th august 2012 at 1300hrs agenda no preliminary business · tuesday 7th august 2012 at 1300hrs ......

Governing Body Board Meeting

Tuesday 7th August 2012 at 1300hrs

Duncan Room, Old Market House

AGENDA

No Time Item Papers

GB12-13/029 1300 PRELIMINARY BUSINESS

029.1 Apologies for Absence

Lorna Quigley, Interim Chief Officer Wirral Clinical Commissioning Group

029.2 Declarations of Interest

029.3 Minutes and Action Points of the Last Meeting dated 3rd July 2012.

Matters Arising

Action Points

Phil Jennings

Agenda Item 02DRAFT Minutes W

Agenda Item 02Incomplete Actio

GB12-13/030 1315 ITEMS FOR DISCUSSION

030.1

Establishment of an Approvals Committee

James Kay Agenda Item 03Approvals Comm

Agenda Item 03Approvals Comm

030.2 Clinical Strategy Group

Abhi Mantgani CSG proposal cosheet GB 07.08.

CSG Terms oReference.do

of 5

QIPP Team TermReference.do

Role of the QITeam Chair.do

030.3 Choose & Book LES

Peter Naylor

030.4 Prescribing Incentive Scheme

Andrew Cooper, Christine Campbell, Iain Stewart

ccg prescribinincentive scheme

DRAFT WGPCprescribing incen

DRAFT WACCprescribing incen

To be tabled

GB12-13/031 1400 ITEMS FOR APPROVAL

031.1

031.2

031.3

NHS Wirral Policy Adoptions

Fraud and Corruption Policy

Publications

Staff Code of Conduct

Helen Jones

Agenda Item 03Policies Cover Sh

Agenda Item 03Fraud and Corru

Agenda Item 03Publications Polic

Agenda Item 03Staff Code of Co

031.4 Wheelchair in a Day (WIAD) Service

Helen Jones

of 5

Wheelchair In a Cover Sheet 31

WHEELCHAIR IDAY Governing B

WIAD Project GChart v1.xls

031.5 Alcohol Service Developments to Support Long-term Recovery

Christine Campbell alcohol propos

cover sheet GB 0

CCG Alcohol Propaper GB 07.08.

GB12-13/032 1430 ITEMS FOR INFORMATION

032.1 Authorisation Plan

Mark Bakewell Agenda Item 03Authorisation Pro

Agenda Item 03Authorisation Pr

032.2 Finance Update

Mark Bakewell Agenda Item 32GB Finance Upda

of 5

Agenda Item 32GB Wirral CCG F

Month 3 FinanPaper.xls

032.3 Serious Incidents Report

Phil Jennings Agenda Item 03Serious Incidents

Agenda Item 03Serious Incident

032.4

Minutes for Noting Governance & Audit Minutes – 27th June 2012 Phil Jennings

Agenda Item 03Minutes Governa

032.5 Quality, Performance & Finance minutes – 19th June 2012 Phil Jennings

Agenda Item 03Minutes Quality,

032.6

Wirral GP Commissioning Consortium – 20th June 2012 Phil Jennings

Agenda Item 03Cover Sheet WG

Agenda Item 03Wirral GPCC Exe

032.7

Wirral Health Commissioning Consortium - June 2012 Phil Jennings

Agenda Item 03Cover Sheet WH

Agenda Item 03WHCC Executive

032.8

Wirral Alliance Commissioning Consortium –31st May 2012 and the extra-ordinary meeting on the 21st June 2012 Phil Jennings

Agenda Item 03WACC Cover Sh

of 5

Agenda Item 03Wirral Alliance CC

Wirral AlliancCommissioning C

032.9 Wirral Health Visiting/Family Nurse Partnership Development Plan 2012/15 Rose Curtis

Agenda Item 03HV service Cove

Agenda Item 03Health Visiting De

GB12-13/033 1445 RISK REGISTER

033.1 Risk Register

Mark Bakewell Agenda Item 03GB Risk Register

GB12-13/034 1450 ANY OTHER BUSINESS

034.1

GB12-13/035 1455 DATE AND TIME OF NEXT MEETING

035.1 Tuesday 4th September at 1300hrs in the Duncan Room, Old Market House

of 5

DRAFT

Page 1 of 10

Wirral Clinical Commissioning Group

Governing Body Board Meeting Minutes of Meeting

3rd July 2012

Room 539 at Old Market House Present: PhilJennings (PJ) Designate Chairman Wirral Clinical Commissioning Group (Chair)

Mark Bakewell (MB) Interim Chief Finance Officer Wirral Clinical

Commissioning Group Christine Campbell (CC) Acting Chief Officer Wirral GP Commissioning

Consortium Andrew Cooper (AC) Chief Officer Wirral Health Commissioning

Consortium Lorna Quigley (LQ) Interim Chief Officer Wirral Clinical

Commissioning Group John Oates (JO) Chair – Wirral GP Commissioning Consortium Akhtar Ali (AA) GP Executive Wirral GP Commissioning

Consortium Pete Naylor (PN) Chair – Wirral Health Commissioning Consortium Sue Wells (SW) GP Executive- Wirral Health Commissioning

Consortium Mark Green (MG) Chair – Wirral Health Alliance Commissioning

Consortium

James Kay (JK) NEA – Vice Chair CWW PCT Cluster

In attendance: Zerina McCarthy (ZM) Secretary Helen Jones (HJ) Project Manager (Item GB12-13 023.1 only) Item No. Agenda Items GB12-13 021.1

Apologies for Absence Apologies were received from Abhi Mantgani, Wirral Clinical Commissioning Group (WCCG) Accountable Officer Designate and Iain Stewart, Wirral Health Alliance Commissioning Consortium (WHA) Chief Officer

DRAFT

Page 2 of 10

GB12-13 021.2

Declarations of Interest Members were invited to register any potential Conflicts of Interest, none were received.

GB12-13 021.3

Minutes from the previous Meeting – 12 June 2012 The following amendments to the minutes were made regarding accuracy: GB12-13/011 should read …………..would speak to Anne-Marie Harrop, Mersey Internal Audit Agency (MIAA)………… GB12-13/012, 2nd paragraph, 2nd sentence – after the wording “BMA Guidance on Directors” insert the wording: …. the Governing Body felt that this was restricted and not applicable to GP partners in practice……….. GB12-13/014, 6th paragraph – to add Each Division would have the freedom to allocate the budget on fair share basis, GB12-13/015, 5th paragraph ………and it was proposed to hold the September meeting in Public. amend to ……..and it was proposed to hold the August meeting in Public. GB12-13/016, 3rd paragraph £1.4m should read £2m Remove 2nd sentence GB12-13/011 (JK) advised the Committee that he had spoken with MIAA who confirmed that Audit Committee Board Members cannot be members of the Governing Body Board. Subject to the above amendments the minutes of Governing Body meeting on the 12th June 2012 were accepted as a true and accurate recording of proceedings. Actions from the previous meeting of 12th June 2012

DRAFT

Page 3 of 10

The Committee noted that the actions identified for completion on the action plan for June 2012 had been met. Minutes of the Extraordinary Board Meeting – 22 May 2012 Ref No 3 – Senior Appointment Proposals Election of Chair – paragraph 4 – to be added after the last sentence …….and looked forward to working positively with CCG as Alliance Chair. Ref No 3 – Selection of Accountable Officer Page 2, 2nd paragraph Dr Mark Green argued that the process needed to attract the right candidates and that it did not therefore be limited to only GP partners amend to Dr Mark Green highlighted that the process needed to attract the right candidates, should not therefore be limited to only GP partners. Ref No 3 – Chief Officer Position Title should be amended to Chief Financial Officer position. Subject to the above amendments the minutes of the Extraordinary Board meeting on the 22nd May 2012 were accepted as a true and accurate record of proceedings.

GB-12-13 022.1

LMC Request for Membership The Chair informed the Committee that he had recently attended a LMC meeting. The LMC expressed their desire to have one of their Members to attend the Governing Board Body as an observer. This request had been discussed by the Governing Body at a previous meeting, and this had been rejected. The Chair invited comments from the members regarding the request LQ advised that the Governing Body that from August 2012 meetings will be held in Public . The meetings will be advertised in the local press and on the CCG website. JK stated that the PCT felt strongly that they had to be a publicly committed date to ensure that papers where circulated in advance of the meeting and that this was linked to the WCCG website. PN advised that each of the Division Board Meeting were being held in Public.

DRAFT

Page 4 of 10

MG (WHACC) asked if there was a statutory requirement and if any guidance was available The Chair stated that there was no statutory requirement. The Governing Body agreed that it would be inappropriate for a member of the LMC to serve on the Board. Action: The Chair is to draft a letter to the LMC Board to invite to meeting on the 7th August but not as a Board Member. There will be 10 minute period at the start of the meeting for the Public or Stakeholders to address the Governing Body Board. The Chair also advised that for meetings held in public there will be a new section for private business whereby content which may be inappropriate for Public or Stakeholder hearing can be discussed at the end of the meeting when the public have left.

GB12-13 023.1

Conflicts of Interest Policy The Chair informed the Committee that this policy had been adopted from the NHS Wirral, good practice guide. HJ asked the Committee if key performance indicators need to be added to policies and if so what process would be put in place for monitoring. JO suggested that on page 9 of 17of the Conflict of Interest policy under the Role of Chair an additional point should be added. …Once a conflict of interest is identified then there is a record of the Chair’s decision on the action taken within the minutes of the meeting….. AC added that for items under discussion within that area, the final decision will be made by the Chair. SW asked if there should be an option to carry on with the meeting. The Chair advised that a 4th option is to be added ‘the Chair decided whilst there was a conflict it was not material to the item under discussion and no further action is necessary. JK referred to the Wirral Alliance Commissioning Board meeting minutes of the 31 May 2012 to highlight a situation that had occurred within the meeting, advising that there will be conflicts but they just needed to be managed. The Governing Body agreed that after a ‘Declaration of Interest’ it should be clearly identified within the minutes the final decision of the Chair. JK referred to page 3, paragraph 3.1 of the Conflicts of Interest Policy. First sentence should include reference to GPs. JK expressed his concerns re the Approvals Committee suggesting

DRAFT

Page 5 of 10

members who are eligible to vote should have no financial connections to the proposal. If necessary external agencies could be invited onto the Approvals Committee i.e. LINKS, Institute of Chartered Management. The Approval Committee is only expected to meet as a body 1-2 times per annum. The Chair informed the group that he had contacted colleagues from Liverpool CCG and Western Cheshire CCG to compare what their respective COI policies were in relation to this, particularly if the Committee needs to receive some GP practice clinical advice. The vote should be reserved for members with no financial connection. JK agreed that the committee may still receive advice from non-voting members. CC requested clarification and understanding expressing concerns over the limited amount of meetings that will be held during the year. JK suggested adopting the old system where meetings would be held on an adhoc basis, however he did state that there may be a need to have more meetings during the year, a minimum of 3-4. SW stated that with possibility of the number of Conflicts of Interests among GP membership, the Approvals Committee could end up being held on a weekly basis. The Chair advised that the Approvals Committee’s role was to support the Governing Body Board, should there be a Conflict of Interest within the Governing Body Board there is nowhere else for the Board to turn to. JK stated that maximum transparency needed to be reinforced. The Chair advised that he would enquire as to whether the Membership for the Approvals Committee was correct. The Chair asked that an Approval Committee if required, should be held in time such that any decision taken could be communicated in time for the next Governing Body Meeting Subject to the above amendments the Governing Body approved the Conflict of Interest Policy. Action: HJ is to contact the Head of Corporate Affairs for NHS Cheshire, Warrington and Wirral to seek advice on appropriate wording. Action: The Chair advised that he would enquire as to whether the Membership for the Approvals Committee was correct.

GB12-13 023.2

NHS Wirral Policy Adoptions Freedom of Information Policy LQ presented the to the Governing Body the above policy for adoption. Once

DRAFT

Page 6 of 10

agreed by the governing body, this policy will be implemented by the Commissioning Support Services (CSS). LQ assured the Governing Body that any responses distributed would be approved by the Chair, Accountable Officer, Interim Chief Officer or the Divisional Chief Officers before publication. CC highlighted Member of Parliament requests indicating the special conditions regarding constituents Page 4 of 17, Paragraphs 2.4 and 2.5 were discussed surround charges and fees for Freedom of Information requests (FOIs). MB advised that they had never charged for FOIs. PN stated that an opinion on a national level needed to be sought and where this sits. CC suggested looking at the Act Actions: HJ will ensure that this is covered in the Freedom of Information policy and explore the possibility of charging. Subject to the above amendments the Governing Body approved and adopted the Freedom of Information Policy. Complaints and Procedures Policy It was requested that the Governing Body Board adopt and approve the Complaints and Procedures Policy. The CSS will administer the process on behalf of the CCG. Assurance was given to the Governing body that all responses would be checked by a CCG officer before being distributed. The Policy is to be reviewed and the language pertinent to WCCG.

Annex D, page 21 of 23 – Habitual/or Vexatious Policy JK advised that the Habitual/or Vexatious Policy should be used appropriately. PN questioned if this related to a particular issue or about the individual? JK advised that it should be case specific rather than person specific. Discussions took place around the Complaints procedure, it was agreed the following: Flow chart ‘Yes’ box from the green arrow indicator ‘Serious Issue’ box should be changed to ‘No’.

DRAFT

Page 7 of 10

‘No’ box from the red arrow indicator ‘Serious Issue’ box should be changed to ‘Yes’ There should also be an arrow indicator from the ‘Service User Feedback’ balloon to the ‘Complaints Manager/Office Risk Assessed. Action: Amendments to be made to the Complaints Policy flowchart Subject to the above amendments the Governing Body approved and adopted the Complaints Policy. Corporate Records Management Policy The Policy has been adopted from the NHS Wirral Corporate Records Management Policy. The Interim Chief Officer presented this policy for adoption, the aim of which is to protect the organization and is good business practice. The Governing Body adopted and approved the Corporate Records Management Policy. Risk Management Strategy and Policy The Policy has been adopted from the NHS Wirral Risk Management Strategy and Policy. At paragraph 4.3, Level 2,amend to include the wording responsibility, assurance and processes. AC suggested that the Clinical Strategy Group will be included as a Level 2 Committee. JK advised that system wide assurances needed to be implemented and there should be no double checking of other Committees.? Don’t remember this Action: At paragraph 4.3, Level 2 - amend to include the wording; responsibility, assurance and processes. Subject to the above amendment the Governing Body approved and adopted the Risk Management Strategy. The Chair thanked the Project Manager for presenting the policies to the Governing Body Board. The Project Officer left the meeting at 1415hrs

GB12-13 023.3

Governance and Audit – Task & Finish Group Terms of Reference (TOR) LQ presented to the Governing Body Board the Governance and Audit – Task & Finish Group. It is expected that this meeting will continue until

DRAFT

Page 8 of 10

October 2012 when an audit and governance committee will be established. The Governing Body Board approved the Governance and Audit – Task & Finish Group TORs.

GB12-13 023.4

Governing Body Board Dates The Governing Body Board dates were approved and accepted with just one amendment: Tuesday 5th March 2013 should read Monday 4th March 2013 Action: Secretary to amend date on schedule of meetings

GB12-13 024.1

Authorization Plan An Authorization Plan has been produced and was noted by the Governing Body Board. A series of Board Development days are being developed which will include Vision, Mission and Values JK suggested the use of milestones and the insertion of a column at the end to identify the status of the project. Action: The document is to be reviewed and updated.

GB12-13 024.2

Finance Update MB presented to the Governing Body a financial update based on month 2 Position A number of key issues where highlighted:

a) Wirral University Teaching Hospitals NHS Foundation Trust Early indications suggest a circa £1m over performance as at the end of May (month 2) including financial adjustments for readmissions etc. (but excludes follow-up ratios). The actual performance stands at circa £1.6m but this includes the long-stay critical care patient which has been discharged from critical care unit and provision has been included elsewhere within the CCG budget (contingency) for this. Reconciliation of month 2 position and financial adjustments is still on going, further analysis of performance will be presented in full report but indications suggest over performance in non-elective particularly (before readmissions adjustment) and across elective areas (both outpatient attendances and Inpatient / Day Case’s) Again, this position is still relatively early in the financial year and is likely to fluctuate

b) Independent Sector “Reserve”

DRAFT

Page 9 of 10

An over performance is expected until the end of June due to the activity that is still in the system from waiting list initiatives in 2011/12, Month 2 over performance is £85k

c) Independent Midwifery – One 2 One £49k over spend at month 2 due to activity levels with One 2 One Provider. Further analysis is required to understand impact across all maternity provision and against planned levels of expenditure Governing Body Budgets

d) Commissioned Out Of Hospital Year to Date over performance of £133k due to £35k YTD over performance on children’s packages of care mainly driven by a one off purchase of a ventilator and a £105k YTD over performance on packages of car due to a number of new package approvals and increase in package costs in LD and MH jointly funded cases. Other Expenditure areas A number of other expenditure budgets require confirmed expenditure plans (including the return of prior year underspends and service development / commissioning funds) and these will be monitored closely over the next few months to identify any potential slippage. A full report (based on the Month 3 (June) position) will be prepared for the Quality, Performance and Finance Committee on the 24th July and presented to the next Governing Body meeting to be held on the 7th August. MB also presented to the Governing Body Board the activity data by PCT. The Chair highlighted the surge in GP referrals from 657 to 996 within the Wirral area. JK asked if they were the fully reconciled figures. MB advised that the WCCG would have our own internal view with effect from July. Information is supplied by the SHA and the outcomes from the Intelligence team, is accurate. JK asked if the data for the Wirral area was mainly from Wirral University Teaching Hospital. MB advised that he wanted to make the Governing Body Board aware of the current situation, giving the Board an early warning sign.

GB12-13 025

Risk Register Contingency reserves

GB12-13 026

Summary of Actions Please refer to the action points attached as per Annex A.

DRAFT

Page 10 of 10

GB12-13 027

Any Other Business The Chair offered his congratulations and those of the Governing Body Board to: Dr Pete Naylor for Outstanding Innovative-Inspirational Leader for the North West Dr Abhi Mantgani for being a finalist in the Outstanding Leader of the Year category Dr Murray Freeman for Outstanding Board Member of the year.

GB12-13 028

Date of Next Meeting There being no further business to discuss the meeting closed at 1500hrs. The next Governing Body Board meeting will take place as a Public meeting on 7th August at 1300hrs in the Duncan/Nightingale Rooms at Old Market House.

Phil Jennings Designate Chair Wirral Clinical Commissioning Group August 2012

ANNEX A toWirral Clinical Commissioning Governing Body Minutes

dated 3rd July 2012

Incomplete Actions

Item No: Date of Meeting

Item Action(s) Action By

Date to Complete By

Date Completed

GB-12-13/22.1 03/07/2012 LMC Request for Membership

The Chair to draft a letter to the LMC

Board to invite to meeting on the 7th

August but not as a Board Member.

PJ 05/07/2012

The NEA – Vice Chair CWW PCT Cluster referred to page 3, paragraph 3.1

07/08/2012

The Project Manager is to contact the Head of Corporate Affairs for NHS Cheshire, Warrington and Wirral to seek advice on appropriate wording.

07/08/2012

The Chair asked that an Approval Committee is held prior to the next Governing Body Board meeting in August.

LQ/ZM 07/08/2012

The Chair advised that he would enquire as to whether the Membership for the Approvals Committee was correct.

PJ 07/08/2012

The Interim Chief Officer is to ensure that Member of Parliament requests on behalf of constituents is included in the Freedom of Information policy.

LQ 07/08/2012

The Chair to clarify with CSS surrounding charg g for FOI requests.in

PJ 07/08/2012

The Policy is to be reviewed and the languag pertinent to WCCG.e The Governing Body Board turned to Page 27 of 27, Appendix G. Discussions took place around the Complaints procedure, it was agreed the following:

03/07/2012

LQ 07/08/2012

GB12-13/023.1 Conflicts of Interest Policy

Freedom of Information

Complaints and Procedures Policy

HJ

‘Yes’ box from the green arrow indicator ‘Serious Issue’ box should be changed to ‘No’.‘No’ box from the red arrow indicator ‘Serious Issue’ box should be changed to ‘Yes’There should also be an arrow indicator from the ‘Service User Feedback’ ballon to the Complaints/Office Risk Assessed.

Risk Management Policy

At paragraph 4.3, Level 2 - amend to include the wording; responsibility, assurance and processes.

LQ 07/08/2012

GB12-13/23.3 03/07/2012 Governing Body Board Dates

Secretary to amend date on schedule of meetings

ZM 07/08/2012

GB12-13/24.1 03/07/2012 Authorisation Plan The document is to be reviewed and updated

LQ 07/08/2012

GB12-13/024.3 03/07/2012 Minutes for Noting The WHA Chair is to present the Wirral Alliance Commissioning Consortium Board meeting minutes of the 31st May and the extra-ordinary Board Meeting

minutes of the 21st June 2012 to the

Governing Body Board meeting on the 7th

August 2012.

MG 07/08/2012

Establishment of an Approvals Committee

Agenda Item: 030.1 Reference: GB12/13/029

Report to: Governing Body

Meeting Date: 7th August 2012

Lead Officer: Dr. Phil Jennings. Chairman (designate) NHS Wirral CCG

Contributors: Mr. James Kay. Non Executive Advisor NHS Wirral CCG

Link to Commissioning Strategy

N/A

Governance:

Link to current governing body Objectives

The Governing Body has determined that an Approvals Committee is necessary in those circumstances where a conflict of interest exists for the GP membership in order to ensure proper governance arrangements

Summary: It is anticipated that conflicts of interest will arise during the work of the Governing Body. In line with the Conflicts of Interest policy the Governing Body has requested an Approvals Committee to be established such that when the Governing Body is rendered non quorate through Conflicts of Interest this committee will serve as an additional mechanism to ensure robust corporate governance. This papers details the remit and membership of the Approvals Committee both during the transitional period pre authorisation and in a substantive form thereafter.

To Approve √

To Note

Recommendation:

Comments

Next Steps: Once approved the committee should begin its work immediately

Establishment of an Approvals Committee. Governing Body Meeting 7th August 2012

1/3


2/3

This section is an assessment of the impact of the proposal/item. As such, it identifies the significant risks, issues and exceptions against the identified areas. Each area must contain sufficient (written in full sentences) but succinct information to allow the Board to make informed decisions. It should also make reference to the impact on the proposal/item if the Board rejects the recommended decision.

What are the implications for the following (please state if not applicable):

Financial

N/A

Value For Money N/A

Risk If an approvals committee is not approved the governing body will not fulfill their statuary obligation with regard to ensuring there is a robust governance structure within the CCG.

Legal There is a risk of legal challenge to the CCG if decision making does not take place according to accepted good corporate governance practice.

Workforce N/A

Equality & Human Rights

N/A

Patient and Public Involvement (PPI)

The establishment of the approvals committee may provide a further opportunity for patient/public involvement in the decision making processes at the Governing body once established in the substantive form.

Partnership Working

Once fully established the approvals committee will demonstrate partnership working with the Lay Members, Secondary Care Members and Members of the Public or Patients

Performance Indicators

N/A

Do you agree that this document can be published on the website? (If not, please note that it may still be subject to disclosure under Freedom of Information - Freedom of Information Exemptions

YES

This section gives details not only of where the actual paper has previously been submitted and what the outcome was but also of its development path ie. other papers that are directly related to the current paper under discussion.

Report History/Development Path

Report Name Reference Submitted to Date Brief Summary of Outcome

http://www.foi.gov.uk/yourRights/exemptions.htm


3/3

Title of Report Agenda Ref Title of Meeting Date Detail of outcome and next step

Private Business The Board may exclude the public from a meeting whenever publicity (on the item under discussion) would be prejudicial to the public interest by reason of the confidential nature of the business to be transacted or for other special reasons stated in the resolution. If this applied, items must be submitted to the private business section of the Board (Section 1 (2) Public Bodies (Admission to Meetings) Act 1960). The definition of “prejudicial” is where the information is of a type the publication of which may be inappropriate or damaging to an identifiable person or organisation or otherwise contrary to the public interest or which relates to the provision of legal advice (for example clinical care information or employment details of an identifiable individual or commercially confidential information relating to a private sector organisation). If a report is deemed to be for private business, please note that the tick in the box, indicating whether it can be published on the website, must be changed to a x. If you require any additional information please contact the Lead Director/Officer.

Agenda Item:030.1 Ref: GB12-13/030

Establishment of an Approvals Committee Governing Body Meeting 7th August 2012

1/4

NHS Wirral CCG Governing Body

Establishment of an Approvals Committee Introduction

1. An essential feature of the reforms introduced by the Health and Social Care Act (2012) is that CCGs should be able to commission a range of community based services to improve quality and outcome for patients. CCGs can also make payments to GP practices for “promoting improvements in the quality of primary medical care (e.g. reviewing referral and prescribing) (Appendix 1)

2. To help CCGs manage potential conflicts of interest associated with such commissioning decisions the NHS Commissioning Board has issued guidance, a Code of Conduct and an associated decision making template. These documents are designed to help CCGs demonstrate that they are acting fairly and transparently and that members of CCGs will always put their duty to patients before any personal financial interest.

3. The Governing Body of NHS Wirral CCG has a majority of GP members. It is anticipated that situations will arise where a conflict of interest exists for these members. In cases such as these where all of the GPs on a decision making body could have a material interest in a decision, there is specific advice in the above mentioned Code of Conduct. In essence the advice is to ensure that GPs and other practice members who may have a potential conflict are excluded from the decision making process. In following this advice it is therefore necessary to implement an additional mechanism to support the Governing Body in making these proposed commissioning decisions.

4. The Governing Body has previously agreed through the Conflict of Interest Policy that this additional mechanism should be an Approvals Committee. This paper describes the formation, membership and duties of this committee.

Membership of the Approvals Committee (Interim Structure)

5. It is proposed to use an adapted version of the Approvals Committee previously employed by NHS Wirral PCT to handle similar commissioning decisions where there were evident potential conflicts of interest.

6. An interim Approvals Committee (based on the PCT forerunner and pending full authorisation of the CCG when the membership of the committee will be reviewed) is proposed to be comprised of the following members.

Voting

o 3 Non-Executive Advisors – one to Chair the Committee o The Public Health Director o The Interim Chief Officer o The Interim Chief Financial Officer

Non-voting

o NHS CCG Wirral Accountable Officer o Clinical Advisors as appropriate

NHS Wirral CCG Agenda Item: 030.1 Ref: GB12-13/030

Establishment of an Approvals Committee : Governing Body Meeting 7th August 2012 2/4

7. A quorum will be 4 voting members and must include two Non Executive Directors, the Interim Chief Officer or delegated representative and the Interim Chief Finance Officer or delegated representative.

Duties

8. The duties of the committee shall be report to the Governing Body on commissioning proposals laid before it use the template provided by the NHS Commissioning Board when

commissioning services in which GPs have a financial interest, as an aid to its decision making (Appendix 2)

use core national criteria when assessing business cases namely: o clinical effectiveness, safety, quality and governance o contribution to offering care closer to home o patient and stakeholder support o justification that savings can be made by the substitution of care o affordability within current and projected budget o assessment of risk o value for money

consider additional local criteria when assessing business cases and AWP proposals, namely:

o wider strategic fit with CCG commissioning priorities and the effects on provider stability

o the effect on equity of provision o congruence with policies previously agreed by the CCG

approve provider of service and length of contract, ensuring notification sent to proposing organisations

Make available details of appeals process to tendering organisations Frequency of Meetings

9. Meetings shall be held as required and scheduled such that a referral to the Approvals Committee from the Governing Body will be considered and a recommendation made in sufficient time to be received at the next Governing Body meeting.

Membership of the Approvals Committee (Substantive Structure)

10. Once the appointments process to the Governing Body is complete the Lay Member with portfolio for Audit and Governance will review the membership of the Approvals Committee. From this work it is anticipated that that the membership will increase to include at least the Consultant and Nurse Member of the Governing Body but may also incorporate a wider range of stakeholders.

Decision to Approve

11. The Governing Body is asked to establish the Approvals Committee as described above to begin work as soon as possible.



Appendix 1

c-of-c-conflicts-of-interest.pdf

http://www.commissioningboard.nhs.uk/files/2012/07/c-of-c-conflicts-of-interest.pdf

Appendix 2

NHS Wirral CCG

Clinical Commissioning Group

Service:

Question Comment/Evidence

Questions for all three procurement routes

How does the proposal deliver good or improved outcomes and value for money – what are the estimated costs and the estimated benefits? How does it reflect the CCG’s proposed commissioning priorities?

How have you involved the public in the decision to commission this service?

What range of health professionals have been involved in designing the proposed service?

What range of potential providers have been involved in considering the proposals?

How have you involved your Health and Wellbeing Board(s)? How does the proposal support the priorities in the relevant joint health and wellbeing strategy (or strategies)?

What are the proposals for monitoring the quality of the service?

What systems will there be to monitor and publish data on referral patterns?





Have all conflicts and potential conflicts of interests been appropriately declared and entered in registers which are publicly available?

Why have you chosen this procurement route?1

What additional external involvement will there be in scrutinising the proposed decisions?

How will the CCG make its final commissioning decision in ways that preserve the integrity of the decision-making process?

1 Taking into account S75 regulations and NHS Commissioning Board guidance that will be published in due course, Monitor guidance, and existing procurement rules.

WIRRAL CCG

CLINICAL STRATEGY GROUP AND QIPP TEAM TERMS OF REFERENCE

Agenda Item: 030.2 Reference: GB12-13/030


Meeting Date: 7 August 2012

Lead Officer: Dr Abhi Mantgani, Accountable Officer Designate

Contributors: Divisional Chairs and Chief Officers Sarah Quinn, Commissioning Manager – WGPCC Sheena Hennell, Commissioning Manager - WHCC


Governance:


Summary: The following documents have been developed to support the formation of the Clinical Strategy Group and the QIPP Team structure:

- CSG Terms of Reference - Role of the QIPP Team Chair - QIPP Team Terms of Reference

To Approve x

To Note

Recommendation:

Comments

Next Steps: Following approval of these documents, the Accountable Officer will work with each of the QIPP Team Chairs to agree the membership and workplan of each of the QIPP Teams, with a view to making this structure operational as soon as possible.

Clinical Strategy Group and QIPP Team Terms of Reference: Wirral CCG Governing Body 7 August 2012

1/3


2/3



Financial

The resource required to support the CSG and the QIPP team structure has been accounted for within the CCG running cost envelope.

Value For Money The clients that will potentially benefit from these proposals represent a significant pressure on all areas of the healthcare system, principally through A&E attendances and emergency admissions. Through supporting these patients in the community, and promoting structured care, and ultimately self-management, it is anticipated that the level of reliance upon healthcare services, and the concomitant resource implication, will significantly reduce.

Risk The CSG and QIPP team structure must be supported by robust terms of reference to ensure that it remains focused and that there is clear governance and accountability through to the Governing Body.

Legal Each of the QIPP teams will need to take into account legal implications as part of workstream development and implementation.

Workforce Each of the QIPP teams will need to take into account workforce implications as part of workstream development and implementation.


Each of the QIPP teams will need to take into account equality and human rights implications as part of workstream development and implementation.


Each of the QIPP teams will need to ensure that arrangements are made for patient and public involvement as part of workstream development and implementation.

Partnership Working

The CSG and QIPP team structure has been established to ensure systematic partnership working in across all clinical lead areas.


Each of the QIPP teams will need to ensure that any workstreams developed are clearly outcome-focused, and that projected outcomes are measurable. Outcomes will be reported through the CSG to the Governing Body.





3/3



Clinical Strategy Group and QIPP Team Terms of Reference

N / a CCG Operational Team meeting

31 July 2012

Approved – for Governing Body approval


Clinical Strategy Group

Terms of Reference Constitution 1. The Federated Clinical Commissioning Group (CCG) Governing Body hereby resolves to

establish the Clinical Strategy Group (CSG) to make recommendations to the Federated CCG Governing Body. Minutes of the CSG will be reported to the Federated CCG Governing Body as a standing item on the agenda. The Committee has no executive powers other than those specifically delegated in these Terms of Reference.

Membership 2. The CSG will be appointed by the Federated CCG Governing Body. The Group will

comprise the following members:

Chair (as defined below)* QIPP Group GP Chairs* Federated CCG Accountable Officer* Federated CCG Chief Officer Federated CCG Chief Financial Officer Divisional Chief Officers Public Health representative Wirral Department of Adult Social Services representative Wirral Department of Children Services representative Patient champion / Non Executive representative*

Each of the members will be required to nominate a designated deputy with delegated authority if they are unable to attend. Membership will be reviewed on a 6 monthly basis.

3. The Chair will rotate between the WGPCC Divisional Chair, the WHCC Divisional Chair and

the WHAC Divisional Chair on a 4 monthly basis. In the absence of the Chair, the meeting shall appoint a Chair. For the meeting to be quorate, 5 members should be present and these should include a The Federated CCG Accountable Officer or Chief Officer, a GP representative of each Division and the Federated CCG Chief Financial Officer.

Attendance 4. Other senior managers and CSS representatives will attend when requested or if they have

papers to present. 5. The Federated CCG Chief Officer will make arrangements to ensure that the Group is

supported administratively. Duties in this respect will include taking minutes of the meeting and providing appropriate support to the Chair and Group members.

6. Agendas and papers will be distributed at least two working days (or one day plus a

weekend) in advance of the meeting. Agreement 7. The CSG should strive to achieve consensus on all major decisions, however members

marked with an asterisk (*) in the above list will have voting rights in the event that a vote is required.

8. Each Division reserves the right to make their own commissioning decision being aware of the

impact of their decisions regarding tackling health inequalities and destabilising services.

1/2

2/2

Frequency 9. Meetings shall be held on a 6 weekly basis and no less than 8 meetings a year will be held.

Additional meetings may be called if required. Function/Purpose of the Group 10. The key functions of the CSG are to:

Co-ordinate strategic commissioning for areas designated as the responsibility of the Federated CCG

Support clinical effectiveness and clinical governance Establish and oversee QIPP Teams, Service Redesign and Development of Clinical

Pathways Lead clinical engagement across partners and stakeholders

Duties 11. The CSG will propose its terms of reference, specifying its composition and the

arrangements for reporting. 12. The CSG will:

support clinical leadership development and strategic commissioning in areas designated as the responsibility of the Federated CCG

support clinical effectiveness and clinical governance encourage development of provision and patient choice champion health inequalities, health promotion and public involvement engage in wider partnerships with Local Authority Commissioners, secondary care,

private and voluntary sector providers promote leadership for health economy wide work on service redesign

Reporting in 13. The QIPP teams will report into the Clinical Strategy Group, including the submission of

minutes for noting. 14. Other groups that may report in or submit minutes for noting include:

Health Treatment Panels Clinical Network Groups Medicines Management Strategy Group

All the groups specified will be subject to review to ensure fitness for purpose and most effective use of resources.

Accountability 15. The CSG will report directly into, and be accountable to, the Federated CCG Governing

Body. Review 16. These Terms of Reference shall be reviewed annually by the Clinical Strategy Group, with

recommendations made to the Federated CCG Governing Body for any amendments. Thereafter, the Terms of Reference will be reviewed annually by the Federated CCG Governing Body to ensure they are still appropriate.

Terms of reference for QIPP Teams Membership 1. All QIPP teams will be chaired by a lead GP appointed by the Accountable Officer of the

Federated CCG governing body, following nomination by their Division.

2. All QIPP teams will have a designated management lead sourced either from the divisional commissioning managers or CSS, with an element of administrative support

3. The QIPP Team Chair will develop specific terms of reference for that QIPP team including

selection of appropriate membership, frequency of meetings, definition of quorum and reporting subgroups.

Function of QIPP Teams 4. QIPP teams will be responsible for coordinating clinical strategy and engagement for

federated CCG level projects, including building relationships with and between clinical representatives of providers and ensuring appropriate representation.

5. QIPP teams will be purely focused on clinical strategy, service development and pathway development and will not have any responsibility for contracting or finance.

6. QIPP teams will lead the development of clinical pathways, service specifications and co-ordinate the work of all QIPP team sub groups or task and finish groups.

7. QIPP teams will identify evidence based opportunities for service redesign or the development of new services and make recommendations to the Clinical Strategy Group.

8. QIPP teams will ensure that service users and the public are engaged in service redesign and the development of new services.

9. QIPP teams will communicate progress on agreed work plans to stakeholders on a regular basis.

10. QIPP teams will ensure that there is a link between provider clinical representatives and

provider management structures. 11. QIPP teams will not have any responsibility or jurisdiction over divisional level projects or any

issues relating to individual GP practices or practitioners.

12. Each division can choose to have clinical leads who work independently of the QIPP team. Accountability QIPP teams will report to the Clinical Strategy Group through:

producing regular progress reports on their agreed work plan presenting outputs such as agreed pathways and service specifications for approval

submitting minutes for noting

Proposed QIPP Teams and Potential Chair/Membership QIPP team chair Potential QIPP

team subgroups Other potential GP members of QIPP team

Management lead

Mental Health Dr S. Rudnick Dementia LD

Management lead to be nominated

Planned Medical (incl LTC)

Dr D.Kershaw Stroke Cardiology Respiratory Diabetes CKD

Sarah Quinn

Planned Surgical Dr P.Srivastava To be confirmed

Sheena Hennell

Unplanned Care Dr H Mckay Care of the Elderly Substance Misuse

Sarah Quinn

Women’s Children

Dr S Puig To be confirmed


Cancer and End of Life

Dr M Freeman End of life steering group


Diagnostics Dr A Lee To be confirmed

Sheena Hennell

Medicines Management

Dr B Taylor


Public Health link (not QIPP team)

To be confirmed


Description of role of QIPP Team Chair

1. There will be a GP Clinical Lead that will Chair each QIPP team, who will be nominated by their Division and accountable to the Accountable Officer of the Federated CCG.

2. The QIPP team chair will have 1 paid session every 2 weeks to support

this role. 3. The QIPP team chair will:

o identify priorities for their QIPP team and agree a work

programme with the Accountable Officer

o drive the delivery of the agreed work programme o work with any other relevant clinical leads identified as members

of the QIPP team

o engage appropriate clinical and managerial representation from partner organisations

o work with allocated manager to develop specific terms of

reference for that QIPP team including selection of appropriate membership, frequency of meetings and definition of quorum

o work with allocated manager to develop and prioritise a

maximum of 4 projects at any time

o work with allocated manager to organise meetings at least twice a year

o coordinate and support any subgroups reporting into QIPP team

4. The QIPP team chair will coordinate Federated CCG Wirral-wide

strategic activity and liaise with Divisional leads where they exist, while respecting the projects that are being undertaken in individual Divisions.

WIRRAL CCG

DIVISIONAL PRESCRIBING INCENTIVE SCHEMES




Lead Officer: Dr Abhi Mantgani, Accountable Officer

Contributors: Divisional Chief Officers and Chairs Divisional Medicines Management Lead Clinicians CWWCSS Medicines Management Team


Governance:


Summary: Each of the Consortia, in conjunction with Medicines Management leads, has developed an incentive scheme with the aim to encourage practices to continue to engage in cost effective prescribing, work on clinical areas related to key national QIPP prescribing indicators and support the overall education and up-skilling of practices in improving their prescribing and organisational standards regarding medicines management.

To Approve x

To Note

Recommendation:

Comments

Next Steps: Following approval the schemes will be launched to Member Practices and will be monitored via the Primary Care Team

Divisional Prescribing incentive Schemes: Wirral CCG Governing Body 7 August 2012

1/3


2/3



Financial

The total potential resource payable under each scheme is £2 per registered patient. Final payment will be determined by assessment of achievement.

Value For Money By engaging general practice in medicines management and effective prescribing there is the increased likelihood that practices will achieve potential prescribing QIPP savings.

Risk If the proposal is not supported there is the risk that the CCG will lose the engagement of its Member Practices with the prescribing QIPP agenda.

Legal N / a

Workforce N / a


N / a


N / a

Partnership Working

The incentive schemes have been developed in close partnership with Member Practices and have been supported by each of the divisional executive teams.


The Medicines Management team has developed robust criteria for measuring performance against the parameters of each incentive scheme in order to assess achievement at the end of the scheme period.




3/3






Agenda Item: 030.4 Ref: GB12-13/030

WGPCC Prescribing Incentive Scheme 2012/13 : 1/10


WGPCC Prescribing Incentive Scheme 2012/13 1. Summary

Scheme will run from September 2012 - March 2013

Incentive monies available up to £2.00 per head of practice population (based on April

2012 figures)

The scheme consists of three parts:

1. Practice growth performance

2. Clinical areas related to QIPP prescribing targets

3. Education and practice engagement

All the parts of the scheme are independent of each other

Practices can choose:

To work towards achieving all three sections (each section will be worth a third of the total incentive funding)

To work towards section 2 and 3 only (each section will be worth 50% of the incentive funding available)

Practices cannot opt to work towards sections 1 and 2 only, or 1 and 3 only.

Wirral Medicines Management Team (MMT) will be able to offer advice on best practice and how to achieve targets but cannot directly complete any required elements of scheme

This incentive scheme is independent of any QOF prescribing targets for 2012/3

Incentive monies received must be spent in line with current local and national guidelines

Governing Body Meeting 7th August 2012



2. Section 1: Overall Growth Performance

This will focus on rewarding each WGPCC practice on managing their prescribing growth.

The measure will be prescribing spend for the period April 2012 to March 2013, compared to the same period the previous year, shown as percentage negative growth.

The payment will be achieved if percentage growth is at or below national data for the same period.

This data will be included in the monthly Prescribing Summary Reports (current report in Appendix 1). It is considered more appropriate to use a comparison to national data rather than an absolute target because growth is affected by price changes or major new areas of expenditure or savings and these will impact on both national and local growth figures.

This data will be included in the monthly Prescribing Summary Reports

2.1 Rationale

Since December 2011 the Medicines Management Team (MMT) has revised the format of the monthly Prescribing Summary, in response to comments from GPs within the CCG, with the approval of the Prescribing Lead. Essentially the new report emphasises the importance of cost growth, not just over or under spend. This is because in 2011, some practices received a different budget allocation compared to the previous year hence the under or overspend alone wasn’t a good marker of prescribing performance. The new report makes this more transparent. The WGPCC prescribing performance in 2011/12 showed an underspend of approximately £1.154M, while the cost growth associated with prescribing was -2.1% when comparing 10/11 to 11/12. This was an excellent achievement as cost growth comparing 09/10 to 10/11 was +2.1%. Since the national prescribing QP indicators have been not been continued in 2012/3, the prescribing scheme aims to continue to support WGPCC in continuing to achieve cost-effective prescribing. 3. Section 2: Clinical Areas Practices must choose at least two of the four following sections as they wish, but must achieve all the targets within each section to achieve payment.

3.1 Laxatives

1) At least 75% of all patients, over 18 years old, prescribed lactulose should have documented evidence of a laxative medication review

2) At least 75% of all patients, over 18 years old, prescribed lactulose who are not taking it at a therapeutic dose, should have their lactulose stopped and be given advising them to buy senna from the pharmacy if necessary and a constipation leaflet that promotes lifestyle measures.

3) At least 75% of patients prescribed docusate should have documented evidence of a laxative medication review




3.2 Appropriate Antibiotic Prescribing 1) The practice must provide evidence of a clinical meeting to discuss the MMT audit

undertaken to review prescribed antibiotics in January 2012. The purpose of the meeting will be to discuss the findings, agree improvement areas and repeat audit

2) Review the total volume of antibiotic prescribing against CCG and demonstrate either reduction of 10 per cent or maintenance in top quarter, demonstrated using Q4 QIPP data

3) Review quinolones and cephalosporin prescribing against QIPP performance indicators and either maintain top national quartile or move band, aiming to achieve green or amber status.

3.3 High Dose Prescribing of Inhaled Corticosteroids in Patients with Asthma

1) Evidence of documented medication review within the last 12 months in at least 80 % of patients with asthma on high dose steroids

2) Evidence of at least 25% of adults over 18 on high dose inhaled steroids being offered reduction in medication in line with BTS guidelines that have been stable for three months

3) Evidence of at last 75% of adults over 18 years prescribed a high dose inhaled steroid having received instruction on appropriate inhaler technique.

3.4 NSAID Prescribing 1) To maintain or achieve top national QIPP quartile for NSAID prescribing volume 2) To maintain or achieve top national QIPP quartile for choice of NSAID (either ibuprofen or

naproxen) when prescribing 3) At least 75% of all patients on a coxib should have documented evidence of a NSAID

medication review giving the reason for choice, if appropriate, and if not either stop or give a more cost-effective alternative

3.5 Rationale The clinical areas above are included in the current national QIPP prescribing indicators . Many practices within the WGPCC are currently struggling to achieve the recommended standards. See Appendix 2 for Q4 WGPCC QIPP Prescribing Summary. For more detail on Wirral performance in these areas and reasons for inclusion in the scheme, please refer to Appendix 3.

1

4. Section 3: Education and Practice Engagement with Prescribing

Practices must show evidence of at least three of the following targets:

a) Production of practice annual prescribing plan incorporating agreed work from MMT and demonstrating agreed action against plan by end of year

b) Prescribing Audit of choice (this must not be the same areas as selected for Section 3 or areas chosen for any element of QOF ie Med management 6&10)

c) Attendance of at least 75 % of prescribing cluster meetings d) At least twice yearly in house prescribing reviews with clinicians e) Wirral MMT accreditation of repeat prescribing system



WGPCC Prescribing Incentive Scheme 2012/13 : Governing Body Meeting 7th August 2012

4/10

4.1 Rationale Practice engagement with prescribing has been traditionally been very good and it is felt important to continue to incentivise and support this aspect of practice work. Newly qualified GPs, Registrars and Nurse Prescribers may not be as familiar with cost effective prescribing and the above therapeutic areas may assist practices and the MMT providing suitable education. Improving prescribing knowledge and related admin skills within non clinical staff has also proved very effective in some local practices in delivering cost efficient prescribing services for patients The MMT intends to continue to offer training courses for suitable practice staff on prescribing and to develop an accreditation process for repeat prescribing systems.

5. Monitoring Arrangements

The Medicines Management Team will provide monitoring reports and facilitate discussion of progress at the quarterly prescribing cluster meetings.

5.1 Payment Timescale

The Medicines Management team will assess performance against incentive scheme targets and summarise a final list for review by the Prescribing Lead GP and Chief Officer.

The payments will be authorised by the Consortium and processed by the Primary Care Team. Performance will be assessed on prescribing data for March 2013.

References 1. National Prescribing Centre Key Therapeutic Topics – Medicines management

options for local implementation. April 2012. Available at http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf. Last accessed 2.7.2012

http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf


Agenda Item: Ref: GB 12-13

Cost per AstroPUs

(Apr11-Mar12)

ANNUAL BUDGET 2011/12

Variance Over/(Under)

end /(Under)

(26,885) (5.9%)

(1.2%) (135,537) (14.4%)

(41,722) (11.8%)

(3.3%) (128,110) (12.5%) (38,058) (3.6%)

(117,688) (8.4%)

(6.6%) (52,221) (10.8%)

(23,137) (4.1%)

(12.9%) (14,138) (2.7%) (2,599) (0.5%)

(0.9%) (10.6%) (31,811) (4.7%)

(6.4%) (3.2%) (26,295) (4.4%) (50,175) (7.7%)

(179,706) (17.5%)

(3.5%)

(5.3%) (3.6%) (100,497) (8.9%) (36,490) (3.1%)

(1.2%) (70,796) (7.8%) (53,475) (5.5%)

(3.7%)

(0.8%) (1.4%)

(0.0%) (21,960) (7.8%)

(7.3%)

(10.5%) (44,459) (10.3%) (64,379) (13.0%)

(7.1%) (4.5%) (143,258) (21.1%)

(5.9%) (6.8%) (15,889) (1.5%) (81,539) (7.1%)

(3.3%) (103,560) (7.0%)

(49,776) (4.7%)

(115,340) (10.4%)

(5.9%) (47,413) (15.9%)

(1.1%) (430,937) (25.0%)

(74,159) (17.9%)

(2.1%) (1,154,160) (5.2%)

Sp

Variance Over

ANNUAL BUDGET 2010/11

Practice Name

Cost (Apr10-Mar11)

Cost (Apr11-Mar12)

% Growth

Cost (09/10)

Cost (10/11)

% Growth

Cost per APU (ePACT) £ £ % £ £ %

Accepted ScriptSwitch

Savings

Declined ScriptSwitch

SavingsAcceptance

Rate (%)

Blackheath Medical Centre (Dr Quinn) £423,489 £431,696 1.9% £364,973 £423,489 16.0% 25.48 458,581 457,854 727 0.2% 6,759 14,281 64%

Cavendish Medical Centre (Dr Melville) £814,012 £803,911 £752,650 £814,012 8.2% 28.59 939,448 822,495 116,953 14.2% 4,174 7,599 63%

Church Road Medical Centre (Dr Patwala) £335,098 £338,726 1.1% £312,045 £335,098 7.4% 24.63 313,299 9,910 3.2% 355,021 1,471 12,000 38%

Commonfield Road Surgery (Dr Brodbin) £923,742 £893,337 £906,014 £923,742 2.0% 25.01 1,021,447 1,059,505 7,279 9,582 71%

Devaney Medical Centre (Dr Bates) £1,270,286 £1,275,387 0.4% £1,212,438 £1,270,286 4.8% 26.75 1,393,075 1,303,747 89,328 6.9% 7,584 22,711 53%

Earlston Road Surgery (Dr Mantgani) £464,189 £433,386 £444,784 £464,189 4.4% 22.70 485,607 481,769 3,838 0.8% 1,720 9,395 53%

Hamilton Medical Centre (Dr Jayaprakasan) £526,533 £534,835 1.6% £509,703 £526,533 3.3% 38.80 557,972 467,739 90,233 19.3% 3,572 8,524 53%

Holmlands Medical Centre (Dr Srivastava) £596,061 £519,062 £557,408 £596,061 6.9% 25.64 533,200 535,799 9,273 45,537 51%

Hoylake Road Medical Centre (Dr Ali) £668,525 £662,527 £747,421 £668,525 25.52 642,822 19,705 3.1% 674,633 7,238 24,046 54%

Kings Lane Medical Practice (Dr Kershaw) £611,461 £572,373 £631,724 £611,461 21.00 598,668 648,843 5,730 8,704 75%

Miriam Medical Centre (Dr Mantgani) £771,027 £845,175 9.6% £672,522 £771,027 14.6% 37.01 1,024,881 753,351 271,530 36.0% 17,791 27,777 65%

Moreton Cross Group Practice (Dr Alman) £1,286,439 £1,241,885 £1,282,889 £1,286,439 0.3% 27.53 1,240,827 1,058 0.1% 1,231,617 9,210 0.7% 17,583 25,015 71%

Moreton Health Clinic (Dr Wright) £1,085,534 £1,027,615 £1,126,455 £1,085,534 24.77 1,128,112 1,164,602 9,197 13,139 74%

Moreton Medical Centre (Dr Pereira) £850,872 £840,875 £803,771 £850,872 5.9% 24.02 911,671 965,146 7,762 22,501 52%

Parkfield Medical Centre (Dr Raymond) £1,308,315 £1,259,313 £1,208,984 £1,308,315 8.2% 29.40 1,242,174 17,139 1.4% 1,167,423 74,751 6.4% 27,724 60,646 51%

Parkfield Medical Centre (Dr Hawthornthwaite) £1,196,787 £1,186,866 £1,213,764 £1,196,787 30.32 1,078,855 108,011 10.0% 1,058,414 20,441 1.9% 25,472 43,082 61%

Prenton Medical Centre (Dr Syed) £300,668 £300,592 £285,319 £300,668 5.4% 26.13 257,897 42,695 16.6% 279,857 2,401 5,931 61%

Seabank Medical Centre (Dr Mantgani) £282,052 £315,698 11.9% £304,258 £282,052 33.41 280,473 35,225 12.6% 269,389 11,084 4.1% 2,176 3,984 69%

Teehey Lane Medical Centre (Dr Sagar) £431,357 £385,871 £421,025 £431,357 2.5% 21.60 430,330 494,709 3,793 10,049 57%

TG Medical Centre (Dr Baig) £669,727 £622,228 £701,012 £669,727 22.61 536,901 85,327 15.9% 680,159 24,237 51,025 67%

Townfield Health Centre (Dr Lee) £1,119,199 £1,053,590 £1,200,951 £1,119,199 23.84 1,069,479 1,151,018 19,419 44,993 53%

Upton Group Practice (Dr Larkin) £1,511,807 £1,462,306 £1,486,610 £1,511,807 1.7% 24.52 1,370,439 91,867 6.7% 1,473,999 SS not in use SS not in use SS not in use

Villa Medical Centre (Dr Cookson) £1,038,400 £1,040,706 0.2% £1,028,606 £1,038,400 1.0% 25.88 1,002,596 38,110 3.8% 1,052,372 6,763 12,528 64%

Vittoria Medical Centre (Dr Edwards) £977,058 £990,565 1.4% £919,368 £977,058 6.3% 36.11 1,105,905 910,802 195,103 21.4% 12,672 38,967 42%

Vittoria Medical Centre (Dr Murty) £265,758 £250,192 £235,401 £265,758 12.9% 30.57 297,605 258,200 39,405 15.3% 3,478 9,952 43%

Whetstone Medical Centre (Dr Pleasance) £1,308,589 £1,294,075 £1,279,472 £1,308,589 2.3% 27.17 1,725,012 1,448,287 276,725 19.1% 18,852 195,347 30%

Woodchurch Medical Centre (Dr Martin-Hierro) £334,449 £340,171 1.7% £325,976 £334,449 2.6% 30.23 414,330 345,429 68,901 19.9% 3,125 8,715 57%

Totals & Averages, 27 (GPCC) - Led by Dr Mantgani & Dr Oate £21,371,434 £20,922,962 £20,935,543 £21,371,434 2.1% 26.83 22,061,607 £21,512,179 £549,428 2.6% 257,246 736,029 55%

N85633 Please note that a manual adjustment of £15.5k year to date has been included in the above figures for Church Road Medical Centre.

This results from the PCT identifying costs which have been charged to NHS Wirral that should have been charged to West Kent PCT. (West Kent PCT have been invoiced accordingly)

Scriptswitch (Apr11-Mar12)

Wirral GP Commissioning Consortium (WGPCC) - Prescribing Summary Report - March 2012

Previous Year - Cost Growth % (0910 vs 1011)

This Year to Date - Cost Growth % (Apr10-Mar11 vs Apr11-Mar12)

Budget Allocation Change

WGPCC Medicines Management Team Outcomes Savings Implemented April 2011-March 2012 is £541,772 (annualised savings)

WGPCC Prescribing Incentive Scheme : Governing Body Meeting 7th August 2012 5/10

NHS Wirral CCG Agenda Item: Ref: GB 12-13:

Practice Name

ACE inhibitor %

items

Low cost lipid

modifying drugs

Low cost PPIs % items

Oral Hypoglycaemic

agents

NSAIDs ADQ/STAR

PU

NSAIDs: Ibuprofen & Naproxen %

Items

Antibacterial items/STAR

PU

Cephalosporins & Quinolones %

items

Inhaled Corticosteroids

NIC/ADQ

Alendronate as % of all

biphosphonates

Long/ Intermediate

Insulin Analogues

Enteral Feeds (SIPS) Cost Per PU

Hypnotics ADQ/STAR

PU

TG MEDICAL CENTRE 66.21 78.93 96.82 77.74 2.56 38.94 0.28 10.90 £0.74 80.27 100.00 £0.46 2.49

COMMONFIELD RD SURGERY 74.37 76.97 97.75 78.89 1.09 67.92 0.28 7.67 £0.73 82.14 100.00 £0.49 1.02

UPTON GROUP PRACTICE 53.85 60.98 95.30 84.47 1.04 48.84 0.30 10.37 £0.50 75.18 98.65 £0.13 0.81

TOWNFIELD HEALTH CENTRE 71.03 70.98 98.25 83.71 1.84 55.13 0.35 10.53 £0.57 79.63 98.33 £0.30 2.03

DEVANEY MEDICAL CENTRE 66.99 64.45 98.22 76.95 1.31 52.76 0.29 15.17 £0.55 88.37 100.00 £0.35 1.11

CAVENDISH MEDICAL CENTRE 73.36 83.02 98.89 79.22 0.92 72.06 0.42 7.81 £0.47 91.37 96.08 £0.72 1.74

VILLA MEDICAL CENTRE 67.74 73.96 96.07 80.06 0.88 62.90 0.31 8.44 £0.63 83.87 100.00 £0.44 1.10

WHETSTONE LANE MEDICAL CENTRE 73.75 77.75 99.21 83.70 1.05 72.70 0.33 9.02 £0.34 85.37 92.38 £0.21 1.08

HAMILTON MEDICAL CENTRE 83.09 80.38 100.00 64.13 1.11 82.78 0.31 6.77 £0.71 92.25 100.00 £0.47 1.91

HOLMLANDS MEDICAL CENTRE 63.07 85.13 97.89 74.54 1.22 57.37 0.43 8.52 £0.59 95.49 100.00 £0.51 1.08

MORETON CROSS GROUP PRACTICE 68.03 76.32 97.79 80.80 1.06 68.14 0.33 8.40 £0.70 74.46 93.22 £0.42 1.13

PARKFIELD MEDICAL CENTRE_HAWTHORNTHWAITE EM 74.37 78.76 98.48 83.29 2.29 66.77 0.33 8.66 £0.54 92.89 91.94 £0.71 2.22

VITTORIA MEDICAL CENTRE_EDWARDS RW 74.33 74.94 98.82 86.47 1.68 63.38 0.45 7.09 £0.63 91.05 100.00 £0.88 3.55

MORETON HEALTH CENTRE 76.97 79.16 98.57 82.34 1.29 66.42 0.34 7.66 £0.58 85.46 90.54 £0.31 1.74

HOYLAKE RD MEDICAL CENTRE 65.07 67.48 95.53 80.45 1.08 49.53 0.36 8.36 £0.43 74.06 100.00 £0.45 1.73

MORETON MEDICAL CENTRE 72.47 76.17 98.85 69.90 1.28 69.36 0.29 9.43 £0.55 88.54 100.00 £0.63 0.57

PARKFIELD MEDICAL CENTRE_RAYMOND CJ 74.58 74.02 98.75 79.01 2.19 57.96 0.37 7.74 £0.57 86.86 98.85 £0.27 1.96

KINGS LANE MEDICAL PRACTICE 70.59 76.72 99.34 79.20 0.91 51.94 0.29 8.50 £0.49 87.19 100.00 £0.38 1.51

TEEHEY LANE SURGERY 76.41 79.49 98.44 87.47 0.98 65.93 0.27 5.25 £0.53 87.38 100.00 £0.37 1.80

SEABANK MEDICAL CENTRE 81.58 82.22 99.31 74.93 0.81 77.97 0.35 5.10 £0.64 81.25 100.00 £0.27 0.65

EARLSTON MEDICAL CENTRE 72.44 74.59 98.76 78.19 1.16 62.45 0.31 7.87 £0.84 92.03 92.31 £0.22 0.59

MIRIAM MEDICAL CENTRE 76.96 78.55 99.00 79.50 2.35 73.39 0.41 7.58 £0.53 86.25 95.83 £0.47 2.42

CHURCH ROAD MEDICAL CENTRE 75.37 82.32 98.25 77.23 0.91 72.11 0.46 8.55 £0.66 84.62 100.00 £0.39 1.99

VITTORIA MEDICAL CENTRE_MURTY KS 74.30 71.49 98.55 79.81 0.96 68.32 0.35 3.00 £0.46 93.02 64.71 £0.43 0.94

PRENTON MEDICAL CENTRE 73.31 72.01 99.41 71.85 0.59 50.00 0.31 6.95 £0.68 84.30 100.00 £0.31 0.63

BLACKHEATH MEDICAL CENTRE 73.07 83.95 98.87 79.59 0.87 58.85 0.38 9.42 £0.38 86.26 100.00 £0.14 2.70

WOODCHURCH MEDICAL CENTRE 70.35 86.27 95.59 83.68 1.72 73.40 0.60 5.43 £0.46 100.00 100.00 £0.52 2.59

National Average 71.57 73.94 96.50 84.87 1.04 62.88 0.34 5.76 £0.50 83.17 84.44 £0.30 1.13

National Top Quartile 73.83 76.58 97.59 87.36 0.90 69.11 0.32 4.34 £0.46 85.89 81.04 £0.24 0.92

National Bottom Quartile 69.81 71.26 96.01 82.56 1.20 58.96 0.36 6.87 £0.55 81.21 92.52 £0.38 1.32

Wirral GP Commissioning ConsortiumQIPP Prescribing Profile Quarter 4 2011/12

WGPCC Prescribing Incentive Scheme 2012/13 : Governing Body Meeting 7th August 2012 6/10


Practice Name Laxative

ADQ/STAR PU

Lipid Modifying drugs: Ezetimibe

% itemsAntidepressants ADQ/STAR PU

3 Days Trimethoprim

ADQ/Item

Minocycline ADQ/1000 Patients

TG MEDICAL CENTRE 2.55 5.01 1.34 5.71 30.99

COMMONFIELD RD SURGERY 2.66 1.09 1.37 5.64 0.00

UPTON GROUP PRACTICE 3.05 2.72 1.52 7.10 48.89

TOWNFIELD HEALTH CENTRE 2.46 3.64 1.68 6.03 0.00

DEVANEY MEDICAL CENTRE 2.35 3.53 2.16 7.23 51.83

CAVENDISH MEDICAL CENTRE 3.88 1.29 2.38 6.18 0.00

VILLA MEDICAL CENTRE 2.72 1.32 1.82 7.18 23.62

WHETSTONE LANE MEDICAL CENTRE 3.21 0.72 2.24 7.29 15.67

HAMILTON MEDICAL CENTRE 2.63 2.59 3.05 6.58 0.00

HOLMLANDS MEDICAL CENTRE 2.83 1.46 1.71 7.05 34.76

MORETON CROSS GROUP PRACTICE 2.16 1.84 1.65 7.88 23.37

PARKFIELD MEDICAL CENTRE_HAWTHORNTHWAITE EM 3.15 2.19 2.29 5.97 49.74

VITTORIA MEDICAL CENTRE_EDWARDS RW 3.53 4.62 3.63 5.30 176.90

MORETON HEALTH CENTRE 1.70 2.18 1.92 7.37 44.82

HOYLAKE RD MEDICAL CENTRE 2.71 6.30 1.63 6.43 20.93

MORETON MEDICAL CENTRE 2.27 4.06 1.97 5.67 0.00

PARKFIELD MEDICAL CENTRE_RAYMOND CJ 4.56 2.69 2.55 5.67 14.74

KINGS LANE MEDICAL PRACTICE 2.67 2.33 1.53 6.43 0.00

TEEHEY LANE SURGERY 1.50 2.54 0.76 6.21 80.26

SEABANK MEDICAL CENTRE 5.15 1.70 2.04 5.77 0.00

EARLSTON MEDICAL CENTRE 2.29 4.49 1.42 6.87 42.30

MIRIAM MEDICAL CENTRE 4.60 2.56 3.51 5.81 44.45

CHURCH ROAD MEDICAL CENTRE 1.99 0.94 1.31 5.85 0.00

VITTORIA MEDICAL CENTRE_MURTY KS 3.15 5.66 2.03 5.26 0.00

PRENTON MEDICAL CENTRE 1.43 3.48 0.94 6.86 0.00

BLACKHEATH MEDICAL CENTRE 1.70 0.13 1.96 6.09 0.00

WOODCHURCH MEDICAL CENTRE 4.43 1.88 2.37 5.48 0.00

National Average 2.35 3.43 1.48 6.15 27.77

National Top Quartile 2.03 2.82 1.27 6.51 19.89

National Bottom Quartile 2.71 4.22 1.75 5.77 33.78

Wirral GPCCQIPP Prescribing Profile Quarter 4 2011/12



GP Consortia Group

ACE inhibitor %

items

Low cost lipid

modifying drugs

Low cost PPIs % items

Oral Hypoglycaemic

agents

NSAIDs ADQ/STAR

PU

NSAIDs: Ibuprofen & Naproxen %

Items

Antibacterial items/STAR

PU

Cephalosporins & Quinolones %

items

Inhaled Corticosteroids

NIC/ADQ

Alendronate as % of all

biphosphonates

Long/ Intermediate

Insulin Analogues

Enteral Feeds

(SIPS) Cost Per PU

Hypnotics ADQ/STAR

PULaxative

ADQ/STAR PU

Lipid Modifying drugs:

Ezetimibe % items

Antidepressants ADQ/STAR PU

3 Days Trimethoprim

ADQ/Item

Minocycline ADQ/1000 Patients

Wirral GP Commissioning Consortium 71.64 76.08 98.08 79.91 1.35 61.95 0.34 8.65 £0.55 85.42 96.78 £0.41 1.54 2.83 2.58 1.98 6.44 44.07

Wirral Health Commissioning Consortium 68.72 72.73 97.52 79.78 1.12 63.31 0.34 9.18 £0.58 85.30 96.63 £0.33 1.27 2.76 2.54 1.80 6.70 25.65

Wirral NHS Alliance 70.71 76.16 98.19 84.17 1.26 55.74 0.32 7.72 £0.60 86.66 97.67 £0.47 1.80 2.55 2.09 1.79 6.79 73.26

National Average 71.57 73.94 96.50 84.87 1.04 62.88 0.34 5.76 £0.50 83.17 84.44 £0.30 1.13 2.35 3.43 1.48 6.15 27.77

National Top Quartile 73.83 76.58 97.59 87.36 0.90 69.11 0.32 4.34 £0.46 85.89 81.04 £0.24 0.92 2.03 2.82 1.27 6.51 19.89

National Bottom Quartile 69.81 71.26 96.01 82.56 1.20 58.96 0.36 6.87 £0.55 81.21 92.52 £0.38 1.32 2.71 4.22 1.75 5.77 33.78

RAG Status

National bottom quartile Red

National 3rd quartile Amber

National 2nd quartile Light Green

National top quartile Dark Green

* RAG Status may differ due to mathematical roundings

Wirral GP DivisionsQiPP Prescribing Profile Quarter 4 2011/12



Appendix 3

Rationale for Choice of QIPP Areas to Include in WGPCC Incentive Scheme 2012/13

The areas chosen reflect Wirral performance against the national prescribing comparators, published in the NPC Key Therapeutic Topics document . 1

1. The reduction of laxatives use for constipation in adults The evidence for the safety and efficacy of all laxatives is limited as they have all been in use for a long time and clinical trials have not been conducted. Additionally, few trials have examined the relative effectiveness of a general approach such as diet, exercise or behaviour training. NICE recommends laxatives should be considered in irritable bowel syndrome but that people should be discouraged from taking lactulose as it promotes gaseous bloating. The NICE guideline on constipation in children and young people advises the use of laxatives along with dietary intervention as first line treatment. This is not the case for adults. The NPC published a MeReC bulletin in January 20112 which states that prolonged treatment is seldom necessary, except occasionally in the elderly, in palliative care, or to prevent recurrence in children. The options suggested by the NPC for this topic are:

- Review, and where appropriate, revise prescribing of laxatives for adults to ensure they are only prescribed routinely for the short-term treatment of constipation, where dietary and lifestyle measures have proven unsuccessful or where there is an immediate clinical need.

- Laxatives should be prescribed for the treatment of children and young people with constipation in line with NICE guidance. Laxatives should be prescribed for the treatment of children and young people with constipation in line with NICE guidance Wirral position In Quarter 4 2011/12, national average for daily use of laxatives (ADQ) per STAR PU was 2.35. Wirral were in the bottom national quartile (red status) with 2.77 ADQ per STAR PU See Appendix 2. The cut off point for the bottom quartile was 2.71 ADQ per STAR PU.

2. Appropriate antibiotic prescribing – especially quinolones and cephalosporins

Wirral position In Quarter 4 2011/12, national average for total antibiotic prescribing was 0.34 items per STAR PU. Wirral were in the bottom national quartile (red status) with 0.38 items per STAR PU. The cut off point for the bottom quartile was 0.36 items per STAR PU. For cephalosporins and quinolones, Wirral had the second to worst performance in the North West with 8.71% of the total prescribing being for these drugs. The national average was 5.76% and the cut off point for the bottom quartile was 6.87%

3. The reduction of high dose inhaled corticosteroids (ICS) in asthma




ICS are the first choice regular preventer therapy in adults and children with asthma. To minimise side effects from ICS, BTS/SIGN guidelines recommend that the dose of ICS should be titrated to the lowest dose at which effective asthma control is maintained. The prolonged use of high dose ICS carries a risk of systemic side effects.

Wirral position In quarter 4 2011/12, the national average NIC/ADQ (cost per daily use) for ICS was £0.50. Wirral were in the bottom quartile nationally with a figure was £0.57 and the cut off point for the bottom quartile was £0.55.

D. Appropriate NSAID prescribing with a reduction in volume

There are well recognised safety concerns with all NSAIDs regarding GI and renal adverse effects, and, with many NSAIDs, regarding increased risk of CV events. The lowest effective dose of NSAID should be prescribed for the shortest time necessary for control of symptoms. Coxibs and diclofenac are associated with an increased cardiovascular risk compared with low dose (1200 mg/day or less) ibuprofen and naproxen. Wirral Position In Quarter 4 2011/12 the national average for daily use of NSAIDs (ADQ) per STAR PU was 1.04. Wirral were in the bottom quartile nationally with 1.24 ADQs per STAR PU. The cut off point for the bottom quartile was 1.20 ADQs per STAR PU. For ibuprofen and naproxen, Wirral’s performance was an amber status compared to the other PCTs in the North West with 62.59% of the total prescribing being for these drugs. The national average was 62.88% and the cut off point for the bottom quartile was 58.96%.

References 1. National Prescribing Centre Key Therapeutic Topics – Medicines management options for local implementation. April 2012. Available at

http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf. Last accessed 2.7.2012

2. NPC. The Management of constipation. MeRec Bulletin Volume 21 No 2. January 2011. Available at http://www.npc.nhs.uk/merec/therap/other/merec_bulletin_vol21_no2.php


http://www.npc.nhs.uk/merec/therap/other/merec_bulletin_vol21_no2.php


WACC Prescribing Incentive Scheme Governing Body Meeting 7th August 2012

1/4


WACC Prescribing Incentive Scheme 2012/13 1. Summary

Scheme will run from September 2012 - March 2013

Incentive monies available up to £2.00 per head of practice population (based on April 2012

figures)

The scheme consists of three parts:

1. Practice growth performance

2. Clinical areas related to QIPP prescribing targets

3. Education and practice engagement

All the parts of the scheme are independent of each other

Each part is either completely achieved or not, i.e. no sliding scale

Wirral Medicines Management Team (MMT) will be able to offer advice on best practice and how to achieve targets but cannot directly complete any required elements of scheme

This incentive scheme is independent of any QOF prescribing targets for 2012/3

Incentive monies received must be spent in line with current local and national guidelines

NHS Wirral CCG Agenda Item :030.4 Ref: GB12-13/030

WACC Prescribing Incentive Scheme 2012/13 Governing Body Meeting 7th August 2012

2/4

2. Section 1: Overall Growth Performance

This will focus on rewarding each WACC practice on managing their prescribing growth.

The measure will be prescribing spend for the period April 2012 to March 2013, compared to the same period the previous year, shown as percentage growth.

The payment will be achieved if percentage growth is at or below national data for the same period.

This data will be included in the monthly Prescribing Summary Reports (current report in Appendix 1). It is considered more appropriate to use a comparison to national data rather than an absolute target because growth is affected by price changes or major new areas of expenditure or savings and these will impact on both national and local growth figures.

This data will be included in the monthly Prescribing Summary Reports

2.1 Rationale

Since December 2011 the Medicines Management Team (MMT) has revised the format of the monthly Prescribing Summary, in response to comments from GPs within the CCG, with the approval of the Prescribing Lead. Essentially the new report emphasises the importance of cost growth, not just over or under spend. This is because in 2011, some practices received a different budget allocation compared to the previous year hence the under or overspend alone wasn’t a good marker of prescribing performance. The new report makes this more transparent. Since the national prescribing QP indicators have been not been continued in 2012/3, this prescribing scheme aims to continue to support WACC in continuing to achieve cost-effective prescribing. 3. Section 2: Clinical Areas Practices must choose at least two of the five following sections as they wish, but must achieve all the targets within each section to achieve payment.

3.1 Antipsychotic prescribing in patients with Dementia

1) At least 75% of all patients with dementia should have documented evidence of at last 6 monthly medication reviews detailing plans for reduction or stopping antipsychotic medication and 100% of patients on the practice dementia register must have at least one such medication review.

2) No more than 10% of patients with dementia should have their antipsychotic medication initiated in primary care.

3) At least 25% of patients with dementia on antipsychotic medication should have evidence of reduction or stopping of medication within 12 months unless they have a documented contraindication or recommendation from a specialist.

3.2 Appropriate Antibiotic Prescribing



3/4

1) The practice must provide evidence of a clinical meeting to discuss the MMT audit undertaken to review prescribed antibiotics in January 2012. The purpose of the meeting will be to discuss the findings, agree improvement areas and repeat audit

2) Review the total volume of antibiotic prescribing against CCG and demonstrate either reduction of 10 per cent or maintenance in top quarter, demonstrated using Q4 QIPP data

3) Review quinolones and cephalosporin prescribing against QIPP performance indicators and either maintain top national quartile or move band, aiming to achieve green or amber status.

3.3 High Dose Prescribing of Inhaled Corticosteroids in Patients with Asthma

1) Evidence of documented medication review within the last 12 months in at least 80 % of patients with asthma on high dose steroids

2) Evidence of at least 25% of adults over 18 on high dose inhaled steroids being offered reduction in medication in line with BTS guidelines that have been stable for three months

3) Evidence of at last 75% of adults over 18 years prescribed a high dose inhaled steroid having received instruction on appropriate inhaler technique.

3.4 NSAID Prescribing 1) To maintain or achieve top national QIPP quartile for NSAID prescribing volume 2) To maintain or achieve top national QIPP quartile for choice of NSAID (either ibuprofen or

naproxen) when prescribing 3) At least 75% of all patients on a coxib should have documented evidence of a NSAID medication

review giving the reason for choice, if appropriate, and if not either stop or give a more cost-effective alternative

3.5 Diabetes Prescribing

1) To maintain or achieve top QIPP quartile on Metformin and Sulphonylurea prescribing 2) Audit all diabetic patients on Exenatide and/or Liraglutide to ensure that at least 75% patients

on on-going therapy have demonstrated either weight loss or at least 3% and reduction in HbA1C by 1% or had their medication discontinued

3) For patients initiated with insulin in primary care that Human NPH is offered as first choice in at least 50% of patients unless there is documented reason to use long-acting analogues.

4. Section 3: Education and Practice Engagement with Prescribing

Practices must show evidence of at least three of the following targets:

a) Production of practice annual prescribing plan incorporating agreed work from MMT and demonstrating agreed action against plan by end of year

b) Prescribing Audit of choice (this must not be the same areas as selected for Section 3 or areas chosen for any element of QOF ie Med management 6&10)

c) Attendance of at least 75 % of prescribing cluster meetings d) At least twice yearly in house prescribing reviews with clinicians e) Wirral MMT accreditation of repeat prescribing system

4.1 Rationale Practice engagement with prescribing has been traditionally been very good and it is felt important to continue to incentivise and support this aspect of practice work. Newly qualified GPs, Registrars and Nurse Prescribers may not be as familiar with cost effective prescribing and the above therapeutic areas may assist practices and the MMT providing suitable education.



4/4

Improving prescribing knowledge and related admin skills within non clinical staff has also proved very effective in some local practices in delivering cost efficient prescribing services for patients The MMT intends to continue to offer training courses for suitable practice staff on prescribing and to develop an accreditation process for repeat prescribing systems.

5. Monitoring Arrangements

The Medicines Management Team will provide monitoring reports and facilitate discussion of progress at the quarterly prescribing cluster meetings.

5.1 Payment Timescale

The Medicines Management team will assess performance against incentive scheme targets and summarise a final list for review by the Prescribing Lead GP and Chief Officer.

The payments will be authorised by the Consortium and processed by the Primary Care Team. Performance will be assessed on prescribing data for March 2013.

25% of payments will be available in advance for practices who sign up to this Incentive Scheme.

Balance payments of refunds for those practices achieving/not achieving the elements of the scheme will be during June 2013. Any appeals will be heard by the Clinical Working Group of Wirral Alliance.

References 1. National Prescribing Centre Key Therapeutic Topics – Medicines management options for

local implementation. April 2012. Available at http://www.npc.nhs.uk/qipp/resources/Key_therapeutic_topics_Medicines_Management_for_local_implementation_April_2012.pdf. Last accessed 2.7.2012



NHS Wirral Policy Adoptions

Agenda Item: 031.1; 031.2; 031.3 Reference: GB12-13/031


Meeting Date: 07.08.2012

Lead Officer: Lorna Quigley

Contributors: Helen Jones


N/A

Governance:


Adoption of policies in order to obtain authorisation

Summary: The following three NHS Wirral PCT policies have been reviewed and amended to meet the needs of NHS Wirral CCG in order for them to be presented as evidence for authorisation.

Fraud and Corruption Publications policy Staff Code of Conduct

To Approve

To Note

Recommendation:

Comments

Next Steps: Once approved the policies will be published in line with the publication policy and disseminated to all consortia for implementation

NHS Wirral Policy Adoptions Governing Body Meeting 7th August 2012

1/3


2/3



Financial

N/A

Value For Money N/A

Risk If the policies are not approved the governing body will not fulfill their statuary obligation with regard to ensuring there is a robust governance structure within the CCG.

Legal

Workforce


All policies apply to all staff and a Equality Impact assessment had been undertaken for each one


Partnership Working



Yes







3/3


Agenda Item:031.1

Ref: GB12-13/031

FRAUD AND CORRUPTION (INCLUDING BRIBERY) POLICY

First issued by/date

Issue Version

Purpose of Issue/Description of Change Planned Review Date

April 2003 4 This policy has been adopted from the NHS Wirral Fraud and Corruption Policy

Named Responsible Officer:- Approved by Date

Policy file: General policy

Impact Assessment Screening Complete - Full impact Assessment Required -

Policy No.

Key Performance Indicators:

1.

Fraud and Corruption Policy Page 1 of 12 Governing Body Meeting 7th August 2012

Agenda Item:031.1

Ref: GB12-13/031


FRAUD AND CORRUPTION POLICY

Contents Page

1. Foreword 3

2. The Governing Body’s Policy 3

3. Introduction 3

4. Investigating a Suspected Fraud 4

5. Conclusion 5

6. Guidance to Staff 6

7. What to do If You Suspect a Fraud 6

Appendices

Page

Appendix A Process map for reporting and dealing with fraud 8

Appendix B Impact Assessment Screening Tool 9

Appendix C Dissemination and Training Plan 11

Agenda Item:031.1

Ref: GB12-13/031


1. FOREWORD

1.1 This document is intended to provide NHS Wirral CCG, referred to hereafter as the CCG with a policy for dealing with suspected fraud. It includes a brief statement for local use and issue to all employees. It sets out the CCG’s position on dealing with suspected fraud and what employees should do if they suspect a colleague, patient or other person of fraud, corruption, malpractice or misconduct. It forms part of the CCG’s programme to ensure that all the elements of current best practice in corporate governance are put into place.

2. THE GOVERNING BODY’S POLICY

2.2 The Governing Body is wholly committed to maintaining an honest, open and well intentioned atmosphere within the CCG. It is also committed to the elimination of fraud, corruption and bribery within the CCG, to the rigorous investigation of any such cases and, where fraud is proven to ensure that wrong doers are appropriately dealt with. The CCG will also take appropriate steps to recover any assets lost as a result of fraud.

2.3 The Governing Body wishes to encourage anyone having reasonable suspicions of fraud to report them. The CCG’s policy, which will be rigorously enforced, is that no employee should suffer as a result of reporting reasonably held suspicions.

3. INTRODUCTION

3.1 One of the basic principles of public sector organisations is the proper use of public funds. This document sets out the CCG’s policy for dealing with detected or suspected cases of fraud, corruption and bribery. The CCG already has procedures in place to reduce the likelihood of fraud occurring – these include Standing Orders, Standing Financial Instructions, schemes of delegation, documented procedures and a robust system of internal control.

3.3 This document is intended to provide some direction and help to those staff and managers who find themselves having to deal with suspected cases of fraud or corruption. It gives a framework for a response and advice and information on various aspects and implications of an investigation.

3.4 This document needs to be implemented in conjunction with the CCG’s policy on discipline.

3.5 For all purposes fraud is defined by the Law Commission as:

“Any person who dishonestly causes another to suffer prejudice, or who dishonestly makes a gain for himself or another” commits the offence of fraud under The Fraud Act 2006.

3.6 Corruption is defined as:

Agenda Item:031.1

Ref: GB12-13/031


“the giving or receiving of any gift or reward as an inducement to do something immoral or dishonest, especially by people in positions of power”.

3.7 The legal definition of theft is “Dishonestly appropriates property belonging to another with the intention of permanently depriving the other of it”

3.8 Bribery is generally defined as giving someone a financial or other advantage to encourage that person to perform their functions or activities improperly or to reward that person for having already done so.

The Bribery Act 2010

The Bribery Act 2010 replaces the fragmented and complex offences at common law, and in the Prevention of Corruption Acts 1889-1916. This broadly defines the two sections:

Two general offences of bribery – 1) Offering or giving a bribe to induce someone to behave, or to reward someone for behaving, improperly and 2) requesting or accepting a bribe either in exchange for acting improperly, or where the request or acceptance is itself improper;

The new corporate offence of negligently failing by a company or limited liability partnership to prevent bribery being given or offered by an employee or agent on behalf of that organisation.

Any suggestion or suspicion of corruption, bribery or fraudulent practice should be reported to the Local Counter Fraud Specialist – as detailed in this Policy.

4. INVESTIGATING A SUSPECTED FRAUD

4.1 All cases of suspected fraud should be referred as soon as possible to the Local Counter Fraud Specialist. It should be noted that time may be of the utmost importance to ensure that evidence is preserved and losses to the CCG are kept to a minimum. A record will be maintained of all reported suspicions including those dismissed or otherwise not investigated. Details of actions taken and decisions reached will also be recorded. These records will be available for quality inspection by Counter Fraud Services.

4.2 It is critical that any investigation is conducted in a professional manner aimed at ensuring the current and future interests of both the CCG and the suspected individual(s). At all times enquiries will be conducted within the bounds of the Human Rights Act, the Regulation of Investigatory Powers Act (RIPA) and the Police and Criminal Evidence Act (PACE).

4.3 Where appropriate the suspected individual concerned may be suspended from duty in accordance with the CCG’s Disciplinary Procedure.

4.4 Cases where the suspected fraud is in excess of £15,000 will be referred to Counter Fraud Services (Operations). Where the figure is less than £15,000, the Local Counter Fraud Specialist will investigate the case. Where appropriate the Director of Human Resources will be involved in investigations where internal disciplinary action is anticipated.

Agenda Item:031.1

Ref: GB12-13/031


4.4 The CCG will ensure that either the L.C.F.S. or relevant regional counter fraud specialist are given access as soon as is reasonably practicable and in any event not later than 7 days from the date of request to:

All premises, records or data owned or controlled by the CCG relevant to the detection and investigation of cases of fraud and corruption;

All staff who may have information to provide which is relevant to the detection and investigation of cases of fraud and corruption.

4.5 It is vital that any employee who reports their suspicions can do so knowing their identity will not be revealed. The CCG undertakes to protect, as far as possible, the identity of such employees and not to release the source of notification at any time during or after the investigation.

4.6 The Governance and Audit Committee will be kept informed of current cases under investigation (in an anonymised format) and will be given a concluding report at the end of the enquiry. It should be noted that in cases where allegations are unsubstantiated the names of the individual(s) concerned will not be revealed.

4.7 All interviews should be conducted in the correct manner. In particular the requirements of the Police and Criminal Evidence Act (PACE) must be complied with when interviewing suspects.

4.8 Under UK employment legislation dismissal must be for a fair reason. The manner of dismissal must also be reasonable. It is therefore important that disciplinary action including dismissal only occurs following action in accordance with the CCGs Disciplinary procedures. The Director of Human Resources should be consulted about the provision of references for employees who have been dismissed or who have resigned following suspicions of an illegal act.

4.9 The L.C.F.S. will notify Counter Fraud & Security Management Services (C.F.S.M.S.) of any investigations and where appropriate, will liaise with the police. The L.C.F.S. will assist, where necessary, in cases referred to C.F.S.M.S. or the police for investigation. The L.C.F.S. will work jointly with Internal and External Audit when appropriate.

5. CONCLUSION

5.1 At the conclusion of an investigation a Final Report will be prepared. The findings will be shared with Internal and External Audit in order to review control and system weaknesses that may have been identified. The format will not always be the same as each case is unique. However, areas covered will include such items as:

How the investigation arose.

Who the subjects are (if appropriate).

Their position in the CCG and their responsibilities.

How the investigation was undertaken.

The facts and evidence that were identified.

Agenda Item:031.1

Ref: GB12-13/031


The outcome of any criminal, civil or disciplinary proceedings.

A summary of findings and recommendations, both regarding the fraud itself and system weaknesses identified during the investigation.

6. GUIDANCE TO STAFF

6.1 You should be assured that there will be no recriminations against staff reporting reasonably held suspicions. The CCG will endeavour to protect at all times the identity of anyone reporting his or her suspicions. Victimising or deterring staff from reporting concerns is a serious disciplinary matter. You may wish to read the Whistle Blowing Policy. This outlines the support you can receive for voicing any reasonably held suspicion.

6.2 Any contravention of this policy should be reported to the Accountable Officer or Chairperson of the Governance and Audit Committee. Equally however, abuse of the process by raising malicious allegations could also be regarded as a disciplinary matter.

6.3 A process map for reporting and dealing with fraud can be found in Appendix A.

7. WHAT TO DO IF YOU SUSPECT A FRAUD

7.1 If you believe you have good reasons to suspect a colleague, patient or other person of a fraud or an offence involving the CCG or a serious infringement of CCG or NHS rules you should contact the Local Counter Fraud Specialist (L.C.F.S.)

Examples could include

Theft of CCG property.

Abuse of CCG property

Deception or falsification of records (e.g. fraudulent time or expense claims).

7.2 Alternatively you may wish to raise the matter with your line manager (unless you suspect the manager of involvement in the fraud) the Director of Finance or senior member of the finance staff, the Governance and Audit Committee or Internal Audit.

7.3 They in turn should notify the L.C.F.S. without delay. Any supporting documentation should be secured and handed to the L.C.F.S. at the earliest possible opportunity.

Under no circumstances should any investigative enquiries be undertaken without the prior approval of the L.C.F.S.

7.4 If you have concerns about speaking to another member of staff or would rather report your suspicions anonymously you can contact the N.H.S. Fraud & Corruption Reporting Line on 0800 028 40 60.

Agenda Item:031.1

Ref: GB12-13/031


7.5 Please be aware that time may be of the utmost importance to ensure that the CCG does not continue to suffer a loss and possibly vital evidence is secured.

7.6 Under no circumstances should a member of staff speak to representatives of the press, radio, TV or other third party unless expressly authorised to do so by the Accountable Officer.

7.7 At no time should a member of staff attempt to communicate with an external contractor, member of staff or any other person whom they believe may have perpetrated a fraud against the CCG other than in connection with their normal duties.

Agenda Item:031.1

Ref: GB12-13/031

Governing Body Meeting 7 August 2012

Fraud and Corruption Policy Page 8 of 12 th

APPENDIX A - PROCESS MAP FOR REPORTING AND DEALING WITH FRAUD

Fraud or corruption is not indicated

Discuss with “public concern at Work Discuss with your

Head of Department


Fraud or corruption is indicated

Deal as appropriate (including crimes other

than fraud and ti )

Call NHS Fraud hotline

0800 028 4060

Inform Chief Finance Officer/LCFS who

review the allegation



Determine course of investigation/outcome

Where applicable COF to initiate action to end loss and correct any

weaknesses in controls or supervision

All reported suspicions – details of subsequent

actions/conclusions

Chief Finance Officer (CFO) records details immediately in a log

CFO reviews case and as appropriate refers

to Governing Body/Internal &

external audit/Police

Log reviewed by Governance and Audit

committee


Significant items reported in Governing Body minutes for their

review

You have concerns or queries about an

aspect of the organisations affairs

Agenda Item:031.1

Ref: GB12-13/031


APPENDIX B - IMPACT ASSESSMENT SCREENING TOOL 1. Initial Screening Process

1.1 Title of the policy/procedure/function/service Fraud and Corruption Policy 1.2 Directorate/Department Governing Body 1.3 Name of the person responsible for this Equality Impact Assessment Helen Jones 1.4 Date of Completion July 2012 1.5 Aims and Purpose of this policy/procedure/function/service

This document sets out the CCG’s policy for dealing with detected or suspected cases of fraud. The CCG already has procedures in place to reduce the likelihood of fraud occurring – these include Standing Orders, Standing Financial Instructions, schemes of delegation, documented procedures and a robust system of internal control.

1.6 Is this a new or existing policy/procedure/function/service Existing 1.7 Examination of Available Evidence – Tick evidence used

Census Data for UK _

Census Data for London _

Census Data for Local Authority Area _

Trust Workforce Data _

Trust Patient Data _

National Patients Survey _

Trust Patients Survey _

Complaints Summaries _

Other Internal Research/Survey/Consultation/Audit (please list)

Other External Research/Survey/Consultation/Audit (please list)

Fraud Act 2006 Human Rights Act The Regulation of Investigatory Powers Act (RIPA) The Police and Criminal Evidence Act (PACE).

Agenda Item:031.1

Ref: GB12-13/031


What is the summary of the available evidence?

All cases of suspected fraud should be referred as soon as possible to the Local Counter Fraud Specialist. It should be noted that time may be of the utmost importance to ensure that evidence is preserved and losses to the CCG are kept to a minimum. A record should be maintained of all reported suspicions including those dismissed or otherwise not investigated. Details of actions taken and decisions reached will also be recorded. These records should be available for quality inspection by Counter Fraud Services.

1.8 Does the evidence indicate that there is, or is the potential to be any significant impact on anyone or any group in relation to the following equality strands? No

Strand Yes/No/Insufficient Data

Justified Yes/No

Ethnicity/Race No N/A

Disability No N/A

Gender/Sex No N/A

Religion/Belief No N/A

Sexual Orientation No N/A

Age No N/A

Human Rights No N/A

If further evidence is required to complete this section, take steps to obtain to before proceeding with the assessment. If the review of evidence indicates that there is a

significant unjustified impact, a Full Equality Impact Assessment must be carried out. 1.9 No further evidence Required. Skip to Section 5. √

1.10 Full Equality Impact Assessment required. No

Agenda Item:031.1

Ref: GB12-13/031


APPENDIX C - DISSEMINATION AND TRAINING PLAN To be completed with the corporate document when submitted to the appropriate committee for consideration, approval and ratification. The status column must be given a Red, Amber or Green rating with evidence to demonstrate an action has been completed. DISSEMINATION PLAN

Title of document:

Date finalised:

Dissemination Lead: (print name and contact details)

Proposed action to retrieve out-of-date copies of the document.

To be disseminated to:

Disseminated by whom?

Timescale Status R A G

Paper or Electronic

Comments

Website

Other (give details)

Training Sessions (give details below)

IMPLEMENTATION PLAN

Training Timescale Owner Status

Training Event

Training Plan Lead

Compliance monitoring Timescale Owner Status

Methodology to be used for monitoring/audit purposes

Responsibilities for conducting monitoring/audit

Frequency of monitoring/audit (e.g. annually, half yearly)

Process for reviewing/reporting results

Agenda Item:031.1

Ref: GB12-13/031


Agenda Item:031.2

Ref: GB12-13/031

Publications Policy Page 1 of 9 Governing Body Meeting 7th August 2012

PUBLICATIONS POLICY


Issue Version


Oct 2010 2 This policy has been adopted from the NHS Wirral Publication Scheme

To be Set


Policy file: General Policy


Policy No.


1.

Agenda Item:031.2

Ref: GB12-13/031


PUBLICATIONS POLICY

Page

s which may be made for Information published under this 5

. Written requests 5

Contents 1. Introduction 3

2. Classes of information

3. Charge

3

scheme

4

ppendices Page

Appendix A Impact Assessment Screening Tool 6

Appendix B Dissemination and Training Plan 8

A

Agenda Item:031.2

Ref: GB12-13/031


1. INTRODUCTION 1.1 This publication policy commits NHS Wirral CCG referred to hereafter as

the CCG, to make information available to the public as part of its normal business activities. The information covered is included in the classes of information mentioned below, where this information is held by the CCG. Additional assistance is provided to the definition of these classes in sector specific guidance manuals issued by the Information Commissioner.

1.2 The scheme commits the CCG:

• To proactively publish or otherwise make available as a matter of routine, information, including environmental information, which is held by the authority and falls within the classifications below. • To specify the information which is held by the authority and falls within the classifications below. • To proactively publish or otherwise make available as a matter of routine, information in line with the statements contained within this scheme. • To produce and publish the methods by which the specific information is made routinely available so that it can be easily identified and accessed by members of the public. • To review and update on a regular basis the information the authority makes available under this scheme. • To produce a schedule of any fees charged for access to information which is made proactively available. • To make this publication scheme available to the public.

2. CLASSES OF INFORMATION 2.1 Who we are and what we do.

Organisational information, locations and contacts, constitutional and legal governance.

2.2 What we spend and how we spend it.

Financial information relating to projected and actual income and expenditure, tendering, procurement and contracts.

2.3 What our priorities are and how we are doing. Strategy and performance information, plans, assessments, inspections and reviews.

2.4 How we make decisions.

Policy proposals and decisions. Decision making processes, internal criteria and procedures, consultations.

Agenda Item:031.2

Ref: GB12-13/031


2.5 Our policies and procedures. Current written protocols for delivering our functions and responsibilities.

2.6 Lists and Registers.

Information held in registers required by law and other lists and registers relating to the functions of the authority.

2.7 The Services we Offer.

Advice and guidance, booklets and leaflets, transactions and media releases. A description of the services offered.

2.8 The classes of information will not generally include:

• Information the disclosure of which is prevented by law, or exempt under the Freedom of Information Act, or is otherwise properly considered to be protected from disclosure.

• Information in draft form. • Information that is no longer readily available as it is contained in files that

have been placed in archive storage, or is difficult to access for similar reasons.

2.9 The method by which information published under this scheme will be

made available

The CCG will indicate clearly to the public what information is covered by this scheme and how it can be obtained. Where it is within the capability of the CCG, information will be provided on a website. Where it is impracticable to make information available on a website or when an individual does not wish to access the information by the website, or if you require a hard copy, please address your query to:

Corporate Affairs NHS Wirral CCG Old Market House Hamilton Street Birkenhead CH41 5AL

2.10 In exceptional circumstances some information may be available only by viewing in person. Where this manner is specified, contact details will be provided. An appointment to view the information will be arranged within a reasonable timescale.

2.11 Information will be provided in the language in which it is held or in such other language that is legally required. Where an authority is legally required to translate any information, it will do so.

Agenda Item:031.2

Ref: GB12-13/031


2.12 Obligations under disability and discrimination legislation and any other legislation to provide information in other forms and formats will be adhered to when providing information in accordance with this scheme.

3.0 CHARGES WHICH MAY BE MADE FOR INFORMATION PUBLISHED UNDER THIS SCHEME

3.1 The purpose of this scheme is to make the maximum amount of information readily available at minimum inconvenience and cost to the public. Charges made by the CCG for routinely published material will be justified and transparent and kept to a minimum.

3.2 Material which is published and accessed on a website will be provided free

of charge. Charges may be made for information subject to a charging regime specified by Parliament. Charges may be made for actual disbursements incurred such as:

• photocopying • postage and packaging • the costs directly incurred as a result of viewing information

3.3 Charges may also be made for information provided under this scheme where they are legally authorised, they are in all the circumstances, including the general principles of the right of access to information held by public authorities, justified and are in accordance with a published schedule or schedules of fees which is readily available to the public.

3.4 If a charge is to be made, confirmation of the payment due will be given before the information is provided. Payment may be requested prior to provision of the information.

4.0 WRITTEN REQUESTS

Information held by a public authority that is not published under this scheme can be requested in writing, when its provision will be considered in accordance with the provisions of the Freedom of Information Act.

Agenda Item:031.2

Ref: GB12-13/031


APPENDIX A IMPACT ASSESSMENT SCREENING TOOL 1. Initial Screening Process

1.1 Title of the policy/procedure/function/service Publications Policy 1.2 Directorate/Department Governing Body 1.3 Name of the person responsible for this Equality Impact Assessment Helen Jones 1.4 Date of Completion July 2012 1.5 Aims and Purpose of this policy/procedure/function/service The aim is to provide guidance to all employees on how to make information available to the public as part of normal business activities in relation to their official position as an NHS employee. 1.6 Is this a new or existing policy/procedure/function/service Existing 1.7 Examination of Available Evidence – Tick evidence used











Freedom of Information Act 2000

Data Protection Act 1998

Agenda Item:031.2

Ref: GB12-13/031


What is the summary of the available evidence? The CCG must: ■ proactively publish or otherwise make available as a matter of routine, information, including environmental information, which is held by the authority and falls within the classifications below. ■ specify the information which is held by the authority and falls within the classifications below. ■ proactively publish or otherwise make available as a matter of routine, information in line with the statements contained within this scheme. ■ produce and publish the methods by which the specific information is made routinely available so that it can be easily identified and accessed by members of the public. ■ review and update on a regular basis the information the authority makes available under this scheme. ■ produce a schedule of any fees charged for access to information which is made proactively available. ■ make this publication scheme available to the public. 1.8 Does the evidence indicate that there is, or is the potential to be any significant impact on anyone or any group in relation to the following equality strands? No


Justified Yes/No


Disability No N/A

Gender/Sex No N/A



Age No N/A

Human Rights No N/A


significant unjustified impact, a Full Equality Impact Assessment must be carried out. 1.9 No further evidence Required. Skip to Section 5. √


Agenda Item:031.2

Ref: GB12-13/031


APPENDIX B DISSEMINATION AND TRAINING PLAN To be completed with the corporate document when submitted to the appropriate committee for consideration, approval and ratification. The status column must be given a Red, Amber or Green rating with evidence to demonstrate an action has been completed. DISSEMINATION PLAN

Title of document:

Date finalised:






Paper or Electronic

Comments

Website



IMPLEMENTATION PLAN


Training Event

Training Plan Lead






Agenda Item:031.2

Ref: GB12-13/031


Agenda Item:031.3

Ref: GB12-13/031

Standards of Conduct and Disciplinary Page 1 of 29 Governing Body Meeting 7th August 2012

STANDARDS OF CONDUCT AND DISCIPLINARY POLICY


Issue Version


July 2006 3 This policy has been adopted from the NHS Wirral Standards of Conduct and Disciplinary Policy

To be Set


Policy file: Health and Safety policy


Policy No.


1.

Agenda Item:031.3

Ref: GB12-13/031


STANDARDS OF CONDUCT AND DISCIPLINARY POLICY

Contents Page 1. Introduction 3

2. Scope 3

3. Standards of Conduct 3

4. Rules 4

5. Failure to Observe Standards of Conduct 7

6. Disciplinary Procedure 10

7. Responsibilities 16

Appendices

Page

Appendix A Disciplinary Policy Scheme of Delegation 18

Appendix B Procedures to be used at disciplinary /appeal hearings 19

Appendix C Notification of disciplinary hearing form HRDIS 21

Appendix Impact Assessment Screening Tool 24

Appendix Dissemination and Training Plan 26

Agenda Item:031.3

Ref: GB12-13/031


1. INTRODUCTION

1.1 NHS Wirral CCG, referred to hereafter as the CCG believes that the aim of a policy detailing the standards of conduct and behaviour required, together with the disciplinary process for all employees is to ensure uniformity of treatment between individuals and groups of staff, to ensure justice for each employee and to encourage learning’s from situation as well as provide a supportive mechanism for employees.

1.2 The Advisory Conciliation and Arbitration Service (ACAS) has provided a Code of Practice (The Code) in relation to Disciplinary practice and procedures in employment; this Disciplinary Procedure is based on the principles detailed within that Code.

1.3 No disciplinary action will be taken without the employee being informed of the nature of the allegations against them and being given the opportunity to respond accordingly.

1.4 All employees will be given an explanation of the penalty imposed and be informed of the consequences of failing to meet the required standards.

2. SCOPE

2.1 This procedure applies to employees within the CCG and should be read in conjunction with current legislation, NHS staff Council, National or local agreements.

3. STANDARDS OF CONDUCT

3.1 As a member of staff of the CCG and therefore a public service employee you are subject to the Prevention of Corruption Acts which is designed to ensure the highest ethical standards within public services. You are therefore expected to:

Declare any external interest which may; result in your gaining direct or indirect financial advantage as a consequence of your work; which could influence any decisions you make; or which could interfere with your contractual obligations to the CCG.

Ensure the interests of patients are paramount and that your use or management of any public funds ensures value for money.

3.2 You must NOT:

Abuse your official position for personal gain or in showing favouritism.

Accept inappropriate gifts or hospitality.

Misuse or make available confidential information on patients, colleagues or the CCG inappropriately.

Agenda Item:031.3

Ref: GB12-13/031


3.3 It is the obligation of all employees to bring to the attention of their manager, or someone more senior if appropriate, any concerns regarding practices within the organisation which could have a damaging effect on patients, service users, other employees, the resources or the reputation of the CCG. There is a procedure for Raising Staff Concerns (Whistle Blowing Policy); this document should be used in such cases.

3.4 The rules set out below are for the information and benefit of all employees. The CCG believes that the examples given will provide individuals with sufficient guidance in most circumstances, and will assist in ensuring that the conduct of all employees is conducive to the provision of excellent standards of care as well as an effective and efficient service.

3.5 These rules are not exhaustive or necessarily definitive. They do not in any way replace recognised professional codes of conduct. Employees are also required to be familiar with and to follow departmental rules, their own professional codes of conduct and CCG Policies and Procedures relevant to their job.

3.6 Failure to observe the rules may result in disciplinary action being taken. Therefore if there are any circumstances in which staff members are unsure of the rules or the appropriate form of conduct they should ask their supervisor, manager or Director.

4. RULES

4.1. Obeying Instructions

Employees should always carry out lawful and reasonable instructions from more senior staff in a professional and courteous manner, and should observe appropriate procedures and regulations.

4.2. Observing Limits of Authority and Competence

No member of staff should abuse their status or position when dealing with other members of staff or members of the public.

No member of staff should undertake work, on their own initiative, which is known to be beyond their level of competence, nor their manager request them to do so.

4.3. Attendance for Duty

No member of staff should be absent from duty without reporting in the prescribed manner, and without good cause. Staff leaving their place of work to visit another site or to attend a meeting should observe local reporting procedures and/or the Lone Working Policy.

Employees who are found to be absent without leave will be subject to further action. Staff members who are absent as a result of illness or accident have a duty to behave in a manner most likely to minimise their length of absence (please see Managing Attendance).

4.4. Care of Trust Property

Agenda Item:031.3

Ref: GB12-13/031


Every member of staff has a duty to take good care of Trust property, not to cause waste or damage to any property and to report any loss or damage immediately.

Materials, facilities (including telephones and faxes) and equipment belonging to the CCG may not be used for private purposes and may not be removed from the premises except with the express permission of an appropriate manager. Staff with access to computers must ensure that they are familiar with, and comply with the rules concerning computers, including e-mail and internet usage.

4.5. Accurate Records

Any member of staff required to maintain records are obliged to ensure such records are accurate and timely. No member of staff may alter or erase or add to a document without appropriate authority. Staff who are entitled to make claim(s) for any expenses should ensure they understand the conditions prior to completing any claim documents.

4.6. Health and Safety

All members of staff have obligations under Health and Safety legislation to ensure safe working practices. Staff must follow any local safety rules, and must ensure that they never attend work in an unfit state, due to alcohol or drug consumption. Staff members are required to report accidents and untoward incidences in a timely manner, using the appropriate documentation in accordance with Health & Safety procedures.

4.7. Discrimination

Staff members must not discriminate against anyone on the grounds of sex, sexual orientation, age, race, marital status, disability colour or religion in the course of their duties. Please see Dignity at Work for more information.

4.8. Bullying and Harassment

Harassment is conduct towards another person(s) of an unwanted and unreasonable nature, and offensive to the recipient which creates an intimidating, hostile or humiliating work environment. No member of staff shall harass another in any respect (i.e. in relation to discrimination as a result of sex, sexual orientation, race, colour, religion, age, disability or position within the environment.

Bullying is characterised as offensive, intimidating, malicious or insulting behaviour, an abuse or misuse of power through means intended to undermine, humiliate, denigrate or injure the recipient. These are often unwanted actions or practices that are directed at one or more individuals and are unwelcome to the victim. The actions can cause distress, humiliation and offence. No member of staff should overtly or covertly bully another employee within the organisation. Please see Dignity at Work for more information

4.9. Other Employment

Members of staff who have, or who consider taking any other employment must notify their Line Manager of the circumstances for this to be authorised and documented accordingly. This is to ensure the line manager

Agenda Item:031.3

Ref: GB12-13/031


is aware of and has prior approval of any additional employment so as to negate any conflict with their contract with the Trust

Members of staff also need to ensure that the CCG knows of any hours worked for other organisations in order that its’ statutory requirement of the Working Time Directive is fulfilled.

4.10. Disclosure of Interests

If employees of the CCG have any involvement with or interest in a private firm or independent organisation which could, through any interaction with the organisation bring financial advantage to the employee or into a potential conflict of interest, it should be declared in writing to the Director of HR or designated deputy.

4.11. Gifts and Hospitality

CCG employees are not permitted to receive money, gifts (other than small gifts of little financial value - e.g. boxes of chocolates, calendars) or other favours from patients, businesses or members of the public in connection with their employment. This includes receiving preferential rates or benefits from private transactions with companies arising from official dealings on behalf of the CCG, with those companies. Gifts or money given for a ward or department, other than gifts of the sort referred to above, may be received on behalf of the organisation, and must be properly recorded. Modest hospitality on a scale equivalent to that which may be offered by the NHS may be accepted in furthering the business of the CCG.

4.12. Contact with Patients, Other Members of the Public and Other Members of Staff

All staff are expected to be professional, courteous and considerate, to respect confidentialities and sensitive information, and to ensure that their actions are not detrimental to the condition or safety of patients. All staff at all times on CCG premises or on business should avoid using abusive, obscene or offensive words/remarks.

4.13. Confidentiality

Staff should be aware that all information concerning patients is confidential. Any breach of patient confidentiality will be treated as a disciplinary offence. Serious breaches will be treated as gross misconduct. It is recognised that in certain circumstances information may have to be given e.g. to the police and authorisation should be sought where there may be uncertainty in respect of the legal position e.g. Children’s’ Act. Clinical staff may in addition have incidents reported to their professional body.

Access to patient information including treatment regime by CCG staff may be agreed where prior authorisation is sought, in order to support individual staff in legal proceedings.

It should be noted that the rules relating to confidentiality should also be applied to information that is received by employees about their colleagues, whether they be subordinates or senior members of the team, in the course of their duties. This information may include sensitive information on topics

Agenda Item:031.3

Ref: GB12-13/031


such as disciplinary or grievance investigations, details of pay or other benefits, or development plans to address capability.

Such information should not be inappropriately shared and all employees are reminded to maintain professionalism when in possession of sensitive or restricted information regarding other CCG staff members.

4.14. Disclosure of Information

Staff, in their capacity as employees of the CCG, may not disclose to the media or any other organisation general information regarding the organisation and its activities. This cannot however override any conditions of service within Agenda for Change terms and conditions.

The Procedure for Raising Staff Concerns / Whistle Blowing Policy is deliberately designed to encourage employees to raise any concerns they may have about what is happening at work. It is emphasised however that such issues should be raised internally first where possible. Employees should not raise concerns with the media except as a matter of last resort and then only when prior advice has been taken from the Communications team in accordance with the Media Policy.

4.15. Uniform and Protective Clothing

If uniform or protective clothing is provided by the CCG, it should be worn in the manner intended. Employees who have direct contact with patients should note that health and safety regulations relating to the wearing of jewellery and tying back long hair should be adhered to. Please refer to Dress Code & Uniform Policy for more information.

Members of staff not provided with uniform are expected to dress appropriately for the environment in which they work and their role as representative for the CCG.

4.16. Smoking and Substance Abuse

All staff are required to conform to the current no smoking policy, and must therefore familiarise themselves with that policy.

All staff must have also read and understood the CCG policy on substance misuse, which includes alcohol. Under no circumstances must staff report to duty under the influence of drugs or alcohol, nor should they consume such substances during their working day.

4.17. Conduct Away From Work

Whilst off duty all CCG employees are expected to conduct themselves in such a way as to not undermine the confidence and trust of the public in the services which the CCG provides, or bring their profession or the organisation into serious disrepute. Disciplinary action may be appropriate on occasions where this standard is allegedly breached depending on the nature of the conduct.

5. FAILURE TO OBSERVE STANDARDS OF CONDUCT

Agenda Item:031.3

Ref: GB12-13/031


As explained in section 6 of this document, failure to observe these rules on conduct may result in disciplinary action being taken by the CCG. Some examples of misconduct (though not exhaustive) are as follows:

5.1 Misconduct

First offence will not lead to dismissal, but may result in formal disciplinary warning being issued. Subsequent offences (within prescribed time limits) could lead to dismissal.

Examples, other than failure to observe the standards of conduct detailed in the Rules, above, may include (although the list is not exhaustive):

Failure to carry out a reasonable instruction.

Failure to attend for duty as required.

Persistent lateness for duty i.e., poor timekeeping.

Neglect of duty.

Inappropriate behaviour

Damage to CCG property.

5.2 Gross Misconduct

This is extremely serious misconduct and if proven is likely to involve dismissal or if strong mitigation, final warning and/or downgrading following a first breach. Examples:

5.2.1 Honesty

Staff members are expected to treat CCG, members of the public and colleague’s property with honesty and respect. Behaviour including actual or attempted theft on NHS or associated premises, whether on or off duty, including unauthorised borrowing of any item of property provided by the CCG for use during employment, fraud or deliberate falsification of records is unacceptable.

5.2.2 Respect for others

Staff members are expected to respect and deal politely and professionally with patients, members of the public and colleagues. Any serious insubordination or deliberate rudeness is unacceptable. Intimidation or verbal threats are therefore outside of this expectation, as is actual assault and bullying. As per the Equality & Diversity policy, discrimination including harassment, clearly undermines the dignity of the person and would be grounds for disciplinary action.

5.2.3 Confidentiality

Subject to the Public Interest Disclosure Act 1998, the CCG expects all staff to maintain confidentiality and to adhere to the requirements of the Data Protection Act 1998 and of the Caldicott Report; disclosure of confidential information inappropriately will therefore be treated very seriously. This information may include:

Agenda Item:031.3

Ref: GB12-13/031


The identity of clients and details of clients medical records

Personal information relating to colleagues or other staff members

Confidential information regarding the CCG, including costings, budgets, turnover etc

Business plans and contract arrangements made by the CCG

5.2.4 Driving

Disqualification from driving, where driving is an essential requirement of the role, could lead to dismissal where redeployment cannot be accommodated.

5.2.5 Professional Registration, Work Permit etc

Employees who allow their professional registration or work permit to lapse, or employees who are removed from the register of their professional registered body, could be dismissed following investigation where redeployment cannot be accommodated. Please refer to Professional Registration Policy for more information.

5.2.6 Use of Drugs, Alcohol

Being unfit for duty due to the influence of alcohol and/or non prescribed or illegal drugs could lead to dismissal following investigation. Any employee reporting for duty smelling of alcohol or showing signs of substance misuse (in the reasonable view of the individual’s manager) will be immediately suspended from duty. Any decision to suspend must be taken in accordance with the Head of HR/OD.

5.2.7 Breach of Procedures

Breaching procedures and standing orders brought to the attention of employees in the course of their duty which could lead to injury to persons, damage to property or damage to public confidence in the service the CCG provides is extremely serious. This also includes any breach of Health and Safety policies, especially where injury to self, others or damage to property could be the result.

5.2.8 Mandatory Training

Failure without just cause, or refusal to undertake mandatory training that is a requirement for your role could constitute a serious disciplinary breach.

5.2.9 Conduct Outside

Criminal offences outside employment, where the offence is relevant to the nature of the employment; affects the ability of the employee to carry out duties; is likely to bring the CCG into disrepute; or undermines the trust and confidence which exists between employer and employee. It is a requirement to declare all enquiries made in relation to alleged criminal activity, but action will only be taken by management if deemed relevant to employment, following investigation.

5.2.10 Use of Information Technology

Agenda Item:031.3

Ref: GB12-13/031


Breaches of the CCG policies relating to Information Technology, or misuse of IT facilities could be deemed as Gross Misconduct where investigation finds:

Excessive use of the Internet or e-mail for personal reasons where it impacts on the individuals day to day work and continues to do so

Inappropriate use of the Internet or e-mail, for example for harassment, gambling or viewing pornographic or offensive images/content

Obtaining and using an inappropriate level of password access i.e. “hacking into” a CCG computer

Using unauthorised applications software

Inappropriate or unauthorised use of the ContactPoint system or ESR Smart Card

This list is not intended to be exhaustive, Gross Misconduct could be defined as any breach of conduct which, following investigation, could reasonably be considered to have severed the trust and confidence which exists between employer and employee.

6. DISCIPLINARY PROCEDURE

6.1 Informal Procedure

A supervisor or manager will most commonly respond to unsatisfactory conduct or standards of performance by counselling the employee. Such counselling will be on a one on one basis and staff will not usually be represented. Counselling will not normally be entered as a formal warning on the employee’s record as they do not form part of the formal disciplinary procedure, and consequently there is no right of appeal against counselling.

A counselling meeting will take the form of a discussion with the objective of encouraging and supporting the employee in improving their conduct. Part of the outcome could be around informal advice or coaching if training needs are identified. The employee should fully understand the outcome of the meeting and written confirmation of discussions/minutes of the meeting including any timescales for review may be provided for reference purposes to aid the employee in reviewing their behaviour if requested by the individual but should not be entered on the employees file.

Employees who have been counselled as part of the informal procedure should be made aware that unless improvements are made within an agreed timescale, they may find the matter of misconduct/poor standards of performance progressed to the formal stages of the procedure.

6.2 Investigation

For any disciplinary action/sanction to be judged as fair there must be some form of investigation process that has ordinarily preceded it.

Obviously, in a minor case, such as persistent poor time-keeping, then a set of timesheets or attendance records would be all that was required.

Agenda Item:031.3

Ref: GB12-13/031


However, should time-keeping be the issue, but the employee denies lateness, then an investigation will follow looking at witnesses, (if appropriate), evidence of computer activity, (or lack of it), etc. In reality, almost all cases will therefore require some form of investigation. This may well include taking witness statements etc.

The starting point should be that an investigating officer shall be appointed. Ordinarily, this will be the line manager, but the HR Department will advise if required. This person will not usually be the person who will hear the case, but will be the manager who presents the case to the Disciplinary Panel, if the outcome of the investigation is that a Hearing is recommended as being necessary.

It should be noted that prior to the commencement of any investigation, the appointed officer should refer to section 6.12 Special Arrangements (page 16), within this policy to ensure any particular arrangements or protocols relevant to a specific case are followed. An example of this is an investigation into an allegation of Fraud.

The investigating officer will probably require the assistance of a representative from the HR Department. This person can advise on process and operate the tape machine during interview (or take notes in the event of the failure of the tape machine) etc. The HR manager will also assist the investigating officer in the presentation of the case to a Disciplinary Panel, (if required).

Once an investigating officer has completed that investigation, they should orally or in writing, present a summary of their findings in the form of a report to the disciplining panel. If the recommendation is not to proceed to Disciplinary Hearing, then the employee should be informed, in writing.

Similarly, if the recommendation from the investigation report is to proceed, and this is accepted, then the employee MUST be informed, in writing of the exact nature of the allegations, the date of the Hearing, and their right to be represented at the Hearing. In addition, if a report has been written by the investigating officer, then this should be forwarded to the employee at this stage, (unless they have already had sight of it before).

It almost goes, without saying, that a pre-requisite of the investigation must be a meeting with the employee (again with their representative present, if so required), when he/she can have an opportunity to give their response to any allegations/charges. All documentation from management side and the employee should be shared at the first opportunity where possible, although in exceptional circumstances papers may be accepted by a disciplinary panel at latter stages, provided both sides have equal opportunity to consider and provide a response to any new evidence.

It is important for investigating officers and Disciplinary Panel members to be aware that the “burden of proof”, in terms of any allegations made, rests with the management case. In other words, the case subsequently formally

Agenda Item:031.3

Ref: GB12-13/031


written up and presented to a Disciplinary Hearing must attempt to prove any allegations made.

It should be noted that in the event an employee is absent from the workplace due to sickness whilst an investigation is ongoing, that the investigation should continue as far as is reasonably practicable. Occupational Health and Human Resources should be liaised with in relation to advice as to the appropriate support mechanisms for the employee in question, together with an agreed way forward in progressing the case that minimises disruption to the investigation whilst still managing the needs of the employee.

6.3 Suspension

Suspension is not a disciplinary sanction and there should be no detriment to any employee suspended. Before suspending an employee, the Head of HR/OD must be contacted and serious consideration must be given to any possible alternative measures that may be available; for example moving the employee to another work area or role. Further advice regarding alternative measures can be obtained from the HR Department.

It may be necessary to suspend an employee in the following instances:

(a) If an employee is, in the Manager’s view, incapable of undertaking duties when required to do so;

(b) If an employee is alleged to be associated in a serious offence affecting his/her employment and further enquiry is necessary to establish the facts;

(c) Pending disciplinary action of a serious nature, delayed by the inability of any party to be present. Such a proposal will be discussed with the employee and the representing organisation (if applicable).

(d) Where there is the potential for significant risk to patient care if the employee continues to remain in the workplace.

6.4 Representation

Ordinarily, staff should be given the opportunity to be represented at suspension meetings. However, where representation is not immediately available, or where the allegations are so serious, (e.g. assault on patient), to warrant action without any delay, then it is permissible to suspend without a colleague representative being there.

6.5 The Formal Disciplinary Procedure

The disciplinary procedure relates to personal conduct of an employee or incidents where consistent poor work performance is the matter at issue. An employee will not normally be dismissed for a first breach of discipline except in cases of gross misconduct.

There are a number of possible stages in the formal disciplinary procedure, these are as follows:

Stage 1 oral warning

Stage 2 first written warning

Stage 3 final written warning

Agenda Item:031.3

Ref: GB12-13/031


Stage 4 dismissal

The nature of the initial three stages of the procedure does not necessarily mean that three warnings must always be given before the final stage, which is dismissal. There may be occasions when, depending on the seriousness of the misconduct involved, it will be appropriate to enter the procedure at stage 2 or stage 3. If the procedure is commenced at stage 3 this will be referred to as a single stage final warning.

There may be circumstances in which downgrading is used as a disciplinary sanction, perhaps as an alternative to dismissal; this may be combined with a final written warning.

6.6 Warnings

6.6.1 Oral Warning

An oral warning will last for 3 months. A letter confirming the oral warning should indicate that failure to improve poor work performance within the agreed timescale, or a further offence being committed which merits disciplinary action, will usually result in a First warning.

6.6.2 First Written Warning

A first written warning will last for 6 months.

The letter confirming a first written warning should indicate that failure to improve a poor work performance within the agreed timescale, or a further offence being committed which merits disciplinary action, will usually result in a final written warning.

6.6.3 Final Written Warning

A final written warning will last for 12 months

A final written warning should be administered where an employee, already on a First warning, commits an offence which merits disciplinary action of a less serious nature than dismissal.

The letter confirming a final written warning must contain the statement that any further serious breach of discipline of any kind, or cause for serious complaint in respect of work performance, which is substantiated, will usually result in dismissal.

6.6.4 Dismissal

The final and most significant sanction possible within this policy is to dismiss an employee. This will be the sanction of first choice ONLY in gross misconduct cases or in cases where having been through a disciplinary case and the allegations found to be proven on the balance of probability; the Panel are made aware that the employee also has an outstanding final warning against them.

Disciplinary Panels will want to be very careful in reaching a decision to dismiss, but this is still a potentially “fair” sanction in law, depending on the nature of the allegations and the process followed.

Agenda Item:031.3

Ref: GB12-13/031


In the application of all disciplinary sanctions, the level of proof required is “on the balance of probabilities”, which is a lesser burden of proof when compared to criminal cases. Panel members must recognise that it is management’s responsibility to prove the allegations, rather than employee proving they were “innocent”.

6.6.5 Timescales

It should be noted that in exceptional circumstances, for example where warnings have been applied previously as a disciplinary sanction, have expired on an employees file and they subsequently re-offend, a disciplinary panel may extend the period of a warning i.e. from six months to twelve months for a written warning, or from twelve months to eighteen months/two years for a final written warning. This is in accordance with ACAS guidance and case law.

Agenda Item:031.3

Ref: GB12-13/031


6.6.6 Downgrading

Downgrading should only be used in very specific circumstances and any proposal relating to downgrading must be discussed with the Director of HR.

6.6.7 Expired Warnings

Expired warnings must be disregarded in subsequent disciplinary situations and will be removed from the personal file.

At the specific request of individual staff, the removal of the disciplinary warning will be confirmed in writing to them at the appropriate time.

6.7 Application of Sanctions

A scheme of delegated authority (see Appendix 1) operates within the CCG that details levels of management currently authorised to take action under these disciplinary procedures. Disciplinary officers should inform HR of any disciplinary action via form HRDIS – see Appendix 3. The format of the hearing and number of members attending on a panel is detailed in Appendix 2.

6.8 Involvement of Director/HR Staff

The Director/Head of HR and HR staff all have an important advisory role in all disciplinary matters, both to management and to employees. Their role is to ensure that an equal standard of discipline applies across the CCG.

6.9 Appeals against Disciplinary Sanctions

All employees subjected to a disciplinary sanction are entitled to appeal against the sanctions imposed by a disciplinary panel.

Any appeal should be made in writing stating the grounds for appeal and sent to the appropriate Head of Service/Executive Director within 20 working days of receipt of the letter confirming the warning.

6.9.1 Oral and First Written Warnings

The employee will be required to provide a written statement detailing the reasons for appeal and the manager will produce a written response. Where necessary, witnesses may be invited, by either party, when the appeal is being considered. The appeal will be heard within 20 working days of receipt unless there is a specific agreement to the contrary.

6.9.2 Final Written Warnings, Down-grading and Dismissals

Following the registration of an appeal, formal statements of case will be requested by the Director/Head of HR from both the management and the staff side representative. These should arrive at least ten working days prior to the hearing. The Director/Head of HR will arrange for these statements of case to be exchanged. An appeal will, ordinarily be heard within 20 working days of receipt unless there is a specific agreement to the contrary.

6.9.3 Re-Hear Full Case

Agenda Item:031.3

Ref: GB12-13/031


Current case law suggests it may be advisable in some/all cases, will be for appeals to re-hear the full case. The HR advisors to the Appeal Panel will advise as necessary on this.

6.10 Representation

An employee has either the right to be represented at all stages of the disciplinary procedure by a Trade Union representative, or accompanied by a workplace colleague of his/her choice.

When a manager wishes to conduct an investigative interview and the employee is not represented, the manager, having explained the reason for the interview, must remind the employee of their right to representation. However, the interview can proceed where representation is not available.

During all such interviews the investigating officer must ensure that they are accompanied by another manager or representative from HR.

When a disciplinary panel has been arranged, the Chair should complete a notification form (see Appendix 3) and send it to the HR department.

6.11 Trade Union Officials

Disciplinary action against a trade union representative can lead to a serious dispute if it is seen as an attack on the union’s functions. Although normal disciplinary standards should apply to their conduct as employees, if disciplinary action is contemplated, then the case should be discussed with a full time officer.

6.12 Special Arrangements

Abuse of Patients

In the case of any disciplinary matter involving abuse of patients, the Accountable Officer should be informed immediately, and consulted regarding subsequent action.

Fraud

In the event of any allegation where fraud is identified or suspected, the HR representative should liaise with the Local Counter Fraud Manager and the Director of Finance should be immediately notified. In cases of disciplinary action where fraud is identified or suspected, the Accountable Officer should be informed. Advice will also be sought from the CCG's Local Security Management Specialist.

Industrial Action

In any case in which disciplinary action is being considered in connection with industrial action, the Accountable Officer must be informed.

Medical and Dental Staff

The procedure does not apply to issues of professional conduct and/or professional competence, instead Doctors and Dentists Disciplinary Framework should be followed. In all other aspects this policy applies.

Criminal Acts

Agenda Item:031.3

Ref: GB12-13/031


Criminal offences do not automatically merit disciplinary action. Each case will be treated on its own merits.

Child Protection/Protection of Vulnerable Adults

In the case of any disciplinary matter that may involve a child protection issue, both local CCG and Area Child Protection Committee procedures should be followed and the Accountable Officer must also be informed.

6.13 Resignations

Where an employee resigns during the course of a disciplinary investigation/hearing, involving serious allegations, the management investigation will normally be concluded. The outcome will be provided to the employee in writing. The employee may be invited to attend a meeting so that the outcome of the investigation can be explained to him or her then in person. A decision will then be made as to whether or not the appropriate regulatory body should be notified.

6.14 Protocol for Hearings

Please refer to appendix 2 which is attached to this policy.

7. RESPONSIBILITIES

7.1 Accountable officer

The Accountable officer has overarching responsibility for ensuring the content of this policy is applied consistently and fairly across the CCG.

7.2 Director of HR

The Director of HR is the named officer responsible for ensuing the content of this policy is applied fairly and consistently across the CCG.

7.3 HR Service

The HR Service is responsible for providing accurate and timely advice to managers and employees to ensure the policy is appropriately utilised across the CCG.

In addition the HR department is responsible for fielding representatives to support investigating officers and managers at the appropriate stages of this policy and for monitoring the number of investigations, hearings and sanctions issued to employees that relate to the application of this policy.

7.4 Head of Service

The Head of Service is responsible for overseeing the dissemination of implementation of this policy across their service and also for naming an investigating officer at the appropriate stages of the formal process as outlined within this document.

7.5 Line Manager

Agenda Item:031.3

Ref: GB12-13/031


Line managers and team leaders are responsible for ensuring that this policy is fairly and consistently applied within their team, department or service and for ensuring that the code of conduct detailed within this document is adhered to by staff members.

7.6 Employee

All employees are responsible for adhering to the code of conduct detailed within this document in order to provide a professional and credible image to the CCG. They are also responsible for ensuing they are aware of this policy and the impact of not meeting the standards detailed within the code of conduct, their job description, contract of employment or other CCG policy or procedure.

8. CONSULTATION WITH STAKEHOLDERS

In order to achieve publication, due consideration has been made to the stakeholder groups (employees via trade union and professional representatives, managers and HR professionals) who will be using or who will be affected by this policy. They have been consulted with and their comments incorporated into the final version.

9. DISSEMINATION

The draft policy has been discussed, amended and approved by the HR policy review group, which consists of members of staff side organisations, senior HR representatives and senior managers

10. IMPLEMENTATION

It is not anticipated that this policy will create any training or support issues over and above the provisions currently provided by the HR department to key stakeholders within the CCG i.e. mandatory attendance of People Management training and ongoing support from designated HR representatives to directorates within the CCG.

11. APPROVAL AND RATIFICATION

Once the members of the Governing Body are satisfied that this policy meets all the criteria in order to be publicised, it is escalated for consideration by the Integrated Governance Committee. When the policy is approved by IG, it is considered to have been ratified and is then cascaded to managers across the CCG for storage in their policy files and published on the Intranet site.

12. REVIEW

This policy is subject to periodic review.

13. DOCUMENT CONTROL AND ARCHIVING

If, following review, it is decided that this policy should be superseded by another and archived; this version will be removed from the Intranet site and replaced, and stored within the shared files in the HR system.

Agenda Item:031.3

Ref: GB12-13/031


Managers will be requested to destroy their copies of the archived document held in their files and to replace it with the updated policy.

Agenda Item:031.3

Ref: GB12-13/031

APPENDIX A - DISCIPLINARY POLICY SCHEME OF DELEGATION

Category of Staff Issue of First Warning By:

Appeal to: Issue of Final Warning By:

Appeal to: Issue of Dismissal By:

Appeal to:

Accountable Officer

NCB Designated Non-Executive member

NCB Designated Non-Executive member

Chairman Designated Non-Executive member

Executive Directors

Accountable Officer

Chairman Accountable Officer


Chairman or Designated Non-Executive member

Other staff directly responsible to the Accountable Officer

Accountable Officer



Chairman or Designated Non-Executive member

Medical/Dental Staff

Head of Service or designated medical/executive Director

Other Medical Executive Director

Head of Service or Designated Executive Director

Other Medical Executive Director

Head of Service or designated Executive Director

Accountable Officer

All other staff Immediate Manager

Next level Manager above immediate Manager

Head of Service or Designated Executive Director

Designated Executive Director

Head of Service or designated Executive Director

Designated Executive Director

Notes

1. Where, for any reason the Chairman is not available, the role of the Chairman may be undertaken by the Vice Chairman. 2. In all instances involving the Accountable Officer or Executive Directors, discussion will first take place with the Trust's Director of

HR.


3. In relation to appeals against any disciplinary sanction, an appeal panel made up of 1 Non-Executive Directors and 1 other Director, not previously involved in the initial disciplinary hearing, will hear the appeal.

Agenda Item:031.3

Ref: GB12-13/031


APPENDIX B - PROCEDURES TO BE USED AT DISCIPLINARY/APPEAL HEARINGS

Where a Disciplinary/Appeal Panel hear a case under the terms of the Disciplinary Procedure, the following full procedure or an agreed abridged version shall be used.

A Disciplinary Panel will consist of at least 3 panel members and similarly so shall an Appeal Panel. In the case of an employee from a professional staff group, the Disciplinary Appeal Panel may include the Head of Service for that group or may be advised by them.

The Chairperson of the Panel shall:

Introduce all present

Explain that the purpose of the Disciplinary/Appeal Hearing is to decide whether disciplinary action is appropriate in the case of a disciplinary hearing or in the case of an appeal hearing decide if the original decision should be supported, revoked or amended

Explain the format of the Disciplinary/Appeal Hearing

1. Management Presentation of Case

(a) The Manager or Management Representative shall state the case in the presence of the employee and/or his or her representative and may call witnesses

(b) The employee or representative shall have the opportunity to question Management and any witnesses

(c) The Panel members shall have the opportunity to question Management and any witnesses

(d) The Manager or Management Representative shall have the opportunity to re-examine his or her witnesses

2. Employee Presentation of Case

(a) The employee or his or her representative shall state the case in the presence of Management and may call witnesses

(b) Management shall have the opportunity to question the employee or representative and any other witnesses

(c) The panel members shall have the opportunity to question the employee or representative

(d) The employee or representative shall have the opportunity to re-examine his or her witnesses

3. Summing-Up

(a) Management shall have the opportunity to sum up the case

(b) The employee or representative shall have the opportunity to sum up the case. The employee or representative shall have the right to speak last

Agenda Item:031.3

Ref: GB12-13/031


NB: In their summing-up neither party may introduce any new matter 4. The Manager or Management Representative, Employee, or representative and witnesses shall withdraw from the proceedings. 5. The panel shall deliberate in private, only recalling both parties to clear points of uncertainty on evidence already given. If recall is necessary both parties shall return, notwithstanding only one is concerned with the point giving rise to doubt. 6. The Panel shall recall both parties so that the decision can be announced. In

the case of a Disciplinary Hearing, if the decision involves disciplinary action the employee should be advised of the provisions for appealing against the decision and the consequences that will follow if acceptable improvement is not made.

In the case of an Appeal Hearing the panel will advise the employee that no further internal processes are possible and the decision of the Appeal Panel is final. Ordinarily, the decision of the Panel will be confirmed formally in writing within 5 working days of the date of the Hearing. Exceptionally, depending on the complexity of the case, the panel may not be able to give their decision on the day. In such cases contact will subsequently be made with the employee or representative as soon as possible after the Hearing and certainly within 5 working days of it, or a suitable explanation will instead be given.

NB: At any point in the proceedings the Panel may, at its discretion, adjourns the proceedings where they feel this is appropriate.

Agenda Item:031.3

Ref: GB12-13/031


APPENDIX C - NOTIFICATION OF DISCIPLINARY HEARING FORM HRDIS

To be completed by the Disciplining Officer and submitted to the Director / Head of HR, within two working days following a formal disciplinary meeting. A disciplinary letter will then be drafted by the chair of the panel detailing the outcome of the disciplinary meeting. Part 1: Disciplinary Hearing Name of Employee:……………………………………………………………………………….. Post / Department:……………………………………. Directorate………………………………… Chair / Disciplining Officer:………………………………………………………………………… Investigating Officer:……………………………………………………………………………… Disciplinary Panel Members: …………………………………………………………………… ……………………………………………………………………………………………………… ……………………………………………………………………………………………………… Representative / Union:…………………………………………………………………………… Date of Disciplinary / Hearing: ……………………………………………………………………

Agenda Item:031.3

Ref: GB12-13/031


Part 2: Equal Opportunities Monitoring - Person against whom allegations made

We require this information for monitoring under the Race Relations Act and other legislation and directives covering equal opportunities and diversity. The Trust is committed to equal opportunities and fully supports this monitoring. As a Public Authority it is our duty under the Race Relations Act.

Ethnicity Codes White Mixed Asian or

Asian British

Black or Black British

White British A White & Black Caribbean

D Indian H Caribbean M

White Irish B White & Black African

E Pakistani J African N

Any other White

C White & Asian

F Bangladeshi K Any other Black background

P

Any other mixed background

G Any other Asian background

L

Other Ethnic Groups

Not Stated

Chinese R Not stated Z Any other Ethnic group

S

Disability Codes

Age Category

Gender Code

No disabilities

N Under 20 years

1 Male M

Dyslexic D 20-24 years

2 Female F

Blind/sight impaired

S 25-44 years

3

Deaf/Hearing impaired

H 45+ years 4

Mobility difficulties

M

Other

Agenda Item:031.3

Ref: GB12-13/031


Part 3:- Disciplinary Allegation (please detail formal allegation considered at Disciplinary Hearing) ……………………………………………………………………………………………… ……………………………………………………………………………………………………………………………………………………………………………………………… ……………………………………………………………………………………………… Part 4:- Disciplinary Action No action taken □ Oral warning □ First written warning □ Final written warning □ Dismissal □ Downgrading □ Duration of warning ………….……………………………………………………… Detail of Disciplinary Decision given verbally to employee (detail here or attach as notes) ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… ……………………………………………………………………………………………… Signed ……………………………………………Date…………………………………………… (Disciplining Officer)

A COPY OF THIS DOCUMENT SHOULD BE SENT TO the Director/Head of HR AND A COPY PLACED IN THE INDIVIDUALS PERSONAL FILE. RESPONSIBILITY FOR ENSURING THIS IS DONE RESTS WITH THE LINE MANAGER RESPONSIBLE FOR THE FINAL STAGE OF THE PROCESS.

Agenda Item:031.3

Ref: GB12-13/031


APPENDIX D - IMPACT ASSESSMENT SCREENING TOOL

1. Initial Screening Process

1.1 Title of the policy/procedure/function/service Standards of Conduct and Disciplinary 1.2 Directorate/Department Human Resources 1.3 Name of the person responsible for this Equality Impact Assessment Helen Jones 1.4 Date of Completion July 2012 1.5 Aims and Purpose of this policy/procedure/function/service

The aim of this policy is to detail the standards of conduct and behaviour required, together with the disciplinary process for all employees is to ensure uniformity of treatment between individuals and groups of staff, to ensure justice for each employee and to encourage learning’s from situation as well as provide a supportive mechanism for employees.

1.6 Is this a new or existing policy/procedure/function/service Existing 1.7 Examination of Available Evidence – Tick evidence used











The Advisory Conciliation and Arbitration Service (ACAS) has provided a Code of Practice (The Code) in relation to Disciplinary practice and procedures in employment;

Agenda Item:031.3

Ref: GB12-13/031


this Disciplinary Procedure is based on the principles detailed within that Code.

What is the summary of the available evidence? No disciplinary action will be taken without the employee being informed of the nature of the allegations against them and being given the opportunity to respond accordingly. All employees will be given an explanation of the penalty imposed and be informed of the consequences of failing to meet the required standards.

1.8 Does the evidence indicate that there is, or is the potential to be any significant impact on anyone or any group in relation to the following equality strands?


Justified Yes/No


Disability No N/A

Gender/Sex No N/A



Age No N/A

Human Rights No N/A


significant unjustified impact, a Full Equality Impact Assessment must be carried out. 1.9 No further evidence Required. Skip to Section 5.


Agenda Item:031.3

Ref: GB12-13/031


APPENDIX ? DISSEMINATION AND TRAINING PLAN To be completed with the corporate document when submitted to the appropriate committee for consideration, approval and ratification. The status column must be given a Red, Amber or Green rating with evidence to demonstrate an action has been completed. DISSEMINATION PLAN

Title of document:

Date finalised:






Paper or Electronic

Comments

Website



IMPLEMENTATION PLAN


Training Event

Training Plan Lead






Agenda Item:031.3

Ref: GB12-13/031


PROVISION OF A WHEELCHAIR IN A DAY(WIAD) SERVICE




Lead Officer: Jane Hayes-Green, Programme Manager CWW CSS

Contributors: Helen Jones, Project Manager CWW CSS, Kim Witkiss, Senior Commissioning & Contracts Manager, CWW CSS


Link to QIPP: improved quality of service with shorter waiting times for an appointment, and the provision of a wheelchair on the day of the appointment. Improved access through a choice and wide range of providers. More innovative wheelchairs and delivery of service, improved mobility to increase independence and quality of life. Financial savings and improved value for money through the development and procurement of this new service.

Governance:


Summary: The timetable for the DH led project for complex and specialist wheelchairs has been delayed due to national drivers outside of the control of local areas. Wirral are still part of the DH early adopter team for this, however this service will not be procured until later in 2013/14. Wirral are therefore looking to continue to develop their innovative approach for a Wheelchair in a Day Service for transit and basic self propel Wheelchairs. Two significant factors have recently arisen to influence the method of procurement. The Wheelchair Project Team seeks the approval of the CCG board to continue with the proposal to develop and deliver a WIAD service through a new method of procurement.

To Approve √

To Note

Recommendation:

Comments

Next Steps: If approved the Wheelchair project team will start the process to procure the Wheelchair in a Day Service for Wirral. A project plan is attached which details the required steps. Western Cheshire CCG have indicated they wish to procure the same service – if

Provision of a Wheelchair in a Day (WIAD) Service Governing Body Meeting 7th August 2012

1/4


2/4

approval is granted from Western Cheshire, the Wheelchair project team will procure the service on behalf of Wirral and Western Cheshire.


3/4



Financial

Early indications are that there are significant financial savings to be made by the development of the WIAD service. It is estimated this service will cost approximately £322,000. The current block contract with the Community Trust is approximately £1,539,000. Based on current data, it appears that 51% of the wheelchairs provided by the CT could be provided by the new Wheelchair in a Day service. A detailed financial plan would need to be developed with the CT to establish the financial impact of taking this activity out of the current service.

Value For Money The new service would provide superior value for money. Payment would be made to providers dependent on the activity through their service.

Risk Implications for the CCGs due to the impact of changes on the Community Trust. Risk of bringing new unknown providers into the market.

Legal Will be open to legal challenge if not procured according to regulations.

Workforce Potential impact on the CT workforce within the Wirral wheelchair service if their activity decreases.


If approved equality impact assessment would be conducted to assure equality and human rights of the users of the service.


Patients and professionals were involved in a review of the existing wheelchair service. The wanted to see shorter waiting times, improved access and more choice and flexibility of wheelchairs provided.

Partnership Working

The Wheelchair Project team is working across Wirral and West Cheshire CCGs and CWW CSS. It has representation from adults and children’s services and social services.


New performance indicators would be introduced into the new service. 95% of patients will be offered an appointment within 4 weeks of referral. 95% of patients will receive their wheelchair on the same day as their appointment.


YES



4/4







PROVISION OF A WHEELCHAIR IN A DAY (WIAD) SERVICE

UPDATE ON PROCUREMENT OPTIONS

1. Overview

Following a review of Wirral Wheelchair services in 2011, Wirral and Western Cheshire CCG’s in collaboration with the Commissioning Support Service (CSS) requested to go out to AQP for two wheelchair services: a Complex and Specialist Wheelchair Assessment and Prescription service and a Wheelchair in a Day service. The complex service procurement was being led by the Department of Health with Wirral & Western Cheshire being one of the early adopter team. The Wheelchair in a Day Service was being driven and procured locally.

The DH led project for complex wheelchairs is continuing but the timetable for early adopters has been delayed. However, the above Commissioners have decided to develop an innovative approach for a transit and self propel Wheelchair and Assessment service, provided in a day.

The impact of this service on the wider market could be significant as the perception exists that this opportunity could appeal to a far broader range of service providers e.g. supermarkets and large stores such as Boots Tesco and Halfords etc. who it could be said are outside of the normal provider environment.

Discussions regarding how this service could be delivered have been on-going for some months with the Procurement Team of Cheshire, Warrington and Wirral CSS. The desire of the CCG’s was to utilise the AQP procurement process to provide choice of provider. The normal process would see the service requirement advertised on Supply2Health and the AQP process delivered accordingly.

2. Issues

However, two significant factors have recently arisen to question how this procurement can be delivered. They are:-

2.1 No market engagement had taken place to ensure that there was interest, capability and capacity within the marketplace to deliver a Wheelchair in a Day service.

2.2 Because the prime cost of the WIAD service is the supply of the wheelchair, with a small cost of an assessment service, it becomes a “supply of goods” and not a “supply of services” contract. The AQP process is only applicable to “Part B Services” therefore cannot be used in this instance for a “supply of goods” contract.

Provision of a Wheelchair in a Day (WIAD) Service Page 1 of 4 Governing Body Meeting 7th August 2012


3. Options

3.1 In terms of market engagement, it is important to ensure that the anticipated providers (other than incumbent providers) become aware of any proposed procurement? They may not be aware of Supply2Health.

Therefore, it is proposed to also advertise via the Official Journal of the European Union (OJEU), which covers the whole of the public sector. This could be done through the use of a Prior Information Notice (PIN) that informs our intent to procure a “WIAD” service. This then enables us to engage with industry to explain what our requirements are and to provide a collaborative approach in the specification development and service delivery outputs.

3.2 An alternative procurement option could still deliver the required service. This is a

tendered exercise resulting in the creation of a framework of suppliers to provide the requirements of WIAD. This outcome is similar to AQP in the sense that the user of the contract has a choice of provider. There is also no commitment to any value of business for any provider. However, a significant difference is that there is no agreed tariff, so price is a key element of the tender evaluation, along with other criteria such as service, quality and delivery. Once the scale of interest has been determined through the PIN, it could dictate the choice of OJEU procurement procedure to be followed – there are two options, “Open” and “Restricted”. Procurement options 1. “Open” allows you to ensure that all of the tender documentation including

specification, contract T&C’s, pricing schedule, evaluation criteria, scoring and weighting, bidder guidance and tendering procedures, are made available for access to bidders when the advert notifying the start of the tender process is placed in OJEU and linked to Supply2Health. There is no separate Pre-Qualification Questionnaire (PQQ) stage. This process is now strongly promoted by the Cabinet Office for procurements over the OJEU threshold of £ 113k. It provides greater opportunity for SME’s and smaller organisations to bid for contracts. Pre-Qualification focuses upon financial status, expertise and capability, but sometimes this criterion was very demanding and restrictive. Current advice is that it should be proportionate to the requirement. PQQ questions are still included in the tender process. Therefore, the benefit is it is less time consuming for all parties concerned. The downside could be the high number of respondents requiring evaluation. The tender process is 52 calendar days from issue of advert to return of the tender.

2. “Restricted” is a two stage process utilising the Pre-Qualification and Invitation

to Tender stages. This means two evaluation events, requiring twice the input from evaluators. The tender process is longer as both stages exceed the Open tender timescale of 52 calendar days. The outcome of the procurement will result



in the award to a range of suppliers, thereby offering choice – a similar outcome to the “open” procedure.

4. Actions

The Wheelchair Project Team proposes to undertake the following actions in order to move this project forward:

a. Place the PIN to ascertain interest, capability and capacity within the marketplace. b. Develop indicative costs of a range of basic wheelchair models, with accessories e.g.

cushion and indicative annual volumes, plus indicative cost of assessment service. These will be used for benchmarking against the tendered offers to show indicative savings. Also, the costs will be used to calculate an annual contract value. This will have an impact upon the current contractual arrangements. This value will need to be ring-fenced and extracted from the existing services – contract variation required in liaison with Procurement.

c. Circulate the draft service specification to a wide range of stakeholders for their input and comments.

d. Consider consequences upon existing contracts and impact on the current provider – need for issuing notice periods – clarification required.

e. Develop a communications plan to ensure all potential users and stakeholders are made aware of the framework, its progress and outcome. How will users access the framework, placing of orders, invoicing etc.

f. Revised contract start date is 1 April 2013 g. To agree contract period e.g. 1 year with 2 x 12 month extension options

5. Recommendations

The Wheelchair Project Team seeks the approval of the governing body to continue with the proposal to develop and deliver a WIAD service.

We recommend that the procurement be delivered using the OJEU Open procurement procedure and seek CCG approval to commence this process and publish the PIN to enable engagement with the market.

Jane Hayes-Green, Helen Jones, Kim Witkiss




CWW CSS, 31 July 2012

Draft Wheelchair in a Day Service Project Plan Ver 1 RESPONSIBLE

Key Activities

wc

0207

wc0

907

wc1

607

wc2

307

cw30

07

wc0

608

wc1

308

wc2

008

wc2

708

wc0

309

wc1

008

wc1

709

wc2

409

wc0

110

wc0

810

wc1

510

wc2

210

wc2

910

wc0

511

wc1

211

wc1

911

wc2

611

wc0

312

wc1

012

wc1

712

wc2

412

wc3

112

wc0

701

wc1

401

wc2

101

wc0

801

wc0

402

wc1

102

wc1

802

wc2

502

wc0

403

wc1

103

wc1

803

wc2

503

wc0

104

wc0

804

wc1

504

wc2

204

wc2

904

Review current Contract Schedules & determine notice period TR

Issue a contract variation for withdrawal of provision of basic chairs TR

Establish a figure for withdrawal from contract LM

Service Specifications JHG/KW/HJ

Write local specification

Develop pathways

Develop KPIs

Develop competancies

Develop referral form

Draft specifications complete

Final specification signed off

Develop Ideal price JHG/KW/HJ

Define wheelchair types

Define ideal price for each wheelchair type

Define extras

Understand current activity

Define assessment

Define ideal price for assessment

Consult on service specification

Circulate to CCG's for comments

Circulate to Wheelchair group for Comment

Communication plan to stakeholders

Develop and execute PIN to gage interest TR

Plan a provider engagement event LD

Prepare a paper for Operations Group re new proposals HJ

Framework procurement process undertaken

Prepare advert for OJEU TR

Advert on OJEU TR

Expressions of Interest received (52 days) TR

Evaluation process starts JHG/KW

Summary for approvals committee Ops Group

CCGs approval, Award contract or rejection letters sent TR

Standstill period

Final sign of by Governing Body Gov Body

Commencement of serrvice

Work together with providers to ensure readiness for commencement of service

Education event for referrers LD

Launch Service

ResourcesList Project Team membersProject Lead - Jane Hayes Green (JHG)

July January February MarchAugust October December April

CH

RIS

TM

AS

HO

LID

AY

PE

RIO

D

NovemberSeptember

Project Manager - Helen Jones (HJ)West Cheshire Lead - Kim Witkiss (KW)Finance Lead - Andrea Wood (AW)Provider Finance Lead - SteveWilson (SW)Contracts Lead - Anna Roberts (AR)Information Lead - Richard Disley Jones(RDJ)Childrens Lead - Rose Curtis (RC)Communications LeadWirral - Lin Danher (LD) Communications LeadWest Cheshire-Anne Marie Storey (AMS)PPI Lead - Andy Mills (AM)PPI Lead - Sally Pritchard (SP)Provider Lead - Karen Milnes (KM)Clinical Lead- Jane Sledge (JS)Service User representative -TBC(SU)Social Servics Lead- Rick O'Brien (ROB)Social Services Clinical Lead- Chris Smith (CS)Joint Commissioning Lead- Peter Wong (PW)

Project PlanGANTT Chart

Gantt Chart for AQP Project

Draft AQP Wheelchair Service Project Plan Ver 1

Key Activities

wc1

20

3

wc1

90

3

wc2

60

3

wc0

20

4

wc0

90

4

wc1

60

4

wc2

30

4

wc

30

04

wc0

70

5

wc1

40

5

wc2

10

5

wc2

80

5

wc0

40

6

wc1

10

6

wc1

80

6

wc2

50

6

Review current wheelchair service

Review current Contract Schedules & exit strategies AR/KW

Review national specifications and amend for local need

Produce local specifications

Clarify scope of service

Develop KPIs

Specifications complete

Public & patient involvement SP/AM/Wirral CCG's

Define level of involvement required

Plan meetings/events

Carry out meetings/events

Communication plan to stakeholders AM/AMS

Develop plan

Implement plan

Develop currency & tariffs

Define wheelchair packages

Understand current activity & costs

Develop local tariff

ResourcesList Project Team members

JHG/KW

JuneResponsible

March April May

WIRRAL CCG

ALCOHOL SERVICE DEVELOPMENTS TO SUPPORT LONG TERM RECOVERY




Lead Officer: Christine Campbell, WGPCC Chief Officer (Acting)

Contributors: Pauline Bolt, Commissioning Support Manager – WHCC Paul McGovern, Commissioning Support Manager – WGPCC Ian Shaw, Joint Commissioning Manager – Wirral DAAT


Governance:


Summary: This paper presents a series of proposals to support the long term recovery of patients that have been identified with alcohol-related health and social care issues. The four proposals are as follows:

a. Intensive targeted support for Identified Frequent Attenders

b. Substance misuse treatment fund c. GP incentive scheme d. Shared Care Nursing Support The funding requested is to be allocated on a non-recurrent basis to support these schemes until the end of March 2013; however, it is the intention to monitor and evaluate each scheme against intended outcomes with a view to continued investment beyond this point, depending upon resource availability moving forward. The principal aims of these proposals are:

o Reduction in A&E attendance & hospital admission o Criminal Offence reductions o Reduced Anti- Social behaviour o Reduced Alcohol-fuelled violence o Action on homelessness o Patients Drug and Alcohol free 6-12 months post treatment

To Approve x

To Note

Recommendation:

Comments

Next Steps: Following approval of the principles of these schemes and the associated resource

Alcohol Service Developments to support long-term recovery: Wirral CCG Governing Body 7 August 2012

1/3


2/3

implications, the Consortium managers will work with the Joint Commissioning Manager for Drug and Alcohol Services to develop these proposals more fully and to implement these.



Financial

The total potential resource implication is: £549,013

Value For Money The clients that will potentially benefit from these proposals represent a significant pressure on all areas of the healthcare system, principally through A&E attendances and emergency admissions. Through supporting these patients in the community, and promoting structured care, and ultimately self-management, it is anticipated that the level of reliance upon healthcare services, and the concomitant resource implication, will significantly reduce.

Risk If the proposals are not supported there is the risk that the activity and resource pressure for emergency admissions and A&E attendances will continue to increase, and that these patients’ overall health will deteriorate.

Legal N / a

Workforce It will be made clear to the providers involved that any staff taken on to support the implementation of these proposals will be done so at the providers’ own risk, and that no further resources will be paid above and beyond those committed through this paper.


N / a


The providers involved will be required to involve the clients in care planning at all stages of the pathways proposed within this paper.

Partnership Working

These proposals have been developed in partnership between the CCG, CWP and Public Health in order to ensure a system-wide approach.


Robust criteria for measuring performance against intended outcomes will be developed prior to implementation of each of the proposals, and will be used to determine future commissioning requirements.




3/3




Alcohol Service Developments to support long-term recovery

N / a CCG Operational Team meeting

31 July 2012

Approval subject to minor amendments – for Governing Body approval


Agenda Item: 031.5 Ref: GB 12-13/031

Alcohol service developments to support long term recovery: 1/6


Alcohol service developments to support long term recovery Background 1. The Wirral CCG Divisions and Wirral Drug and Alcohol Team have been working

together in a variety of projects and have identified the need to pro-actively increase support to enhance rehabilitation and recovery pathways for patients with both severe and recurrent alcohol problems.

2. Considerable resources and services are already in place supporting high end users

through detoxification and rehabilitation. However, it has been identified that there are potential gaps in current pathways when patients leave treatment, have no ongoing management plan, and have to take responsibility for their own personal recovery.

3. This inevitably creates a risk of relapse and consequently potential return of future

presentations and admissions through the Emergency Department and other services. This paper examines a series of possible developments to address gaps in services. It should be noted that the resource implications outlined within this paper are on the basis of these schemes being approved on a non-recurrent basis, until 31 March 2013. However, each proposal will reviewed in line with future funding availability to determine possible extension beyond the pilot period.

Terminology 4. This paper is aimed at patients predominately with alcohol related problems; however

there is a clear recognition for some patients combined problems of drug and substance misuse with alcohol consumption is an issue and the term Alcohol and Substance Misuse is intended to reflect this fact.

Introduction 5. Due to current potential resource availability there are four possible areas where

investment could potentially be targeted across the spectrum towards recovery from alcohol and substance misuse. The following opportunities will be put forward for consideration in this paper.

a. Intensive targeted support for Identified Frequent Attenders b. Substance misuse treatment fund c. GP incentive scheme d. Shared Care Nursing Support

Proposals Intensive targeted support for Identified Frequent Attenders 6. A Multi-Disciplinary Team meets on a monthly basis to provide a case management

approach to patients that have been identified as ‘frequent attenders’ to the Emergency Department. These patients often lead extremely chaotic lives and have multiple health and social care issues that contribute to their reliance upon the




healthcare system. A significant number of the cases identified for discussion at these meetings require intensive support to overcome substance misuse problems.

7. This client group requires immediate and unrestricted access to detoxification and

rehabilitation in order to reduce their level of risk to themselves, their health and to those around them as quickly as possible. The current pathway to these services has set access criteria including a level of motivation and commitment, which would not be appropriate for this very chaotic client group.

8. Through discussion with the Wirral Drug and Alcohol Action Team, it is proposed that

an alternative pathway for this client group is developed, which will facilitate rapid access to detoxification and rehabilitation facilities for the most chaotic client group. Access to this additional pathway would be strictly for those clients discussed by the MDT meeting.

9. The cost of detoxification is determined by the level of supervision and medical

intervention required, ranging from £900 to £3,500 per two-week period. 10. Should a full period of residential rehabilitation be required, a programme of up to 9

months costs £15,000 per individual. 11. Based on this investment the following potential outcomes are expected:

o Reduction in A&E attendance and hospital admission o Criminal Offence reductions o Reduced Anti-Social behaviour o Reduced Alcohol-fuelled violence o Action on homelessness o Patients Drug and Alcohol free 6-12 months post treatment

12. Potential investment requirement

Based on the case mix through the MDT meeting so far, it is anticipated that 10 individuals would benefit from this kind of intervention; however, it is not possible to predict the level of interventions that would be required for each. It is therefore proposed that a total potential fund of £75,000 is ring-fenced to support this, which would be purely for the spot-purchase of beds and programmes as outlined above.

Substance Misuse Treatment Fund 13. The resource outlined in section 6 is specifically for those patients with the highest

level of need. In addition to this, there are patients outside of those identified at the MDT meetings that require detoxification and rehabilitation. These beds and programmes are currently commissioned through the Wirral Drug and Alcohol Team, through a combination of block contract and spot-purchasing.

14. Patients that have been drinking at hazardous and harmful levels for sustained

periods can suddenly lose control of their drinking and be on the brink of crisis. As this group may not be well known to Alcohol Services or have any previous recorded history of problem drinking, they may not necessarily be offered treatment as a priority case. As practices are incentivised to become more engaged with the treatment of patients with substance misuse issues, it is likely that there will be more ‘new’ patients with alcohol difficulties identified, and consequently an increasing demand for detoxification.




15. In addition, there are also patients that have previously been through rehabilitation

but who relapse or struggle whilst in recovery stage: access to a fast-track option would be beneficial to prevent any escalating crisis.

16. The costs to spot purchase detoxification beds for two week periods depending on

the patient’s physical condition are:

o Medically supported detoxification beds £3500 o General detoxification beds £900

17. It is intended that a similar arrangement is established to that currently in place for the

WGPCC Social Care Fund: a fund is ring-fenced for the specific purpose of spot-purchasing detoxification beds for the client group outlined above. Access criteria would need to be determined, along with a process for applying for, approving, and arranging access to the beds. The CCG will be responsible for putting this process in place and arranging associated management / administrative support.

Potential investment requirement 18. By investing a total of £200,000, the CCG could commission 28 additional medically

supported beds, and 110 general beds (both for a two-week period). This resource would only be used as and when the beds are required, and no upfront investment or commitment would be necessary.

Wirral Shared Care Team 19. Shared care for drug misuse is well established in Wirral and all Wirral Practices now

actively participate in the shared care scheme. Feedback from local GPs suggests they would like to see the Shared Care Scheme extended to include alcohol; to this end, Wirral CWP Alcohol Service is in the process of developing a shared care alcohol service that will provide a designated alcohol treatment practitioner to every GP Practice. This will be delivered through the use of a Shared Care joint working protocol (JWP).

20. To date 12 practices have signed up to the JWP and 9 alcohol treatment practitioners

(ATPs) and one Clinical Co-ordinator are in post. Each ATP carries a caseload of 40 clients at any one time and carries out assessment of new clients entering treatment. Working within a finite resource, the team has identified and targeted only those practices where they feel there is the greatest need (based on clients entering treatment, and GP referrals into treatment).

21. In order to provide this service to all Wirral practices, it has been calculated that a

further 4 ATPs and 2 Clinical Co-ordinators would be required. It is expected that shared care workers will be in place across all Wirral places using existing funding and resources from 1st April 2013. However, in the interim, and to facilitate the introduction of these workers, to support the Member Practices, it is proposed that short term funding (1st October 2012 – 31st March 2013) is approved to expedite the employment, training and deployment of these additional staff with the understanding that the provider will continue to support these workers from 1st April 2013.

22. The Shared Care Worker role will support GP practices with the care and

management of patients presenting with symptoms of alcohol abuse, and will be the point of liaison with the MDT meetings, for those clients that have been identified as




the most chaotic. The team will be seen as the single point of contact for the practices for patients with alcohol problems, and each practice would have a named Alcohol Treatment Practitioner as a point of contact.

23. It is proposed that funding for 6 additional shared care workers for 6 months from 1st

October 2012 – 31st March 2013 is approved, to roll out the shared care programme across all Wirral practices.

Potential investment requirement

Clinical Co-ordinator (Band 6) £35,651.44 (midpoint + on costs) x2 £35,651 (6 months) Alcohol Treatment Practitioner (Band 5) £28,070.91 (midpoint + on costs) x 4 £56,142 (6 months) Non-Pay Travel £200 x 6 £1200 Phones £200 x 6 £1200 Stationary etc £60 x 6 £360 Training etc £250 x 6 £1500

Total costs £96,503

Incentive scheme for GPs 24. The developments outlined above will rely on engagement with and sign-up from the

Member Practices in order to ensure that patients are supported within the community following specific alcohol-related interventions.

25. It is therefore proposed that a Local Enhanced Service is developed that will

encourage a consistent approach to this client group within general practice, and will incentivise practices to take an active role in their management and ongoing support within the community. Whilst the full details of the scheme are still to be determined, it is proposed that requirements would be as follows:

- sign-up to the Joint Working Protocol as part of the Shared Care Model outlined

above - review of patient within fortnight of discharge from detox or rehabilitation (to be

arranged by Alcohol Treatment Practitioner (ATP), but delivered by GP) to assess ongoing health and prescribing needs. It is proposed that further reviews for these clients are undertaken on a six-monthly basis, to be guided by the recommendations of the ATP

- one practitioner per practice to undertake and complete the RCGP e-learning module in the Management of Alcohol in Primary Care (5 x 20 minute online sessions)

- commit to comply with the treatment and support recommended by the MDT meeting - read code patients appropriately

Potential investment requirement E-learning £250 per individual x 61 practices £15,250




£160 backfill x 61 practices £9760

In order to support the other requirements of this scheme, it is proposed that a further resource of £2,500 per practice is made available. The total resource implication for all 61 practices is therefore: £177,510

Timescales 26. In order to deliver any of the above proposals the following timescales are expected:

o Intensive targeted support could be put in place immediately as target group are already identified and under care plans through the Emergency Department

o Substance Misuse Treatment Fund once the resource is identified and agreed

treatment packages could be spot purchased on demand within 1 month of approval, this would also require identification of a fund co-ordinator and a panel of clinical experts to approve immediate and urgent requests.

o Incentive scheme could be finalised, agreed and launched within one month of Board

approval.

o Shared Care Team interim resource in place from 1st October 2012. Total Resource Requirement 27. In order to support the proposals outline above, the total potential resource required

would be as follows:

a. Intensive targeted support for Identified Frequent Attenders £75,000

b. Substance misuse treatment fund £200,000 c. Shared Care Model £96,503 d. Local Enhanced Service £177,510 Total £549,013 This resource would be funded from the CCG non-recurrent investment fund

Recommendation 28. The Board is asked to:

- Support the proposals outlined above - Authorise the development and agreement of an Alcohol Local Enhanced Service,

based upon the principles outlined within this paper - Approve a total potential investment of £549,013 to support the proposals outlined

within this paper Paul McGovern Pauline Bolt Commissioning Support Manager Commissioning Support Manager Ian Shaw Christine Campbell



Alcohol service developments to support long term recovery: Governing Body Meeting 7th August 2012

6/6

Joint Commissioning Manager, Wirral DAAT Acting Chief Officer (WGPCC) July 2012

NHS Wirral Clinical Commissioning Group Authorisation Plan







N/A

Governance:


Authorisation of Clinical Commissioning Group for 2013/14 financial year

Summary: Project Plan relating to authorisation of CCG with relevant task milestones for completion and submission of evidence.

To Approve

To Note

Recommendation:

Comments

Next Steps: Continued monitoring of progress towards authorisation in line with suggested milestones for completion

Authorisation Plan Governing Body Meeting 7th August 2012

1/3


2/3



Financial

N/A

Value For Money N/A

Risk Authorisation not achieved within required timescales

Legal N/A

Workforce N/A


N/A


Engagement with patients / public key to authorisation process

Partnership Working

Engagement with stakeholders / Member practices key to authorisation process


Milestone markers and RAG rating within GANNT chart








3/3


Key Tasks

13.8

.12

20.8

.12

27.8

.12

3.9.

12

10.9

.12

17.9

.12

24.9

.12

360 Stakeholder SurveySubmit stakeholder listConfirm stakeholdersSurvey periodreports submitted for comments

Application processDeclarations of complianceupload evidencechecking of evidenceSubmit evidence

Site visitMock panel CWW clusterVisit (TBC)

Outcomedecision returned to CCG

1.10

.12

8.10

.12

15.1

0.12

22.1

0.12

29.1

0.12

5.11

.12

12.1

1.12

19.1

1.12

26.1

1.12

3.12

.12

10.1

2.12

17.1

2.12

24.1

2.12

31.1

2.12

7.1.

13

14.1

.13

21.1

.13

28.1

.13

4.2.

10

Gantt Chart for Authorisation Process

Draft Authorisation Project Plan Version 2 Key Activities

wc0

406

wc1

106

wc1

806

wc2

506

wc

0207

wc0

907

wc1

607

wc2

307

cw30

07

wc0

608

wc1

308

wc2

008

wc2

708

wc0

309

wc1

008

wc1

709

wc2

409

wc0

110

wc0

810

wc1

510

wc2

210

wc2

910

wc0

511

wc1

211

wc1

911

wc2

611

wc0

312

wc1

012

wc1

712

wc2

412

wc3

112

wc0

701

wc1

401

wc2

101

wc2

801

Website Developed LQ Critical

Publication policy developed and agreed LQ/GB Critical

Development/ Adoption of policies GB Less Significant

Declarations of Interest Policy LQ/HJ Completed

General Policies LQ/HJ Less Significant

HR policies LQ/HJ Less Significant

H&S policies LQ/HJ Less Significant

Financial Policies MB Less Significant

Publication of Policies LQ Less Significant

Hold meetings in public LQ Critical

Authorisation Application Form LQ/GB Critical

CCG Constitution GB Critical

Missions/ Values/ Aims workshop GB Critical

Diagnostic Workshop GB Critical

Assurance Framework GB Critical

Pyschometric Development GB Critical

Engagement with all practices re constitution LQ Critical

Constitution signed off by all practices GPs Critical

Approve Constitution GB Critical

Publish Constitution LQ Less Significant

Documents re Governance arrangements LQ Critical

TOR for all Boards and Committees LQ/HJ Critical

Role descriptions for all officers LQ/HJ Critical

MOU for all Consortia LQ/HJ Critical

Letter of Support for Chair of CCG Governing Body LQ/GB Less Significant

Relevant Minutes of multi-professional meetings, Gov body, & other Committees LQ Less Significant

Draft JSNA CH Less Significant

Draft Joint Health and Wellbeing Strategy HWB Less Significant

Financial Management Arrangements MB Critical

Relevant Health and Wellbeing Board minutes LQ Less Significant

List of Joint Commissioning draft agreements/plans LQ Less Significant

Organisational Development Plan LQ/MC Critical

SLA with assured CSS PE Less Significant

List of 2012/13 contracts agreed and signed off GB Completed

2012/13 integrated plan and draft commissioning intentions for 2013/14 GB Less Significant

360˚ stakeholder survey report and CCG comment NCB Less Significant

Provide participants contact details (approx 8 wks before authorisation) NCB Less Significant

Survey sent out NCB Less Significant

Survey results received for comments NCB Less Significant

Submit survey results GB Less Significant

Intergrated risk management framework, inc clinical, financial and corporate LQ Critical

Communications and Engagement strategy LQ/HJ Less Significant

Equality and diversity strategy GMW Less Significant

Case studies Consortia Critical

Example of CCG delivering measurable improvements in quality & productivity AC/CC/IS Critical

Example of member practice involvement in decision making AC/CC/IS Critical

Examples of CCG engaging different groups and communities AC/CC/IS Critical

Examples of CCG taking devolved responsibility for commissioning budgets/del imp AC/CC/IS Critical

Examples of CCG involvement in 2012/13 contracting round AC/CC/IS Critical

Example illustrating CCG innovation AC/CC/IS Critical

Example of approach and progress made in at least 1 area of care (stat responsible) AC/CC/IS Critical

Example of CCG collaboration with another CCG and a MDT range of clinicians AC/CC/IS Critical

Example to illustrate leadership development AC/CC/IS Critical

Example of where CCG has enhanced clinical invlovement in service redesign and imp. AC/CC/IS Critical

Authorisation submitted to NHSCB LQ Less Significant

January

Responsible

August October DecemberNovemberSeptemberJune July

3

60

De

gre

e a

sse

ssm

en

t

A

uth

ori

satio

n a

sse

ssm

en

t b

eg

ins

Priority

Authoristation assessment process NCB Less Significant

Authorisation decision returned to CCG NCB Less Significant

Resources KeyContributors

RatingAndrew Cooper (AC)Andy Mills (AM)Chris Harwood (CH)Christine Campbell (CC) Priority

Geraldine Murphy-Walkden (GMW)General Practitioners (GPs)Governing Body (GB)Health and Wekkbeing Board( HWB)Helen Jones (HJ)Iain Stewart( IS)Lorna Quigley (LQ)Mark Bakewell (MB)Michelle Chadwick (MC)National Commissioning Board (NCB)Paul Edwards (PE)

Less Significant for completion of the project within timescale

Severe risk to achievement, action plan required

Risks to acheivement of activity by due date

On Target to Achieve activity by due date

Critical to completion of the project within timescale

R A G

Less Significant

Completed

NHS Wirral – Financial Position Month 3




Lead Officer: Mark Bakewell – Interim Chief Financial Officer

Contributors:


Sound financial control is essential to the CCG strategy and is directly linked to the delivery of the CCG Commissioning and Operational Plan for the financial year.

Governance:


To achieve financial control total with sound financial management.

Summary: This report updates the CCG on financial position as at the end of June (M3) within the 2012-13 financial year

To Approve

To Note

Recommendation:

Comments

Next Steps: Continued monitoring of financial position throughout the financial year

Financial Position Month 3 Governing Body Meeting 7th August 2012

1/3


2/3



Financial

The report identifies the relevant financial position of the CCG as at the end of June within the 2012/13 financial year

Value For Money All expenditure plans are subject to an ongoing value for money review

Risk Keys risks identified with regards to financial performance of CCG

Legal Legal advice is sought on financial issues as and when required.

Workforce N/a


Financial Plans will consider as appropriate the equality impact assessment for proposals within the budgeted expenditure


Budgets include funding to ensure continued involvement of patients and public in CCG decisions.

Partnership Working

The CCG works with a number of NHS Trusts and the Local Authority within a number of its commissioning budgets.


The plan reflects the planned achievement of statutory financial duties within the overall PCT position






3/3


M3 Finance Report

Quality, Performance and

Finance

24th July 2012

Noted with appropriate Risks



CCG Finance Report – for the period 1st April 2012 to 30th June 2012 Page: 1/5 Governing Body Meeting 7th August 2012

NHS Wirral Clinical Commissioning Group

Finance Report for the period 1st April 2012 to 30th June 2012 Introduction

1. This report sets out the financial position for NHS Wirral Clinical Commissioning Group (Wirral CCG) as at the end of June (Month 3) within the 2012/13 financial year.

Resources

2. The total budget allocated to Wirral CCG for the year is £469 million from within the

overall PCT baseline of £659m. Based on the federated model approach a number of budgets have now been aligned to the newly formed Governing Body (£137m) to be managed on an economy wide basis and the remaining budgets devolved to the individual consortia (£332m). This is where practice level information is available and performance is based on actual activity (using GP Registration for individual patients).

3. As in the previous financial year the budgets are split according to “commissioning”

expenditure or “running costs” expenditure.

4. Commissioning Expenditure Budgets are split across a number of categories based on “planned” levels of expenditure in 2012/13. The table below illustrates how these budgets are assigned: Commissioning Expenditure Governing Body Consortia NHS Contracts Non NHS Contracts Prescribing Commissioned Out of Hospital Intermediate, Social Care and Reablement Other Commissioning Expenditure Reserves Running costs

5. Running Costs are split between those of the core teams (including Clinical Backfill)

which report under the individual consortia and the Commissioning Support Service (CSS) which reports under the Governing Body but within the 12/13 financial year do not reflect the SLA offer that is currently being negotiated.

Financial performance

6. As at the end of June (Month 3) the year to date position for Wirral CCG is an over spend of £686k with over performance against commissioning expenditure of £830k offset by an under performance against running costs of £144k

7. The variance position between Governing Body and the individual consortia is an overspend at a this level of £1.54m with the governing body underspent by £854k (partly due to the release of contingency reserve to offset over performance in areas described below)


CCG Finance Report – for the period 1st April 2012 to 30th June 2012 Page:2/5 Governing Body Meeting 7th August 2012

8. A year to date overall Financial Summary for Wirral CCG is available in Appendix 1

YTD variance Combined Consortia£ 000

Governing Body £ 000

Total Wirral CCG £000

Commissioning Expenditure 1,679 (849) 830

Running costs (139) (6) (144)

TOTAL 1,541 (854) 686

9. Appendix 2 shows the Divisonal Financial Summary including a summary for each of the consortia. Consortia Budgets Commissioning

£000 Running Costs

£ 000 Total £ 000

WGPCC 289 (75) 214 WHCC 1,451 (48) 1,403 WHA (54) (16) (70) Total 1,679 (139) 1,541

10. Narrative regarding financial performance is reported on an exception basis according to

variation against planned levels of expenditure. More detailed information is included in Appendices 3 to 5.

Commissioning Expenditure



NHS Contracts

11. The overall CCG performance position in relation to NHS contracts shows an overspend at month 3 of £1,312k primarily being due to over performance on the Wirral University Teaching Hospitals NHS Foundation Trust (WUTH) contract of £1.286m

12. The year to date position is based on actual activity as at Month 2 with a pro-rata adjustment to equate to month 3 position and application of estimated contract adjustments for re-admissions / outpatient follow-up ratios as appropriate (again based on the month 2 activity position)

13. Month 3 performance information has been received and is currently being validated but early indications suggest that the variance has increased marginally (circa £100k) from the Month 2 position. Further analysis will be updated once validation process has been completed and work with consortia is underway to understand any attributing factors.

14. Due to the relatively early position in the financial year it is difficult to forecast any trend at this point. This will need to be closely monitored over the coming months alongside other performance information including referral information , conversion rates, RTT targets etc

15. Performance at Governing Body on other contracts is slightly underspent (£25k) with

overspends on the Liverpool Womens and Christie contracts off set by underperformance on the Clatterbridge Cancer Centre (CCC) and Aintree contracts.

Non-NHS Contracts

16. At month 3 Non NHS Contracts are over spent by £384k. The over performance is primarily due to Independent Sector reserve (167k) for the backlog of patients on the 18 week waiting list transferring to Spire.

17. Over performance against planned levels of activity also exist against the “Spire” contract for patient choice referrals (non RTT Backlog patients), Independent Midwifery (One 2 One Provider) and Spa Medica, which are all included at divisional level reporting.

Prescribing

18. Prescribing is showing a year to date underspend of £47k however this is based on one month’s actual data for April with two months forecast costs for May and June and further information is therefore required to make an accurate assessment of planned levels of expenditure

Commissioned Out of Hospital

19. Commissioned Out of Hospital is £193k overspent at month 3. The main drivers for the over performance exist under the Continuing Healthcare section with Older People (£68k) and Learning Disabilities (£26k), Joint Funded packages £83k and Childrens packages being offset by underperformance on Funded Registered Nursing Care (FRNC) and other packages of care

Running Costs

20. There is an underspend of £144k in relation to running costs at month 3 but requires further review with the individual consortia leads to ensure all approved expenditure is being captured within the reporting position.



Reserves

21. Reserves are underspent by £902k at Month 3 which is due to the release of the contingency element on a year to date basis to offset areas of over performance as described earlier within the performance briefing.

22. Detailed plans are still required against a number of areas of planned expenditure that are still being held in reserve until approval through the various CCG committees.

Forecast Outturn

23. Due to the relatively early position in the year and limited amounts of performance monitoring data for the financial year it remains difficult to accurately forecast the year end position however due to the contingency fund available and anticipated slippage on a number development schemes it is anticipated that the CCG will “break-even” against its planned expenditure for the 2012/13 financial year

Financial Risk

24. The CCG’s Financial Plans for 2012/13 were approved on 8th May 2012 at the Governing Body meeting and identified the main areas for financial risk. These risks are summarised below:

Issue Potential Risk

Value Degree of

Forecast Risk Packages of Care

Continued increase in number of cases Change to Guidance

£1.0 million ● Performance on Secondary Care Contracts

Strategic Plan Initiatives fail to impact on increasing demand for secondary care services

CCG demand management initiatives do not impact on referrals as planned

Failure to achieve Better Care Better Value reductions

£3.0 million ● Prescribing

Uplift insufficient to meet increasing demand Impact of national changes to prices NICE guidance Failure to achieve BCBV reductions

£1.2 million (2%) ●

Cost Efficiencies Planned savings do not come to fruition (cash

releasing) £6.2 million ●

25. These risks remain relevant and require review once further information becomes

available regarding performance against planned levels of expenditure



Conclusion

26. The Executive Board is asked to note:

the financial position as at the end of June 2012 the requirement for the CCG to develop, agree and implement spending plans as

soon as possible where not already approved the potential risks identified for 2012/13 financial performance

Mark Bakewell Interim Chief Financial Officer NHS Wirral Clinical Commissioning Group 27th July 2012

Month 3 Annual Budget Budget To Date Spend To Date Variance

£'000 £'000 £'000 £'000

Clinical Commissioning Groups(CCG)

NHS Contracts 327,663 81,098 82,410 1,312

Non‐NHS Contracts 12,025 2,995 3,380 384

Prescribing 60,125 14,309 14,262 (47)

Commissioned Out of Hospital 29,743 7,375 7,568 193

Intermediate, Social Care & Reablement 9,011 2,137 2,078 (60)

Other Commissioning Expenditure 10,088 1,177 1,128 (49)

Reserves 10,388 1,447 545 (902)

Cost Improvement Programme 0 0 0 0

Total CCG Commissioning Expenditure 459,042 110,539 111,370 831

Running Costs 9,877 2,464 2,319 (144)

Overall CCG 468,920 113,003 113,689 686


£'000 £'000 £'000 £'000


NHS Contracts 65,825 16,345 16,320 (25)

Non‐NHS Contracts 3,816 954 969 15

Prescribing 9,843 2,342 2,295 (47)

Commissioned Out of Hospital 29,743 7,375 7,568 193

Intermediate, Social Care & Reablement 9,011 2,137 2,078 (60)

Other Commissioning Expenditure 88 22 0 (22)

Reserves 10,388 1,447 545 (902)


Total CCG Commissioning Expenditure 128,713 30,623 29,774 (849)

Running Costs 8,103 2,020 2,014 (6)

Total Governing Body CCG 136,817 32,643 31,788 (854)


£'000 £'000 £'000 £'000


NHS Contracts 261,837 64,753 66,090 1,337

Non‐NHS Contracts 8,210 2,041 2,411 369

Prescribing 50,282 11,967 11,967 0

Commissioned Out of Hospital 0 0 0 0

Intermediate, Social Care & Reablement 0 0 0 0

Other Commissioning Expenditure 10,000 1,155 1,128 (27)

Reserves 0 0 0 0


Total CCG Commissioning Expenditure 330,329 79,916 81,596 1,679

Running Costs 1,774 444 305 (139)

Total Division CCG 332,103 80,360 81,901 1,541

Divisional Financial Summary ‐ 2012/13


Financial Summary ‐ 2012/13


Governing Body Financial Summary ‐ 2012/13


CCG Summary ‐ App 3

GP Commissioning Consortia ‐ 2012/13 Budgets

Performance Monitoring

Month 3 Annual Budget Budget to Date Spend to Date

Variance ‐ Over /

(Under)

Commissioning Expenditure £000 £000 £000 £000

a) NHS Contracts 327,663 81,098 82,410 1,312

Wirral University Teaching Hospital NHS Foundation Trust 208,537 51,497 52,783 1,286

Wirral Community NHS Trust 43,916 10,847 10,847 0

Cheshire and Wirral Partnership NHS Foundation Trust 32,624 8,143 8,141 (2)

North West Ambulance Service NHS Trust 10,558 2,609 2,609 0

Clatterbridge Centre of Oncology NHS Foundation Trust 8,919 2,205 2,182 (22)

Royal Liverpool & Broadgreen University Hospital 7,434 1,836 1,834 (2)

Aintree Hospital NHS Fundation Trust 3,085 761 745 (16)

NonContracted Activity 2,195 549 526 (22)

Countess of Chester NHS Foundation Trust 2,299 568 597 29

Liverpool Womens NHS Foundation Trust 2,102 519 541 22

WARRINGTON & HALTON HOSPITALS NHS FT 119 29 49 19

St Helen'S & Knowsley 706 174 182 7

Sth Manchester NHS FT 207 51 46 (6)

Liverpool PCT 21 5 4 (1)

Wrightington, Wigan&Leigh FT 191 47 55 8

Christie Hospital NHS Foundation Trust 153 38 47 10

Central Manchester Uni NHS Foundation Trust 328 81 65 (16)

ISTC ‐ Diagnostics 238 59 58 (1)

Merseycare 48 12 12 0

PCMH 1,682 493 512 19

Other (CQUIN, IM&T, Advancing Quality etc) 2,300 575 575 0

b) Non‐ NHS Contracts 12,025 2,995 3,380 384

Specialist Care (Health Treatment Panel) 2,046 511 525 14

Independent Sector 3,898 965 1,286 321

St Johns Hospice 1,665 416 415 (1)

Royal NI Deaf 25 6 8 2

PCMH 1,591 398 406 9

Independent Midwifery 918 230 297 68

Assura‐ Ophthalmology 208 52 52 0

Other Contracts (E.g Hoylake Cottage, Claire House etc) 1,675 417 389 (28)

c) Prescribing 60,125 14,309 14,262 (47)

Prescribing 50,282 11,967 11,967 0

Other Prescribing 9,843 2,342 2,295 (47)

d) Commissioned Out Of Hospital 29,743 7,375 7,568 193

Continuing Healthcare 12,693 3,173 3,310 137

Joint Funding Packages of Care 7,909 1,977 2,061 83

FRNC ‐ Funded Registered Nursing Care 5,077 1,266 1,238 (28)

Childrens 1,486 372 404 32

Other Packages (E.g CITC / Joint Finance etc) 2,577 587 555 (32)

e) Intermediate, Social Care & Reablement 9,011 2,137 2,078 (60)

Grove House 700 175 175 0

Intermediate Care 407 102 102 0

Winter Planning 2,118 414 412 (2)

Total Care Team Transfer 250 62 63 0

HART 650 162 163 0

Integrated Care at Home 99 25 0 (25)

Support for Carers 90 22 22 0

Social Care Development 4,697 1,174 1,141 (33)

f) Other Commissioning Expenditure 10,088 1,177 1,128 (49)

Consortia Commissioning Fund 965 80 40 (39)

Service Development Budgets 1,695 384 382 (2)

Locally Commissioned Services 1,787 447 460 13

PBC Savings 5,641 267 245 (22)

Practice Transfer Consortium Adjustment 0 0 0 0

g) Reserves 10,388 1,447 545 (902)

Earmarked & Other 9,445 1,447 557 (891)

Contract Risk Reserve 943 0 (12) (12)

h) Cost Improvement Programme ‐ unallocated 0 0 0 0

Total Commissioning Budget 11/12 459,042 110,539 111,370 831

Total Running Cost Budget 11/12 9,877 2,464 2,319 (144)

Grand Total 468,920 113,003 113,689 686

100.00%

Total Wirral CCG

31/07/2012 19:03Month 3 Finance Paper.xls

GB Summary ‐ App 4




Variance ‐ Over /

(Under)


a) NHS Contracts 65,825 16,345 16,320 (25)

Cheshire and Wirral Partnership NHS Foundation Trust 32,624 8,143 8,141 (2)

North West Ambulance Service NHS Trust 10,558 2,609 2,609 0

Clatterbridge Centre of Oncology NHS Foundation Trust 8,919 2,205 2,182 (22)

Royal Liverpool & Broadgreen University Hospita 7,434 1,836 1,834 (2)

Aintree Hospital NHS Fundation Trust 3,085 761 745 (16)

NonContracted Activity 197 49 27 (22)

Liverpool Womens NHS Foundation Trust 2,102 519 541 22

St Helen'S & Knowsley 706 174 182 7

Christie Hospital NHS Foundation Trust 153 38 47 10

Merseycare 48 12 12 0

b) Non‐ NHS Contracts 3,816 954 969 15

Specialist Care (Health Treatment Panel) 2,046 511 525 14

Independent Sector 80 20 20 0

St Johns Hospice 1,665 416 415 (1)

Royal NI Deaf 25 6 8 2

c) Prescribing 9,843 2,342 2,295 (47)

d) Commissioned Out Of Hospital 29,743 7,375 7,568 193

Continuing Healthcare 12,693 3,173 3,310 137

Joint Funding Packages of Care 7,909 1,977 2,061 83

FRNC ‐ Funded Registered Nursing Care 5,077 1,266 1,238 (28)

Childrens 1,486 372 404 32

Other Packages (E.g CITC / Joint Finance etc) 2,577 587 555 (32)

e) Intermediate, Social Care & Reablement 9,011 2,137 2,078 (60)

Grove House 700 175 175 0

Intermediate Care 407 102 102 0

Winter Planning 2,118 414 412 (2)

Total Care Team Transfer 250 62 63 0

HART 650 162 163 0

Integrated Care at Home 99 25 0 (25)

Support for Carers 90 22 22 0

Social Care Development 4,697 1,174 1,141 (33)

f) Other Commissioning Expenditure 88 22 0 (22)

Safeguarding Nurse 88 22 0 (22)

g) Reserves 10,388 1,447 545 (902)

Earmarked & Other 9,445 1,447 557 (891)

Contract Risk Reserve 943 0 (12) (12)


Total Commissioning Budget 11/12 128,713 30,623 29,774 (849)

Running Costs

Total Running Cost Budget 11/12 8,103 2,020 2,014 (6)

Grand Total 136,817 32,643 31,788 (854)

100.00%

Total Governing Body


Div Summary ‐ App 5




Variance ‐ Over /

(Under)


a) NHS Contracts 261,837 64,753 66,090 1,337

Wirral University Teaching Hospital NHS Foundation Trust 208,537 51,497 52,783 1,286

Wirral Community NHS Trust 43,916 10,847 10,847 0

NonContracted Activity 1,998 499 499 0

Countess of Chester NHS Foundation Trust 2,299 568 597 29

WARRINGTON & HALTON HOSPITALS NHS FT 119 29 49 19

Sth Manchester NHS FT 207 51 46 (6)

Liverpool PCT 21 5 4 (1)

Wrightington, Wigan&Leigh FT 191 47 55 8

Central Manchester Uni NHS Foundation Trust 328 81 65 (16)

ISTC ‐ Diagnostics 238 59 58 (1)

PCMH 1,682 493 512 19

Other (CQUIN, IM&T, Advancing Quality etc) 2,300 575 575 0

b) Non‐ NHS Contracts 8,210 2,041 2,411 369

IS Reserve 11 3 170 167

ISTC 2 1 0 (0)

ISTC ‐ E06 0 0 0 0

ISTC ‐ Gc5W 0 0 0 0

ISTC ‐ Cataracts 505 126 191 65

ISTC ‐ Management Costs

Extended Choice Network 96 24 39 15

Spire ‐ Standard Acute Contract 3,204 791 865 74

Independent Sector 3,818 945 1,266 321

PCMH 1,591 398 406 9

Independent Midwifery 918 230 297 68

Assura‐ Ophthalmology 208 52 52 0

Other Contracts (E.g Hoylake Cottage, Claire House etc) 1,675 417 389 (28)

c) Prescribing 50,282 11,967 11,967 0

Prescribing 50,282 11,967 11,967 0

Other Prescribing 0 0 0 0

d) Commissioned Out Of Hospital 0 0 0 0

e) Intermediate, Social Care & Reablement 0 0 0 0

f) Other Commissioning Expenditure 10,000 1,155 1,128 (27)

Consortia Commissioning Fund 965 80 40 (39)

Service Development Budgets 1,695 384 382 (2)

Locally Commissioned Services 1,787 447 460 13

PBC Savings 5,553 245 245 0

Practice Transfer Consortium Adjustment 0 0 0 0

g) Reserves 0 0 0 0


Total Commissioning Budget 11/12 330,329 79,916 81,596 1,679

Running Costs

i) Core team Costs 894 220 194 (26)

j) Clinical Backfill 880 224 111 (113)

k) PBC LES 0 0 0 0

l) Commissioning Support Offer

Total Running Cost Budget 11/12 1,774 444 305 (139)

Grand Total 332,103 80,360 81,901 1,541

100.00%

Total Divisional Consortia


2012/13 BudgetsPerformance Monitoring

Month 3

Annual Budget Budget to Date Spend to Date

Variance ‐ Over /

(Under) Annual Budget Budget to Date Spend to Date

Variance ‐ Over /

(Under) Annual Budget Budget to Date Spend to Date

Variance ‐ Over /

(Under)

Commissioning Expenditure £ £ £

a) NHS Contracts 126,134,274 31,233,536 32,584,164 1,350,627 104,038,937 25,698,305 25,742,759 44,455 31,593,364 7,803,770 7,752,889 (50,880)

Wirral University Teaching Hospital NHS Foundation Trust 99,759,417 24,634,979 25,934,844 1,299,866 83,396,354 20,594,220 20,683,380 89,160 25,324,858 6,253,819 6,157,228 (96,591)

Wirral Community NHS Trust 21,008,327 5,189,022 5,189,025 4 17,562,431 4,337,891 4,337,894 3 5,333,160 1,317,282 1,317,283 1

NCA ‐ RJAH Orthopaedic & Dist H 41,219 10,304 10,305 0 34,458 8,614 8,614 0 10,464 2,616 2,616 0

NCA ‐ BCU East 42,812 10,702 10,703 1 35,790 8,946 8,948 1 10,868 2,717 2,717 0

NCA ‐ BCU Central 57,619 14,404 14,405 0 48,168 12,042 12,042 0 14,627 3,657 3,657 0

NCA ‐ BCU West 42,888 10,722 10,722 0 35,853 8,963 8,963 0 10,887 2,722 2,722 0

NCAs 671,320 167,830 167,830 0 561,207 140,301 140,301 0 170,421 42,605 42,605 0

NCA ‐ Uni Hsp Birmingham NHS FT 25,798 6,449 6,449 0 21,567 5,392 5,392 0 6,549 1,637 1,637 0

NCA ‐ Oxford Radcliffe Hsp NHS T 6,262 1,564 1,566 1 5,235 1,308 1,309 1 1,590 397 397 0

NCA ‐ Lancashire Tchg Hsp NHS FT 12,285 3,071 3,072 0 10,270 2,567 2,568 0 3,119 780 780 0

NCA ‐ Southport & Ormskirk H 35,318 8,829 8,829 0 29,525 7,381 7,381 0 8,966 2,241 2,241 0

NCA ‐ Mid Cheshire Hosps NHS FT 20,138 5,034 5,034 0 16,835 4,209 4,209 0 5,112 1,278 1,278 0

NonContracted Activity 955,660 238,910 238,915 5 798,907 199,723 199,727 4 242,603 60,650 60,651 1Countess of Chester NHS Foundation Trust 1,099,997 271,644 324,180 52,536 919,570 227,088 162,665 (64,423) 279,245 68,959 109,643 40,684

WARRINGTON & HALTON HOSPITALS NHS FT 57,098 14,100 7,927 (6,174) 47,733 11,787 37,279 25,491 14,495 3,579 3,501 (79)

Sth Manchester NHS FT 98,995 24,446 26,272 1,826 82,758 20,436 13,928 (6,508) 25,131 6,206 5,330 (876)

Liverpool PCT 10,190 2,547 2,142 (405) 8,519 2,130 1,791 (339) 2,587 647 544 (103)

Wrightington, Wigan&Leigh FT 91,560 22,609 24,065 1,456 76,542 18,901 24,686 5,786 23,243 5,740 6,604 864

Central Manchester Uni NHS Foundation Trust 157,027 38,777 33,966 (4,811) 131,270 32,417 18,395 (14,022) 39,863 9,844 12,967 3,123

ISTC ‐ Diagnostics 113,711 28,427 15,594 (12,833) 95,059 23,764 33,066 9,302 28,866 7,216 9,311 2,095

PCMH ‐ WHCC 1,682,026 493,009 512,167 19,158 0 0 0 0 0 0 0 0

Other (CQUIN, IM&T, Advancing Quality etc) 1,100,266 275,066 275,066 0 919,794 229,948 229,948 0 279,313 69,828 69,828 0

b) Non‐ NHS Contracts 3,166,161 786,222 950,290 164,068 3,667,932 912,535 1,106,413 193,879 1,373,759 342,090 353,525 11,436

IS Reserve 5,280 1,320 81,359 80,039 4,414 1,104 68,014 66,911 1,340 335 20,654 20,319

ISTC 1,191 297 218 (79) 996 248 182 (66) 302 75 55 (20)

ISTC ‐ E06 0 0 0 0 0 0 0 0 0 0 0 0

ISTC ‐ Gc5W 0 0 0 0 0 0 0 0 0 0 0 0

ISTC ‐ Netcare SpaMedica 241,389 60,347 113,391 53,043 201,795 50,449 66,148 15,699 61,279 15,320 11,652 (3,667)

Extended Choice Network 45,926 11,481 24,897 13,416 38,393 9,598 14,169 4,571 11,659 2,915 276 (2,638)

Spire ‐ Standard Acute Contract 1,532,513 378,408 413,656 35,248 1,281,142 316,339 345,806 29,467 389,043 96,062 105,010 8,948

Independent Sector 1,826,299 451,853 633,520 181,667 1,526,740 377,738 494,319 116,581 463,623 114,707 137,648 22,941PCMH 0 0 0 0 1,021,101 255,273 263,962 8,689 570,000 142,500 142,470 (30)

Independent Midwifery 439,150 109,787 105,600 (4,187) 367,118 91,779 171,600 79,821 111,482 27,871 19,800 (8,071)

Assura‐ Ophthalmology 99,659 24,914 24,915 1 83,313 20,827 20,828 1 25,299 6,325 6,325 0

Other Contracts (E.g Hoylake Cottage, Claire House etc) 801,053 199,667 186,254 (13,413) 669,660 166,917 155,704 (11,213) 203,355 50,687 47,282 (3,405)

c) Prescribing 24,102,804 5,724,703 5,724,703 0 20,070,162 4,785,707 4,785,707 0 6,095,801 1,453,269 1,453,269 0

Prescribing 24,102,804 5,724,703 5,724,703 0 20,070,162 4,785,707 4,785,707 0 6,095,801 1,453,269 1,453,269 0

Other Prescribing 0 0 0 0 0 0 0 0 0 0 0 0

Financial Model Assumptions ‐ New Drugs Prescribing 0 0 0 0 0 0 0 0 0 0 0 0

d) Commissioned Out Of Hospital 0 0 0 0 0 0 0 0 0 0 0 0

e) Intermediate, Social Care & Reablement 0 0 0 0 0 0 0 0 0 0 0 0

f) Other Commissioning Expenditure 2,242,911 511,356 447,734 (63,622) 6,722,464 539,368 589,709 50,342 1,033,899 104,132 90,073 (14,058)

Consortia Commissioning Fund 178,886 37,231 0 (37,231) 29,887 7,470 5,618 (1,852) 756,564 34,801 34,801 0

Service Development Budgets 567,733 113,603 113,603 0 1,066,942 254,956 254,956 0 60,346 15,084 13,367 (1,717)

Locally Commissioned Services 854,762 213,688 187,297 (26,391) 714,559 178,638 230,831 52,194 216,989 54,247 41,905 (12,341)

PBC Savings 641,530 146,834 146,834 0 4,911,076 98,304 98,304 0 0 0 0 0

Practice Transfer Consortium Adjustment 0 0 0 0 0 0 0 0 0 0 0 0

Total Commissioning Budget 11/12 155,646,149 38,255,817 39,706,890 1,451,073 134,499,495 31,935,914 32,224,589 288,675 40,096,823 9,703,260 9,649,757 (53,503)

12.14%

Wirral Alliance CCG

47.84% 39.99%

Wirral Health Commissioning Consortium Wirral GP Commissioning Consortium

Running Costs

i) Core team Costs 377,656 94,407 92,769 (1,638) 379,118 91,140 66,278 (24,862) 136,762 34,182 35,061 879

j) Clinical Backfill 430,872 107,718 61,258 (46,460) 323,825 84,906 34,940 (49,966) 125,694 31,425 14,846 (16,579)

k) PBC LES 0 0 0 0 0 0 0 0 0 0 0 0

Total Running Cost Budget 11/12 808,528 202,125 154,027 (48,098) 702,943 176,046 101,218 (74,828) 262,456 65,607 49,907 (15,700)

Grand Total 156,454,677 38,457,942 39,860,917 1,402,975 135,202,438 32,111,960 32,325,807 213,847 40,359,279 9,768,867 9,699,664 (69,203)

Serious Incidents Reports

Agenda Item: 032.3 Reference: GB 12-13/032

Report to: Quality, Performance and Finance Meeting

Meeting Date: 24th July 2012


Contributors: Cheshire Warrington & Wirral – Commissioning Support


N/A

Governance:


Summary: The Quality, Performance and Finance group members are asked to note the following 10 new serious incidents relating to NHS Wirral: 2012/13527 – Reported by Clatterbridge Cancer Centre NHS Foundation Trust 2012/12350 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/12349 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/12481 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/9491 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/10822 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/14554 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/15359 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/16905 – Reported by Cheshire and Wirral Partnership NHS Foundation Trust 2012/16199 – Reported by Wirral University Teaching Hospital NHS Foundation Trust

Serious Incidents Report Governing Body Meeting 7th August 2012

1/3


2/3

To Approve

To Note X

Recommendation:

Comments

Next Steps: The Root Cause Analysis Reports and Action Plans for the incidents listed above will be received and reviewed at a future Quality, Performance and Finance group The Action Plans will be monitored until the group are satisfied that all actions have been managed appropriately and agreed that the incident can be closed.



Financial

N/A

Value For Money

Risk If an Audit committee is not approved the governing body will not fulfill their statuary obligation with regard to ensuring there is a robust governance structure within the CCG.

Legal

Workforce



The establishment of the audit committee will ensure that there is patient/public involvement in the decision making processes at the Governing body

Partnership Working

Once fully established the audit committee will demonstrate partnership working with the Non Executive advisors , Merseyside Internal Audit and member practices






3/3



Serious Incidents

QPF12-13/12/12.3

QPF 24 July 2012

To be presented at the Governing Body Board Meeting – 7th August 2012



Serious Incidents Report Page 1 of 2 Governing Body Meeting 7th August 2012

SERIOUS INCIDENTS SUMMARY REPORT 1. A Serious Incident is defined as an unexpected, untoward event in which a

person (whether a patient, staff member or visitor) suffered serious harm or could have been seriously harmed or one which is likely to give rise to serious public concern or major criticism of the service involved.

2. A Serious Incident requires a provider organisation to undertake a root cause

analysis within 45 working days of the incident occurring, develop a remedial action plan and provide on-going evidence of implementation of the action plan. This process is currently managed through the Wirral Clinical Commissioning Group Quality, Performance and Finance meeting.

SERIOUS INCIDENT SITUATION REPORT

3. Within the period of 1st April 2012 –12th July 2012 Wirral had 10 new incidents

reported on the Strategic Executive Information System (StEIS) being investigated and performance managed.

4. The table below details the serious incidents reported between 1st April 2012

–12th July 2012:

Reporting Organisation Incident Type Number Clatterbridge Cancer Care NHS Foundation Trust

Drug Incident (General) 1

TOTAL 1

Unexpected Death of Community Patient (in receipt)

3

Unexpected Death of Outpatient (in receipt)

1

Unexpected Death (general) 2

Slips / Trips / Falls 1

Cheshire and Wirral Partnership NHS Foundation Trust – Wirral

Unexpected Death of Community Patient (not in receipt)

1

TOTAL 8

Wirral University Teaching Hospital NHS Foundation Trust

Wrong Site Surgery * Never event *

1

TOTAL 1


Serious Incidents Report Page 2 of 2 Governing Body Meeting 7th August 2012

GRAND TOTAL 10

NEVER EVENTS 5. The National Patient Safety Agency has identified some incidents which are

described as Never Events. These are largely preventable events which if all the appropriate procedures are followed should not occur. The list of Never Events that are included in the 2011-2012 NHS standard contracts are:

a) Wrong site surgery b) Wrong implant/prosthesis c) Retained foreign object post-operation d) Wrongly prepared high-risk injectable medication e) Maladministration of potassium-containing solutions f) Wrong route administration of chemotherapy g) Wrong route administration of oral/enteral treatment h) Intravenous administration of epidural medication i) Maladministration of Insulin j) Overdose of midazolam during conscious sedation k) Opioid overdose of an opioid-naïve patient l) Inappropriate administration of daily oral methotrexate m) Suicide using non-collapsible rails n) Escape of a transferred prisoner o) Falls from unrestricted windows p) Entrapment in bedrails q) Transfusion of ABO-incompatible blood components r) Transplantation of ABO or HLA-incompatible Organs s) Misplaced naso- or oro-gastric tubes t) Wrong gas administered u) Failure to monitor and respond to oxygen saturation v) Air embolism w) Misidentification of patients x) Severe scalding of patients y) Maternal death due to post-partum haemorrhage after elective

Caesarean section

6. In our standard contracts with local NHS care providers there is a requirement to eliminate Never Events. There is a financial consequence for providers if they fail to comply with this requirement.

7. There was 1 Never Event reported by Wirral University Teaching Hospital

NHS Foundation Trust which was a Surgical Error, in July 2012.

Wirral Clinical Commissioning Group

Governance & Audit – Task & Finish Group Minutes of Meeting

27th June 2012

Room 509 at Old Market House Present: James Kay Chair – NEA – Vice Chair CWW PCT Cluster

Mark Bakewell Interim Chief Finance Officer - Wirral Commissioning Group

Andrew Cooper Interim Chief Officer - Wirral Health Commissioning Consortium

Lorna Quigley Interim Chief Officer- Wirral Clinical Commissioning Group

Helen Jones Project Manager– CWW Commissioning Support Services

Anne-Marie Harrop Audit Manager, Mersey Internal Audit Agency Robin Baker District Auditor – Audit Commission

In attendance: Zerina McCarthy Secretary

Governance & Audit – Task & Finish Group Minutes Page 1 of 7 Governing Body Meeting 7th August 2012

Item No. Agenda Items GA/12-13/ 1.1

Apologies Apologies had been received from Liz Temple-Murray.

GA/12-13/ 1.2

Declarations of Interest Members were invited to register any potential Conflicts of Interest, none were received.

GA/12-13/ 1.3

Minutes from the Last Meeting The Minutes of the last meeting were accepted as a true and accurate record of proceedings. Action Points 2. Membership The Chair asked as to whether the CCG were in need of their own Counter Fraud Specialist Officer or whether CCG could use the services of CSS.

The Interim Chief Finance Officer advised that CCG would potentially be looking to buy into the wider service offered by the CSS.

The Chair advised that there was a definite need for the Counter Fraud Strategy to be part of the CCG policies and procedures. This would be


taken forward as part of the organisational development process

The Project Manager from the CSS advised the group Members that the old PCT policy had been amended to reflect the changes to CCG and discussion took place that as interim measure the PCT Cluster already had in place the statutory framework for this financial year and therefore the CCG were covered until the end of March 2013.

The WHCC Chief Officer asked if this would include referral to the Bribery Act and again this would from part of organizational development process

The Interim Chief Financial Officer advised on a development of an overarching work plan over the next 6 months. The work plan will be added onto the Authorisation Plan to be reviewed and monitored. The work plan will become a ‘standing agenda’ on the Task and Finish Group.

3. Terms of Reference (TORs) The TORs have been forwarded to be included on the next Governing Body Board Meeting – Item closed 4.1 Development of CCG Assurance Framework The Interim Chief Financial Officer advised the group that long term work was in progress on the Development of the CCG Assurance Framework which included the Vision, Mission and Values. MB advised that there will be open discussions around the Vision, Mission and Values during the months of July and August. The Audit Manager advised that the PCT Cluster had been given assurance that this Group had now been formed and areas are being monitored. The WHCC Chief Officer reminded and advised the Members that the 1st

Stakeholder event was due to take place today at the Floral Pavilion, New Brighton with many of our stakeholders confirming attendance. 4.2 Accountability Arrangements On agenda


4.3 Draft Constitution Update MB & AC agree to supply a GANTT Chart/Project Plan on the authorization program for the next meeting – On agenda 4.4 Authorization Development Plan Concern was raised by the Chair as to whether there was an adequate level of human resource with the CCG in relation to the current workload. This needs to be recorded as a potential risk. Risk has been recorded – item closed 5. Working Group Action Plan and Milestones On agenda

GA/12-13/ 2.1

Proposed Work Plan

Development of CCG Assurance Framework The Interim Chief Financial Officer advised that the assurance framework was one of a number of pieces of work that were key, as part of the development programme for the CCG for the next few months and as such has been identified in the work plan once the mission /visions / values process has been completed The Chair requested that the GANTT and Risk Register charts were produced on A3 size papers for ease of reading. MB informed the group that advice and comments would be sought on the Risk Register from the Audit Manager over the next week so an amalgamation of existing registers could took place The PCT’s Appointed Auditor advised at what level should a risk is evaluated, i.e. Divisional Level or CCG Board. The Audit Manger advised that she will undertake a review of the whole process, looking at who will be responsible for each area. A document should be implemented to capture risks at Operational level. The process will be audited to give assurance to the CCG Board. Once the template is approved as a mechanism it is proposed to carry out the following actions: transfer template to Divisions migrate up to a Master template scoring risks to be incorporated into the Assurance Framework

The Audit Manager advised that until 1st April 2013 the group should link into the Cluster’s methodology. The Chair proposed setting up team building/workshop/educational sessions to advise and support those involved in the Risk Register process, informing of what


a Risk Register is and the importance of it. The PCT’s Appointed Auditor stated that it was challenging for the CCG Board Members however it was imperative that discussions took place around the Risk Identification process. The Chair reiterated the enthusiasm from the CCG Board Members in getting this right first time. Action: Further work to be undertaken. Programme in Progress around Assurance Framework, Risk Register, Risk Management Process – Standing Agenda Item GANTT Chart The Chair advised that the use of colour within the GANTT Chart could be amended to provide a more effective monitoring tool. The Chair suggested that the use of ‘milestones to achieve’ would give a much clearer indication on the progress of works and use the ‘RAG Colour rating’ in a separate column. Anything not on schedule for the agreed milestone will need to be either amber or red. Red identified a need for an action plan and Amber requiring at least some action to achieve the milestone. The PCT’s Appointed Auditor stated that it was helpful to distinguish between these categories. Further discussion then took place with regards to some of the components within the authorization process and the Interim Chief Financial Officer advised that the CCG would be looking to review a number of documents from 1st / 2nd wave applicants rather than recreate from the basic documents provided. Updates are to be provided at future meetings Action: The Interim Chief Officer and the Project Manager to review the GANTT Chart and amend as necessary. Action: Secretary to include as a standing agenda item Accountability Arrangements The Interim Chief Financial Officer informed the Members progress was being made with regards the Draft Scheme of Delegation process including the operational detail which identifies the particular cost centre management and respective budget holders. MB also advised that discussions had been taking place with CSS to decide as to what potential processes could be delegated to them as part of the delegation process to make this a viable operational process.


The Chair asked MB as to how CSS would be monitored to ensure that what they are providing to CCG is not being shared elsewhere. MB advised that this was part of the ongoing discussions that are taking place with the CSS to understand their service provision and the implicated costs and that relevant KPI’s etc would be monitored closely particularly during this difficult transition process The Chair advised that during the discussions with CSS, MB to ensure that the length of contract agreed is not long term MB informed the Group that he would update the working group at the next meeting with the relevant draft documentation for discussion

Action: MB to update and provide draft documentation at next meeting DRAFT Constitution update & Authorisation Development Plan The Interim Chief Financial Officer informed the Group that 1 meeting per month of the Operational Team had been dedicated to the Authorisation Development Plan. The Chair asked if the CCG had any Quality Manuals i.e. Standing Operating Procedures in situ. The Interim Financial Officer advised that this would be more a requirement of the CSS and that they would be required to have this level of detail. The Audit Manager stated that this would be part of audit plan for the CSS and via the provision of 3rd party assurance to the CCG. The Interim Chief Officer advised that she was in the process of pulling together the documents to form the Constitution and that with a wave 4 deadline of December 2012, documentation needed to be uploaded by November 2012. Action: The Interim Chief Officer to produce a headline GANTT chart to assist the group in the overall milestones for the various workstreams Information Governance The Chair that this item is deferred until the next meeting

GA/12-13/ 3.1

Terms of Reference (TORs) The Terms of Reference were included by the Chief Financial Officer as information only as this group were still in an evolving phase. The Chair questioned the initial membership of the Group and felt that the Interim Chief Officer and the Interim Chief Financial Officer should not be regarded as voting Members.


Once this action had been completed they are then to be presented to the next Governing Body Board on the 3rd July 2012. It was also agreed that the TORs should be forwarded to the next Cluster / Audit Committee meeting. Action: Secretary to redraft TORs and add to the next Governing Body Board agenda for approval. TORs also to be sent the next Cluster Audit Committee meeting.

GA/12-13/4

Summary of Actions Please refer to the action points attached as per Annex A.

GA/12-13/5

Any Other Business The Chair invited the RB to give an update on the external audit arrangements. RB advised that he was currently the appointed auditor for the PCTs and that the 2011/12 audit has been completed and signed off for the PCTs. However, the 2012/13 process is somewhat more complicated with the Government announcing the abolition of the Audit Commission and a procurement process had been undertaken to provide new arrangements going forward. Grant Thornton have been appointed as the new auditor for the north west region and this is currently out for final consultation with stakeholders. Until the consultation process is completed in September 2012 the Interim Auditor will continue to be RB and as the CCG is formally a sub-committee of the Cluster PCT, the usual audit arrangements will apply including IFRS and value of money opinion.. The PCT value for money audit will inevitably include the CCG’s progress to date including the progress of its authorisation application and RB advised that this should be highlighted to the Governing Body from an awareness point of view Action: That the PCT’s Appointed Auditor and Audit Manager are invited to attend the Governing Body Board Meeting in November 2012 to update on arrangements and progress of internal / external audit plans The Interim Chief Financial Officer touched on segmental reporting, stating that he would welcome some advice with regards to the approach to be taken and what information the CCG / PCT may be required to provide RB advised that Public Health without doubt should be a separate segment. MB assured the group that the financial reporting mechanisms was structured to support the segmental reporting arrangements however other reporting requirements may not be as adaptable. Action: Pre-discussion to be arranged with the Interim Chief Operating Officer


and the Chair prior to inviting audit colleagues to the November Board meeting. Annual Governance Report RB is to e-mail through to the Chair and Interim Chief Financial Officer the Annual Governance Report RB advised that out of the 4 PCT audits, Wirral was the most challenging process given some of the changes within the finance team. Those areas that were drawn to the auditors attention were; CT staff retaining access to Ledger post separation More work was needed around payroll reconciliation that envisaged due to

lack of assurance from a systems compliance point of view Asset infrastructure and existence of buildings and land, including a

complicated land deal on the Victoria Central Hospital site

RB advised that there was uncertainty around the land deal, partly due to the turnover of staff and lack of organisational memory. Recommendations and responses had been raised at the Cluster Audit meeting as part of governance report and WCCG should note the relevant issues for future consideration The Chair advised that the CCG were in need of some level of assurance from the Cluster Director of Finance and the CSS Director of Finance regarding the issues presented Action: The Annual Governance Report is to be emailed to the Chair and Interim Chief Financial Officer.

GA/12-13/6.

Date of Next Meeting There being no further business to discuss the meeting closed at 1105hrs. The next Audit & Governance task and finish meeting is scheduled to take place on 25th July 2012 at 0930hrs.

James Kay Chair July 2012

Wirral Clinical Commissioning Group Quality, Performance & Finance Committee

Minutes of Meeting

19th June 2012 Room 539 at Old Market House

Present: James Kay Chair – NEA – Vice Chair CWW PCT Cluster

Phil Jennings Interim Chair Wirral Clinical Commissioning Group

Tony Kinsella Head of Performance & Intelligence Public Health Mark Bakewell Interim Chief Finance Officer Wirral Commissioning

Group Paul Arnold Deputy Director of Human Resources, NHS

Warrington Abhi Mantgani Interim Accountable Officer Wirral Clinical

Commissioning Group Christine Campbell Interim Chief Officer Wirral GP Commissioning

Consortium Andrew Cooper Interim Chief Officer Wirral Health Commissioning

Consortium Lorna Quigley Interim Chief Officer Wirral Clinical

Commissioning Group In attendance: Zerina McCarthy Secretary Item No.

Agenda Items

Introduction The Chair welcomed Members to the first meeting of the Wirral Clinical Commissioning Group Quality, Performance and Finance Committee. Before he progressed onto the formalities of the Agenda he requested feedback from Members on their understanding of the purpose of the Group and if he was the right member to chair this meeting. He confirmed his interest in being involved with the Committee but thought that another member might be more suitable to take over the Chair role. He asked for opinions from members. The Interim Accountable Officer advised that he thought it would be inappropriate for the Accountable Officer to be the Vice-Chair of this meeting. AM also expressed his concerns on the lack of members attending with ‘clinical involvement’. He suggested that each Consortia should be represented on the Committee by clinical representatives.

Quality, Performance & Finance Committee Minutes Page 1 of 6 Governing Body Meeting 7th August 2012


The Interim Chair of the Governing Body (PJ) advised that this Committee would be a key body holding providers to account. He therefore suggested that as the CCG Interim Chair he should also chair this committee. Members agreed that the title of the Committee should remain as is. After some discussion it proposed that the Interim Chairman of Wirral Clinical Commissioning Group would for future meetings also be the Chair of the Quality, Performance and Finance Sub Committees.

1.1 Apologies Apologies were received from Iain Stewart, WHA Chief Officer

1.2 Declarations of Interest Members were invited to register any potential Conflicts of Interest, none were received.

1.3 Minutes from the Last Meeting As this was the first meeting of the Quality, Performance & Finance Committee there were no previous minutes.

2.1 Purpose of the Meeting Lengthy discussions had taken place within the Introduction, having agreed that the Chairman of Wirral Clinical Commissioning Group would take over from the current incumbent with effect from the next scheduled Quality, Performance & Finance meeting. Action: Interim Chairman of Wirral Clinical and Commissioning Group to Chair future meetings.

2.2 Terms of Reference The DRAFT Terms of Reference were presented to the Committee. The Members were invited to voice any comments. The WGPCC Chief Officer expressed concerns over the Quorum of the Committee suggesting that the advised numbers for a quorum for the meeting appeared to be low. There were further discussions and a redraft of the meeting was proposed. Action: Interim Chief Operating Officer/Interim Chief Financial Officer and the Interim Accountable Officer to consider the suggestions from the Members and redraft paper. To be presented at the next scheduled Quality, Performance and Finance Committee. The Interim Chief Operating Officer joined the meeting at 1530 hrs.


2.3 Reporting Schedule

No further Quality, Performance and Finance meetings have yet been scheduled for the forthcoming year. The Chair requested that the Secretary with the Interim Chief Financial Officer schedule in meetings and return to the next Committee meeting for ratification. Action: Interim Chief Financial Officer and Secretary to present schedule of meetings at the next Committee Meeting.

3.1 Items for Approval As this had been the initial meeting of the Quality, Performance and Finance Committee there were no items presented to the Committee Members for approval.

4.1 Provider Performance The Head of Performance & Intelligence Public Health gave a brief overview on the data that would be provided to the Committee in the future. He advised that a visual balanced scorecard approach would be presented and advised on.

4.2 Finance Update The Interim Chief Financial Officer advised that full reports would be available at the next meeting.

4.3 Contracting Issues Wirral University Teaching Hospital

The NHS Wirral Contract Monitoring Group Meeting of Thursday 19th April 2012 was noted by the Committee. Wirral Hospital – continuing areas of concern regarding patients waiting 52 weeks. A longer term plan would be discussed at a WUTH meeting to take place later today on how this will be addressed. Cheshire and Wirral Partnership Trust It was noted that no clinicians had been involved in the contract meeting of the 12th April 2012. CC advised that clinicians had attended previous meetings but had dropped off at the April meeting. The committee was advised that within the next 2 weeks clinical leads will be identified to attend future meetings. CC advised that there had been concerns over waiting times in relation to Attention Deficit & Hyperactivity Disorder but that additional funding had been identified to address this. The Trust is well within its target for delayed discharges but is committed to reducing


this further. The Designate Chair for Wirral Clinical Commissioning Group highlighted that this target has implications for the WUTH 4 hour target. CC and PJ to address this outside of this meeting to ensure that the 2 Trusts are working together on this matter. Action: Interim Chair for Wirral Clinical Commissioning Group and the Chief Officer, WGPCC to discuss outside of this meeting. Wirral Community Trust The minutes of the meeting were presented to the Committee. The Chair identified that there was no clear indication in the minutes of who had chaired the meeting. He also advised that on ‘page 3 of 4’ of the minutes there were a series of issues which were vague and needed definite outcomes. Action: The above issues from the contracting meetings to be followed up and reported back to the next meeting.

4.4 Quality Update (Exceptional Items) The Interim Chief Officer presented to the Committee the Cluster Quality Reporting Requirements/Template advising that the document is ready to be populated. Exception reporting will be brought to the Committee at regular intervals.

5.1 Risk Register Template The Interim Chief Officer advised that the Risk Register template had been prepared as a 1st draft document.

6 Summary of Actions Please refer to the action points attached as per Annex A.

7 Any Other Business 7.1 Authorisation Update

The Authorisation Update will become a standing agenda item. A work in progress document, the Interim Chief Officer advised that the immediate biggest risk is NHS summer break when staff will be unavailable for comment. The Chair expressed his concerns at the approach to RAG ratings used on the Gantt chart. He felt that many of these were inappropriate. The Interim Chief Operating Officer advised that many of the red items had had some form of documentation implemented but were not fully completed. The Chair requested that the Interim Chief Operating Officer and the Interim Chief Financial Officer review the GANTT chart and its use of RAG rating and try to standardize these for review at the next meeting. Action: Interim Chief Officer and Interim Chief Financial Officer to review GANTT


Chart for Authorisation Process. 7.2 Cluster End of Year Review A DRAFT letter to the CEO NHS Cheshire, Warrington and Wirral from the Regional Director – NHS North of England was presented to the Committee. The Chair directed the Committee Members to view the last page of the letter ‘Summary, Paragraph 3’. In view of this guidance from the SHA, the Chair asked as to what assurances this committee could give to the CCG Governing Body that CIP plans are in place in all of our providers and that the implementation of these will not adversely impact on patient quality and safety. 7.3 The Interim Accountable Officer asked that the Wirral Investment Plan was included as a standing agenda item. Actions: Secretary to add the Wirral Investment Plan as a standing agenda item. The Governing Body agenda to include an update from this committee on provider CIP plans and their potential for impact on patient safety and quality.

8. Date of Next Meeting There being no further business to discuss the meeting closed at 1625hrs. The next Quality, Performance & Finance meeting is scheduled to take place on 24th July 2012 at 1500hrs.

Phil Jennings Chairman July 2012

Draft Minutes of WGPCC Executive Board

– 19 June 2012


Report to: Executive Board Meeting Date: 24 July 2012

Clinical Lead: Dr John Oates, Chair – WGPCC Executive Board Dr Abhi Mantgani, Executive Clinical Lead

Lead Officer Christine Campbell, Chief Officer (Acting)

Prepared by: Anita Fletcher, WGPCC Administrator

Decisions for Noting:

The Executive Board members agreed that Mark Bakewell would attend

all 111 meetings with Dr McKay. The Board members agreed to the proposal for the implementation of

an over 65s health check and post discharge follow up for all Wirral GP Commissioning Consortium practices and approved the total investment of £654,254 to support this scheme.

The Board members were happy to support the investment of £251,636 in a management of long term conditions in the household scheme.

Board approval was given for the draft enhanced service within Appendix One of the Patient Engagement in Commissioning Local Enhanced Service and for the likely resource implication of £85,454.50 to support this scheme.

The Board members were in agreement for Complaints and Incidents to be a standing agenda item for future meetings.

The Executive Board members agreed that the financial implications of the 111 scheme should be added to the risk register.

Do you agree that this document can be made public?

Minutes of WGPCC Executive Board Meeting (19 June 2012) 1 of 1 Governing Body Meeting 7th August 2012

Wirral GP Commissioning Consortium Executive Board Meeting Minutes

Tuesday 19 June 2012, 6.30pm

Nightingale Room, Old Market House Present Dr Navaid Alam (NA) TG Medical Centre Dr Akhtar Ali (AA) Hoylake Road Medical Centre Mark Bakewell (MB) Finance Lead John Callcott (JC) Non-Executive Advisor Christine Campbell (CC) Acting Chief Officer Abigail Cowan (AC) Prescribing Advisor Karen Hornby (KH) Commonfield Road Surgery Dr Hannah McKay (HM) Moreton Medical Centre Dr Abhi Mantgani (AM) Executive Clinical Lead Lysa Morton (LM) Parkfield Medical Centre (Raymond) Dr John Oates (JO) Chair / Parkfield Medical Centre (Hawthornthwaite) In attendance: Anita Fletcher (AF) WGPCC Administrator Rick O’Brien (RO) Wirral Department of Adult Social Services Sarah Quinn (SQ) Commissioning Manager Agenda No

Note

Public Comments/Questions There were no members of the public present at the meeting.

1. Declarations of Interest The following members declared an interest in items 8, 9 and 10, given that these have resource implications for general practice: AM, JO, AA, NA, LM, HM, KH

2. Apologies for Absence Apologies were received from: Fiona Johnstone (FJ) Director of Public Health Dr Denyse Kershaw (DK) Kings Lane Medical Centre Dr Andy Lee (AL) Townfield Health Centre Ann Riley (AR) Nurse Member/Parkfield Medical Centre Eddy Shallcross (ES) Patient Council Chair Dr Pankaj Srivastava (PS) Holmlands Medical Centre

Minutes of WGPCC Executive Board meeting held 19 June 2012 Page 1 of 9 Governing Body Meeting 7th August 2012

Agenda No

Note

3. Minutes of Previous Meeting held on Tuesday 15 May 2012 An amendment to Section 7, paragraph 4 of the minutes was requested; the minutes should read “Members were advised that there had been no variation to the Wirral Hospital Trust budget since the month 9 position due to the contract performance being frozen.” Following this amendment, the minutes were agreed to be a true record of the meeting.

Actions of Previous Meeting held on Tuesday 17 April 2012 Phlebotomy – CC advised that Practice interest will be gauged for this at the Engagement Event on 28th June 2012. Governing Body Minutes – These minutes will be tabled following their approval at the next Clinical Commissioning Group Governing Body Board. Wirral GP Commissioning Consortium Executive Board minutes from this financial year will be submitted to the Governing Body.

4. Matters Arising Community Surgery Service Proposal – Documentation had been issued to practices and bids for this service were awaited. WROCS Issues – With regard to the issues with WROCS, AR had contributed to resolving the issues. Phil Eagle had taken this on board and it was being actioned. A suggestion was made for an e-mail to be sent to practices asking them to advise if problems were still being encountered with WROCS.

5. Minutes for Noting As there were no ratified minutes for noting available, JO gave a verbal update. Dr Jennings had been elected Chair of the shadow Governing Body. In line with the Department of Health guidance, an advert for the Accountable Officer post had gone out and interviews were being held on Monday 25th June 2012. It had been agreed that the Accountable Officer and Chair should be from different divisions. The Nurse and Secondary Care representatives would be sought when the Chief Officer, Accountable Officer and Finance Officer were established.

6. Operational Commissioning Plan Progress Report Members were advised that the paper summarises the progress against the 2012/13 Operational Commissioning Plan up to the end of May 2012. A summary of progress in each clinical lead area is provided with each area rated red, amber or green based on the overall achievement of workstreams within that area. Any significant risks are also highlighted in the summary. Members were advised that there were no clinical lead areas currently rated as red. Members were asked to note the overall progress against the plan and requests any further information as appropriate. Members were informed that there had been no change to progress since the last report. Planned Medical was showing amber; although the majority of projects were on track there was a delay on two projects but revised dates for these had been set. Chronic Disease Management was also showing amber; projects were on track but an overall clinical lead was still to be identified. The next report would be provided in more detailed as many deadlines were due at the end of June.


Agenda No

Note

The question was raised as to whether the 111 project should be reported as a risk, given that this was on the Governing Body risk register. The 111 service is due to start at the end of March 2013; some cost will be borne centrally, but the remainder will be borne by the CCG, and the pressure is unknown. It was agreed that this would be added to the risk register, and HM would report back with any further financial clarity as quickly as possible. It was agreed that MB would attend all 111 meetings with HM.

7. WGPCC Budget 2012/13 Executive Board members were advised that the report and appendices set out the financial plan and detailed budgets for the Clinical Commissioning Group, and for Wirral GP Commissioning Consortium for 2012-13, at the governing body meeting on 8th May 2012. The overall Clinical Commissioning Group budget for 2012-13 is £469 million. In setting the 2012-13 budgets and in an attempt to mitigate risks the financial plan has supported providing additional financial resources in recognition of growing costs, or by establishing controls through commissioning and operational processes. An additional 1% contingency fund has been established for all baseline commissioning budgets and split across the respective body which will be used, if required, to offset against unplanned increases. As in previous years, a “fair share” approach has been adopted for the allocation of the budget between the respective clinical commissioning groups which remains in line with the recommended national approach. As there had been no new toolkit released in 2012-13, the 2011-12 methodology had been updated for practice list sizes as at April 2012. The total budget for Wirral GP Commissioning Consortium is £135,128 million. Budget books would be issued to Board members and each practice shortly. Members were advised that £4.99 million had been returned to the Consortium in relation to its 2011-12 underspend; this will need to be committed on a non-recurrent basis for the 2012-13 financial year. It was agreed that the allocation of prescribing budgets would need to be decided outside of this meeting with the agreement of Member Practices. A covering letter would have to be issued with the budget books as they will include the prescribing figures. Full details are set out in the finance report. The finance report and appendices were noted by the Executive Board.


Minutes of Page 4 of 9 Governing Body Meeting 7 August 2012

WGPCC Executive Board meeting held 19 June 2012 th

Agenda No

Note

8. Over 65s Health Check and Hospital Discharge Follow Up As JO has declared an interest as a partner in a GP Practice that will have the potential to deliver this scheme, JC chaired this item in his place. The Board were asked to approve the proposal for the implementation of an over 65s health check and post discharge follow up for all Wirral GP Commissioning Consortium practices and to approve the total investment of £654,254 to support this scheme. SQ explained that this proposal had been developed in discussion with Clinical Leads. There are high rates of readmission on Wirral and these could be tackled by improving follow ups in Primary Care. Members were informed that this paper was seeking support for the principle of the schemes, and the commitment of funding, and that further detail would be added and sent to the clinical leads for approval. The paper sets out what practices would have to undertake to receive payment. Each practice will be paid £5.20 per registered patient, based on their normal list size as at 1st May 2012, in order to carry out the over 65s health check and discharge review. Practices would be required to record patient data and interventions as part of the schemes and that this would be monitored and audited in order for reward payment to be released. The question was raised as to why this scheme was set at 65s as this was felt young. This had been set at 65s as it was better to identify problems earlier on in life, and our patient demographic has a higher mortality rate. Members were informed that the over 65s review would include a template for practices to follow. A directory of services would accompany this so that practices will have a clear idea of where to refer patients. One of the key benefits of this review is that, through undertaking a mini mental assessment of the patient, practices would be able to identify a higher number of patients that may have early dementia, and refer these for further assessment / support as appropriate. Also, practices would focus on carers and ensure that any patients who are carers themselves are aware of the full range of support services available to them. Practices would be encouraged to work with partners such as the Local Authority in order to address any social issues that may be impacting upon a patient’s health, for instance, through carrying out a Healthy Homes Check the Local Authority could help patients with COPD by ensuring that they have adequate heating and that their home is free from damp. The quality and timing of discharge notification will be vital to the success of the discharge element of the enhanced service. It was agreed that the target would be changed to require practices to review patients within ten working days of discharge. Practices would receive significant resources to support this scheme and must ensure that they use this to put the appropriate staffing infrastructure in place. It would be entirely up to practices as to how they utilise this resource to ensure completion of this scheme. Board members were advised that the scheme had been strongly support by the Patient Council Executive Board on 12th June 2012, and that many Board members had offered to support in developing the directory of services. The Board agreed to the proposal for the implementation of an over 65s health check and post discharge follow up for all Wirral GP Commissioning Consortium practices and approved the total investment of £654,254 to support this scheme.

Agenda No

Note

9. Management of Long Term Conditions in Housebound Patients As JO has declared an interest as a partner in a GP Practice that will have the potential to deliver this scheme, JC chaired this item in his place. Members were advised that historically as a Locality, money was given to practices to support the management of their diabetic housebound population.. The Consortium would like to ensure that all patients have equal access to healthcare, irrespective of their mobility. In order to address this, and to support the Consortium’s priorities of promoting self-care and reducing hospital admissions, the Consortium has identified a resource that will enable practices to focus on ensuring that any patients with a chronic disease, that are also housebound, receive the same standard, quality and scope of care as others. Board members were advised that the scheme had been approved by the Patient Council Executive Board on 12th June 2012. Should the Board support this proposal, data would be sought from practices on the profile of their housebound population, and the health interventions that these patients had received within the preceding fifteen months. The areas for focus would be agreed with each practice on the basis of this. The upfront part of the resource would then be released to practices once the focus areas had been agreed. These areas will include: uptake of diabetic foot checks, flu vaccines and retinal screening, and other requirements under the Quality and Outcomes Framework. Resource available to practices will be proportionate to their total list size, to enable them to fully comply with the requirements of this proposal. Practices will be able to decide how best to invest this resource, this may include purchasing new equipment or purchasing additional nursing time. Members were advised that a total of £260,000 had been identified to support this scheme. Divided between the total patient population, this equates to £2 per patient, which would be divided between the practices accordingly. It is proposed that £1.50 per patient would be available as an upfront payment, upon release of the data to the Consortium and sign-up to the scheme. A further 50p per patient would be paid after six months, if the practice is able to demonstrate satisfactory commitment to and progress with the agreed target areas. It was agreed that this support would be welcome and would contribute to the current work going on to improve care for patients with long term conditions. The Board was asked to support the investment of £251,636 in a management of long term conditions in the household scheme. The Board was happy to support this.


Agenda No

Note

10. Patient Engagement in Commissioning Local Enhanced Service As JO has declared an interest as a partner in a GP Practice that will have the potential to deliver this scheme, JC chaired this item in his place. Members were advised that this proposal had been driven by the Patient Council and Patient Council Executive Board as there is the need to look at improving levels of engagement with the Consortium. The idea is to look to engage with patients using methods beyond attending meetings. The Local Enhanced Service will provide a framework for practices to encourage patients to learn more about, comment on, and ultimately influence, the Consortium’s commissioning priorities. Practices would be required to undertake the following: • Dedicated patient engagement section on the practice website, to include a section

explaining the role of the Consortium, and a link to the Consortium’s own website. • Collect patient email addresses using a dedicated patient engagement flyer which would

be developed by the Consortium, and with the patient’s permission provide these to the Consortium in order to add to its virtual Patient Council.

• Provide the Consortium with a theme of complaints received by patients. • Support Consortium engagement activities when requested by displaying posters,

issuing surveys and recruiting patient representatives. A postcard had been designed to be issued to patients; this explains briefly what each area is about and has a tear-off slip for patient to sign and return, fully explaining compliance with data protection regulations. Members were advised that payment levels were set out in the document. The Consortium has made significant achievements in engaging with patients over the past 15 months, through its Council, its website, and its newsletter to patient households. However, there is much more to be done to reach different sections of the population and to take advantage of different ways of reaching patients. The Board was asked to approve the draft enhanced service within Appendix One; and approve the likely resource implication of £85,454.50 to support this scheme. The Board gave approval to both recommendations.


Agenda No

Note

11. Medicines Management Update From the year end prescribing summary Wirral GP Commissioning Consortium were underspent by £1.154m with a negative cost growth of 2.1% compared to 2010/11 which is excellent news. The report emphasises the importance of cost growth, not just under/overspend, so it is a better indicator of prescribing performance. The red numbers indicate a negative cost growth. Quality & productivity topics were extra QoF targets set for one year only (2011/12). The quality & productivity achievement points for the practices are summarised in the table. For WGPCC they were, in the main, a success. Areas that did well were ezetimibe, nsaid and gluten-free. To get 5 points the practice had to be in the national top quartile. Other points were given if the practice was up to 20% below the top quartile. One practice got the full 15 points and 16 out of the 27 practices got above 13 points. The Medicines Management Team will be following up quality & productivity with practices that have not achieved the full points to see if additional work will complete the project. QIPP – The main focus of the Medicines Management Team’s work remains around the National Prescribing Committee therapeutic topics, aiming to increase savings and improve indicators as per instructions from Wirral CCG. The new areas for focus were discussed. Diabetes is is a priority area of work. Primary & secondary care were meeting today to discuss ways of working together to improve prescribing of long acting insulin analogues, hypoglycaemic agents and review of self-monitoring. Other areas of work include antibiotic prescribing which is amber for volume and red for cephalosporin/quinolone prescribing. Practices with above average prescribing will be targeted by the Medicines Management Team and given individual feedback from the Practice Pharmacists using epact data. They will also be asked to be re-audited and AL will be kept updated with this progress. Nsaids –Practice Pharmacists are continuing to highlight patients on diclofenac/coxibs to be reviewed by their GP. Respiratory work – For QIPP high dose corticosteroids in asthma patients need to be reviewed and stepped down, were appropriate, and also switched to the most cost effective combination inhaler. WGPCC is amber for this. The Medicines Management Team will also be continuing ongoing work with COPD patients to switch them to the most cost effective combination inhaler: Symbicort and Seretide Accuhaler are around £20/mth cheaper than Seretide Evohaler. They will also continue to switch all individual prescribing of long acting beta agonists and inhaled corticosteroids to combination therapy for safety reasons. Finally the Repeat Prescribing review is underway and Dr Jane Wright has agreed to support the team with this work.


Agenda No

Note

12. Patient Council Update Members were advised that the last Patient Council Executive Board had taken place on 12th June 2012. Members were informed that a directory of services for GPs would be developed which had been given support by the Patient Council Executive Board. Some members of that Board were interested in being involved in the setting up of this. Practices would be asked for some input in this area. New members had joined the Patient Council Executive group and this was improving significantly. Patient members had been invited to attend the Engagement Event which was due to take place on 28th June 2012.

13. Public Health Update No update was available as FJ had sent apologies to the meeting.

14. Executive Nurse Update No update was available as AR had sent apologies to the meeting.

15. Practice Managers’ Update Members were informed that the next Practice Managers’ meeting was due to take place on 4th July 2012. KH and LM were hoping to engage with Practice Managers on a one-to-one basis at the Engagement Event and to raise awareness of training.

16. Update on Social Services / Local Authority RO attended the meeting on behalf of GH and gave a brief update in this area. The Chief Executive of the Council had now retired. Phil Davies had been elected as the new Leader of Wirral Council which was felt to be good news. Partnership working bodes well for future working. An external peer for safeguarding had taken place during May 2012. This had been challenging and feedback had been received; RO thanked people who had been involved in this. The next step for the peer review was to look at outcomes. The resetting of partnership working arrangements was being looked at and GH was keen to take this forward. RO explained that there was the need to complement their work with social care.



Agenda No

Note

17. Any Other Business 111 Bid – With regards to the 111 bid, the provider should be known in time for the Governing Body Board, this will be for noting at the meeting but will be anonymised. Complaints/Compliments – It had been decided to formally log complaints and compliments; anything that affects the Consortium’s patients should be logged formally. Members were advised that two complaints had been received that week in relation to services provided to the Consortium by Peninsula Health LLP. These complaints had been in relation to communication breakdown and have been fully investigated by the provider, with any outstanding concerns addressed. As a commissioner we are assured of the remedial actions taken, but will be monitoring the provider action plan to ensure that any such events do not recur. Members were happy for this to be a standing agenda item. Funding – Members were advised that £13.5 million had been made available to Wirral Clinical Commissioning Group to invest in 2012/13. Current plans for Wirral-wide investment are as follows: • To be used for practice development for Care Quality Commission requirements as the

Consortium would like to see every practice meet the targets • money to be divided between the Consortia to give additional resources to their

practices, with the weighting being towards the consortia that did not make significant savings last year

• Augmentation of the Social Care Fund • Investment in the Choose and Book infrastructure, and incentivising practices to start

using this again before it becomes mandatory • Public Health initiatives – alcohol and osteoporosis • IT investment to boost IT infrastructure in practices, such as with kiosks to help with

patient engagement and information. Investment in diagnostics equipment, such as gastroenterological scopes, and breast screening unit.

18. Items for Risk Register Members agreed that the financial implications of the 111 scheme should be added to the risk register.

19. Date and Time of Next Meeting The next meeting is due to take place on Tuesday 24 July 2012, 6.30pm in the Nightingale Room, Old Market House, Birkenhead.

The meeting finished at 8.20 pm

Minutes of WHCC Executive Board

– 20 June 2012


Report to: Executive Board Meeting Date: 20 June 2012

Clinical Lead: Dr Peter Naylor, Chair – WHCC

Lead Officer Andrew Cooper, Chief Officer

Prepared by: Wendy Durno, Executive Assistant


A paper was tabled outlining procurement options for Telehealth Non-

Clinical Triage and Falls Response Services. The Board were assured that all challenges have been looked at and the DASS AT contract variation would be acceptable. The contractual changes will be covered to the end of the financial year 2012/2013. The Board approved the paper.

The Wirral GP Commissioning Consortium (WGPCC) Minor Injuries and Illness Service paper was presented to the Board. This paper has already been approved by WGPCC Board members. The paper suggested a tariff of £25 per patient contact. The Board approved the proposal and agreed that it would need to monitor the service numbers and requested that WGPCC provide a regular activity report for WHCC patient activity.

The Financial Plan 2012/13 was presented for noting, as it has already been approved by the Governing Body Board. It was also noted that the 111 Service is not currently in the Financial Plan as a risk.

No financial update was given due to apologies. It was agreed that the sub-committee structure requires a review as

Wirral CCG now has a Quality, Performance and Finance Committee and is in the process of establishing an Audit Committee. It was agreed that it is no longer necessary for the consortium to replicate these committees and a review of all WHCC subcommittees was agreed.


Minutes of WHCC Executive Board Meeting (20 June 2012) 1 of 1 Governing Body Meeting 7th August 2012

WIRRAL HEALTH COMMISSIONING CONSORTIUM EXECUTIVE COMMITTEE

Minutes of Meeting

Wednesday 20th June 2012 Albert Lodge - Victoria Central Health Centre

Present: Dr Pete Naylor (PN) (Chair) Chair Mr Andrew Cooper (AC) Chief Officer Dr Murray Freeman (MF) GP Executive Lead

Dr David Jones (DJ) GP Executive Lead Dr Sean Magennis (SM) GP Executive Lead Dr Sue Wells (SW) GP Executive Lead Ms Teresa Owen (TO) Deputy Director of Public Health Mr Brian Barnes (BB) Patient Forum Representative

In Attendance:

Mrs Sheena Hennell (SH) Commissioning Manager Miss Wendy Durno (WD) Executive Assistant Four members of the public

Minute

Apologies for absence Apologies were received from Dr Shyamal Mukherjee, Graham Hodkinson, Councillor Phil Davies, Andrea Wood, Carol Heath and Anita Swift. It was advised that Dr Paula Cowan would be arriving at approximately 2.00pm due to other commitments. [Post-meeting note: Dr Cowan arrived in time for private business only]. Declarations of interest No declarations of interest were made. Public Comments/Questions Four members of the public were welcomed to the meeting. No comments were made. Minutes from the last meeting The minutes from the last meeting were reviewed and accepted as an accurate reflection.

Minutes of the Executive Committee – 20th June 2012 Page 1 of 4 Governing Body Meeting 7th August 2012


Minute

Matters Arising and Action Points Matters Arising The Board was advised that the Primary Care Advice Liaison Service (PCAL) has now progressed to procurement stage. The Wirral specification was agreed by all three CCGs. The GP Commissioning Skills training dates have been communicated. Action Points All actions had been completed. Long Term Conditions QIPP Project Sheena Hennell, Commissioning Manager, attended the meeting to promote the LTC QIPP Workstream North West project. Copies of the presentation were circulated for information. All CCGs are involved in the project, in partnership with AQUA (Advancing Quality Alliance). It was acknowledged that there is a huge challenge with long term conditions on Wirral. Future challenges were outlined – 60% increase in number of people with three or more LTC over next 10 years, one condition costs £3k per year and three costs £8k. The goals of the QIPP workstream are incorporated into CCG budgets. The project aims to address various aspects of people living with LTC to improve clinical outcomes and reduce unplanned admissions. A “neighbourhood” multi-disciplinary integrated team will work together to support multiple conditions. The project group are looking for input on the team’s name and to fully define the purpose of the team. The model used to determine Health Visitor numbers in each neighbourhood area will be utilised to identify the required skill mix and number of people involved in the team. Secondary care colleagues are also involved in the project group. A risk stratification tool is in development. This is a validated tool which will identify patients potentially at risk of unnecessary admission to hospital. The strategic information team from the Cheshire, Warrington Wirral Commissioning Support Service (CWW CSS) is developing the tool based on local requirements. Finance for this piece of work is included within Commissioning Support Service core costs. The importance of ensuring that the IT system is continually updated and all necessary parties have access to records was noted. The project group meets fortnightly and two patients from the Older Peoples Parliament are involved in the group. Workgroups and focus groups are ongoing. It was agreed that the key to a successful team is to have one member responsible for co-ordinating the team, i.e. MDT Co-ordinator, to keep everyone on task. Success stories around the country will be sent out to the Board for information. Flyers detailing the LTC QIPP workshop being held on 19th July were circulated. Action – Sheena Hennell to send LTC project patient flyer to Brian Barnes for information Action – Sheena Hennell to send out Integrated Health & Social Care teams success stories to Board members for information Telehealth Non-Clinical Triage and Falls Response Services A paper was tabled outlining procurement options for Telehealth Non-Clinical Triage and Falls Response Services. Options available are tender process or contract variation. It was advised that the DASS Assistive


Minute

Technology (AT) contract would be varied to provide the service. Initial findings for the first six months of the telehealth / COPD upskilling project suggest that COPD admissions have reduced when compared to the same six months of last year. In addition, patient and staff feedback has been positive to date. Andrew Cooper, Chief Officer, queried whether it was likely that there would be challenges made regarding the procurement process. Sheena assured the Board that all challenges have been looked at and the DASS AT contract variation would be acceptable. The contractual changes will be covered to the end of the financial year 2012 / 2013. The Board approved the paper. WGPCC Minor Injuries Service The Wirral GP Commissioning Consortium (WGPCC) Minor Injuries and Illness Service paper was presented to the Board. This paper has already been approved by WGPCC Board members. The paper suggested a tariff of £25 per patient contact. The Board was asked to review the proposal and agree if acceptable. An alternative tariff would be pursued if the Board members are not in agreement. A discussion followed on whether there were any other similar services within the consortium already and it was agreed that there was no such service available. The Board approved the proposal and agreed that it would need to monitor the service numbers and requested that WGPCC provide a regular activity report for WHCC patient activity. Financial Plan 2012/13 The Financial Plan 2012/13 was for noting as it has already been approved by the Governing Body Board. It was also noted that the 111 Service is not currently in the Financial Plan as a risk. Paragraph 22 of the paper was queried with regard to Payment by Results (PbR) reduction in tariff of 1.8%. After discussion it was thought that the figures applied to the national tariff. The Board requested that this item is discussed at the next meeting when the Finance Lead is in attendance. Action – Executive Assistant to ensure that Financial Plan is added to agenda of next meeting. Financial Update This item was not discussed due to apologies from the Finance Lead. Items for Risk Log There were no items for the Risk Log. Risk Register The Board agreed that the sub-committee structure requires a review. Wirral CCG now has a Quality, Performance and Finance Committee and is in the process of establishing an Audit Committee. It was agreed that it is no longer necessary for the consortium to replicate these committees and a review of all WHCC subcommittees was agreed.


Minute

A CCG-wide Risk Register will be developed; however, it was noted that WHCC will still need to identify and flag any consortium risks to the CCG Governing Body as appropriate. Clinical Advisory Group Update The summary report of the CAG meeting was noted by the Board. No comments were received. Subgroup Minutes for Noting The minutes from the March meetings of the sub-committees were noted. No comments were received. Summary of Actions Please refer to action points attached. Any Other Business Action - The impact on Minor Injury Service to be added to the Financial Approvals Summary sheet. It was requested that a consortium update paper was provided for the cluster meetings. After a short discussion it was felt that the agenda for cluster meetings was already heavy and that due to time constraints an update would not be necessary on this occasion. The Chair thanked the members of the public for attending. Date and Time of Next Meeting The date and time of the next meeting is Wednesday 18th July 2012, 1.00pm at Albert Lodge, Victoria Central Health Centre. Please send any apologies to Wendy Durno on [email protected]

mailto:[email protected]

Minutes of WACC Executive Board (Extraordinary Meeting)

– 21 June 2012


Report to: Governing Body Meeting Date: 7 August 2012

Clinical Lead: Dr Mark Green - Chair

Lead Officer Iain Stewart – Chief Officer

Prepared by: Allison Hayes – Executive Assistant


Review and agree to revised actions from Board Meeting held on 31st May 2012.


Cover Sheet re Minutes of WACC Executive Board Meeting (21 June 2012) 1 of 1 Governing Body Meeting 7th August 2012

Minutes of WA Commissioning Consortium Board Meeting 31.05.2012 1/10 Governing Body Meeting 7th August 2012

Wirral Alliance Commissioning Consortium Board Meeting

31.05.2012 Organisational Development

Lead CCG Manager:

Iain Stewart

Lead Author: Iain Stewart

Contributors:

Approve X

All

Cen

tral & E

astern

Ch

eshire

Warrin

gto

n

Western

Ch

eshire

Wirral

Recommendation Summary:

Note

Relevant PCT

X

Purpose of Report: To update PCT on salient decisions agreed by Wirral Alliance CCG

Recommendation:

Next Steps: Implementation of approved schemes


DOES THIS REPORT / ITS RECOMMENDATIONS HAVE IMPLICATIONS AND IMPACT WITH REGARD TO THE FOLLOWING: 1. QUALITY

Patient Safety No If yes please outline the impact

1(a)

Clinical Effectiveness No If yes, please outline the impact

1(b)

Patient Experience (including patient and public involvement) No If yes, please outline the impact

1(c)

2. ADDITIONAL RESOURCE IMPLICATIONS (either financial or staffing resources)

No

If yes, please outline the additional resources required

3. HEALTH INEQUALITIES No If yes, please outline the effect upon health inequalities

4. HUMAN RIGHTS, EQUALITY & DIVERSITY REQUIREMENTS No If yes, how will this impact on these requirements

5. EQUALITY IMPACT ASSESSMENT No

If yes, how will this impact on these requirements


YES


Report Name Ref Locality Submitted to Date Brief Summary of Outcome



Wirral Alliance Board Meeting DRAFT Minutes

Thursday 31st May 2012– Civic Medical Centre

Attendees: Dr H Downs Civic Medical Centre Dr M Salahuddin Gladstone Medical Centre Dr I Camphor Heatherlands Medical Centre Dr J Where Riverside Surgery Dr G Francis Spital Surgery Dr M Green St Hilary Brow Group Practice Dr B Conlan The Orchard Surgery Mike Roach Non Executive Advisor In attendance: Allison Hayes Executive Assistant WACC Dave Miles Senior Finance Officer Kerry Hogan Commissioning Manager WACC Allan Stewart Practice Manager – Civic Medical Centre Apologies: Fiona Johnstone Director of Public Health Iain Stewart Chief Officer WACC Agend

a No

Note = Action Point


1. Apologies for Absence As Above Declarations of Interest None declared Minutes of Previous Meeting and action points held on 26th April 2012 The Chair updated the group with regards to her position as Chair and the proposal for Dr Mark Green to succeed as Chair for Wirral Alliance Commissioning Consortium. Dr Camphor proposed Dr Mark Green for chair and Dr Downs seconded this. Members of the group then voted unanimously in favour for Dr Green to succeed Dr Francis as Chair. Dr Camphor also gave thanks to Dr Green for her contribution and continued support to Wirral Alliance Commissioning Consortium. A discussion took place with regards to the Vice Chair role for WACC. A member proposed Dr Francis who declined. Dr Downs proposed Dr Salahuddin and Dr Conlan seconded this. It was agreed by all members that Dr M Salahuddin would be the Vice Chair of the Wirral Alliance Commissioning Consortium. The Ex Chair then fed back to the group her recent conversation with Cameron Ward. Previous Action Points

Coaching Away Day – the group agreed for another Coaching Away Day to be rescheduled.

CWG Recommendations – the group recommended that Voice recognition and text messaging reminders be considered at the next CWG meeting.

The minutes were agreed to be a true record of the meeting. Dr G Francis proposed the minutes, Dr I Camphor, seconded them.


2. Matters Arising The Ex Chair thanked Wirral Alliance Commissioning Consortium management, finance and non executive director teams for their help and support over the last number of weeks. Anonymous Letter circulated to Wirral GPs The Ex Chair sought advice from Kathy Doran about the appropriateness of discussing the contents of the anonymous letter with the Alliance Board. Members were asked to consider whether a debated around this was appropriate. Members agreed to discuss the contents of the letter. Members considered the contents of the letter and agreed that an independent examination of the allegations made would be their preferred response from the PCT Cluster. Members requested the Chair write to the PCT Cluster Chief Executive. The WACC Chair requested assurance from the Board that no member practice was involved in the composition and subsequent publication of the anonymous letter. Assurance was given that this was so.

3. Chair Report Interim Wirral CCG Governing Body update WACC Chair provided an update on the interim Wirral CCG Governing Body meeting which he recently attended and informed members of the current status of the roles of Chair, Accountable Officer and Chief Finance Officer. The Chair expressed the views of the Alliance with regards to the national guidance process. This included the position of Chair to being open to all aspirant candidates. The AO position being advertised through a wider talent pool; i.e. senior managers and other clinicians. The term GP partner was deemed to be too restrictive. He informed members of the Alliance that the Accountable Officer interview panel representation had been confirmed as: 3 representatives from Wirral Health CC, 3 representatives from Wirral GPCC and 1 representative from Wirral Alliance CC and all subsequent positions would be done in an equitable way. Appointment of the interim Chair was discussed. A discussion took place about the governance approach by the interim CCG to the recruitment process for these key senior roles. WACC Non Executive Advisor is to seek clarification on the role of the seconded Non- Executive Director from the PCT cluster in the capacity of a casting vote for decisions within the interim CCG. Some members expressed their dissatisfaction with the governance approach by the interim CCG and requested a response from the Alliance The Chair agreed to respond on behalf of the Board. A discussion took place around the importance of an LMC representative being part of the CCG Governing Body membership. Discussions were summarised and members agreed to continue but to raise but to raise concerns about governance with the interim CCG.


GP Locum Job Plan The Chair updated members regarding the new GP Locum Role. The group discussed the salaried GP Job Plan and the proposed options. The proposed options are as follows: Option 1: 1 full day (2 sessions) per fortnight per practice. To include 1 session to work with the Wirral Alliance Management Team to support the development and delivery of clinical commissioning proposals/projects and 1 study day session for the Salaried GP appointed. Option 2: Block book Salaried GP time – 3 full days (6 sessions) per week per practice on a 2 week rotational basis. To include 1 session to work with the Wirral Alliance Management Team to support the development and delivery of clinical commissioning proposals/projects and 1 study day session for the Salaried GP appointed. Option 3: An initial 7 weeks introduction to practices carrying out 3 full days per week in each of the 7 constituent practices and then 1 session per fortnight to become familiar with each practice. WACC Board members agreed to option 3 but were asked to express their preferences to the WACC Commissioning Manager regarding the allocation for the 7 weeks and to specify their preferred days. The Ex chair informed the group of another GP who may wish to considered in the future. PCAL The commissioning manager gave an update about the service specification for PCAL and informed the group about the tender process and the panel representatives. The service is now a one Wirral wide service. Board members agreed to a one Wirral wide service. Direct Access Diagnostics Members discussed the AQP Future Intentions regarding Direct Access Diagnostics. The Chair informed the group about the contents of a recent discussion that had taken place around the service and the ex-chair highlighted that GPs should be more informed around the procurement and approval process around AQPs. The commissioning manager is to clarify the process around AQPs with the Contraction Team. Minor Injuries & Illness Service Tariff The group discussed the Minor Injuries and Illness Service Capacity Review. A member proposed that WACC create its own proposal for this service which is to be implemented into WACC constituent practices. Dr Camphor seconded this. Members directed the WACC Chair to write to Wirral GPCC to decline the use of the service but that they re-direct all WACC patients. Riverside Surgery is a practice who do use the service and it was discussed how better supported they could be in order for them to discontinue use of this. Riverside Surgery confirmed that support would be beneficial.


AQP for Audiology The commissioning manager requested that members consider the following options with regards to the proposal:

1. WACC Continue with WUTH only 2. WACC agree to go with AQP 3. WACC go out to a tender process

Members suggested that this should be discussed at the Wirral Governing Body level and the commissioning manager is to feedback this. The Chair requested that a guidance document around AQPs is developed. A member suggested that this could be a topic to be discussed at the next Coaching Away Day.


4. Wirral Alliance consortium Approvals Process for Access to Commissioning Funds Approval Process Members discussed the process and agreed to its implementation. The Non-Executive Advisor highlighted the importance of including initial and future costings in proposal and to show any savings. Members agreed to the use of the Commissioning Funds and Accessing funds proposal and documentation. Practice Proposals Heatherlands Medical Centre submitted 2 proposals:

1. Better access better care – improved outcomes for patients in Nursing/Residential Homes.

2. Employ Commissioning Support Officer for 15 hours per week to work solely on commissioning.

Heatherlands Medical Centre provided the members with a rational behind the proposals for the Board to consider. A discussion took place around proposal 1 and BC felt there would be cross over with regards to the current Nursing Home Scheme. WACC Board members agreed for proposal 1 to go ahead providing it links with the WACC Nursing Home Scheme. Members agreed to decline proposal 2 but for it to be reviewed as an overall process for the consortium. Civic Medical Centre submitted 1 proposal:

1. Proposal to commission the Institute for Innovation and Improvement to implement general practice within Civic Medical Centre.

Civic Medical Centre provided the group with a rational behind the proposal for the Board to consider. Members agreed for the proposal to go ahead providing the referrals and prescribing modules are included.


5. Finance WACC Finance Officer presented the latest finance report that was the month 12 for the financial year 2011/2012 and also the Financial Plan for 2012/13. The Board were asked to: Review and approve the position at year end month 12 (March 2012). And to note the final financial position. Overview Key points for the Board to note for the year end position:

The total GP Clinical Commissioning Group Budget for 11/12 was approximately £456.2m WACCG Budget was £54.9m.

Bottom line spend against month 12 allocation is (£538k) underspent – 1.00% under budget. This is compared to (£596k) – 1.09% underspent in month 11.

NHS Contracts are showing an over spend against month 12 allocation of £78k – 0.20% over budget, of which Wirral University Teaching Hospital is (£132k) underspent.

The 11/12 financial performance for WUTH was agreed by NHS Wirral and was (£1.4m) underspent. WACCG share of this underspend was (£132k).

Non NHS Contracts show an under spend against 11/12 allocation of (£394k) – 21.42%, of which (£229k) relates to Independent Sector contracts.

Commissioned out of Hospital budgets reported an overspend of £619k in 12/12 up from £499k overspent as at month 11.

Running Costs The Chair updated the group around the recalculation of the WACC running costs. The Chair proposed to merge both the WACC Board and CWG meetings in order to reduce the running costs of the division to support the development of WACC Management Team. Members agreed to support this. Members discussed the Non Executive Advisors position within the division and members agreed for WACC to continue to utilise this role.

6. Performance ad Quality The commissioning manager updated the group around the current A&E performance reports and targets. The group were asked to note these.

7. CWG Recommendations DME Patients Pilot – the commissioning manager informed the group about the feedback and issues raised at the Practice Managers forum around the pilot. GPs fed back their findings and experience of the process. Members were asked to confirm their interest and support for the pilot and agreed for it to continue for a further 3 months. Nursing Home Scheme – the commissioning manager informed the group on the current situation of the scheme and that due to some changes to the original scheme further costing implications will be implied. The commissioning manager is to take the amended proposal to the next CWG meeting.


8. Patient Engagement Group A member provided the group with the outcomes of the most recent WACCPEG meeting, which he attended and gave a presentation on the new NHS 111 service. The chair informed the group of the proposed future plans for the PEG. The commissioning manager updated the group about a meeting she attended with St Hilary Brow Group Practice Patient Representatives and the criteria’s around PPG and PEGs. It was suggested that the WACCPEG is represented by 1 member from each constituent practice with an appointed deputy. The chair is to attend the next WACCPEG meeting to be held on 26th June. Health & Wellbeing Board No items were discussed

9. Public Health Update Members were asked to note the written update by Fiona Johnstone, Director of Public Health.

10. AOB QIPP Invite Members were asked to note the invitation.

11. Risk Log The Chair and commissioning manager are to discuss the contents of the risk log.

12. The next meeting of the Wirral Alliance Commissioning Consortium Board will take place on 28th June 2012 at 1pm – 5pm in the Beveridge Room OMH – lunch will be provided.

Minutes Agreed as Correct and Accurate

Signed:

Minutes of WA Commissioning Consortium Board Meeting 21.06.2012 Page 1 of 2 Governing Body Meeting 7th August 2012

Wirral Alliance Commissioning Consortium Extraordinary Board Meeting

FINAL DRAFT MINUTES

21st June 2012, The Orchard 1.30pm – 3pm

Dr M Green – Chair Present: Dr M Green St Hilary Brow Group Practice Dr H Downs Civic Medical Centre Dr B Conlan The Orchard Surgery Dr R Williams Riverside Surgery Dr I Camphor Heatherlands Medical Centre Dr J Kingsland St Hilary Brow Group Practice Dr G Francis Spital Surgery Mr I Stewart WACC Chief Officer Mr M Roach WACC Non Executive Advisor

Reference Minute

Chair welcomed members and outlined the reason for convening an extraordinary board meeting. Discussion between members proceeded with regard to the previous discussion on the reply received from the CEO, CWW PCT Cluster relating to the anonymous letter circulating among the Wirral GP community. GP member emphasised the need for the board to comply with the wishes and decision of the last board meeting. Chair advised that having reflected on the previous meeting and taken advice from the Strategic Development Lead and Chief Officer, he confirmed the reason for the EGM was to revisit previous intent and decisions from the previous board meeting on 31st May 2012. A GP member summarised what the Alliance should be focusing upon. Discussion commenced about the governance approach taken by the interim CCG towards the recruitment process for key senior officer roles. GP member gave his perspective based upon national work with other CCGs and the pace at which the implementation of the Health Bill is proceeding, which in summary, leads him to believe that senior NHS officials at national level will be uninterested in local internal disputes. He reiterated that the goals of the Alliance must be responsible control of delegated budgets and the development of patient services. Discussion turned to the consistency of approach for recruitment of the key senior roles onto the interim CCG governing body and members agreed that Wirral Local Medical Committee should have a role in supporting Wirral practices determine the suitability of the nominated candidate for the AO role. Members further discussed the previous board decision to compile two letters. WACC Non-Executive Advisor advised that sending letters could be construed as inflammatory and would seriously damage the reputation of the Alliance. GP member added that members must consider the impact of such letters on the working relationship between the Alliance and the other divisions.

Minutes of WA Commissioning Consortium Board Meeting 21.06.2012 Page 2 of 2 Governing Body Meeting 7th August 2012

Reference Minute

GP member stated that he could not support the draft letter to the CWW PCT Cluster CEO in its current form. Chair replied that he was happy to amend the letters so long as board members are clear with what they expect to achieve by sending the letters and referenced the on-going instability within the group impacting upon the management team support with the recent resignation of the commissioning manager. Chair proposed the board draws a line under the internal debate about governance processes in the CCG and instead agrees that concerns about the workings and development of the interim CCG governing body are taken through the proper channels, i.e. Chair member raises formal concerns at governing body meetings. Chair further stated that if Wirral GPs have personal concerns about the interim CCG, they should contact their LMC to pursue their concerns. GP member provided feedback on behalf of an absent GP member who could not attend the extraordinary meeting due to annual leave commitments. GP member stated that the Alliance should ensure that good governance is well established across Wirral by 2013 through its influence on the governing body. Non-Executive Advisor reminded members of the progress the Alliance group has made in a short time; the achievements made in terms of patient services into practices and significant budget surplus available for reinvestment during 2012/13. Chair summarised the key discussion points of the meeting and requested absolute clarity on the two matters;

‐ Members were asked should proposed letters be written to local and national senior NHS leaders on the subject of governance processes within the interim CCG;

Outcome: Not to produce and send suggested letters

‐ Members were asked do they agree that governance concerns are taken through the CCG governing body via the Alliance Chair member;

Outcome: Agreement to raise concerns via the Alliance Chair member. Chair requested a statement of intent from each board member on behalf of their practice to remaining in the Alliance and continuing the clinical commissioning agenda – 5 members stated their intent to remain; 1 member stated that long-term commitment could not be given at this time as reflection is required after today’s meeting; 1 member practice was not in attendance so could not express their intent. Chair thanked members for their time and contributions and the meeting ended.

Wirral Health Visiting/Family Nurse Partnership Development Plan 2012/15




Lead Officer: Rosemary Curtis

Contributors: Chandra Dodgson


N/A – Health Visiting and Family Nurse partnership are commissioned by the NCB

Governance:


N/A

Summary: This report was presented to the NHS Warrington, Cheshire and Wirral Cluster Management Team for approval, as the commissioning responsibility lies with the NCB. The proposal was approved on 4th July 2012. Health Visiting and the Family Nurse Partnership Programme are key priorities in the NHS Operating Framework. The report outlines the development of capacity and capability required for these two services to meet the requirements to fully deliver a nationally mandated new model of working by March 2015, and the associated investment requirement. The report also gives information on the progress in development so far, in particular the success of Wirral in being an ‘early implementer’ of the Health Visiting Development Plan for England. The services in Wirral are provided by the Wirral Community NHS Trust. The health visiting service is a public health programme providing evidence based interventions which are effective in both the primary and secondary prevention of poor health outcomes/life chances. Evidence of the long term impact of poor health and wellbeing during pregnancy and the first two years of life is summarised in the Marmot Review (Fair society, healthy lives DH 2009); the health visiting /FNP service aims to meet the recommendations of this review from a public health perspective, and contributes to meeting those recommendations from a child poverty, education and social care perspective.

To Approve

To Note x

Recommendation:

Comments The report attached is the one presented to the CMT for approval.

Next Steps: The WCT are contracted to provide the service; contract monitoring is in place

Wirral Health Visiting/Family Nurse Partnership Development Plan 2012/15 Governing Body Meeting 7th August 2012

1/2

Wirral Health Visiting/Family Nurse Partnership Development Plan 2012/15 Governing Body Meeting 7th August 2012

2/2


Financial

These services sit within the Public Health budget allocations. This development plan requires additional investment (detailed in appendix 2) over the three year period to increase both the numbers of qualified health visitors, and maintain sufficient community staff nurses to create a ‘grow your own’ succession strategy, as outlined in the Health Visitor Implementation Plan: Implications of being an ‘Early Implementer’ Site report approved by the NHS Wirral CDG on 29/03/11.

Value For Money The development plan will enhance the clinical effectiveness of the service in delivering the Healthy Child Programme to all families, and the skills of practitioners in delivering the Universal Plus and Universal Partnership Plus elements of the service to vulnerable families, particularly in utilising evidence based programmes such as the FNP to improve short and long term outcomes for children and families.

Risk N/A

Legal N/A

Workforce As outlined in proposal


The development plan explicitly targets resources towards identified need, so enhancing services for the most vulnerable children and families.


The development plan includes routine ongoing consultation with families on all levels of the pathway, and utilising strengths based approaches which enhance families’ capability in providing good quality care for their young children

Partnership Working

This service is highly integrated with both maternity and Children’s Centre services.


Are built into the service specification/contracting requirements





Health Visitor Implementation Plan: Implications of being an Early Implementer site

Wirral CDG 29/03/11 Appro



Wirral Health Visiting/Family Nurse Partnerships Development Plan 2012/2015 Page 1 of 9 Governing Body Meeting 7th August 2012

Wirral Health Visiting/Family Nurse Partnership

Development Plan 2012/15

Lead Cluster Director:

Cathy Maddaford

Lead Author: Rosemary Curtis

Contributors: Chandra Dodgson

Approve

All

Cen

tral & E

astern

Ch

eshire

Warrin

gto

n

Western

Ch

eshire

Wirral

Recommendation Summary:

Note x

Relevant PCT

x

Purpose of Report: Health Visiting and the Family Nurse Partnership Programme are key priorities in the NHS Operating Framework. This report outlines the development of capacity and capability required for these two services to meet the requirements to fully deliver a nationally mandated new model of working by March 2015, and the associated investment requirement. The report also gives information on the progress in development so far, in particular the success of Wirral in being an ‘early implementer’ of the Health Visiting Development Plan for England.

Recommendation: That the proposed development plan is approved, including the investment required to deliver it.

Next Steps: Contract with Wirral Community NHS Trust to deliver the local development plan.



DOES THIS REPORT / ITS RECOMMENDATIONS HAVE IMPLICATIONS AND IMPACT WITH REGARD TO THE FOLLOWING: 1. QUALITY

Patient Safety Yes The development plan will enhance the quality of safeguarding provided by the health visiting service by providing increased capacity and capability in the workforce.

1(a)

Clinical Effectiveness Yes The development plan will enhance the clinical effectiveness of the service in delivering the Healthy Child Programme to all families, and the skills of practitioners in delivering the Universal Plus and Universal Partnership Plus elements of the service to vulnerable families, particularly in utilising evidence based programmes such as the FNP to improve short and long term outcomes for children and families.

1(b)

Patient Experience (including patient and public involvement) Yes The development plan includes routine ongoing consultation with families on all levels of the pathway, and utilising strengths based approaches which enhance families’ capability in providing good quality care for their young children.

1(c)

2. ADDITIONAL RESOURCE IMPLICATIONS (either financial or staffing resources)

Yes

This development plan requires additional investment (detailed in appendix 2) over the three year period to increase both the numbers of qualified health visitors, and maintain sufficient community staff nurses to create a ‘grow your own’ succession strategy, as outlined in the Health Visitor Implementation Plan: Implications of being an ‘Early Implementer’ Site report approved by the NHS Wirral CDG on 29/03/11.

3. HEALTH INEQUALITIES Yes The health visiting service is a public health programme providing evidence based interventions which are effective in both the primary and secondary prevention of poor health outcomes/life chances. Evidence of the long term impact of poor health and wellbeing during pregnancy and the first two years of life is summarised in the Marmot Review (Fair society, healthy lives DH 2009); the health visiting /FNP service aims to meet the recommendations of this review from a public health perspective, and contributes to meeting those recommendations from a child poverty, education and social care perspective.

4. HUMAN RIGHTS, EQUALITY & DIVERSITY REQUIREMENTS Yes The development plan explicitly targets resources towards identified need, so enhancing services for the most vulnerable children and families.

5. EQUALITY IMPACT ASSESSMENT No

If yes, how will this impact on these requirements






Report Name Ref Locality Submitted to Date Brief Summary of Outcome

Health Visitor Implementation Plan: Implications of being an Early Implementer site

Wirral CDG 29/03/11 Approved

New Health Visiting Model: Application to Become a NW Early Implementer Site

Wirral CDG 21/03/11 Further clarification requested

Reducing Inequalities by Using Evidence Based Programmes to Improve Outcomes for Vulnerable Groups; The Family Nurse Partnership Programme in Wirral

Wirral CDG 01/11/10 Approved additional funding required to ‘mainstream’ pilot

The Family Nurse Partnership Programme Pilot for Wirral

Wirral CDG 21/09/10 Further clarification sought

Health Visiting Report

Wirral CDG 04/08/09 Approved reconfiguration of service to address safeguarding concerns.



Implementing the Child Health Strategy: Delivering the Healthy Child Programme for Pregnancy and the Early Years

Wirral PEC 19/05/09 Noted

Expectations of the HCP: implications and proposed service developments for HV services across Wirral

17/03/09 Approved investment to redesign service.



NHS CHESHIRE, WARRINGTON AND WIRRAL

WIRRAL HEALTH VISITING/FAMILY NURSE PARTNERSHIP DEVELOPMENT PLAN 2012/15

Introduction 1. The NHS Operating Framework 2011/12 and 2012/13 prioritises the

development of services for children during pregnancy and the first two years of life to support improved health and development outcomes. Specifically, it requires PCTs to ensure they:

“Develop effective health visiting services, with sufficient capacity to deliver the new service model set out in the ‘Health Visitor Implementation Plan 2011-2015 – A Call to Action’ to deliver the Healthy Child Programme, provide greater support to families and develop local community capacity in support of children and families, working closely with Sure Start Children’s Centres and other local services. The government is committed to developing an expanded and stronger health visiting service as a key element of improving support to children and families at the start of life. This will entail ending the decline in workforce numbers, beginning to increase posts, workforce numbers and training capacity in the short term, and increasing the overall numbers of health visitors by 4,200 by April 2015” And “Improve outcomes for the most vulnerable first time teenage mothers and their children by maintaining existing delivery Family Nurse Partnerships alongside planning for an expanded service in appropriate areas”

2. During 2009/10 NHS Wirral approved investment to enable the redesign of local

health visiting services and the piloting of the Family Nurse Partnership Programme (FNP). These service developments have resulted in measurable improvements in the impact of service delivery, particularly to the more deprived areas of the borough (identification of safeguarding risks, early identification of children with social/communication disorder/delay, uptake of routine screening/health promotion appointments).

3. However despite this increased investment, Wirral’s funding on the Health Visiting

workforce remained at 76% the NW average (NHS NW Health Visiting Workforce Summary May 2010). This summary recommended a 51% increase in the qualified workforce to meet the recommendations of Cowley and Bidmead (2009) for caseload sizes needed to deliver a high quality Healthy Child Programme to Wirral’s population.

4. In 2011/12 the improvement in performance following redesign led to Wirral being

selected as an ‘early implementer’ site for the National Health Visiting Implementation Plan, and active participation of the commissioning lead in the NW Partnership which has responsibility for ensuring the implementation of the national plan for the region;

Early Implementer Site



5. The Wirral Health Visiting service engaged in and supported a number of events and

activities during 2011/12, including presentations at cluster, SHA and DH which were well received;

6. Developments in service quality during this period include:

Introduction of a universal antenatal contact at 30-36 weeks gestation, supported by training in Promotional Interviewing for staff to enhance skills in promoting behavior change;

Development of a breastfeeding app for smart phones to improve access to

immediate advice and support for women contemplating giving up breastfeeding;

Introduction of a Healthy Child Clinic providing booked and drop in access to health and development reviews, health promotion advice and minor ailments advice 9 – 5 five days a week (trial of longer hours had poor uptake). This improved uptake of routine development reviews from 30% to 90% in a deprived area; families from across Wirral are now accessing this service, and a roll out of this model is planned for 2013/14;

Uptake of the Healthy Child Programme universal offer of contacts and

development reviews is now consistently over 97% in all areas;

Health visitors regularly offering health promotion advice to local community from a local market stall;

Publication of an article in ‘Community Practitioner’ journal regarding

breastfeeding promotion;

Some teams co-located in Children’s Centres, with team size and skill-mix allocated using an evidenced based tool to meet identified local needs;

Growing the workforce/succession planning using Band 5 Community Nurses to

create career progression has resulted in moving from no suitable applicants for vacant posts in 2009 to multiple suitable applicants for all advertised posts;

The FNP continues to work intensively with 125 vulnerable young women and

received a favourable assessment from the DH National Unit on the occasion of the team’s second annual review of performance in March 2012.

Development Plan 2012/13 7. Learning from the successful delivery of the first year of Wirral’s local Health

Visitor/FNP Implementation Plan, including Early Implementer Site status, informs this proposed detailed plan for 2012/13;



A service specification (appendix 1), meeting the requirements of the NHS NW Health Visitor Partnership Board, has been developed to meet local needs and will be delivered from April 2012; it includes outcome based performance indicators;

Team configuration will be further developed to ensure consistency in team size

and responsibility levels for Team Leaders and efficient use of resources, ensuring sufficient resources are deployed in communities with the highest levels of need.

Reallocation of staff resources to meet identified needs will continue during

2012/13; a fair deployment of staff resources (numbers/skill mix/experienced v newly qualified staff) will be fully in place by March 2013;

Workforce expansion plans will as a minimum meet the SHA targets set for

2012/13/14/15; Building on the success over 2010/11/12 of delivering the core offer of the Healthy

Child Programme (Universal Offer), and the Universal Plus offer, development in 2012/13 will focus on delivering the Universal Partnership Plus offer, including working closely with Children’s Centres to jointly develop/implement the Wirral Children’s Centres PbR pilot, further increasing the size of the FNP team to meet local public health priorities, and developing 2 x Band 7 Specialist Health Visitor posts with the skills to lead and deliver intensive interventions for families with complex needs (disability and adult mental health).

In addition, the service will move from a paper based to an electronic data

collection and record keeping system for all staff and services by March 2013; Further work during 2012/13 will prepare for delivery of the Community Offer in

2013/14, and working to support the local Child Poverty Strategy and the ‘Troubled Families’ initiative in partnership with the LA;

8. The success in improving the reach of the HCP to all families, and improved staff

skills in assessing family functioning, has resulted in a significant increase in the identification of safeguarding issues requiring referral to Children’s Social Care and involvement in multi-agency interventions to protect children and support families. This has resulted in significantly higher workload pressures for the experienced practitioners within teams. Wirral’s historically high numbers of Looked After Children (currently 208 under 5s) also places a significant workload stress on teams. The Wirral FNP annual review highlighted the high levels of vulnerability in the client group which this team serves, e.g. significantly raised (compared to other FNP sites) amounts of time being spent on issues around housing and homelessness, higher numbers of young women who have been in the care system, higher numbers of younger women (16 year olds).



Investment Requirements 9. The proposed development plan has been costed for investment required (detailed in

appendix 2) for the period 2012/13/14/15; it provides:

WTE

2012/13 2013/14 2014/15 2015/16

66.00

78.60

88.00

88.00

Additional WTE (Full Year Effect)

2012/13 2013/14 2014/15 2015/16

Total Additional

WTE

Total Recurrent Additional Cost £

12.60

9.40

‐

22.00

992,830

The necessary capacity to deliver the HCP well, with expansion of the accessible

healthy child clinics and breastfeeding support; Clear career progression from Band 5 Registered Nurse to Band 7 Specialist

Practitioner facilitating the recruitment and retention of a skilled workforce; Capacity to deliver the community offer of the National Service Specification; Capacity to contribute to integrated working with the LA;

Conclusions 10. During 2011/12, significant progress has been made in improving the quality and

impact of the delivery of the HCP in Wirral. There is robust evidence that further significant improvements in short and long term health outcomes and life chances for children can be achieved through the provision of a high quality and well resourced service.

11. The development plan meets the requirements of the Operating Framework and the SHA workforce expansion target; it provides the capacity to deliver improved outcomes for young children and their families;

12. The investment required is within the budget allocations made for this service. Recommendations



13. The Board are asked to approve investment to deliver a high quality service to support improvements in outcomes and life chances for young children.

Cathy Maddaford Director of Quality and Performance/Executive Nurse Rosemary Curtis Programme Lead – Children CAMHS and Maternity CWW CSS; June 2012 Appendix 1

Appendix 1.doc

Appendix 2

Appendix 2 Option Costing HV 110612.xl

NHS Wirral Clinical Commissioning Group Risk Register







Delivery of Commissioning objectives and performance targets for clinical commissioning group

Governance:


Performance Targets / Financial Performance

Summary: Update on progress regarding development of risk register for clinical commissioning group based on federated / consortia level risks.

To Approve

To Note

Recommendation:

Comments

Next Steps: Continued development of risk register and associated policies / guidance for use within clinical commissioning group.

Risk Register: Governing Body Meeting 7th August 2012

1/3


2/3



Financial

Develop robust process for identification, assessment and mitigation of financial risk

Value For Money N/A

Risk Develop robust process for identification, assessment and mitigation of all risks to clinical commissioning group

Legal Identification of risk may require judgement of legal implications

Workforce Identification of risk may require judgement of workforce implications


N/A


Risk management process may require patient and public involvement

Partnership Working

Risk management process may require assessment of impact on partners


Identification of Risk and mitigation will require use of performance indicators








3/3
