Council of Members 26 March 2015 Minutes of last meeting: January - PDF document

Council of Members 26 March 2015

Minutes of last meeting: January 2015 Dr. Richard Proctor, Council of Members Chair

Effective Co-Commissioning of Primary Care Dr Jonty Heaversedge, CCG Chair and Dr Richard Proctor, CoM Chair

Working together for improved outcomes As a CCG we have committed to clinically led and locally determined and responsive commissioning of health services in Southwark. This presents huge opportunities to make a difference for the patients we know best. But… as a membership organisation of general practices it also poses challenges – we determine commissioning intentions in the best interests of our entire population at the same time as providing services relentlessly focused on doing the best for ‘our’ registered list. We have established a great many things to assist us: • Elected Governing Body members to provide a single leadership voice and a Council of Members to provide practices with a direct role in commissioning planning and oversight. • A Conflicts of Interest infrastructure to advice and help us by testing the objectivity of our thinking. • Management resources to assist in the planning and implementation of our strategies. • Engagement opportunities with members, local people and stakeholders. These support us, provide legitimacy, evidence base and focus but they require and can not replace - effective interactions, mutual understanding and team work to make effective and safe decisions 4

Table work: the scenario In developing our plans for 2016/17 we have proposed and are developing a consensus that: A nationally determined set of QOF indicators does not optimally incentive providers to improve outcomes for local people. Our proposition is that a locally determined set of indicators with disproportionate reward associated with addressing greatest local need would work better. Moreover, we believe the level of QOF associated resource does not reflect the new level of primary care delivered preventative care we would wish to describe and commission. Questions: Who do we engage in this commissioning discussion? What should the criteria for our decision making be? Who should make this decision and how – how would we best use our discussion? As a public body how would we best communicate our decisions? 5

Table Discussion and Feedback

Arrangements for the Co-Commissioning of Primary Care Dr Richard Proctor, CoM Chair Andrew Bland, Chief Officer and Malcolm Hines, Chief Financial Officer

Primary care co-commissioning In February 2015 the CCG was formally notified that it had received approval to co- commission primary care services for the borough – pending changes to our constitution. Our successful application was submitted on 30 January following endorsement from the Council of Members and the decision of the Governing Body to proceed in that month. The CCG will be a Joint Commissioner (Level Two) with NHS England from 1 April 2015 as opposed to a Delegated Commissioner where full responsibility is transferred to CCG. This an arrangement for Southwark BUT it sits alongside the same approval for the other five boroughs in south east London who we will work and share resources with. Our application was approved as it demonstrated: • That CCG involvement in commissioning of primary care would deliver enhanced outcomes for our population by focusing the resources and design of services across the whole care pathway • The required support of local people through engagement, our partners (particularly the Health and Wellbeing Board) through their agreement and significant engagement with member practices. This alongside appropriate governance has secured this position. 8

How will we co-commission services (1 of 2) From 1 April 2015 the scope of our commissioning intentions / plans will broaden to include primary care. Whilst responding to a wider scope our commissioning intentions will still be: a) Developed with members, b) Recommended by our Governing Body and c) Approved annually by our Council of Members They will be joint with NHS England who will seek to align their requirements for commissioning to our local intentions – when combined they should provide a coherent local approach – the CCG will need to assure itself of this before any decisions are made Decision making will remain local and clinically led – We will develop our intentions in the usual way; our Conflicts of Interest Panel will advise us of their objectivity and alignment to population need and improved outcomes and impact in reducing inequalities before our Governing Body decide upon them. 9

How will we co-commission services (2 of 2) CCG-generated commissioning intentions for primary care will be subject to our usual processes before going to a Joint Committee – a committee of our Governing Body and of the NHS England Board where they will be agreed and progressed in public. That committee will seek to work by consensus but where a vote is required there will be seven voting members: 1. Six from the CCG (2 Lay members, 2 GP Governing Body members, the external nurse member or secondary care member and the Chief Officer) and 2. One from NHS England (this vote will be shared by three attendees) The CCG members will have a majority say in all circumstances accept those where a decision would break NHS England statutory duties – here the NHS England vote would be weighted to equal the CCG vote and they would have a casting vote. Local and clinically led commissioning would preside in these arrangements as CCG members would be articulating the Governing Body’s view with a majority vote if needed . The committee will be chaired by a CCG lay member, the committee will be held in public and representatives from Healthwatch, the Health and Wellbeing Board (Local Authority) and the LMC in attendance 10

Primary Care Joint Committee membership • CCG Chair • GP member of the Governing Body (from a different Clinical Members practice to the chair) • Governing Body specialist in secondary care OR External Governing Body nurse • Lay Member for Public and Patient Involvement or Quality (Chair) Lay and Executive Members • Lay Member for Governance (Vice Chair) • Chief Officer NHS England Members • Medical Director for South London • Director of Commissioning Operations (1 voting member, 2 non-voting members) • Director of Primary Care 11

Was this straight forward? In short….No. National guidance has changed four times around governance since the 30 January 2015. As a consequence: Delegated co-commissioning arrangements are still unclear and these CCGs are being awarded budgets without the due diligence that Southwark CCG would expect. We have successfully argued for a Southwark only joint committee rather than a regional arrangement that would have allowed voting from non-local stakeholders from other boroughs. We have not agreed proposals for parity of voting between CCG and NHS England committee members for all decisions (accepting this only where statute would be broken). We have secured the primacy of our existing arrangements (Council of Members and Governing Body) making the joint committee a place for joint agreement of our locally derived commissioning intentions. We have successfully agreed that our Conflict of Interest arrangements are appropriate for co-commissioning and in doing so ensured GP members are not excluded from decision making. 12

Question and Answers

Council of Members to approve: The proposed constitutional changes relating to co-commissioning Refer to Terms of Reference for Joint Committee (in CoM papers)

Update on CCG Financial Position Malcolm Hines, Chief Financial Officer

Financial Performance Duties YTD Annual Forecast Duty YTD Target RAG RAG Performance Target Performance Achieve planned surplus (Expenditure £5,474k £6,916k £5,972k £7,141k not to exceed income) Capital resource does not exceed the N/A N/A N/A N/A allowance Revenue resource does not exceed £346,568k £339,652k £379,826k £372,685k the allowance Capital Resource use on specified matters does not exceed the N/A N/A N/A N/A allowance Revenue resource use on specified matters does not exceed the N/A N/A N/A N/A allowance Revenue administration resource use £6,807k £6,234k £7,621k £6,915k does not exceed the allowance Notes: 1. The above duties correspond to those reported in Note 42 of the Annual accounts, and represent the statutory duties of the CCG. 16

CCG Programme Budget Summary: M11 2014/15 Annual Variance to Predicted End Best Case Worst Case Programme Budget Budget (£k) Month 11 (£k) of Year (£k) (£k) (£k) Acute 222,766 -1,329 -1,597 -1,268 -1,925 Client Groups 70,388 2,500 2,496 2,636 2,251 Community and Primary Health 35,271 176 200 300 100 Services Prescribing 31,046 -720 -786 -655 -1,055 Corporate Costs 6,227 121 150 220 100 Earmarked Budgets and 535 121 0 0 535 Reserves Planned Surplus 5,972 5,474 5,972 5,972 5,972 Total 372,205 6,343 6,435 7,205 5,978 Reserves not utilised in 535 535 0 above position Reserves not yet utilised in above position (Month 10 for 535 535 0 3 comparison) 17