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Commissioning Collaborative Board
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29 January 2015
APPROVED
Minutes of the
Commissioning Collaborative Board held on
Thursday 29 January 2015
St Johns House, LE1 6NB
PRESENT
Dr Richard Palin
Professor Mayur Lakhani
Mr Toby Sanders
Dr Chris Trzcinski
Dr Avinashi Prasad
Mrs Sue Lock
Mr Spencer Gay
Mrs Karen English
Mrs Michelle Iliffe
IN ATTENDANCE
Mrs Poonam Beeharry
Mrs Melanie Thwaites
Mr Warwick Kendrick
Vice Chair, East Leicestershire and Rutland CCG (Chair)
Chair, West Leicestershire CCG
Managing Director, West Leicestershire CCG
Deputy Chair, West Leicestershire CCG
Co-Chair Leicester City CCG
Chief Operating Officer, Leicester City CCG
Chief Finance Officer, West Leicestershire CCG
Interim Accountable Officer, East Leicestershire and Rutland
CCG.
Chief Finance Officer, Leicester City CCG
Corporate Affairs Officer, East Leicestershire and Rutland
CCG (minutes)
Assistant Director of Children’s and Families Team
Independent Lay Member, East Leicestershire and Rutland
CCG (Update from PPAG only)
LEAD
RESPONSIBLE
ITEM
CCB/15/01
Apologies received from:
• Professor Azhar Farooqi, Chair, Leicester City CCG
(Chair)
• Mrs Donna Enoux, Chief Finance Officer, East
Leicestershire and Rutland CCG
CCB/15/02
Declarations of Interest on Agenda Topic
Dr Richard Palin declared an interest in relation to any item
relating to Leicestershire Partnership Trust
To RECEIVE the Verbal Update from the Provider Performance
Assurance Group (PPAG) held on Thursday 29 January 2015
(Verbal Item)
Mr Warwick Kendrick provided a verbal update on the high level
issues from the PPAG meeting held on Thursday 29 January
2015. Mr Kendrick drew attention to the following:
University Hospitals of Leicester (UHL)
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•
•
•
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Referral to Treatment (RTT): The group was provided
with assurance regarding the timescale for improvements.
However there was concern around Orthopaedics and
Urology backlogs.
Cancer referrals and performance –The group were
informed about revised trajectories that will be in place by
the end of January 2015 with the protocol being issued in
early February 2015.
The main concerns in relation to UHL relate to the
backlog of which has increased from 51 to 121 patients
which is as a result of a mix of complex cases.
Leicestershire Partnership Trust (LPT)
• The group reviewed the community nursing services and
noted variations in service delivery in particular around
East Leicestershire and Rutland area. This will be picked
up with LPT for them to prepare an action plan to bring
back to PPAG.
• Out Of County Placements – This has increased from 0 to
16. It was confirmed this would be kept under review.
• Looked After Children (LAC): Health assessments are
being reviewed by the contract square to ensure
performance is recovered. A report will be brought back
to next PPAG meeting.
• Child and Adolescent Mental Health Services (CAMHS):
It was recommended to do deep dive in relation to patient
quality issues. Mrs Dawn Leese and Mrs Melanie
Thwaites are to review scope of deep dive.
• CQC inspection: There will be a CQC inspection at LPT in
March.
ELR CCG Hosted contracts:
• Arriva: Performance has stalled in last few months due to
increasing demand. It was noted that the providers are
working well with commissioners.
• EMAS: Underperformance continues in the East
Leicestershire and Rutland and West Leicestershire
areas. For the City, EMAS is performing on the two main
indicators. EMAS will be presenting to each Governing
Body in the following months.
• Continuing Healthcare (CHC): Whilst the group were
assured that the contract square was doing all it can, this
still remains am area of major concern.
Dr Richard Palin added that the group discussed the idea of
holding a CHC summit across the three Leicester, Leicestershire
and Rutland (LLR) Clinical Commissioning Groups (CCGs)
which is being taken forward by the Chief Nurse for West
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Leicestershire CCG, Mrs Caroline Trevithick.
CCB/15/03
To Approve the Minutes of Previous Meeting of the
Commissioning Collaborative Held on 18 December 2014.
(Paper A)
Minutes for the Commissioning Collaborative Board held on18
December 2014 were accepted as an accurate record of the
meeting.
It was RESOLVED to:
•
CCB/15/04
APPROVE the minutes of the previous meeting.
Matters Arising: update on actions from the meeting of the
Commissioning Collaborative held on 18 December 2014
(Paper B)
CCB/14/54 - New Referral Guidelines on LUTs, Chronic
Kidney Disease and Tinnitus: It was noted that this item will be
going to West Leicestershire CCG’s Governing Body in February
2015.ACTION COMPLETE
CCB/14/79 - Specialised Community Eating Disorders
Services for Children: It was noted that an interim model is
being worked up and will come to CCB in February 2015.
ACTION COMPLETE
CCB/14/112 - LMSG – ToRs
-
To provide update on the LMSG ToRs.
To provide update on when the revised ToR to be
submitted for approval to CCB in 2015.
It was decided to move this update to February 2015 as
Prof. Azhar
Prof, Farooqi was not at the meeting to provide the update.
Farooqi
CCB/14/115 - Verbal update on the changes in the roles and
arrangements: Mr Toby Sanders noted that this had already
been discussed in other forums and confirmed that relevant
parties were aware of the changes. ACTION COMPLETE
It was RESOLVED to:
•
RECEIVE the matters arising
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CCB/15/05
To RECEIVE Colorectal Cancer Exclusion Pathway
Improvement (Paper C)
Dr Richard Palin presented the report which details the business
case prepared by UHL requesting a shift from colonoscopy to
CT colography.
Dr Richard Palin explained drawing attention to:
• The efficacy of this test is thought to be as good but less
invasive and cheaper.
• There has been pressure on UHL for lower GI targets.
UHL have capacity within radiology to make a switch to
using the graph as test of choice.
• There are no details regarding the risk in relation to
perforated bowel.
• The business case went to CPSG and was broadly
approved. More work has been done in relation to the
justification for cost per case, which is detailed in the
paper.
Dr Avi Prasad noted that patients over 60 require colonoscopies
and queried whether this had been factored into the savings. Dr
Avi Prasad also queried how the savings will be used. Dr
Richard Palin explained that the cost of fibre optic endoscopies
had been built into the proposal and explained that the capacity
will be used elsewhere for the screening service.
Professor Mayur Lakhani stated the case made clinical sense
but noted that some patients will also require an endoscopy
which means patients will be having two procedures as opposed
to one. Dr Richard Palin stated that his understanding was this
had been built into the model.
Mr Toby Sanders noted that this may conflict with discussions
being held in relation to contracting which is looking at less tariff
based and more block contracting. Therefore there is a need to
ensure this does not end up as a block.
Mrs Michele Iliffe noted Mr Toby Sander’s concerns and queried
whether the decision to approve this case would still stand if
there were no cost benefits.
Dr Chris Trzcinski stated that this was the right thing to do for
patients irrespective of money.
It was RESOLVED to:
•
NOTE the contents and APPROVE the business case
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CCB/15/06
To RECEIVE IVF policy- approval for number of cycles and
Other fertility policies for approval (Paper D)
Dr Chris Trzcinski presented the report which provides details in
relation to the effectiveness of IVF for multiple cycles and
funding implications for LLR.
Dr Chris Trzcinski drew attention to the following key items to
note:
•
•
The policy differs from NICE guidance on number of
treatments.
Whilst the age range has been expanded up to 42 years,
there has not been an increase in relation to the number
of cycles. Dr Chris Trzcinski noted that this is in line with
majority of other CCG’s, and in line with rest of the East
Midlands.
The main reason for not increasing the number of cycles is cost
associations.
Dr Chris Trzcinski noted that a further paper in relation to
Associated policies for IVF/ICSI for East Midlands had not been
circulated. The policies the paper referred to are:
• Gamete Cryopreservation and Intrauterine (IUI)
• Donor Insemination (DI) Policy (excluding In vitro
fertilisation (IVF) Intracytoplasmic sperm injection (ICSU
treatment)
• Surrogacy
Dr Chris Trizcinski verbally updated members noting the
following:
The paper suggested adopting the draft policies (excluding
surrogacy as there is no draft policy in relation to this) which
were generated by East Midlands Specialised Commissioning
Group (EMSCG) in 2011 as an interim measure, otherwise LLR
will be vulnerable to challenge.
The options are to have an East Midlands wide policy and
engage GEM to work on that, or develop policies individually.
Mr Toby Sanders stated that adopting the draft policies in the
interim made sense; however he was unsure of whether the
draft policies were adequate or sensible. Dr Chris Trzcinski
stated that the policies are what services will be using at this
present time.
Mr Toby Sanders noted that the congress had said the principle
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of GEM co-hosting the policies on behalf of the East Midlands is
a good idea. Mr Toby Sanders also noted that there had been
discussion around specialised services and co –commissioning
which will require a committee in common across a larger
number of CCG’s to be established in order to discharge the
specialist functions. Mr Toby Sanders highlighted the benefits of
this noting that it would allow for a decision making body at an
East Midlands level. At the last congress, Mr Toby Sanders
stated that he had asked for paper to be scoped to Governing
Bodies to get support in principle and suggested boards to have
a discussion regarding this noting that those present felt it was
the right approach.
Dr Avi Prasad queried whether other people in the congress had
policies in relation to surrogacy and whether work could be done
with them to develop a policy. Dr Chris Trzcinski explained that
Mrs Patricia Barnett who was leading on this has subsequently
left and this was now being led by the contracts manger, Ms
Desra Robinson.
Dr Avi Prasad stated that he was unsure if the draft policies
were aligned to NICE guidelines.
Dr Richard Palin summarised actions as:
• Ms Desra Robinson to ascertain what policies in relation
to Gamete Cryopreservation and Intrauterine (IUI) and
Donor Insemination are being used elsewhere as an
information gathering exercise.
• Dr Chris Trzcinski to review the policies to ensure the
draft policy by EMSCG is not out of line with other policies
• Mr Toby Sanders to pursue to the idea of an East
Midlands wide committee in common with the intention of
putting these policies to them first.
Mr Toby Sanders explained that whilst this work is being carried
out, there is a need to ensure that the draft policies which are
being proposed to adopt is checked by a clinician. Dr Chris
Trzcinski agreed to obtain an opinion of a relevant clinician
Dr Chris
and bring back some information to next month’s meeting.
Trzcinski
It was RESOLVED to:
•
•
RECOMMEND the attached IVF/ICSI policy produced by
GEM be accepted in full and in particular the element of
one funded cycle for LLR CCG’s for all age patients up to
age 42 effective immediately. Full IVF/ICSI policy
attached as Appendix 2
Noting the other policies to discuss next month
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AOB:
Dr Richard Palin noted a change to the order of business and
confirmed one item has been raised under Any Other Business
which was discussed next.
Emergency Floor Outline Business Case (OBC)
Mrs Sue Lock noted the CCB has previously supported the
OBC, and explained that Mr John Adler, Chief Executive of UHL,
has now requested support for the full business case as they
have their gateway review on 30 January 2015.
Mrs Sue Lock explained that she has asked Mrs Nicki Bridge to
review the full business case and her comments have been sent
round for consideration.
Mr Toby Sanders noted that the OBC was still with the NHS
Trust Development Authority (TDA) and therefore UHL must
have been given a clear steer from the TDA in order for UHL to
request a letter of support from the commissioners given that it
had not yet been signed off. Mr Toby Sanders drew attention to
the letter sent to Mr John Adler following the CCB’s review of the
OBC which highlighted three areas. Mr Toby Sanders felt the
risk lay with urgent care workstream as it had not been worked
up to the level of other workbooks. It was noted that the Urgent
Care Board were looking at the longer term model. Mr Toby
Sanders felt that a supportive response should be considered as
it would be unfortunate if CCG’s response slowed down what is
desperately needed.
Professor Mayur Lakhani agreed the support is required;
however there should be a caveat that stating the primary care
centre is included.
It was agreed that a letter showing strategic support would Mrs Sue Lock
be drafted by Mrs Sue Lock.
Mr Toby Sanders stated that Governing Bodies should be
updated on the FBC at their next meeting.
CCB/15/07
All
To RECEIVE update on Specialist Community Eating Disorder
Services for Children(Paper E)
Mrs Melanie Thwaites presented the report which informs the
Collaborative Commissioning Board of developments towards
the establishment of a specialist community eating disorders
service for children and adolescents in Leicester, Leicestershire
and Rutland. Mrs Melanie Thwaites drew attention to:
•
A paper was brought to the CCB in October 2014 flagging
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•
•
•
issues in relation to increased prevalence and activity.
The paper proposed a new model which was agreed in
principle, but with the requirement to work with NHS
England closely.
There has been national development since October
2014, where this has been recognised as a national
issue.
The Government announced that additional funding
would be made available which was reaffirmed in
planning guidance which confirms there will be £30m
funding per annum.
NHS England will lead on co-ordinating the investment
programme however the timescales are not clear.
There remains an immediate requirement for £50k of nonrecurrent funding to commission sufficient capacity to
ensure sustained clinical safety and quality of the service
Mrs Karen English queried whether the correct commissioners
were being asked for funding. Mrs Melanie Thwaites explained
that it was clear that the current model was a community
provision commissioned by the CCGs.
Mrs Sue Lock stated that the paper did not contain any detail on
patient numbers. Mrs Melanie Thwaites explained that the detail
was in the original paper but that the non-recurrent investment
would facilitate two part time staff to step up their hours to
maintain capacity.
Mrs Sue Lock queried the validity of the money from the
government. Mrs Melanie Thwaites explained that the Area
Team had emailed a finance colleague at the Department of
Health who confirmed the money is there.
Mr Gay queried whether this was a specialist service or a
service the CCG’s buy. Mrs Thwaites explained that the
services was a community provision to be commissioned by the
CCGs but that specialised services would be responsible got
co-ordination the realise of the funding and that CCG’s needed
to work with NHS England to ensure tier 3 and 4 are linked in.
Mr Toby Sanders suggested that the £50k could be taken from
the money that comes down from the Government in relation to
this and queried whether the service could cope until the
beginning of April 2015. Mrs Melanie Thwaites explained that
the Department of Health have yet to finalise a process so if this
goes on past April there will be a risk to the service.
Mr Spencer Gay expressed his support for £50k as it did not
appear to be a financial risk.
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Mrs Michelle Iliffe queried how long this money would support
the service for. Mrs Melanie Thwaites stated it would be for six
months.
Mrs Thwaites agreed to share the email traffic in relation to Mrs Melanie
this with members.
Thwaites
It was RESOLVED to:
• APPROVE the funding of £50,000 for 2015/16 only for
community services for children and adolescents with
eating disorders
Thursday 26 February 2015 at 1.30pm at Leicester City CCG
St Johns House, 30 East Street, Leicester, LE1 6NB
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