- NHS Central London Clinical Commissioning Group

Central London Clinical Commissioning Group Governing Body Minutes
(Public Session) DRAFT
Wednesday 12 November 2014
5.3 & 5.4, 15 Marylebone Road
16.00 – 18.00
Ruth O’Hare (Chair)
Paul O’Reilly
Sheila Neogi
Mona Vaidya
Afsana Safa
Daniel Elkeles
Clare Parker
Philip Young
Michael Morton
Gordon Hunting
Alan Hakim
In Attendance
Rachel Wigley
Eva Hrobonova
Mary Mullix
Matthew Bazeley
Kiran Chauhan
Rosalyn King
Neil Shadbolt
Daniela Valdés
Borough Lead Director, Tri-Borough ASC
Deputy Directory, Tri-Borough Public Health
Representing Secondary Care Nurse Member
Managing Director, CLCCG
Deputy Managing Director, CLCCG
Director of Health Outcomes, CLCCG
Head of Finance, CLCCG
Head of Planning and Governance, CLCCG (minutes)
Neville Purssell
Jonathan Webster
Governing Body Vice Chair and GP Member, CLCCG
Secondary Care Nurse Member, CWHHE CCG
Governing Body Chair and GP Member, CLCCCG
Governing Body GP Member, CLCCG
Governing Body GP Member, CLCCG
Governing Body GP Member, CLCCG
Governing Body GP Member, CLCCG
Chief Officer, CWHHE
Chief Finance Officer, CWHHE
Governing Body Deputy Chair, CLCCG
Governing Body Lay Member, CLCCG
Governing Body Lay Member, User Panel Chair,
Welcome, Introduction and Apologies
Apologies were received as noted above.
Declarations of Interest
There were no new declarations of interest.
Approve Minutes of Previous Meeting (P)
The Governing Body was asked to approve the minutes of the previous
meeting. The minutes were agreed as an accurate record of the Part I
Matters Arising
There were no matters arising.
Action Log (P)
Action 400 – This was an on-going process and it was agreed to leave the
action open.
Action 403 – This action had been addressed in the previous meeting –
action closed
Action 401 – This process was underway and on the agenda of the
meeting – action closed.
Action 402 - This was on the agenda of the meeting – action closed.
Ratification of Chairs Actions (V)
The Chair advised the Governing Body of a Chair’s Action that had been
taken at a recent Leadership Executive Committee (LEC) meeting relating
to agreement on a ‘payment by activity’ approach in the respiratory
procurement. Dr Paul O’Reilly and Dr Neville Purssell had supported the
decision in the Leadership Executive Committee (LEC).
Detailed minutes would be available on request.
Update on Investment Committee Decisions
There were no decisions to report.
Papers Circulated for Noting/Information
There were no comments received on the papers circulated for
Report from the Chair
Members were referred to the Managing Director’s and Chief Officer’s
reports for background information. The Chair proceeded with a verbal
update as there had been a lot of activity in the past 7 days.
1) Recruitment of new Accountable Officer – Daniel Elkeles was due
to leave on 19 December and the Chair was leading the
recruitment process on behalf of all 5 CCGs, working with Harvey
- Pre-shortlisted candidates would meet representatives of the
Central London CCG Governing Body and of the four other CCGs
on 10 December, and volunteers had been sought to meet with the
- The final interview was scheduled to take place on 11 December.
- There would be a stakeholder event on 11 December for those who
wished to meet the three shortlisted candidates.
As this was Daniel Elkeles last meeting he was thanked for his
energy and intelligent approach to leadership.
2) Community Independence Service (CIS) – A launch event had
been held for the lead provider of the CIS on 12 November. This
service was a major part of the Better Care Fund. There had been
active discussions between potential providers that were expected
to bid for the service.
3) Primary Care Co-commissioning was also unfolding. More
guidance had been received from NHS England in the last 24
hours and would be discussed later on the agenda.
4) The Better Care Fund and the Tri-Borough Board had met the
previous evening. This involved representation from 6
- Tri-Borough CCG Chairs
- Chairs of the Tri-Borough Health & Wellbeing Boards
- Senior executive managers
There had been good discussions, and constructive work was ongoing which boded well for the Better Care Fund in the TriBorough.
5) Central London Healthcare Community Interest Company
– meetings with the new provider network were continuing and Dr
Ruth O’Hare and Matthew Bazeley had been invited to attend CLH
CIC’s board meetings. CLH CIC had been represented at the CIS
launch event.
It had been impressed upon CLH CIC the
importance of the Out of Hospital contracts being delivered by GPs
and delivering QIPP and CLCCG’s strategy.
Report from the Chief Officer (P)
Clare Parker presented in the absence of Daniel Elkeles and noted the
that CSU colleagues had now been brought in house, with further
details in the separate paper.
NHS England Five-Year Forward View - in agreement with NW
London’s aims.
North West London hospitals had merged with Ealing but this had
taken some time to happen.
Report from the Managing Director
Highlights were:
Establishment of the Leadership Executive Committee (LEC)
(Terms of Reference in papers for noting). A summary of the
discussions that took place at the LEC was provided in the report.
In the interests of transparency questions were welcomed, together
with minute requests.
The Governing Body wanted to thank the Management team and
staff for the work on the recent Annual General Meeting.
As host commissioner for CLCH, CLCCG had undertaken
interviews as part of CLCH’s Foundation Trust application,
particularly on board governance and quality assurance.
Questions on the process were welcomed.
Diagnostics Award
This item was removed from the agenda as it had been covered in the Part
II Governing Body meeting, to be ratified in January 2015.
Primary Care Co-commissioning in North West London
It was reported that a recent NHS E document had involved a step change
to the task. Dr O’Hare reported that GPs had been surprised at the extent
of the changes – a much bigger task with more responsibility and less
management resource than had been anticipated.
At the start of the year the Governing Body had agreed that CLCCG could
explore with the other CWHHE Chairs the possibility of co-commissioning
primary care across North West London in a new body, with NHS England.
Following a call for expressions of interest, CLCCG applied and was given
the go ahead to explore the options. GP engagement included Plenary,
Locality meetings and a separate event on 4 November, with attendance
by 11 out of 35 practices.
Practices were cautious but had given the Governing Body a steer to begin
to explore co-commissioning. Decisions taken by the group would have to
go to the Governing Body during the time of shadow co-commissioning
and a definitive vote would then take place in March/April 2015.
Further guidance on the changes from NHS England would be discussed
at the Collaboration Board.
Gordon Hunting commented that to test before a final decision in March
2015 felt like a very tight timetable.
The Governing Body agreed to authorise the Chair to represent
CLCCG on the joint body, on the basis that decisions taken would
need to come back to the Governing Body for ratification/approval
prior to a final decision being taken in March/April 2015.
OOH Services Business Case/Update Paper
Out of Hospital (OOH) Business case
It was noted that there was potential for conflicts of interest as primary
care providers were likely to be the providers of the services, hence
Investment Committee involvement.
The Investment Committee had tested the value for money aspect and had
determined that while prices were lower than the existing Local Enhanced
Services, which the Out of Hospital contracts replaced, the increased
expenditure had been driven by increased activity. Cost increases were
expected to be mitigated by reducing activity in the acute sector, but this
would take a while to filter through and so there was likely to be some cost
Costs had exceeded what had been previously set and so the Governing
Body was being asked to ratify the Finance and Performance Committee’s
decision on a further £1.6 million above the current budget, as there was
likely to be some cost pressure.
Out of Hospital Services Update
One locality out of 16 in Hounslow had gone live in the previous week.
Checks on IT and the efficacy of SystmOne were needed before rolling out
One of the points endorsed by the Finance and Performance Committee
was the importance of patient/lay engagement in the development of these
services. It was confirmed that
 Gordon Hunting represented both the CLCCG Governing Body as
well as the patient voice.
 Nafsika Thalassis had been actively involved on the independent
review panel and had sat on the Investment Committee that
approved the OOH Business Case.
 Michael Morton would be involved in the governance and was fully
involved in discussions at a critical time.
The Governing Body ratified the decision of the Finance &
Performance Committee to approve the OOH Business Case.
Revised Investment Committee Terms of Reference
Ben Westmancott provided the update. The Investment Committee was a
joint group with neighbouring CCGs, and was a mechanism to deal with
inherent conflicts of interest, and to provide additional scrutiny of
commissioning decisions. The Committee had been in place for over a
year and there had been a review of the Terms of Reference and of the
operation of the Committee.
Changes to the Terms of Reference were as follows:
Increased number of lay members, such that there was a majority
of independent members on the Committee;
Clarification that CCG chairs were not able to vote when they
were conflicted;
To allow the Committee to set up sub-groups to deal with appeals
of decisions from the CCG if they arose.
On a final point, it was felt that the Committee needed a name that better
reflected its activities. Governing Body members were invited to contribute
to that process.
The Governing Body ratified the changes to the Terms of Reference
of the Investment Committee.
Emergency Preparedness, Response and Resilience Policy
Mary Mullix noted that a joint plan was needed across North West London
and review work had taken place on the Policy, which had then been
shared with the NWL NHS England lead for EPRR as well as the CWHHE
The Governing Body approved the Emergency Preparedness, Response
and Resilience (EPRR) Policy.
Maternity Transition
The Governing Body was being asked to delegate authority to approve the
date of closure (to Ealing CCG Governing Body). This reflected the
process followed for the Hammersmith & Fulham A & E closure.
Factors to note:
There would be a limited impact on Central London mothers-to-be.
The model had been changed to suit dense population sizes in
certain areas.
The proposal had been based on surveying women and GPs on
preferred second choice if Ealing were not available.
The proposal would address missed opportunities (from a Public
Health perspective) to link ante-natal and post-natal care.
A new maternity booking system was in place, hosted by Imperial,
which would help to avoid duplicate bookings and would give real
data on first choice.
Prioritisation of local expectant mothers would need to be
communicated to neighbouring Trusts.
The Governing Body approved the delegation of approval to Ealing
CCG Governing Body to undertake on its behalf:
The decision on when the maternity unit operating on the
Ealing Hospital site should close
Decisions about the move and timing of any other necessary,
clinically interdependent service changes resulting from the
The Governing Body further requested that the CCG Chair, CCG
Accountable Officer and the Chair of the CCG Quality and Safety
Committee (or equivalent) advise Central London CCG’s Governing
Body if any major/significant unforeseen clinical or other issue arose
such as, in their opinion, the risks of closure outweighing, at that
time, the risks of delay.
Co-opting Update
Daniela Valdés presented the process for electing two co-opted (nonvoting) members to the Governing Body. This would allow a Practice
Manager and Practice Nurse to give broader representation on the
Governing Body. Daniela Valdés had attended a Practice Nurse meeting
to present the paper and a number of questions had been raised. The
hope was to approach potential members in the next couple of weeks.
Ruth O’Hare noted that the input of a Practice Manager and Practice
Nurse would be very much valued as they represented important elements
of the primary care team.
Matthew Bazeley noted that in the context of the GP Provider Network
which had established a Board with GPs, a Chair, Practice Manager,
Practice Nurse and lay member – the challenge was for the CLCCG to
have the same level of representation.
The Governing Body approved the process for co-opting (non-voting)
members to the Governing Body, on the basis that the members
would represent their peers.
Month 6 Finance (FPC) Report
CLCCG was on track with its financial position and forecast outturn across
the Collaborative generally. There were some cost pressures, and London
Ambulance Service performance issues needed to be considered.
on the underlying position (matters going into 15/16) there was a
deterioration in the position. The driver was mainly in the acutes
which would not impact on this financial year but following.
prescribing pressure had arisen from an increase in Category M
generic drug prices in month 6, but month 7 was due to improve.
There were changes to risks and opportunities, and the potential
for cost and volume increases. Some related to placement
contracts. It was also noted that the risk around overseas visitors
had gone but the level of charges from CNWL indicated that the
money may not have been sufficient to cover the cost of the
service. Charges for this year had been based on last year’s very
limited information and current year spend had been higher. More
information was being sought from the Trust.
Some risk also around sectioned patients, numbers of which were
few but involved fluctuating spend from year to year.
CERNER activity was not being appropriately coded. It was
agreed that the Heads of Finance across the 5 CCGs should work
with contract managers to set out recovery pathways for these
contracts. The anticipated date for CERNER figures remained
month 9.
The Governing Body noted the update.
Month 5 Shaping a Healthy Future Finance Report
Clare Parker noted that at the last meeting an increase in spend of £1.7
million had created pressure. As part of the collaborative arrangement
Brent had agreed to contribute and the budget was on track to balance.
The Governing Body noted the update.
Integrated Performance and Quality Report (QSC)
Paul O’Reilly highlighted that the key concern at the FPC had related to
the London Ambulance Service. A number of individual GPs, particularly
in the South Locality, had raised concerns.
The LAS had reported to the Finance and Performance Committee and the
North West London Quality Group.
It was agreed that individual case issues should be fed back to the Director
of Nursing at the LAS via Jonathan Webster, Director of Quality, CWHHE.
Matthew Bazeley noted
that Central London CCG had done better than expected on the
Quality Premium.
Good progress was being made on care plans
progress on Dementia work (which had some challenges) was due
to be reported at the next Governing Body meeting.
Action – Matthew Bazeley to report on the Quality Premium at the
next meeting.
Mary Mullix noted that with regard to Imperial Quality, a review of
CERNER data was being done and there would be a resubmission of data
for month 6.
Action – revised Month 6 data to be resubmitted to the Quality &
Safety Committee, Collaborative Quality and Patient Safety
Committee in December.
Board Assurance Framework (P)
This was a significant update from the previous version with changes
highlighted in blue.
Scores had changed for 3 particular risks.
 Risk 1 – there had been a number of comments from patients and
a reworked document would go to the Collaborative for discussion
and then to the Governing Bodies.
 Risk 12 – Risk had reduced, but it was noted that work was ongoing to reduce the reliance on interim staff.
 Risk 4 – Safeguarding Adults – the score was still at 20 and had
not changed raising the question over whether or not the controls
that were in place were working. More work needed with Jonathan
Webster and Mary Mullix to see if things needed to be done
Philip Young noted that at Hounslow the probability of the merger between
Chelwest and Middlesex might have changed and the reduction of risk was
probably not timely.
The Governing Body noted the updated BAF.
Revised Detailed Scheme of Delegation
The Governing Body noted the revised Detailed Scheme of
Delegation which had been approved by the Audit Committee in
September under the Authority granted to it at the previous
Governing Body meeting.
There were no items raised under AOB.
Questions from the Public
There were no questions from the Public.
Next Meeting
15:30 PM – 17:30 PM on Wednesday 14 January 2015 in the Boardroom, Hellenic Centre