HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP. Minutes of the Meeting of the Harrogate and Rural District Clinical Commissioning Group

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1 Item 9.4 HARROGATE AND RURAL DISTRICT CLINICAL COMMISSIONING GROUP Minutes of the Meeting of the Harrogate and Rural District Clinical Commissioning Group Finance, Performance and Commissioning Committee 27 February :00 10:00 Boardroom, 1 Grimbald Crag Court, St James Business Park, Knaresborough, HG5 8QB Present Amanda Bloor, Chief Officer, HaRD CCG (Chair) Bernard Chalk, Chief Finance Officer, HaRD CCG Dr Alistair Ingram, Clinical Chair, HaRD CCG Alec Cowell, Head of Finance and Contracting, HaRD CCG Jane Baxter, Head of Commissioning, HaRD CCG Apologies Dr Rick Sweeney, GP Member, HaRD CCG In Attendance Alison Simm, Corporate Affairs Officer (Secretariat), HaRD CCG 1.0 Introductions and Apologies Apologies were received, as above. 2.0 Minutes of the Meeting held on 04 February 2014 The minutes for the meeting held on 04 February 2014 were accepted with no amendments. The action log was reviewed by the Committee and the following was noted: Alec Cowell working through what the cost of Out of Hours should be. Discussion then to be had with Harrogate and District Foundation Trust (HDFT) re: Extra costs. Out of Hours contracts being reshaped in light of Vale of York CCG giving notice to HDFT to 31/3/2015. Yorkshire Ambulance Services over trade of 1 million over North Yorkshire, 200,000 for HaRD CCG. The CCG have requested further details prior to payment. This is recognised as a potential area of dispute. Yorkshire Ambulance Services 2014/2015 contract, negotiations continue in relation to baseline activity.

2 Quality & Performance Dashboard: Meetings will be set up with Business Intelligence to discuss the process of producing the Dashboard. Given the proximity of this meeting to the previous FPCC, it was agreed to focus on the following: HDFT Contract & Activity Partnership Commissioning Unit (PCU) Commissioning Support Unit (CSU) 3.0 HDFT Contract: 2013/2014 Year End reconciliation on activity has been reached between HDFT and HaRD CCG. There is a 2.9 million over trade, with over 2 million in Elective and Outpatients. A further issue surrounds the disputed activity invoiced to NHS England specialist commissioning of 450K. Bernard Chalk and Alec Cowell have undertaken a detailed review of activity by speciality, looking at areas with highest activity. Activity has been reviewed against commission threshold criteria. Their findings will be shared at the Governing Body workshop on 6 March There is a need for greater clarification for GP s on referral guidance, with referral criteria available on HaRD CCG intranet. ACTION: To agree CSU to review intranet. Bernard Chalk summarised some of the main areas where there were unexplained rises in activity over plan: Hernia surgery & Haemorrhoidectomy. Trigger finger. Tonsillectomy. Termination of Pregnancy s. Trauma & Orthopaedics.. ACTION: Bernard Chalk proposed a monthly review on individual selected specialties with a GP Governing Body member. Bernard Chalk and Alec Cowell viewed an IQ SUS validation software package by a company called IQ Commissioning, which includes cost details. ACTION: Bernard Chalk to arrange further demonstration for Senior Management Team and GP s. Hambleton,Richmondshire & Whitby CCG and South Tees Acute Trust are already undertaking monthly reviews on referral management. Jane Baxter is linking with them to share their learning. Bernard Chalk identified an extra financial risk for 2013/2014 and 2014/2015 of 600,000 of orthopaedics activity that has been coded to Specialist Commissioning. Bernard Chalk is meeting Specialist Commissioning colleagues from NHS England South Yorkshire Area Team to discuss and clarify the situation.

3 North Yorkshire & Humber Area Team are aware of this issue and ongoing work to resolve. 2014/2015 Business Cases: IVF IAPT Section 136 Autism To be further reviewed in Governing Body planning workshop on 6 March 2014 prior to the Governing Body meeting on 3 April Activity: Bernard Chalk is currently in discussion with HDFT. There are some areas of growth such as ENT, Dermatology and Trauma & Orthopaedics. HDFT assumptions and CCG assumptions and where there are differences to be discussed at the Governing Body planning workshop on Thursday 6 March Bernard Chalk raised a further issue with Specialist Commissioning and BMI The Duchy. Specialist Commissioners have said they will not recognise BMI The Duchy as a specialist centre from 1/4/2014. BMI The Duchy are commissioned for specialist Orthopaedic activity. HaRD CCG commissions 600,000 and Specialist Commissioning 1.2 million. This creates a risk to HaRD CCG and BMI The Duchy. The CCG to have further discussions with NHS England Specialist Commissioning. Alistair Ingram to be given a list of procedures covered by Specialist Commissioning. 4.0 Partnership Commissioning Unit Management Meeting Meeting was held on 13 February After discussion it was agreed to move to a bi-monthly meeting. Amanda Bloor raised concern that the CCG needed to assure itself that PCU was undertaking commissioning in line with CCG plans. The management meeting was more updating than a strategic management meeting. There is a need to clarify contacts and lines of communication within PCU and review the activity of PCU. PCU are now attending the Quality & Clinical Governance meetings and will attend the Governing Body twice a year attending on 5 June 2014.

4 5.0 Commissioning Support Unit Annie Macleod has been appointed as the HaRD CCG Relationship Manager. Amanda Bloor is meeting with Annie Macleod on Monday to discuss the following issues: Information Technology Helpdesk Independent Funding Requests Business Intelligence Website Embedded staff The CCG will be establishing a more formal process to manage CSU contract and will be reviewing the range of services it commissions from CSU. Annie Macleod has been formally invited to attend the monthly Finance Performance & Commissioning Committee. 6.0 Any Other Business 6.1 Transformation Committee: Amanda Bloor and Bernard Chalk will meet with Sally Burton to discuss the transformation committee. Role of committee clarified to drive forward transformation. Bernard Chalk drafting revised Terms & Reference and membership to be consolidated. 6.2 Better Care Fund Proposal (BCF) The BCF proposal is being peer reviewed by NHS England and City of York Council. Bernard Chalk is creating a flowchart mapping the approval process in agreeing funding movements. 6.3 Urgent and Emergency Care Working Group The Working Group met on Tuesday 25 February. Bernard Chalk is writing up the agreed key proposals. In summary there are 2 main work streams. Urgent Care Centre Andy Alldred to lead Out of Hospital Rob Penman to lead.

5 2 Project Managers to be appointed, 1 at HaRD CCG and 1 at HDFT. HaRD CCG to fund 1 project manager on a fixed term contract. Andy Alldred to attend the Public Participation event on 11 March. 7.0 Other Contracts 7.1 BMI The Duchy Harrogate Bernard Chalk presented the paper BMI The Duchy Harrogate Contract 2014/15 report written by Paul Twigg. The CCG had novated to it an AQP contract with BMI The Duchy Harrogate for elective general surgery and elective orthopaedic surgery. The CCG agreed to roll-over the contract in to 2013/14 with a zero value (no activity plan) and is currently trading circa 700,000 for the year to 31 March The meeting agreed to extend the existing contract with BMI for one year to 31 March Local Voluntary Sector Agreements for 14/15 Bernard Chalk presented the paper Local Voluntary Sector Agreements for 14/15 written by Paul Twigg. The CCG has a small number of voluntary sector agreements which are not part of pan-north Yorkshire services and as such not part of the Strategic Commissioning Collaborative decision making process. North Yorkshire County Council (NYCC) The majority of these are contracted by NYCC and part funded by the CCG under section 256 agreement. The following were agreed: NYCC: Extend for one year at 0% uplift. NYCC: Review the services in 2014/2015. St Michaels Hospice St Michaels Hospice is the sole provider of hospice care within the boundary of Harrogate and Rural District CCG.

6 The following was agreed: To continue with the existing funding in 2014/2015. The following were noted: The Stroke Association currently receives two allocations of funding from the CCG. Both are currently under review and the CCG will need to make a decision around future intensions and funding at later date. Marie Curie Nursing Service is currently commissioned for a Planned Variable Service by the CCG. The CCG has in year agreed to adjust the skill mix to 20%(RN) and 80%(HCA) and increase the annual spend to 80K. 8.0 Next Meeting Tuesday 29 April Boardroom Grimbald Crag Court Knaresborough

7 Actions from the Finance, Performance and Commissioning Committee on 27 February 2014 Meeting Date Item Action Responsibility Action Completed / Due to be Completed (as applicable) To update time HDFT Contract Talk to Annie Macleod about CSU setting Amanda Bloor up the HaRD intranet HDFT Contract Process for monthly review on individual Bernard Chalk selected specialties with a GP governing Body member HDFT Contract Arrange demonstration of IQ SUS Bernard Chalk validation software HDFT Contract HR&W CCG & South Tees Acute Trust Jane Baxter monthly review procedure HDFT Contract Further talks with Specialist Bernard Chalk Commissioning over BMI the Duchy HDFT Contract List of procedures covered by special Alec Cowell commissioning to Alistair Ingram Better Care fund Better Care Fund approval process Bernard Chalk