south west london committee for collaborative decision ... cic agenda v2.pdf · carol varlaam ccdm...

South West London Committee for Collaborative Decision Making (in public)

Tuesday 27th March 2018, 17:30 - 19:30 Venue: Meeting room(s) 6.2/6.3, 120 The Broadway, Wimbledon

Convenor: Carol Varlaam

AGENDA

1 17:30 Welcome, Introductions and Apologies Carol Varlaam

2

17:35

Declarations of Interest All members and attendees may have interests relating to their roles. These interests should be declared in the register of interests. While these general interests do not need to be individually declared at meetings, interests over and above these where they are relevant to the topic under discussion should be declared.

Carol Varlaam

Paper 01

3

17:40

Funding to Deliver Extended Access and Primary Care at Scale in 18/19

Lucie Waters

Paper 02

4

18:20

Developing a South West London Individual Funding Requests (IFRs) Triage Process and Panel

Jonathan Bates

Paper 03

5

19:00

Public Questions Members of the public present are invited to ask questions of the Committee relating to the business being conducted today. Priority will be given to written questions that have been received in advance of the meeting.

Carol Varlaam

6 19:15 Any Other Business Carol Varlaam

1 of 1

South West London Committee for

Collaborative Decision Making

Register of Declared Interests

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Carol Varlaam

CCDM convenor; Wandsworth

Clinical Commissioning Group

Lay Member

No Current Organisations

Parchmore Partnership

Partner XRoles and Responsibilities held

within member practices

To date Declare.

Discuss where relevant with Conflict of Interest Guardian

Haling Park Medical Practice



To date Declare.


South Norwood Medical Practice



To date Declare.


Croydon GP Collaborative

Parchmore Partnership, Haling Park Medical Practice and South

Norwood Medical Practice are shareholders

Declared March 2016

X Shareholding 2016 To date

Declare.


London School of General Practice

GP Trainer XPosition of Authority in an

organisation in the field of health

and social care

To date Declare.


Croydon Local Medical Committee

Member XPosition of Authority in an


and social care

2002 12.5.17 Declare.


National NHS Pathways Governance Group (Royal College General

Practitioners)

Chairman

XPosition of Authority in an


and social care

2009 To date Declare.


National Urgent and Emergency Care Steering Group - NHS

England

Member



and social care

01-Jul-16 Declare.


South London Faculty Board, Royal College of General Practioners



and social care



NHS England (London) - Pan London Integrated Urgent Care

Governance Group

Chairman



and social care

To date Declare.


London Ambulance Service Clinical Quality Group

GP Representative for NHS SW London XPosition of Authority in an


and social care

To date Declare.


London Urgent and Emergency Care Clinical Leadership Group



and social care

To date Declare.


National NHS Pathways Programme Board (NHS England/Health &

Social Care Information Centre)

Member

Declared May 2016

X

Position of Authority in an


and social care

To date Declare.


Health Education England South London

GP Trainer XPosition of Authority in an


and social care



Russell School Trust (Royal Russell School)

Governor XOther 2006 To date Declare.


Croydon Clinical Commissioning

Group ChairDr Agnelo Fernandes

Action taken to mitigate risk

Nature of InterestDeclared Interest- (Name of the organisation and nature of

business)Name

Current position (s) held- i.e.

Governing Body, Member

practice, Employee or other

Date of InterestType of Interest

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business)Name





Community Phlebotomy Service

Parchmore Partnership provides premises for this service XOther To date Declare.


Community Anti-Coagulation Service

Parchmore Partnership provides premises for this service to Boots

PLC

XOther To date Declare.


Community Minor Surgery Service

Parchmore Partnership provides premises for this service XOther To date Declare.


Community Diabetes Service - Bromley Healthcare

Parchmore Partnership provide the premises for this service XOther To date Declare.


Guy's, King's and St Thomas's Medical School

Parchmore Partnership Medical Learner Centre XOther To date Declare.


Dr ABC First Aid Training Company

Wife-owner. Provides training for schools/nurseries and some GP

practices (there is no link to the CCG or contracting)

XOther 2010 To date Declare.


Quintos Works Limited - Physiotherapy (non NHS)

Parchmore partnership provides the premises for this service XOther 2010 To date Declare.


Circumcision Centre

Parchmore Partnership provide the premises for this service

Declared October 2015

XOther To date Declare.


Lambeth, Southwark and Lewisham LIFTco.

Director. Representing class B shares

on behalf of Community Health Partnerships Ltd with the aim of

inputting local knowledge to the LSL LIFTco, for the following LIFT

companies: Building Better Health –Lambeth Southwark Lewisham

Limited

Building Better Health –Lambeth Southwark Lewisham (Holdco 2)

Limited Building Better Health –Lambeth Southwark Lewisham

(Holdco 3) Limited Building Better Health –Lambeth Southwark

Lewisham (Fundco 2) Limited Building Better Health –Lambeth

Southwark Lewisham (Fundco 3) Limited Building Better Health –LSL

(Fundco Tranche 1) Limited

Building Better Health –LSL (Fundco Holdco Tranche 1) Limited

Building Better Health –LSL Bid Cost Holdco Limited Building Better

Health –LSL Bid Cost Limited

Building Better Health - LSL (Holdco 4) Limited

Building Better Health - LSL (Fundco4) Limited

X

Shareholding To date Declare.


Lambeth Clinical Commissioning Group. Chief

Officer.

X 01/04/2013 To date Declare.


Married to Director of Performance and Delivery - Kings Health

Partners

X Personal 29/10/2012 To date Declare.


Eastbourne Homes Limited (Private company set up to provide

housing services to council tenants and lease holders)

Non Exec Director

X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

Croydon Clinical Commissioning

Group ChairDr Agnelo Fernandes

Andrew EyresChief Operating Officer, Croydon

CCG

Roger Eastwood Lay Member Croydon

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business)Name





South East Independent Living Limited (Management of real estate)

Non Exec Director

X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

South Essex Homes Limited (management of council housing for

Southend-on-Sea Borough Council)

Non Executive Director

Declared 25 July 2016

X Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict

Eastwood Consultants Limited (Management consultancy activities)

Director and Co Owner

X X Non Exective Director 01-Sep-14 To date Highlighted in meeting if direct conflict

Eastbourne Housing Investment Company Limited (letting and

operating of real estate)

Non Exec Director

X Non Exective Director 01-Jul-16 To date Highlighted in meeting if direct conflict

South East Independent Living Limited

(provides supporting people services to over 65 year olds in East

Sussex for Eastbourne, Lewes and Wealden districts and

"Navigator" services for younger people with complex needs in East

Sussex)

Non Exec Director

X Position of Authority in an


and social care

To date Highlighted in meeting if direct conflict

Elaine ClancyDirector of Quality and

Governance, Croydon CCG

Parent Governor- Langley Park School for Girls X

01/09/2017 To date Highlight in Meeting if direct conflict

Partner of The Groves Medical Centre. X Profit share

The Groves Practice has shares in the private provider New

Malden Diagnostic Centre.

Member of the Council of Governors for Kingston Hospital as a

CCG representative. Member of Governing Body, audit,

Information Governance, and Co-Chair Interim Transformation

Board.

The Groves Practice is part of the GP Federation Provider in

Kingston , Kingston GP Chambers

Chair of Remuneration Committee and member of Finance,

Audit and Clinical Governance Committees.X

Spouse is an employee of Kingston Hospital. Profit share

Partner Nelson Medical Practice

Partner and Chair of Executive Management Team.X X

Wife established Merton Against Trafficking for which I have

undertaken voluntary work for.X

Close friend set up Chapel Street (Charity) - runs services for

NHS but not Merton.X

Membership of Finance, Remuneration; and Integrated

Governance & Quality committee. X X 13/09/17 Present

Sarah BlowAccountable Officer

SWL CCG AllianceGovernor for Greenshaw Learning Trust X 01/01/14 present

Clare GummettMerton Clinical Commissioning

Group Lay MemberAge UK Merton - Chair of Trustees. X

Senior GP partner Hampton Practice, Practice is a member

RGPA, SCMO Your Healthcare.X

Member Kingston Richmond LMC. X X

Conflicted Agenda Item 3 Recused/Non-Voting Dr Naz Jivani

Kingston Clinical Commissioning

Group Chair

David KnowlesKingston Clinical Commissioning

Group Lay Member

Roger Eastwood Lay Member Croydon

Dr Graham LewisRichmond Clinical

Commissioning Group Chair

Dr Andrew MurrayMerton Clinical Commissioning

Group Chair

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business)Name





Close friends working for NHS including HRCH. May 2017 Present

Director, MPL X May 2017 Present

Associate Director, Prolex Consultancy X

Susan Smith Richmond CCG Lay Member Nil return

Fergus KeeganDirector of Quality and

Governance, Richmond CCGNil return

GP Partner at Benhill and Belmont GP Centre. GP Centre is a

Member of the Sutton GP Federation.X X

Spouse is a Consulatant Gynaecologist/Infertility services at

Epsom and St. Helier NHS Trust and is Clinical Director for

Women's Health.

LMC Representative for Sutton LMC, Project lead for the new

Belmont surgery in developong the new Benhill and Belmont

GP Centre. GP trainer and supervise OOH shifts in SELDOC

for GP trainees.

<£1000 PA

Director Sutton Health Care. X

Sutton CCG Board Audit Committee,

Sutton CCG Executive Quality CommitteeX

STP Paediatric and Medicenes Management SRO X

Director – Susan Gibbin Consultancy Ltd. X

Corporate consultancy support to Carnall Farrar, Strategic

Health and Care ConsultancyX

Trustee and Board member of the Bourne Education Trust X

Chair of Governors – Downs Way School, Oxted.X

Managing Partner Brocklebank Group Practice and St Paul’s

Cottage Surgery. Both practices hold PMS contracts.X

Practice is a member of Wandsworth Integrated Healthcare

Limited –holds no director post and has no specific

responsibilities within that organisation other than those of other

member GPs.

X

Chair WCCG Board, Integrated Governance & Quality

Committee, St Georges Hospital Clinical Commissioning

Reference Group, System Resilience Group and Clinical Lead

for Transforming Primary Care Programme.

X

James Blythe

Managing Director, Merton and

Wandsworth Clinical

Commissioning Group

Wife is an employee of St George’s University Hospitals NHS

Foundation Trust and holds a speciality training number in

Obstetrics and Gynaecology with HEE South London.

X May 2017 Present

Does not participate in discussions or decisions

regarding clinical quality, safety or staff conduct within

the relevant departments at SGUHFT.

Dr Nicola JonesWandsworth Clinical


Dr Chris Elliott Sutton CCG Clincial Chief Officer

Dr Jeffrey CroucherSutton Clinical Commissioning

Group Chair

Susan Gibbin

Sutton CCG Lay Member,

Performance

Sutton CCG

Member: Governing Body

Vice Chair:

Primary Care Commissioning

Committee

James Murray Interim CFO, SWL Alliance

Dr Graham LewisRichmond Clinical


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business)Name





Stephen HickeyWandsworth CCG Lay Member,

Audit and GovernanceTrustee for Merton Community Transport Charity X

Sam Page Independent Nurse, Wandsworth

CCG Governing Body member

Director Sam Page Consultancy - Consultancy to NHS, local

authority and voluntary sector organisations. X Jan-17 On-going

Interest to be declared as relevant with potential withdrawal

from discussion.

Less Ross Lay Member Sutton No current conflicts of interests Conflict of Interest training completed Feb 2018

Julie Hall Merton GB Nurse MemberDesignated Adult Safeguarding Nurse for Hillingdon CCG. (24th

Oct 2016 -)X

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South West London Committee for Collaborative Decision Making

PAPER 02

Page 1 of 2

Committee Date Tuesday, 27 March 2018

Presenter Lucie Waters

Author Annabel Appleby

Responsible Director

Lucie Waters

Clinical Leads Dr Nicola Jones

Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so

The Board is asked to

Approve the recommended approach for apportioning funding across SWL CCGs in 18/19.

Summary of purpose and scope of report

The objective of this paper is to:

• Set out the background information regarding extended access and primary care transformation, as context for the decision that needs to be made by the Committee in Common

• Summarise the requirements for extended access and primary care transformation in 18/19

• Present a recommendation for apportioning the funding across CCGs in 18/19.

Quality and Safety/ Patient Engagement/ Impact on patient services

The report, and corresponding appendices, set out the requirements for extended access and primary care at scale in 18/19. The STP funding is dependent on the STP meeting these requirements.

Finance, resources and QIPP

• SWL’s funding for 18/19, to deliver extended access and transformation of primary care, is £8million

• The STP can determine the spread of allocations within their patch

• SWL has some flexibility in using the money across extended access and primary care transformation

• The paper presents a recommendation for apportioning the funding across CCGs in 18/19 which the Committee in Common is asked to approve.

Title of paper Funding to Deliver Extended Access and Primary Care at Scale in 18/19

1 of 2

South West London Committee for Collaborative Decision Making

PAPER 02

Page 2 of 2

Equality / Human Rights / Privacy impact analysis

Equality impact assessments will be undertaken at CCG level as services are developed.

Risk Mitigating actions

If the STP does not meet the requirements set out in the specifications for extended access and primary care at scale then SWL may not receive the funding set out in the report.

The STP team will work closely with CCG primary care teams to develop plans and ensure these meet the national / London requirements.

CCGs will follow local governance arrangements to oversee the development of local plans.

SWL STP will have a QA process aligned to the London process.

Spend and delivery will be monitored on an ongoing basis by the Alliance SMT.

Supporting documents

N/A

Governance and reporting

(list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper)

All SWL CCGs have discussed this paper internally and have advised their CiC representatives on their local CCG view.

2 of 2

Funding to deliver Extended Access and Primary Care at Scale in 18/19

SWL Committee in Common27th March 2018

Start well, live well, age well 11 of 8

Purpose of paper

The objective of this paper is to:

• Set out the background information regarding extended access and primary care transformation, as context for the decision that needs to be made by the Committee in Common

• Summarise the requirements for extended access and primary care transformation in 18/19

• Present a recommendation for apportioning the funding across CCGs in 18/19

22 of 8

Background

• The General Practice Forward View set out a requirement for each CCG to deliver Primary Care Extended Access; 8-8 7 days a week access to additional GP appointments

• In 17/18, SWL received £4.58m to implement extended access in primary care. Apportionment of this funding across CCGs was agreed by the previous SWL Chief Officers Group; the split was based on business cases submitted by CCGs and did not reflect weighted population

• Across SWL, CCGs have delivered the extended access requirement via a range of at-scale models and approx. 18,000 appointments per month have been created across the patch

• Moving forwards, CCGs will work with providers to fully embed the extended access services within the wider system (e.g. direct booking into services from 111 and ability for A&E to redirect patients into primary care)

• In addition to finalising the extended access specification, the national and London focus is moving onto transformation of primary care through at-scale working, which was also included as an ambition in the General Practice Forward View

33 of 8

The 18/19 specification for extended access

This slide summarises some of the additional requirements of extended access services in 18/19. STP funding is dependent on the STP meeting this specification.

1. Coverage of a full 8-8 7 day a week GP primary care service must be in place – this as a minimum allows for an extended access GP service that is open weekday evenings 18:30 to 20:00 and 08:00-20:00 on the weekend. Appointments must be available each day for both in advance and same day booking. The service should support the provision of both additional routine and urgent primary care provision

2. Appointments in the extended access service must be directly bookable via; all local GP practices, 111 provider(s) (with services effectively prioritised on the DOS) and local urgent and emergency care provider(s), supporting the appropriate direction of service users

3. Provide 30 minutes of additional appointments per 1000 registered population per week, as a minimum

4. Providers of extended access services must have full access to patient medical records including read and write access, and have integrated systems which allow for transfer of patient information to support safe and effective care

5. The expectation is that service utilisation should be 90% as a minimum. It is noted that it may take time from the launch date of a new service to increase utilisation rates and the age of service delivery will be considered when assessing the reported utilisation figures

44 of 8

The 18/19 requirement for primary care transformation

This slide summarises some of the requirements of primary care transformation through at scale working. The funding is dependent on the STP demonstrating tangible progress against this framework in 18/19.

1. Comprehensive population based care, operating on a scale large enough to support economies of scale, aligned with boundaries of the local care system and arranged into ‘primary care networks’ – groupings of practices with combined registered lists of 30-50,000

2. Responsibility for the delivery of core medical services, patient outcomes and continuous improvement across all practices

3. Developing organisational capabilities to support delivery including; access to legal, HR and financial advice, workforce planning and recruitment strategy, training and development programmes for staff

4. Effective governance and stewardship including; strategic direction, accountability, and creating a culture based on NHS values, trust, sharing of risk and patient safety

5. Building collaborative system partnerships; primary care demonstrating participation in and leadership of networks of providers within an Integrated Care System

55 of 8

Key funding messages for SWL STP

• SWL’s funding for 18/19, to deliver extended access and transformation of primary care, is £8million

• The STP can determine the spread of allocations within their patch

• SWL has some flexibility in using the money across extended access and primary care transformation

• The funding is provided on the basis that:

– STPs are using this money for the purposes of continued delivery of extended access services. STPs must meet the core standards requirements as set out in the London 2018/19 Extended Access Guidance document and any noncompliance will lead to a review of commitment to access this funding

– An element of the funding will be used as a transformation fund to support primary care transformation work focussing on accelerating collaborative working and new models of working ‘at scale’

– CCGs commit to continue to invest in primary care services at the same level as they did for the previous year to achieve access and transformation

– The STP will be expected to develop and present plans on planned spend to deliver the shared vision. The STP will be expected to present this to London in April or May

66 of 8

Proposed split of funding for 18/19

It is recommended that the STP split the funding across SWL CCGs based on the following principles:

• As the starting point, CCGs receive the same funding that they received in 17/18

• Additional funding is split across CCGs to level up the £/head funding that each CCG receives

• The table below shows how the 18/19 funding would be split by CCG, based on these principles

7

CCG 18/19 funding £/head

Croydon £2,036,353 £5.41

Kingston £987,034 £5.41

Merton £1,065,322 £5.41

Richmond £1,040,450 £5.41

Sutton £977,512 £5.41

Wandsworth £1,893,330 £5.41

SWL Total £8,000,000 -

7 of 8

Recommendation

8

The CCG Governing Body is asked to consider approving this approach for apportioning funding across SWL CCGs:

• CCGs will all receive £5.41 per head funding in 18/19

• CCGs will follow local governance arrangements to oversee the development of local plans

• SWL STP will have a QA process aligned to the London process; money will be released upon evidence of investment and assurance that plans meet the London specifications and will deliver required benefits

• Spend and delivery will be monitored on an ongoing basis by the Alliance SMT. The STP will in turn be monitored at London level; 50% funding will be released upon demonstration of robust plans, and 50% will be released at Month 6, upon assurance that delivery is to plan

• The SWL Transforming Primary Care Delivery Group should review progress and options for accelerating primary care transformation over the next six months to get maximum advantage from 19/20 funding

Does the CCG Governing Body agree with the recommended approach for apportioning funding across SWL CCGs?

8 of 8

PAPER 03

Page 1 of 2

Date Tuesday, 27 March 2018

Presenter Jonathan Bates, Director of Commissioning Operations, SWL Alliance

Author Zoli Zambo, ECI Programme Lead, SWL Health and Care Partnership

Responsible Director

Jonathan Bates, Director of Commissioning Operations

SWL Alliance

Clinical Lead

Confidential Yes ☐ No Items are only confidential if it is in the public interest for them to be so

The Board is asked to:

AGREE to the formation of a single IFR service across SWL.

Summary of purpose and scope of report

The paper seeks to agree the alignment of the current IFR arrangements in SWL into a single IFR service for the population.

Quality & Safety/ Patient Engagement/ Impact on patient services:

IFR services remain governed by those responsibilities mandated to CCGs, with the delivery of the commissioner responsibilities pooled together for greater consistency of decision making.

Finance, resources and QIPP

Each month on average there are 15 IFR Triage Panel meetings and nine IFR Panel meetings across SWL; this is on average a total of 24 meetings per month across the six SWL CCGs. It is envisaged that in a single IFR model the number of meetings will reduce, with triage panels meeting weekly; and fortnightly IFR panel meetings held across SWL. This is being factored into the contractual negotiations with NEL CSU, who provide the administration for the meetings; and CCG resources supporting this will also be revised.

Equality / Human Rights / Privacy impact analysis

The single IFR service will make the decision making more robust and will improve the equity of services across SWL.

Risk Mitigating actions

Risks will be managed by the Directors of Commissioning group.

None.

Title of paper Developing a SWL Individual Funding Request (IFR) Triage Process and Panel

1 of 2

PAPER 03

Page 2 of 2

Supporting documents

N/A

Governance and reporting

(list committees, groups, other bodies in your CCG or other CCGs that have discussed the paper)

All SWL CCGs have discussed this paper internally and have advised their CiC representatives on their local CCG view.

2 of 2

P A G E 1 O F 9

Developing a SWL IFR Triage Process and Panel Author: Zoli Zambo Sponsor: Jonathan Bates Date: February 2018

Executive Summary

1. Context

Currently across South West London (SWL) there are six separate Individual Funding

Request (IFR) Triage Panels, one for each individual Clinical Commissioning Groups

(CCG). There are also three IFR Panels (Croydon, Richmond and a shared panel for

Kingston, Merton, Sutton and Wandsworth). This is a highly resource intensive. The

recently established Prior Approval Service has led to procedures previously being

managed through the IFR route now being more appropriately managed by Prior Approval.

In addition, having different processes across SWL can potentially lead to inconsistency in

decision making.

The proposal outlined in this paper is as follows:

Move to a single IFR Triage Panel that meets weekly

Move to a single SWL IFR Panel, with clinical representation from SWL CCGs that meets

fortnightly

Put in place an IFR Appeals Panel to review the limited number of contested IFR decisions

The proposed way forward would deliver the following benefits:

Greater consistency of decision-making

Improved expertise in a smaller number of CCG IFR representatives

Reduced costs

Greater alignment and service resilience across SWL.

2. Recommendation

The Committees in Common is asked to agree to the proposal outlined above.

Practical implementation will be overseen by the SWL Directors of Commissioning Group.

G O V E R N I N G B O D Y P A G E 1 O F 4

1 of 9

P A G E 2 O F 9

Developing a SWL IFR Triage Process and Panel

1 . I N T R O D U C T I O N

The IFR process is used to consider individual requests for funding where a service,

intervention or treatment falls outside existing service agreements. Some treatments are

“not routinely funded” because either their clinical and cost effectiveness is marginal or

where NHS provision may be inappropriate (e.g. the benefits are purely cosmetic and not

clinical).

Prior to the procedure being undertaken, authorisation for these procedures must be

obtained by the treating clinician (i.e. the practitioner who is responsible for administering

the treatment). In this respect the requirement is the same as for those procedures that are

covered in the Prior Approval Scheme.

Any procedures not routinely funded can be requested via the IFR route. The IFR process

ensures that each request for individual funding is considered in a fair and transparent

way, with decisions based on the best available clinical evidence.

Completed IFR applications are approved only when the IFR panel agrees that the patient

is exceptional or the patient has a very rare clinical condition.

Exceptionality is defined as:

Significantly different from the general population of patient with the condition in

question; AND

Likely to gain significantly more benefit from the intervention than might normally be

expected for the average patient with the condition.

The IFR process has two stages for the commissioners. The IFR Triage Panel reviews all

IFR applications and ensures that all information from the applicant is available and

undertakes the necessary evidence review. Only those cases that are not rejected at this

stage proceed to the IFR panel for a full discussion.

2 . C U R R E N T A R R A N G E M E N T S I N S O U T H W E S T L O N D O N

Currently across SWL there are six separate IFR Triage Panels, one for each individual

CCG. Composition of triage panel members varies from CCG to CCG.

There are three IFR Panels across SWL:

1) Croydon

2) Richmond

3) Joint IFR Panel for Kingston, Merton, Sutton and Wandsworth.

As with the triage panels, composition of IFR panel members varies from CCG to CCG.

On average, each month there are 15 IFR Triage Panel meetings and 9 IFR Panel

meetings making an average total of 24 meetings per month for six SWL CCGs. In terms

of personnel, there are a total of 32 IFR Panel members across SWL.

2 of 9

P A G E 3 O F 9

3 . C A S E L O A D

Currently the IFR services in SWL deal with cases, which evolved over time and are a

mixture of legitimate IFR applications and Prior Approval Scheme tickbox forms.

The legitimate IFR cases are based on exceptionality and rarity of the patients for

treatments that CCGs do not routinely commission (for example: cosmetic surgery).

The Prior Approval Scheme tickbox form cases are treatments, which are subject to

meeting predefined clinical criteria as defined in the SWL Effective Commissioning

Initiative (ECI) Policy. These procedures are now under the remit of the Prior Approval

Service, such as body contouring procedures and Open MRI scanning.

Commissioner

Legitimate IFR cases*

per year

Croydon CCG 25

Kingston CCG 11

Merton CCG 4

Richmond CCG 17

Sutton CCG 5

Wandsworth CCG 28

SWL total 90

* data based on 2017/18 (April to October 2017/18) extrapolated data

25% of the cases are drug cases, which will need to be the majority of the input from senior

pharmacists and the rest of the cases are for public health specialist to work up.

4 . C U R R E N T C O S T O F I F R P A N E L S

There are two components for each CCG to consider when evaluating the cost of running

the IFR process. Administration is currently provided by NEL CSU and is costed in the

CSU contract. The decision making personnel provided by CCGs is not budgeted for

directly as this is often provided as part of standard job descriptions or arrangements with

Local Authorities (for public health input). The CCG representation costs outlined below

are indicative and are modelled on figures from Croydon adjusted for each CCG according

to population size.

Cost of IFR service

NEL CSU

CCG

Representation

Total

Croydon £95,341 £40,955 £136,296

Kingston £51,531 £22,158 £73,689

Merton £54,478 £23,426 £77,904

Richmond £55,580 £23,899 £79,479

Sutton £49,320 £21,208 £70,528

Wandsworth £89,268 £38,385 £127,653

SWL £395,518 £170,031 £565,549

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5 . P R O P O S A L

Six individual IFR Triage Panels and three IFR Panels results in inconsistent panel

member composition, has significant potential to give rise to inconsistent decision-making,

and fails to make efficient use of CCG resources including the expense of panel members.

Some other parts of London have joint IFR triage and IFR panel across their multiple

CCGs.

It is proposed to move to a single joint IFR Panel across SWL along with a single SWL

single clinical triage panel.

We are working with current IFR triage and panel members in SWL and other joint IFR

services such as North West London to determine the final detail of the joint SWL IFR

service. Based on the current modelling the clinical triage would be undertaken weekly

with IFR Panel meetings taking place approximately every two weeks.

An Appeal Panel reviews applications where the applicant appeals the decision making

process of the IFR Panel. The membership of an Appeal Panel must exclude any persons

who have previously considered the application for which the decision is appealed. IFR

appeals are rare (approximately one case per year). We are working with other London

IFR services to ensure robust capability to be in place by working collaboratively with

them.

SWL CCGs would remain responsible for clinical oversight and for providing the clinical

input into the IFR Panel process.

There are a number of benefits associated with the proposed way forward:

Greater consistency in the application of the IFR policy and decision making

Improved expertise in a smaller pool of CCG IFR representatives

Reduced expense for CCGs by requiring representation at fewer IFR meetings

Alignment and enhanced joint working across the SWL STP footprint.

When all SWL CCGs are in agreement then the operational aspects of the service change

will be further developed and delivered through SWL Directors of Commissioning. This will

include, but not limited to:

Agreement of the proposal will require:

Recruiting IFR Triage, IFR Panel and Appeal Panel members

Redrafting the IFR Policy, Operating Procedures and Terms of Reference

Agreeing financial arrangements for IFR Triage and IFR Panel member costs

Agreeing the financial limit for the IFR Panel to agree funding for an individual case.

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P A G E 5 O F 9

The frequently asked questions relating to the implementation are collated and answered in

Appendix 2.

This is a relatively small commitment to deliver the benefits outlined and in Appendix 1 the

timelines for this is listed with those responsible. The SWL joint IFR service is scheduled to

go live in July 2018. Close monitoring of activity levels and Key Performance Indicators are

planned for the first 6 months, with a formal evaluation in January 2019.

6 . C O N C L U S I O N

The Committees in Common is asked to agree to the proposal outlined.

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P A G E 6 O F 9

Appendix 1 – Project timeline

Created by Zoli Zambo, ECI programme lead

No. Action Lead Update Due Status

1 Governance sign-off of Proposal principle ZZ On track to be completed Green

1.0 ECI group work up of proposal in principle ZZ Completed, discussed multiple times 12-Jan Complete

1.1 DoC agree proposal in principle AS Done, got the go ahead from them in principle 26-Jan Complete

1.2 SWL SMT agree proposal in principle ZZ Inform Accountable officers and Chairs 01-Feb Complete

1.3 CCG GB's to delegate authority ZZ Approved in all CCG GBs 15-Mar Complete

1.4 CiC to sign-off Proposal principle ZZ Scheduled for 27/3 27-Mar Green

2 Operational documentation

2.0 Feedback on proposal from IFR team AS Sought views in Q3 2017/18 30-Dec Complete

2.1 Visiting other IFR services ZZ Visited NWL (and CSU delivers joint Kent service) 27-Feb Complete

2.2 IFR member views sought on principle ZZSupporting in principle, operational questions

raised06-Mar Complete

2.3 IFR panel members workshop x 3 ZZScheduled to coincide with all three IFR panel

meetings09-Apr Green

2.4ECI group agree the updated Operational

Procedures suit of documentsAS/ZZ

Update current papers based on feedback and

examples from Kent and NWL25-Apr Green

2.5CDG to approve the updated Operational

Prcedures suit of documentsAS/ZZ To be scheduled into the agenda 04-May Green

2.6 SWL SMT to be provided update on progress ZZ To be scheduled into the agenda 11-May Green

3 Mobilisation CCG ZZ Green

3.0 Advertise jobs for triage and IFR panel ZZ Can give advance warning to IFR panels 11-May Green

3.1 Shortlisting ZZ Two IFR leads + ZZ 25-May Green

3.2 Interviews ZZ Interview panel with an IFR, ECI lead and HR 31-May Green

3.3 Appoint ZZ SRO for IFR to ratify panel decision 05-Jun Green

3.4 Training AS NEL CSU to provide if any training needed 30-Jun Green

3.5 Start joint service ZZExpecting some exisiting members to take on the

roles01-Jul Green

4 Mobilisation CSU AS Green

4.0 Service specification to be updated AS + ZZTo be based on the signed off Operational Prcedures

suits of documents31-May Green

4.1 Meetings to be scheduled from July onwards ASAs per the expected volumes with contingency for

excessive demand or unexpected issues31-May Green

4.2BlueTeq access to be provided for panel

membersAS

Move to paperless environment requires set-up and

possibly training as well as creating account15-Jun Green

4.3 Training for panel members AS NELCSU to provide if any training is needed 30-Jun Green

5 Evaluation ZZ Green

5.0 Month 1 activity and feedback report to CDG AS + ZZ To ensure that service delivers to KPIs 15-Aug Green

5.1 Summary report for the first quarter to CDG AS + ZZ To be scheduled in to agenda 15-Oct Green

5.2 Summary report for the first quarter to SMT ZZ To be scheduled in to agenda 30-Oct Green

5.3 Review after 6/12 to CDG ZZ To be scheduled in to agenda 30-Jan Green

SWL Joint IFR Service16/03/2018

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Appendix 2 – Frequently Asked Questions

1 . D O E S T H I S W O R K W E L L A N Y W H E R E ?

Yes, there are many regions that have single IFR panels in place for a larger footprint as this is about rare and exceptional cases, which are by definition few and far between. We are linking closely with NWL, who runs a similar set-up and some SWL IFR panel members also worked there so have first-hand experience of the workings.

2 . H A V E T H E L O C A L I F R T E A M B E E N I N V O L V E D I N D E V E L O P I N G T H E

S E R V I C E ?

This proposal was initiated by NEL CSU, who supports all six SWL CCGs in delivering the

IFR services administratively. They also run Joint IFR services elsewhere (e.g. Kent). In

addition feedback from IFR panel members and IFR leads has been sought and will

continue to be sought in finalising the operational aspects of the new service.

3 . I S T H E R E G O I N G T O B E A D E D I C A T E D I F R T E A M F O R S W L ?

Yes, it is the essence of the proposal to make the system more robust by building up skills and experience of staff by exposing them to more cases with adequate cover to ensure that all cases have appropriate level of specialist input (pharmacist or public health).

4 . H O W W I L L S T A F F I N G T H I S S E R V I C E W O R K ?

There will be a central team, just like there is currently, who will coordinate all

administration and provide the framework for the IFR service. The decision making

function will include clinicians who will be the members of the IFR triage and the IFR

panels. However, there will be fewer people involved as the number of cases are relatively

low at CCG or LDU level.

5 . T H E W O R K L O A D W I L L B E S I G N I F I C A N T L Y H I G H E R F O R P H A R M A C I S T

A N D P U B L I C H E A L T H I N P A R T I C U L A R ?

As there will be fewer individuals involved in the clinical preparation of the cases (pharmacists doing evidence reviews for drugs and public health for other treatments) expertise will be built up. The administration arm of the service can also support reviewers by screening requirements and proactively writing up simpler cases and proactively drafting requirement for additional information (as it is in North West London).

6 . D U R A T I O N O F T H E M E E T I N G S W I L L B E T O O L O N G I F T H E R E I S O N L Y

O N E T R I A G E O R I F R P A N E L .

Initial modelling undertaken by NEL CSU and feedback from NWL indicates that the

proposed weekly triage and fortnightly IFR panel meetings are sufficient even in the

transition stage. However, capacity will be built in to ensure more frequent meetings are

possible if necessary.

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IFR triage panel IFR panel

Number of cases for

discussion per meeting

15 4

Expected duration of each

meeting

3 hours 2 hours

7 . W H O W I L L B E O N T H E P A N E L A N D W H O W I L L D O T H E

A D M I N I S T R A T I O N ?

NEL CSU will continue to provide the administration to the service unless a different decision is made by the SWL CCGs. Current IFR panel members and other will be invited to apply for IFR triage panel and IFR panel roles. The proposed membership is below:

IFR triage panel

IFR panel

Lay member

GP GP

Consultant in public health (or delegate) Consultant in public health (or delegate)

Senior Pharmacist Senior Pharmacist

Commissioning manager Commissioning manager

IFR officer IFR officer

8 . H O W W I L L W E H A V E L O C A L C C G R E P R E S E N T A T I O N O N T H E I F R

P A N E L S ?

One of the proposals is to have a rotating chair on the IFR panel, such as a clinical chair

(as in North West London) or a senior clinician such as a CCG planned care clinical

director/lead. It is for the CCGs to determine the level and frequency clinical

representation.

9 . W H A T F E E D B A C K W I L L T H E C C G R E C E I V E O F T H E W O R K I N G S O F T H E

I F R S E R V I C E ?

There will be regular activity reports as there are now or on demand as well as annual

reports for the CCGs Quality Committees, or to other statutory bodies as required.

1 0 . W I L L T H E R E B E C A P A C I T Y F O R D E A L I N G W I T H U R G E N T C A S E S ?

Yes, the joint services will be able to turn around most requests quicker than the current arrangements as meetings are held more frequently and the expertise will have been developed further in processing cases.

1 1 . H O W M U C H W I L L T H E N E W S E R V I C E C O S T ?

The IFR service has two components, the NEL CSU administration and the CCG/Local Authority input. The NEL CSU contract is being renegotiated for SWL and the described efficiencies are part of the discussions. The costs associated with the CCG/LA input are currently subject to various local arrangements. These are yet to be finalised at an individual CCG and individual panel member level.

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1 2 . W I L L T H E I F R R E Q U E S T M O V E O N T O A N E L E C T R O N I C

P L A T F O R M ?

The IFR requests forms are being re-designed based on the feedback of users and are planned to be made electronic using the BlueTeq system. BlueTeq is also used for High Cost Drugs and the Prior Approval Service.

1 3 . W H A T A R E T H E S Y N E R G I E S W I T H T H E P R I O R A P P R O V A L

S E R V I C E ?

There are numerous synergies and this is part of the reason why the caseload for the IFR service is on a downward trajectory. In the future once the Prior Approval Service is established there are obvious reasons why these two should be brought under one umbrella and considerations could be given to the approach to High Cost Drugs too.

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