicator i.e. the intention to increase the
number of children vaccinated, had been
achieved and agreed to be as supportive as
possible when reviewing for Quality Premium.
The CCG has also not achieved against their End
of Life priority as they were too ambitious
initially.
CCG is behind trajectory for the IAPT and
Dementia standards this year, largely due to late
implementation and some re-procurement.
None applicable.
Await final sign off of NWL financial
strategy by NHS England following
legal advice.
IAPT and Dementia performance
will remain a standing item on
assurance meeting agenda.
None applicable.
CCG to update on changes to OD
plan at Q1 assurance meeting.
None applicable.
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