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«Minutes of a Meeting of the Finance and Performance Committee Held on Tuesday, 24 May 2016 in the Boardroom, Blackpool CCG Present: Roy Fisher, CCG ...»

Approved 28 June 2016

Minutes of a Meeting of the Finance and Performance Committee

Held on Tuesday, 24 May 2016 in the Boardroom, Blackpool CCG

Present: Roy Fisher, CCG Chairman (Chairman)

Dr Amanda Doyle, Chief Clinical Officer (up to Item 7a)

David Bonson, Chief Operating Officer

Andrew Harrison, Chief Finance Officer

Dr Cruz Augustine, GP Member

Dr Marie Williams, GP Member

Dr Michelle Martin, GP Member

In Attendance: Pat Crawford, Interim Deputy Chief Finance Officer Janet Barnsley, Service Director, M&L CSU Beth Goodman, Contract Management Locality Lead, M&L CSU Dr Mark Johnston, Deputy Chief Operating Officer (up to Item 7a) Melanie Preston, Head of Medicines Optimisation (up to Item 7b) Paul Magee, Interim Quality and Performance Specialist (Clinical) M&L CSU (up to Item 7d) Chris O’Neil, Commissioning Manager (for Item 7e) Vicki Lockwood, QIPP Programme Officer Clare Thomason, Associate Director, Attain Louise Talbot, Secretary to the Governing Body Roy welcomed Clare Thomason to the meeting.


1. Apologies for Apologies for absence had been received from David Edmundson, Allan Jude Absence and Helen Lammond–Smith.

2. Declarations RESOLVED: That the interests declared by members of the Committee as of Interest listed in the CCG’s Register of Interests be noted. The Register Relating to the is available either via the Secretary to the Governing Body or

Items on the the CCG website at the following link:

Agenda http://blackpoolccg.nhs.uk/about-blackpool-ccg/whowe- are/our-governing-body/

3. Minutes of the RESOLVED: That the minutes of the meeting held on 26 April 2016 be Meeting Held on approved as a correct record.

26 April 2016

4. Matters There were no issues.


5. QIPP Mark Johnston introduced Clare Thomason, Associate Director of Attain who would be supporting the CCG over the coming weeks on QIPP and are currently one week into their work. Clare gave a presentation and explained that Attain had been commissioned to support Blackpool CCG with the development of the 2016/17 QIPP Plan. The CCG’s senior leads had expressed concern regarding the confidence in delivery and realisation of QIPP plans and required sup

–  –  –

6. Spire Fylde Janet spoke to a circulated report which had been submitted to the Executive Coast Hospitals Team for discussion. The report provided an update in relation to activity Update. over performance and coding changes resulting in increased case mix and associated costs at Spire Fylde Coast Hospitals. She took colleagues through

the report which covered:

–  –  –

as some CCGs had paid more than their fair share. The data received from the working group looking at this showed significant increase across the Fylde Coast and utilisation. This was currently being looked at.

Amanda explained that we may be paying more for OATS due to the delayed transfers of care from other commissioners.

Pat then took members through the remainder of the report covering prescribing, continuing health care, Vanguard and QIPP. The level of the Vanguard funding award had yet to be confirmed however, the CCG was expecting to receive less than previously expected. A material change could impact significantly on the timing and funding of the planned roll out of the new care models and also on delivery of the QIPP programme. In the meantime, anticipating a reduction, the extensive care programme at Blackpool had been divided into two sectors rather than three previously proposed with planning resources also cut by one third. It was noted that Fylde and Wyre CCG is also looking at a similar provision of two nurses covering rather than three. Pat also took colleagues through the information around the movements in reserves and the planned risks and mitigations. She asked colleagues to let her know if there were any changes to the plan as it is updated monthly and reported to NHS England.

Amanda Doyle left the meeting.

The utilisation of reserves would be reported back to the committee to agree any reserves in lieu of QIPP under delivery.

Mark Johnston left the meeting.

Andrew commented that the planned update in respect of risks would be submitted to the next meeting of the Committee and members would be kept updated at future meetings. Members noted the other matters included within the report and colleagues were informed that the Governing Body report made reference to a potential upside risk on rates. Discussions were currently ongoing and £0.5m had been included in the plan. Members also noted that the finance team had worked with managers to present the monthly financial statements in a form that aimed to help them meet their responsibilities. It is planned for managers to sign off their budgets in the near future. At the same time, the detailed financial policies would be strengthened so that the requirements relating to the responsibility and controls perspective on the governance processes are clear.

David sought clarification on the Quality Premium and Andrew commented that there were three or four areas that had been built into the mitigations.

RESOLVED: That members note that the CCG’s financial position remains tight and that significant risks remain in the position.

–  –  –

(b) Medicines Optimisation – Melanie explained that this was the first time an update on medicines optimisation had been submitted to the committee as it had previously been submitted to Quality and Engagement Committee. It

–  –  –

had been agreed that a level of detail for future meetings would need to be provided and Melanie took members through the report.

(i) Update – Melanie informed members that the GP practice prescribing for March year to date showed a final overspend of just under £300,000 and it was noted that this was a much better position than originally anticipated.

She made reference to the yearly budget for prescribing by month for the CCG for 2014/15 and 2015/16.

Melanie made reference to the Category M drugs and confirmation was awaited as to whether we would receive the benefits of this. The QIPP schemes were delivering. Two main areas of growth related to diabetes and anticoagulants. Melanie explained that there was a disproportionate use of Apixiban over Warfarin and there had been an increase in usage. She explained that the newer anticoagulant drugs (NOACs) are considerably more expensive compared to Warfarin. Increasing costs are being driven by the proactive identification of patients with atrial fibrillation in primary care and the apparent preference of secondary care prescribers to initiate the NOACs.

A joint communication from both Blackpool CCG and Fylde and Wyre CCG was being sent to BTH to raise this concern.

Melanie explained that the prescribing QIPP schemes identified areas where prescribing could be most cost effective to deliver some quick wins but also some longer term increases of work. Phase three was currently being progressed. A list of these pieces of work were available in the Medicines Prescribing Group minutes. Two main schemes had been considered by the Clinical Leadership Team and they were comfortable in proceeding with the schemes.

Melanie explained that there are regular practice pharmacist meetings and they have delivered what we have asked them so far which was extremely pleasing. She also explained that our costs per item were generally lower than across Lancashire.

The Medicines Prescribing Group had been set up to provide a more robust internal process to manage recommendations or decisions relating to medicines. It had been proposed that the minutes of the meeting are received by the Clinical Leadership Team for information or for further discussion as appropriate. The report provided information on the remit of the group.

Melanie explained that for future committee meetings, it is intended that medicine optimisation updates would be provided within the Integrated Business Report in order to have a consistent approach. The minutes of the Medicines Prescribing Group would be submitted to the Finance and Performance Committee in addition to the Clinical Leadership Team.

–  –  –

(c) Performance Business Report – Month 12 – March 2016 – Paul spoke to a circulated report which provided a summary position of all the relevant indicators as at March 2016 (Q4) as published by NHS England. It contained an exception narrative for any indicators not meeting the requisite targets for where there is an early warning of a change in performance against any

particular indicator. Paul highlighted the following:

Referral to Treatment – Blackpool CCG had met the RTT target for March • 2016 for incomplete pathways. The committee noted however, that the 52 week plus wait for Blackpool CCG would deteriorate by the next report due to four Blackpool CCG patients waiting for plastic/ENT at Lancashire Teaching Hospitals.

Cancer Waits – There had been one patient breach as they had missed • the 31 day indicator due to an inadequate elective capacity at LTH.

Mixed Sex Accommodation Breaches – There had been two reported • MSA breaches for Blackpool CCG in March, the details of which were contained within the report.

Health Care Associated Infection – An incident attributed to the CCG in • March had since been attributed to the Trust.

C.difficile – The trajectory was 68 and there had been 67 cases, therefore, • the targets had been achieved.

IAPT – The target had been achieved. Whilst it was pleasing to note that • we had achieved the access but not the recovery.

A&E Waits – Breaches/Sanctions – Noted.

RESOLVED: That members receive the Performance Business Report.

(d) Contract Business Report Summary – Month 12 – March 2016 – Beth spoke to a circulated report and explained that the position for Month 12 for Blackpool Teaching Hospitals again reflected the continual rises in demand for services. When analysing the position in totality for NHS Blackpool CCG across all contracts, the cost difference equated to 2% above plan. A final financial position from the BTH contract had been agreed with the Trust of £126.08m which included £1m of extensive care. Beth made reference to the provider summary report for Month 12 and it was intended that this would be included in future contract reports for the committee.

RESOLVED: That members note the final contract position at Month 12 and receive the report.

(i) GP Referral Report – Month 12 – March 2016 – Beth spoke to a circulated report and informed members that the intention for the next meeting was to produce a GP referral report for all providers by practice.

RESOLVED: That members receive the report.

(ii) Contract Performance Dashboard – Beth explained that it was intended to retain the information in the current format for 2016/17. Additional dashboards had been produced which were included within the report. The information provided additional assurance for our smaller providers.

–  –  –

10. Any Other There were no issues.


11. Declaration That with the exception of any agreed items to be submitted to the CCG of Confidentiality Governing Body meeting held in public, all other items should be regarded as confidential.

12. Date, Time The next meeting would be held on Tuesday, 28 June 2016 at 1.00 pm in the and Venue of Boardroom, Blackpool CCG.

Next Meeting


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