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Governing Body declarations from 1 April 2013

Governing body declarations of interest updated as at 30 April 2013

Name Date Position/Role Potential or actual areas where interest could occur Action taken to mitigate risk Comments

Annie Dolphin 01/04/2013 Lay Chair DDES CCGPanel member - County Durham and Darlington NHS Health

Improvement Revenue Fund administered by County Durham

Community Foundation.

Will declare interest in specific instances and

will not take part in discussions or decisions as

agreed appropriate

Annie Dolphin 01/04/2013 Lay Chair DDES CCGPerformers list decision panel chair NHS England DDT Area

Team



agreed appropriate

Keith Tallintire 14/08/2012 Lay Member, Governance

Derwentside Homes Ltd, Prince Bishops Homes Ltd, Prince

Bishops Community Bank, Mid Durham Area Action

Partnership, Derwentside Enterprise Agency Ltd, KT Financial

Services Ltd, County Durham and Darlington NHS Foundation

Trust, Joint Trustee, County Durham and Darlington Charitable

Funds, County Durham Local Government Pension Fund,

Social Housing Enterprise Durham Ltd.



agreed appropriate

David Taylor-Gooby 14/08/2012 Lay Member PPI Freelance writer, sometimes write on NHS mattersWill not mention matters which could influence

DDES in his writings.When area of doubt will consult accountable officer or the chair.

Stewart Findlay 28/11/2011 Chief Clinical Officer NHS Alliance lead for cardiovascular disease

Will declare interest in specific instances as

appropriate and not participate in discussion or

decision making.

Stewart Findlay 28/11/2011 Chief Clinical Officer NHS Clinical Commissioners lead for the North East



decision making.

Stewart Findlay 28/11/2011 Chief Clinical Officer

Bishopgate Medical Centre also provide occupational health

services for Cummins (Serco), Health Sure (Serco), Health

Management, Norwich Union, Sunlight Services, Healthcare

Connexions, OCCHEA, Connought Compliances, Nexus, TMD

Friction.



decision making.

Stewart Findlay 28/11/2011 Chief Clinical OfficerBishopgate provide Dr Bowron in his role as Medical Referee at

the Wear Valley Crematorium at Coundon, Bishop Auckland.



decision making.

Stewart Findlay 28/11/2011 Chief Clinical OfficerBishopgate also provides a GP Clinical Tutor and Appraisal

lead within the Durham Dales area (Dr Bowron).



decision making.

Stewart Findlay 28/11/2011 Chief Clinical OfficerBishopgate also provides a GP Clinical Tutor and Appraisal

lead within the Durham Dales area (Dr Bowron).



decision making.

Dinah V Roy 22/11/2011 Director of Clinical Quality & Primary Care Development Director,Gatehouse (Health) Ltd (a company that holds an

APMS contract with Hartlepool PCT)



decision making.

Dinah V Roy 22/11/2011 Director of Clinical Quality & Primary Care Development GP Appraiser.



decision making.

Dinah V Roy 22/11/2011 Director of Clinical Quality & Primary Care Development Member RCGP.



decision making.

Dinah V Roy 22/11/2011 Director of Clinical Quality & Primary Care Development Member BMA.



decision making.

Dinah V Roy 22/11/2011 Director of Clinical Quality & Primary Care Development GP Principal at Oxford Road Medical Centre, Spennymoor



decision making.

Joseph Chandy 22/11/2011 Director of Performance & Information Partner Shinwell Medical Group



decision making.

Practice has submitted an outline business case for premises

extension.

Joseph Chandy 22/11/2011 Director of Performance & Information Employee, Peterlee Health CentreNot take part in decisions around capital funds

prioritisation or premises process approvals

Joseph Chandy 22/11/2011 Director of Performance & Information 1.5% partner Wheatley Hill PracticeNot take part in decisions around capital funds

prioritisation or premises process approvalsAssisting the GP partners in their new premises development

Joseph Chandy 04/02/2013 Director of Performance & Information Senior partner at Shinwell Medical Group was a provider of

specialist care at Barchester Hawthorns until 1 January 2013.

No involvment in any commissioning/new

procurement discussions regarding this

decommissioned contract.


Joseph Chandy 22/11/2011 Director of Performance & Information Related to the senior partner, Shinwell Medical Group, the

senior partner is amember of South Easington Social

Enterprise

Joseph will not participate in any related

procurement panels.

Easington South Social Enterprise is a not for profit

organisation providing services in the community

Joseph Chandy 12/02/2013 Director of Performance & Information Trustee Dr Joseph Chandy Charitable Trust

No part in CCG discussion/ decision-making

regarding any funding to the voluntary sector

that would advantage this charity.

The trust is involved in an asset transfer of Roseby Road,

Horden. This involves the local authority and CDDFT health

improvement team.

Joseph Chandy 06/03/2013 Director of Performance & Information Carodoc Practice, Wingate, Assisting Dr P. Fairlamb Practice

with restructing.

JC not to be involved during this period in any

commissioning discssions regarding out

sourcing CCG HR support.

HR support for practice is provided by CDDFT HR Team

Joseph Chandy 16/04/2013 Director of Performance & Information Carodoc Practice, Wingate, Partner.



decision making.

Partner in practice from April 2013

Helen Moore 24/04/2012Vice Chair Sedgefield Locality Commissioning Group & GP

FerryhillGP with a Special Interest in Vasectomy and Dermatology

When provision of services in these particular

areas are being discussed Helen will alert

everyone to her involvement and if necessary

will withdraw from the discussinos or decision

making process on procurement.

Helen Moore 09/04/2013Vice Chair Sedgefield Locality Commissioning Group & GP

FerryhillGP with a special interest in skin surgery and teledermatology






Stephen Muscat 14/08/2012 Vice Chair Easington Locality GP in medical group and member of the BMA.






Satinder Sanghera 14/08/2012 Chair Durham Dales LocalityClinical Quality Lead Durham Dales, GP Partner Weardale

Practice






John Maguire 14/08/2012 Sessional GPClinical lead for urgent care clinical governance and NHS 111

employee of NHSCDD






John Maguire 14/08/2012 Sessional GPSalaried GP in Bishop Auckland urgent care as an employee of

CDDFT






Mike Taylor 14/08/2012 Chief Finance and Operating Officer Sister in law employed at CDDFT as matron/clinical service

manager for unscheduled care

Will declare interest when appropriate and

withdraw from discussion and with agreement

withdraw from discussion and decision-making.

No discussion of related issues outside work

Mark Pickering 30/11/2011 Head of Finance & Performance - non votingWife employed as a director of Tees Esk and Wear Valleys

NHS Foundation Trust who are both an existing and potential

future provider to the CCG


appropriate and will not take part in any

relevant decisions

Anna Lynch 22/11/2011Director of Public Health County Durham, Durham County

Council - non votingTrustee of East Durham Trust

Must not take part in discussion regarding any

funding issues concenred with organisations on

which DPH is either chair , trustee or member


Council - non votingChair of East Durham Domestic Violence Forum

Must not take part in discussion regarding any

funding issues concenred with organisations on

which DPH is either chair , trustee or member


Council - non votingDCC - Statutory chief Officer with delegated duties in constitution

Will declare interest in relation to decisions

regarding joint commissioning with DCC


Council - non votingNon voting member of North Durham CCG Governing Body

Will not take part in Board discussions that involve

decisions regarding ND CCG


Lesley Jeavons 14/08/2012 Durham County Council - non voting Durham County Council Representative Will declare interest in specific instances and


agreed appropriate

GOVERNING BODY Tuesday 14th May

Item No: DDES-GB/13/27

NHS DURHAM DALES, EASINGTON AND SEDGEFIELD

CLINICAL COMMISSIONING GROUP GOVERNING BODY

DDES CCG Remuneration Committee Terms of Reference

1. Introduction This report presents the terms of reference considered by the Committee at its first meeting following authorisation. The discussion concentrated on membership and quoracy with confirmation that non-officer governing body members not just lay members were eligible to attend if required due to potential conflicts of interest. Amended terms of reference covering these issues are attached as appendix 1 with the amendments highlighted in emboldened italics.

2. Implications and risks This report presents the amended terms of reference of a governing body committee for approval. Regular review will ensure that these remain fit for purpose and reflect the development of the clinical commissioning group, current legislation and best practice.

Document Management

Version Date Presented to (meeting)

Commissioning Consideration

Finance Consideration

Sponsor Director

Approved

3.0 4.0

24/04/2013 14/05/2013

Remuneration Committee Gov Body

N/A N/A

N/A N/A

Mike Taylor Mike Taylor

Yes

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3. Recommendations The Durham Dales, Easington and Sedgefield Governing Body is asked to:

Approve the amendments to the Remuneration Committee terms of reference as recommended by that Committee

4. Author and sponsor director Author: Clair White Title: Head of Corporate Services Director: Mike Taylor Title: Chief Finance and Operating Officer Date: May 2013 LIST OF APPENDICES: Appendix 1 Amended terms of reference for the Remuneration Committee

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Purpose of Paper Information Sharing

Development / discussion X

Decision / action X

This paper supports / has implications for:

NHS Durham Dales, Easington and Sedgefield’s Strategic Priorities

Access to safe high quality services

Development and delivery of commissioning and supporting financial plans

Effective internal and external engagement including communications

Effective governance arrangements and organisational delivery

X

Effective contract management and performance against key targets

Performance Measures

To review effectiveness of terms of reference and recommend any appropriate changes no later than the review date set

Additional resources

(financial or staffing)

None

QIPP N/A

NHS Constitution N/A

Equality and Diversity N/A

Impact on / Involvement of partners

Open robust governance arrangements will help ensure confidence of partners in the new organisation.

Other policies / Issues N/A

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NHS DURHAM DALES, EASINGTON AND SEDGEFIELD CLINICAL COMMISSIONING GROUP

TERMS OF REFERENCE FOR THE GOVERNING BODY REMUNERATION COMMITTEE

1 Role 1.1 The remuneration committee (the committee) is established in accordance with

DDES clinical commissioning group’s constitution, standing orders and scheme of delegation. These terms of reference set out the membership, remit, responsibilities and reporting arrangements of the committee and shall have effect as if incorporated into the clinical commissioning group’s constitution and standing orders.

1.2 The purpose of the committee is to make recommendations to the governing body

on pay and remuneration for senior employees of the CCG and people who provide services to the CCG. The committee will also determine any issues of practice reimbursement where it would be inappropriate or impracticable for another committee, with practice representatives as members, to do so. It will ensure that the organisation as a whole has sound policies and procedures relating to the remuneration, terms and service and performance management of its staff.

1.3 The advice given from the committee will have been reached following due

consideration of all relevant internal and external factors, so that the decisions of the governing body are publicly defensible and reached with probity, discipline and objectivity. For the purposes of this committee, an “officer” is an individual who holds a director or executive post and/or is a full time employee or an individual who claims a significant proportion of their income from the group.

2 Remit

The duties and functions of the committee are categorised as follows: 2.1 Consider and make recommendations to the governing body on the remuneration,

allowances and terms of service of senior employees having proper regard to the CCG’s circumstances and to the provision of any national agreements where appropriate including all aspects of salary (including any performance-related elements/bonuses); provisions for other benefits, including pensions and lease cars; arrangements for termination of employment and other contractual terms.

2.2 Monitor and evaluate the performance of the senior employees of the CCG where

appropriate.

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2.3 Advise and ensure appropriate contractual arrangements including the proper calculation and scrutiny of any termination payments, including severance packages – having proper regard to the organisation’s circumstances, performance and to the provisions of any national agreements where appropriate.

2.4 Determine the policy for paying the relocation expenses of the CCG’s employees. 2.5 Advise the governing body on those aspects of the remuneration of staff other than

the senior employees where local decisions are required. 2.6 Advise on any other matter that the Secretary of State for Health deems necessary

or appropriate.

3. Ground Rules

3.1 All meetings will be held in accordance with the CCG’s agreed corporate behaviours and the Nolan Principles of Public Life.

3.2 Agendas will be issued seven days prior to the meeting. Requests for items to be

included on the agenda should be sent to the chair at least ten days before the meeting.

3.3 All papers for discussion must be submitted to the appropriate lead for approval

before the agreed deadline. 3.4 If an item needs to be raised on the day, this will be covered under ‘any other

business’, subject to there being available time. 3.5 If separate papers require circulation, these should, wherever possible, be issued

with the agenda. This is intended to enable members to have the opportunity to read information in advance.

3.6 At the start of each meeting, members will be asked to confirm the accuracy of the

declaration of interests. 3.7 All questions/issues arising will be decided by a simple majority of those members

present who do not have a material interest in the particular question/issue involved. In the case of equality of votes, the chair will have the casting vote.

3.8 Minutes of each meeting will be formally recorded and submitted to the next

meeting. Once approved, they will be received at the next available governing body meeting.

4. Membership 4.1 The committee shall be formed by the clinical commissioning group from amongst

its governing body members who are not officers (as defined in 1.3 above). The minimum membership for each meeting will be the chair or deputy chair of the governing body and two other non-officer governing body members.

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4.2 The following may be invited for all or part of the meeting provided their own

remuneration or terms of service are not being discussed:

Chief Clinical Officer

Chief Finance and Operating Officer

Head of Corporate Services

HR/other external advisors.

5. Frequency of meetings The Committee will meet as and when required.

6. Secretarial support The governing body administrator will provide secretarial support for the chair in the management of remuneration business and with support from the CFOO/Head of Corporate Services will draw the committee’s attention to best practice, national guidance and other relevant documents, as appropriate.

7. Delegated authority

7.1 The governing body has delegated authority to the remuneration committee to make

recommendations on pay and remuneration for senior employees of the clinical commissioning group and people who provide service to the group as well as matters of practice reimbursement it is appropriate for the committee to determine.

7.2 The committee is authorised by the governing body to obtain independent legal or

other independent professional advice, within reasonable limits, as and when the committee considers this necessary.

8. Accountability arrangements

8.1 The committee will report in writing to the governing body the basis for its

recommendations. The governing body will use that report as the basis for their decisions but remains accountable for taking decisions on the remuneration, allowances and terms of service of other officer members. Minutes of the governing body meetings shall record such decisions.

8.2 The full minutes of the committee will advise the governing body in the form of a

report to be submitted to the private part of governing body meetings.

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9. Quorum

A meeting of the committee will be quorate when the CCG Governing Body lay chair or deputy chair and two other members are present and not excluded by virtue of a conflict of interest.

10. Review The performance, membership and terms of reference of the committee will be reviewed at least every year, to ensure that they meet all legislative requirements and best practice. Any changes to the terms of reference must be ratified by the governing body. Version: 4.0 Date: 25 April 2013 Owner’s Name: M Taylor, Chief Finance and Operating Officer Date Approved: Review Date:

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DURHAM DALES, EASINGTON AND SEDGEFIELD

CLINICAL COMMISSIONING GROUP

Governing Body

Tuesday 14th May


DURHAM DALES, EASINGTON AND SEDGEFIELD CLINICAL COMMISSIONING GROUP

Finance report for the year ended 31 March 2013

1. Introduction This report explains the Durham Dales, Easington and Sedgefield (DDES) CCG’s financial position as at the year-end 2012/13, subject to audit. This is summarised in Appendix 1. The final accounts of County Durham PCT for 2012/13 financial year were submitted for audit on 19th April 2013. This submission has enabled the calculation of CCG reports for the year-end. To date, ongoing challenges regarding access to patient related data have prevented the analysis of this data at a locality or practice level, but this information will be distributed to practices once available.

2. Implications and risks The end of year position is a bottom-line under-spend of £420k on an annual budget

of £415,041k. This is in line with the financial plans agreed with the PCT Cluster for

2012/13, and demonstrates that the CCG has met it’s financial target for the year.

There have been no major movements from the forecast position identified within the

Month 11 report, and a summary of these movements is shown below

Document Management




Owner’s Name

Approved

2

Budget Area Movement between

Month 11 Forecast

outturn and actual

outturn

£000

Mental Health / LD -132 u/s

Continuing healthcare +215 o/s

Prescribing +155 o/s

The overall financial position for the CCG has been verbally shared with localities and the executive team, pending further analysis at a locality level. The overall budget allocated to the CCG was increased by circa £3m to reflect the CCG’s share of County Durham PCT’s continuing healthcare restitution cases. This sum represents the estimated value of restitution claims received by the PCT, and have been provided for within the final accounts of the PCT to mitigate the risk of legacy claims falling to the CCG in future years. The CCG has demonstrated a positive over-delivery of allocative QIPP for the year, having delivered £3.7m against a target of £2.5m. The outturn position has been an integral element of financial planning for 2013/14 financial year.

3. Recommendation The Governing Body is asked to:

receive and consider this report on the year-end financial position subject to audit

4. Author and sponsor director Author: Mark Pickering Title: Head of Finance and Performance Director: Mike Taylor Title: Chief Finance and Operating Officer Designate Date: 2 May 2013

1.0 15/05/13 Governing Body n/a M Pickering M Taylor

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Purpose of Paper Information Sharing X


Decision / action


NHS County Durham and Darlington’s Strategic Priorities

Delivery: 5 year strategic plan x

Maintenance: business critical x

Transition: Implementing Equity and Excellence


Reporting financial performance to consider alongside activity and other performance data

QIPP Performance reported impacts on delivery of QIPP targets and position included in report

NHS Constitution

Aspires to higher standards of excellence

Equality and Diversity No significant impact


Supports delivery of relevant partner targets

Other policies / Issues -

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APPENDIX 1

Finance Report for the period ending YEAR END POSITION

Mar-13 Budget Actual Variance Variance

£'000 £'000 £'000 £'000 £'000

Commissioning Budgets

Acute Services 223,223 223,223 229,392 6,169 -84

Mental Health/ Learning Disabilities 53,063 53,063 52,908 -154 -132

Community/Primary Care Services 55,672 55,672 56,832 1,161 26

Continuing Health Care/Funded Nursing Care 17,787 17,787 19,034 1,246 215

Children' Services 1,407 1,407 1,820 413 60

Prescribing 52,046 52,046 51,556 -490 155

Total Commissioning Budgets 403,197 403,197 411,543 8,345 239

Corporate Budgets & Reserves

Corporate Budgets 3,289 3,289 3,079 -210 83

Reserves 8,555 8,555 0 -8,555 -322

Total Corporate Budgets and Reserves 11,844 11,844 3,079 -8,765 -239

Total Revenue Expenditure 415,041 415,042 414,622 -420 0

Durham Dales, Easington and Sedgefield CCG

Annual

Budget

Movement

Document management

Version Date Summary Owner’s Name Approved

01 Agenda DDES CCG governing body Lyndsey Jones-George

Not applicable


GOVERNING BODY

Tuesday 14th May 2013 9.00 am – 1.00pm

Held in Public

Spennymoor Town Hall, Spennymoor, Co Durham, DL16 6DG

AGENDA

Apologies for absence

Time

Documents

DDES-GB/13/21 Declarations of Interest

Register of Interest

9.05am Attached

DDES-GB/13/22 Identification of any other business items

DDES-GB/13/23 Minutes of the Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group (CCG) governing body held on 9 April 2013

9.10am Attached

DDES-GB/13/24 Matters arising from the minutes of the DDES CCG governing body held 9 April 2013

9.20am

DDES-GB/13/25 Action Log

9.40am Attached

2

DDES-GB/13/26 Spennymoor Young Peoples Engagement event David Taylor-Gooby -Lay member, Patient & Public Involvement Wendy Minhinnett – Success to present

9.45am Verbal /Presentation

DDES-GB/13/27 Ratification – Terms of Reference of Remuneration Committee Chief Finance and Operating Officer - Mike Taylor

10.15am Attached

CLINICAL QUALITY DDES-GB/13/28 Clinical Quality Summary Report

Director of Nursing - Gillian Findlay

10.20am Attached

DDES-GB/13/29 CQUIN Update Director of Nursing - Gillian Findlay

10.35am Attached

DDES-GB/13/30 Independent Contractor Performance Triage Group Director of Clinical Quality and Primary Care Development Locality Link Director – Sedgefield - Dr Dinah Roy

10.45am Attached

TEA & COFFEE BREAK 10.55am DELIVERY

DDES-GB/13/31 Clinical Chief Officer Progress Report Chief Clinical Officer - Dr Stewart Findlay

11.05am Attached

DDES-GB/13/32 Patient & Public Engagement Director of Nursing - Gillian Findlay

11.15am Attached

DDES-GB/13/33 Director of Public Health Update Anna Lynch -Director of Public Health

11.20am Verbal update with

attachments DDES-GB/13/34 Finance report for the period of Month 12 & Year End

Chief Finance and Operating Officer - Mike Taylor Head of Finance and Performance - Mark Pickering

11.25am Attached

DDES-GB/13/35 Agreement of 2013/14 Budgets Chief Finance and Operating Officer

11.40am Attached

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- Mike Taylor Head of Finance and Performance - Mark Pickering

DDES-GB/13/36 NEAS Ambulance Report Director of Performance and Information/Locality Link Director - Easington - Joseph Chandy

11.55am Attached

DDES-GB/13/37 Performance Report for the period of March Director of Performance and Information/Locality Link Director - Easington - Joseph Chandy In attendance to present the report: Planning and Performance Manager - Deborah Ward

12.10pm Attached

DDES-GB/13/38 Risk management report Chief Finance and Operating Officer - Mike Taylor

12.25pm Attached

INFORMATION

DDES-GB/13/39 Big Project Funding – Easington Chief Clinical Officer - Dr Stewart Findlay

12.40pm Verbal

STANDING ITEMS

12.45pm

DDES-GB/13/40 Minutes to be received

– Durham Dales Clinical Group 28th March 2013

– Sedgefield Locality Executive Committee 20th March 2013

– Quality, Finance and Performance group 26th March

– Executive Committee 2nd April 2013 16th April 2013 30th April 2013

– Audit & Assurance 19th October 2012

Attached

DDES-GB/13/41 Any other business

12.50pm

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Date and time of next meeting Tuesday 11 June 2013 Sedgefield Community Hospital

Contact for the meeting: Lyndsey Jones-George, Governing Body Administrator, DDES CCG Tel: 0191 3713 221 or email [email protected]

mailto:[email protected]

1


GOVERNING BODY

Tuesday 09 April 2013 9.00 am – 12 noon

Boardroom, Sedgefield Community Hospital, Sedgefield TS21 3EE

Unconfirmed Minutes

Present: Annie Dolphin Lay Chair (Chair) Keith Tallintire Lay Member, Audit & Assurance Dr Stewart Findlay Chief Clinical Officer Gillian Findley Director of Nursing

Dr Dinah Roy Director of Clinical Quality & Primary Care Development

Dr John McGuire Sessional GP representative Dr Helen Moore Sedgefield Locality GP Lead Dr Stephen Muscat Easington Locality GP Lead Lynn Wilson Public Health Lead for Anna Lynch Denise Elliott Strategic Commissioning Manager Durham County Council for Lesley Jeavons David Taylor-Gooby Lay Member, Patient and Public

Involvement Mark Pickering Head of Finance & Performance In attendance: Lyndsey Jones Governing Body Administrator Deborah Ward Planning and Performance Manager,

NHS County Durham and Darlington (item 16)

Clair White Head of Corporate Services

Apologies for absence Mike Taylor, Satinder Sanghera, Joseph Chandy, Peter Carr, Anna Lynch - Lynn Wilson in attendance, Lesley Jeavons - Denise Elliott in attendance.

Action

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The chair welcomed everyone to the first statutory Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) governing body meeting. As from 01 April 2013 the meeting is no longer a subcommittee of NHS County Durham & NHS Darlington, as the CCG is now fully authorised as a statutory body. The corporate team has now moved into their new premises and most of the staff are in post. Clair White was welcomed as the new Head of Corporate Services for DDES CCG.

DDES-GB/13/01 Conflicts of Interest Register The conflicts of interest register was discussed and it was agreed that following the NHS changes a number of amendments were needed. . The chair asked for everyone to look at the register and liaise with LJG with any changes and updates. The register will be included in the agenda as a standing item and will be updated at every meeting. ACTION – The group to liaise directly with LJG to update the register with any changes and updates before the next and each subsequent meeting.

All

DDES-GB/13/02 Declarations of Interest GF declared an interest as she is still employed at North East Ambulance Service (NEAS) until the end of next week.

DDES-GB/13/03 Identification of any other business items There were no other items identified for any other business.

DDES-GB/13/04 Minutes of the Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG) sub-committee/governing body held on 12 March 2013 The minutes were approved as an accurate record of the proceedings of the subcommittee of NHS County Durham & Darlington and the DDES governing body.

DDES-GB/13/05 Matters arising from the minutes of the DDES CCG sub-committee/governing body held 12 March 2013 Page 5 SC-GB/13/53 The group queried how the board to board meeting with County Durham & Darlington Foundation Trust was progressing regarding the Francis II report. GF updated that each

3

CCG will need to arrange a star chamber along with a list of people that would need to be invited. GF will be attending the Star Chamber within City Hospital Sunderland with Ann Fox. Progress was queried around the complaints process for when members of the public/patients have an issue or complaint in respect of primary care and it was confirmed that the DDES meeting with the public set for 30 April will establish what happens The quality team are holding an away day on 02 May 2013 where they will look at these issues and make recommendations to the governing body, SF requested that we need to ensure that the process is as simple and streamlined as possible. The outcome of the away day will produce a quality pathway which will be used to monitor providers. Assurance of provider quality was discussed and DR advised that she is part of the quality surveillance group, where relevant people come together; this includes all providers and the North & South Area Teams. AD asked if these arrangements could be articulated in a simple form to assure the governing body on how all the groups and work fit together, and how the accountability works. ACTION – DR will develop this at the quality away day. Page 5 SC-GB/13/53 PALS service. There are still no further updates from the Area Team around the provision of a PALS replacement service. There have been discussions suggesting that Healthwatch provide an alternative complaints service. There is currently a communications plan in development and Denise Elliott is meeting with Healthwatch for further updates although it is thought to be more of a signposting service. The group highlighted that there is a lack of information for patients. ACTION – GF will link and discuss with Beverly Reilly, Director of Nursing and Quality at the Area Team, around an update on the PALS replacement service. Page 5 SC-GB/13/54 The Clinical leads confirmed that the Antenatal & Postnatal depression protocol was disseminated to the practice members. Page 6 SC-GB/13/55 DR confirmed that she was not at the previous meeting therefore the action relating to the agenda item had not been picked up. Page 8 SC-GB/13/59The Blue River consultancy report has now been received.

DR

GF

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Page 14 SC-GB/13/68 The Quality Governance Framework was received at the governing body on 27th March.

DDES-GB/13/06 Minutes of the Durham Dales, Easington and Sedgefield Clinical Commissioning Group subcommittee/extraordinary governing body meeting held on 27 March 2013 Add Jenny Flynn to list of apologies GF’s surname on the apologies list to be amended to Findley The references to the clinical conflicts of interest were discussed and it was agreed that the lay members would consider the process for declarations of interest, and what needed to be recorded.

Subject to these changes the minutes were approved

DDES-GB/13/07 Matters arising from the minutes of the DDES CCG sub-committee/extra ordinary governing body held 27 March 2013 SC-GB/13/75 – Quality Governance Paper - change mental to mentality

DDES-GB/13/08 Action Log Updated.

DDES-GB/13/09 Review of the Governing Body Terms of Reference Chief Finance and Operating Officer - Mike Taylor Mark Pickering presented in Mike Taylors absence The Governing Body Terms of Reference were brought to the governing body for acceptance and approval of the new version. These had been looked at in detail previously but as the CCG was now a statutory body in its own right and the meeting was no longer a sub-committee of the PCT they had been updated. Subcommittee has now been removed along with the transition sections. The chair drew attention to the section in the ground rules that covered the submission of papers. Due to the turmoil created by all the changes there had been some flexibility around acceptance of late papers and papers being tabled. Now that staff were largely in place the timetable must be adhered to except in very exceptional

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circumstances. GB members and the public needed to be able to access and read the papers in good time and from the next meeting this would be expected. It was also highlighted that some of the papers received were not in the correct template, had out of date information and recommendations omitted. The papers need to be checked by the owner prior to submission to ensure they have all the correct information and that the recommendations should reflect the decisions that were required. DTG raised an issue about the description of the lay member roles and it was suggested that the 50% quorum description could be clarified and it was agreed that these changes could be reflected at the next review date. ACTION – MT to reflect these changes when the terms of reference were next reviewed. The governing body accepted and approved the terms of reference.

MT

STRATEGY DDES-GB/13/10 Durham Dales, Easington and Sedgefield Clinical

Commissioning Group Governance Framework including Policy Update Chief Finance and Operating Officer - Mike Taylor Mark Pickering presented in Mike Taylors absence The purpose of this paper was to provide the governing body with the current position in respect of policies and development of the governance framework generally. The paper provided further detail around some gaps identified within the Corporate and Human Resource polices. These are still under development and moving forward they would be regionally driven. There had been discussions around each CCG having their own individual suite of polices, however, it has been agreed that DDES will adopt or adapt best practice/policies from North East Commissioning Support (ES) who will review and update these where necessary. The governing body approved the process and timescale for developing the CCG’s governance framework and accepted the information about the policies and procedures in the appendix.

CLINICAL QUALITY DDES-GB/13/11 Clinical Quality Update

Director of Clinical Quality and Primary Care Development Locality Link Director – Sedgefield - Dr Dinah Roy Director of Nursing - Gillian Findlay

6

The purpose of the report was to provide the CCG with a monthly briefing of the headline issues relating to clinical quality and assurances that actions are being undertaken with providers where necessary. This report covers all information and issues received in February 2013. There were some issues raised around the content and standard of the report and the way that it was presented. DR explained that due to capacity issues in NECS it has proven difficult to obtain the report, but she is meeting with the NECS quality lead, Kirstie Hesketh, to finalise exactly what DDES required from the report for future meetings. DR asked the governing body members to accept the report on this occasion, however, she gave assurance it will be more comprehensive and provide more assurance about clinical quality issues in the future. JM raised concerns about where 111 sits in the clinical quality framework. The governance gap has been recognised regionally and is a great concern. It was decided that JM will meet with GF, as the lead, outside the governing body to discuss this in more detail. There have been instructions received from NHS England in connection with the 111 service and the lead clinician Kat Noble is moving on from her role within 111 to become Medical Director of NHS Direct England. It was confirmed that the DDES lead is Gareth Chin who attends the 111 meetings and that the clinical quality team are working closely with the Area Team on a resolution for this. GF advised that NEAS are carrying out their own audit into three incidents that had occurred recently one of which resulted in a patient’s death. There are still issues around the number of 111 patients coming from Urgent Care to County Durham & Darlington Foundation Trust (CDDFT). Urgent Care issues are CDDFT’s responsibility, therefore, this needs escalating as a governance issue. SF noted that the processes and systems are unclear and Chief Officers are looking into this regionally. The incident system was historically administrated by NHS County Durham & Darlington but it is unclear what will happen now and in the future. This process is being considered and GF will ensure that the previous system will transfer across and continue. ACTION – JM to meet with GF to discuss 111. ACTION – GF will ensure previous incident and reporting systems remain through the usual channels and will discuss with Kirstie Hesketh from NECS regarding the

GF GF

7

general inbox address and confirm. SM requested more information around the two nursing home incidents highlighted in the quality report, and it was agreed that DR would discuss this with him outside the meeting.

The governing body noted the content of the report, that the standard

and content would improve in future, and agreed that locality leads

would ensure onward dissemination to practices.

DELIVERY DDES-GB/13/12 Chief Officer Progress Report including Stakeholder Briefing

Pack Chief Clinical Officer - Dr Stewart Findlay This report included an update on national policy and summarised the progress that DDES CCG have made as a CCG over the previous month. SF highlighted some specific areas of the report. The 2013/14 planning framework discussions were complete and there was one change to the quality premium indicators that had been made to bring DDES into line with the cluster CCGs and due to the difficulty of evidencing the indicators. The three are now confirmed as:

Under 75 mortality rate from cancer

Unplanned hospitalisation for asthma, diabetes and epilepsy in under 19s

Emergency admissions for children with a lower respiratory tract infection

DDES have entered into an out of hours on call rota with the CCGs across North of England; and will need to cover two weeks from now until September. There are some problems with the operation of the in house on call system as there was a recent instance of the protocol governing communication of temporary A&E closure not being followed. The Area Team are working with the CCGs to ensure the rapid resolution of this. Two contracts for 2013/14 have now been signed with Tees, Esk & Wear Valleys NHS Foundation Trust (TEWV) and Northumbria, Tyne & Wear NHS Foundation Trust (NTW). Block contacts are close to agreement with North Tees & Hartlepool Foundation Trust and City

8

Hospitals Sunderland Foundation Trust. The County Durham and Darlington Foundation Trust (CDDFT) negotiation continues and agreement is anticipated soon. The final offer is on the table and if not agreed the contract will revert to payment by results with consequential risk pressure during the year and potential stripping out of non-recurrent funding. SF updated the GB about the Durham Dales Nursing Home Service that was awarded to CDDFT and was due to go live in practices in the Dales this month. The provider has breached the contract as they have given notice that they are unable to meet the date. It was confirmed that these issues are being progressed via the Chief Officers meeting and are being highlighted to the Local Authority. A discussion took place around a care home support service delivered by CDDFT with community matrons doing similar work carried out by the Durham Dales practice. This was a short measure introduced in the North and it was suggested that this could have been moved into the south to ensure the service still went ahead, albeit for a short term solution. There was also a Stakeholder briefing pack included in the report which gave information about the key changes in NHS organisations and public health from 1 April 2013.The governing body received the report and noted the progress to date JM left at 10.20 am.

DDES-GB/13/13 PPE Activity David Taylor-Gooby -Lay member, Patient & Public Involvement Verbal Report A press cutting was shared with the group that covered the recent Spennymoor Youth Forum event that focused on health. DTG outlined the format of the event where over 30 young people got together to consider health issues and make suggestions about health improvement. The output from the meeting is being collated into a report that will be shared with the Governing Body once available. There will be more meetings set up and DTG will link with Sue Carty & Liam Cairns at DCC in connection with the already established groups for young people. It was confirmed that HealthWatch now have a project lead working in the Tees area and DE will send information to Helen Moore as Sedgefield wish to invite HealthWatch to their locality meeting.

9

ACTION – DE to send the project lead details for HealthWatch to Dr Helen Moore Apps, twitter, Facebook and other social media options were discussed as tools to be used as a route to young people and it was recognised that this was something to look at for the future. It was agreed that this would be discussed with Siobhan Jones from the NECS engagement team at a meeting about the Communications strategy. ACTION - DTG will liaise with public health and other groups on taking the work with young people forward. The Youth Forum report would be considered for a future GB meeting in public.

DE DTG

DDES-GB/13/14 Equality & Diversity Annual Report 2012/13 Director of Performance and Information/Locality Link Director - Easington Joseph Chandy Gillian Findley presented the paper in Joseph Chandy’s absence The draft report had been presented to the PCT cluster before it disappeared and it was appropriate to bring it to the CCG GB because as a statutory organisation the CCG has a responsibility to deliver on its equality duties from 1 April. The CCG will have to produce an annual report and decide whether to adopt the existing NHS County Durham & Darlington objectives or develop new ones. Arrangements for access to public meetings for people with disabilities were discussed and how requirements are funded. It was confirmed that there were arrangements in place for this with Ben Murphy and advice on the process moving forward. The governing body considered the report and discussed the CCG responsibility for delivering on its equality duties from 2013 onwards.

DDES-GB/13/15 Finance report Chief Finance and Operating Officer - Mike Taylor In attendance to present the report: Head of Finance and Performance - Mark Pickering This report outlined the DDES CCG’s financial position as at the end of February 2013. MP confirmed that everything is on track for the year end with an

10

overspend within Acute, community services and high cost children’s packages of care where there are themes starting to emerge. CDDFT – the final contract has not yet been agreed which affects the certainty of the year end position. There is more certainty in respect of the other major providers. Continuing Health Care (CHC) restitution cases - Some of these are still being supported by the PCT cluster fund, the latest total shows that 678 cases have applied for consideration. Approximately 400 cases have been considered of which a considerable number have been found to be not eligible, however provision is still needed for 2013/14. AD said that she understood that North Durham CCG and Darlington CCG are now underspent on CHC and she asked how they had achieved that. It was confirmed that Darlington had renegotiated a larger budget and had managed to reduce their costs. It was also queried whether the budget was shared equally across the three CCGs or if there may be an uneven distribution of high cost cases within the three areas. It was confirmed that the budget had been allocated equitably but that DDES had more CHC cases each year, even though additional funding was put in each year this was not sufficient to cover the cost. Community services – The major expenditure currently is linked to the Urgent Care element of the contract with CDDFT. There is some non-recurring funding but as invoices have started to come in it is clear that there will be an overspend. QIPP – DDES has delivered against target within the current year and is ahead of the curve for the 2013/14 target. With the use of reserves and underspends elsewhere the headline message is that all is on track to achieve financial balance at the year end. KT raised concerns regarding finance team staffing levels and whether this will pose any risks to the CCG. MP confirmed that with NHS County Durham & Darlington still closing their accounts this will put a strain on resources over the next four weeks but the majority of staff are now in post full time and this has reduced pressure. There are some vacancies within the finance team which has impacted on DDES because of the recruitment freeze but that has now been lifted by NECS so this should start to resolve. There are some issues around accessing patient data within NECS

11

and the CCG and this may have an effect on performance reporting, however, the whole country is in the same situation and a solution is being sought at national level. The governing body received and considered the report on the current financial position.

COFFEE BREAK DDES-GB/13/16 Performance report

Director of Performance and Information/Locality Link Director - Easington - Joseph Chandy In attendance to present the report: Planning and Performance Manager - Deborah Ward This paper set out the NECS February assessment of performance for DDES CCG, initially focussing on the indicators that NHS North is measuring commissioners against (appendix one). Updated performance data on the flu vaccination uptake was attached at appendix two. The draft of the outcomes monitoring template was also attached (appendix three). The performance tables produced by NHS North providing benchmarking of data at individual PCT as well as PCT cluster level were not available at the time of preparing this report.

Dee Ward summarised the CCG performance in the highlighted areas as follows: C Difficile – this was a County Durham target and result. The position to January was 179 cases reported against a trajectory of 141 cases and so that target for the year could not be met. Work continues with all providers in reducing the number of cases in 2013/14 and an action plan has been requested to support this. March figures are still being fed through to finalise the plan. Ambulance Category A 8 minute response rate- DDES performance had reduced to 60.15% in January but initial figures showed an increase in February to 64.79%; a 10% improvement, however, hospital handover delays have created a problem during this period. There were no 18 week breaches and no patients waiting after 52 weeks for treatment. NHS Healthchecks – verification of the final position for DDES was awaited although NECS are working closely with CCGs on local action plans.

12

Choose & Book (C&B) - There has been a further improvement in usage across County Durham which was at fourth position in the region achieving 84% against the 90% target. This was a good improvement and JC was working on an audit of practices using C&B. The appendices attached to the report were discussed. It was confirmed that the flu data table was cumulative and for the year 2012/13. GB members commented that it was helpful to see the initial draft of the outcome measures in appendix 3 and DR suggested that quality and health and wellbeing action plan outcomes could be added so that everything was in one place. ACTION – DW will link with the clinical quality team to look at amending the document and adding all the measures in to have one comprehensive list. Also to link with TM around the performance indicators. DE to send performance indicators to DW. DW queried what the DDES requirement would be for reporting progress on each contract and SF referred to linking reporting to Commissioning for Quality and Innovation (CQUIN). ACTION – DW to clarify the inclusion of CQUIN in the reporting on the contracts. It was confirmed that most CCGs are requesting the same type of reporting, something comprehensive that is easy to read and understandable for localities. The governing body received and considered the current performance position.

DW DE

DW

DDES-GB/13/17 Risk management report Chief Finance and Operating Officer - Mike Taylor Mark Pickering presented in Mike Taylors absence The purpose of the paper was to set out the current risks facing the organisation, their assessment and the action taken or required to manage them. The report was created from detailed discussions at the Quality, Finance & Performance group meetings where all action plans were reviewed. There were two new clinical risks in the corporate register with little change in the overall number. The 2 new risks had been

13

added by GF and covered potential private provider failure. There was a query that there was no detail about the highest rated risk on the report - DDES CCG/43 – domestic homicide and related mental health implications. GF advised that this could now be revised. She was meeting with Diane Richardson that week and would update the GB at the next meeting. Dinah Roy advised that the clinical quality team will review the homicide report and share the learning points with practices. SM raised issues around GPs completing fire arms license paperwork and whether this needs to be added to the register. It was confirmed that this issue has been discussed with the LMC and the compromise is that police will take full responsibility for licensing and accountability will not sit with GPs. There were some questions about the action plans which support the risks and how the mitigated risk is then presented. A forecast of the impact of the mitigation would give the GB more assurance and an additional column could be added for this. Action point for Mike – reflect the mitigation impact The governing body considered the current risks facing the CCG, whether these were accurately assessed and reviewed the action being taken to ensure the risks were being appropriately managed.

INFORMATION

DDES-GB/13/18 S256 Contracts Chief Clinical Officer - Dr Stewart Findlay SF reported that the S526 contracts included a letter from Durham County Council and details of the contract that the NHS County Durham previously held with the Local Authority. There may be a couple of services that DDES CCG wish to review in the year and in future years. MT is leading on this to agree some minor changes with the Local Authority. The contract had been signed for 2013/14 and was split between the two CCGs. The documents were received for information.

STANDING ITEMS DDES-GB/13/19 Minutes to be received

– Durham Dales Clinical Group: – 24 January 2013 – 28 February 2013

14

– – Sedgefield Locality Executive Committee: – 5 December 2012

– – – Executive Committee: – 15 January 2013 – 05 February 2013 – 19 March 2013

The Chair highlighted the importance to routinely receive the appropriate executive and locality committee minutes as part of the CCG governance arrangements. Processes were being put in place to ensure that happened. ACTION – LJG to link with Sue Humpish to ensure this happens.

LJG

DDES-GB/13/20 Any other business There were no any other business identified

Date and time of next meeting 14 May 2013 at 9 am Meeting to be held in public. Spennymoor Town Hall

Minutes approved by ……………………………………………. Chair Annie Dolphin

Date ………………………………………………………………… Contact for the meeting: Lyndsey Jones-George, Governing Body Administrator, DDES CCG Tel: 0191 3713 221 or email [email protected]


GOVERNING BODY Tuesday 14th May



CLINICAL COMMISSIONING GROUP GOVERNING BODY MEETING

Progress Report on Ambulance Performance in Rural

Areas

1. Introduction

The previous commissioning body (County Durham PCT) was working with North East Ambulance Service NHS Foundation Trust to address a number of issues including delays in hospital turnaround for ambulances and performance against the Red call 8 minute response target. The PCT commissioned 2 reports: one from Organisational Research in Healthcare (ORH) looking at the current level of service provision in the Durham Dales area and a second from Explain Market Research, which is a qualitative piece of research seeking to understand the views of residents in the Durham Dales. This paper provides an update on progress.

2. Implications and Risks

Ambulance responses to red calls in 8 minutes is of concern to Durham Dales, Easington and Sedgefield Clinical Commissioning Group (DDES CCG). DDES CCG performance has improved in February to 68.16% and the year to date position for County Durham to 65.03%. Emergency ambulance services in DDES CCG are provided by North East Ambulance Services NHS Trust (NEAS). There is a nationally agreed target for NEAS to deliver 75% of all emergency ambulance responses to call categorised as red within 8 minutes. The national target is for this level of service to be provided across the NEAS response area. NEAS covers a very large area from the Scottish

2

boarders to North Yorkshire and across the Cumbria boarder. NEAS have consistently achieved their national target. In 2012/13 there was a local commissioned target via the Commissioning for Quality and Innovation Scheme for NEAS to achieve 75% for 8 minute responses to red 8 calls at PCT level. Results were therefore presented for the new North Durham and DDES CCG areas together. Year to date NEAS had achieved 65.03% for the former PCT Cluster area. DDES CCG has been working with NEAS to understand the reasons why the target was not met. There are issues with national shortages of paramedics, deployment of vehicles and an increased demand for services combined with some bad weather that have contributed to the performance outcome. Work to address these issues continues and NEAS has an action plan to improve rural performance which has been shared with commissioners. NEAS are leading a significant piece of work, following a cross agency summit that was held earlier in the year. DDES CCG is working with NEAS on this piece of work and they are making improvements to patient flows throughout the system and in particular the issue of handover delays at University Hospital of North Durham. The PCT also commissioned 2 reports relating to services in the Dales. There was a significant delay in DDES CCG receiving these reports due to delays at the former PCT. A Summary of the Explain report is given at appendix 1. The first stage of the ORH report has now been received. In summary, this report gives a position statement and sets the parameters for the stage which is modelling of the current resource levels and looks at options for changing resource levels. Next Steps A meeting has been arranged on 8th May 2013 between DDES CCG and NEAS to discuss the first stage ORH report and agree the next steps. ORH will provide a second report that will give details of possible alternative deployments and any additional resource requirements to achieve 75% response rate to red calls in 8 minutes at CCG level with and without a “ringfence” arrangement for vehicles at CCG and sub CCG level. The reports will be shared with the rural ambulance monitoring group for the Dales and an action plan agreed. Once the outcome of the second ORH report and the feedback from stakeholders is known a detailed plan for improvement in ambulance services across the DDES area will discussed at the Executive Meeting of DDES CCG.

3

3. Recommendations

The Committee is asked to:

Note that the reports have been received

To approve the plans for consulting with stakeholders in relation to the reports

Note the need for further work on the potential deployment options available

4. Author and Sponsor Director

Author and Director: Gill Findley Title: Director of Nursing Date: 3.5.13

4

Purpose of Paper Information Sharing x

Development / discussion

Decision / action



Delivery: x

Maintenance: x

Transition:


Delivery: red 8 performance target, hospital handover delays targets

Maintenance:

Transition:

QIPP

NHS Constitution

Equality and Diversity


NEAS

Rural Ambulance Monitoring group

Other policies / Issues

5

Appendix 1

Explain Market Research This report was commissioned to provide a more qualitative review of ambulance services in the Dales areas of DDES. The key points from the report are as follows:

There are high levels of satisfaction, particularly in relation to the compassion and caring of the crews

Strong positive reputation for the current ambulance service provider

There were no consistent themes for improvement of the current service model

People appreciated the additional primary care duties of the paramedics working in the dales

The majority felt that there were weaknesses in the current model of service

Ambulance control staff feel that the model is “above and beyond requirements”

There are strained relationships between stakeholder groups and a call for transparency

An indication that any change /reduction in ambulance provision in the Dales would be met with strong opposition

1

DURHAM DALES, EASINGTON AND SEDGEFIELD CLINICAL COMMISSIONING GROUP GOVERNING BODY

Tuesday 14th May DDES-GB/13/30

NHS DURHAM DALES, EASINGTON AND

SEDGEFIELD CLINICAL COMMISSIONING GROUP GOVERNING BODY

Local Policy & Procedure for the Management of General

Practitioner Professional Performance 1 Introduction General Practitioners are responsible for complying with the relevant standards set by their regulatory or professional bodies (e.g. the GMC’s good medical practice), contract requirements and duties in accordance with the Performers List Regulations. A breach of such standards, contract or regulations might indicate a performance concern, which may be dealt with through this policy and procedure, independent of any action taken by the regulatory or professional body concerned. In such cases, performance concerns will be investigated fairly using a supportive approach with appropriate steps being taken to address the issues and prevent a recurrence.

2 Implications & Risks The GP PTG has a responsibility to triage primary care concerns to identify if it’s potentially a professional performance issue and therefore requiring referral to the NHS England Area Team for further consideration.

3 Recommendations The governing body is asked to:- Approve the Local Policy and Procedures for Management of General Practitioner Performance Concerns

4 Author and sponsor director

2

Author: Clinical Quality Team, NHS North of England Commissioning Suppport Title: Director: Dr Dinah Roy Title: Director of Clinical Quality & Primary Care Development Date:



Decision / action


NHS County Durham and Darlington’s

Strategic Priorities

Delivery: 5 year strategic plan X

Maintenance: business critical X

Transition: Implementing Equity and Excellence

X


TBC

QIPP N/A

NHS Constitution

N/A

Equality and Diversity No specific impact

Impact on / Involvement of

partners

N/A

Other policies / Issues Liberating the NHS

Document Management




Sponsor Director

Approved

1.0

Gov Body NA

Managing Director

VSM – CORP01

Stephen Childs

Company Secretary

8d - CORP06 (Durham)

Barbara Sword

Head of EPMO

9 - CORP07 (Tees)

Jonathan Maloney

Resource Manager

8a – CORP08 (Tees)

* Emma Green (0.8)

EPMO Support Manager

7 – CORP12 (Tees)

Tim Ellingham

VACANCY

Project Manager Officer

5 – CORP09 (Tees)

Leena Milroy (0.4)

Hannah Hope

Gabrielle Caswell

EPMO and Company SecretaryAs at 25 Apr

* Leaving on 8 May 2013

Finance – Controlling & AccountingFinance Director

VSM – CORP02 (Tees)

Neil Nicholson

Head of Controlling & Accounting

9 – CA01 (Durham)

Anne Dinsley

Finance Manager Accounting

8b – CA02 (Durham)

Keith Dunn

Senior Finance Officer

Accounting

6 – CA03 (Durham)

Vicki Adamson

Ruth Summerson

VACANCY

Finance Officer Accounting

4 – CA04 (Durham)

Melanie Brydon

Yvonne Wanless

Asha Raichura


3 – CA05 (Durham)

Stacey Bell

Susan Forshaw (0.93)

Senior Finance Manager

Controlling

8c – CA06 (Durham)

Anthea Thompson

Finance Manager Controlling

8a – CA07 (Newburn)

Tarryn Lake

VACANCY

Senior Finance Officer Controlling

6 – CA09 (Newburn)

Sara Noon


5 – CA10 (Durham)

Gillian Hall

Finance Officer Controlling

4 – CA11 (Durham)

Anne Matthews

Kirstie Docherty


3 – CA12 (Durham)

Mohammed Rahman


Accounting


Lynsey Roberts



Shena Johnson


Controlling

8c – CA06 (Tees)

Yvonne Gibson


Controlling

8c – CA06 (Newburn)

Gary Walsh

VACANCY


8a – CA07 (Tees)

Louise Newson (0.8)

Robert Sands


8a – CA07 (Durham)

Rachel Allsop

Paul Oates



David Floyd

Adele Meldrum (0.64)

Richard Turnbull

Sabrina Hazeldine


6 – CA09 (Tees)

Clare Hunter


4 – CA11 (Tees)

Olanrewaju Onolaja


3 – CA12 (Tees)

Susan Harrison

As at 25 Apr



Claire Miller



Mark Pickles

VACANCY

Senior Finance Officer –

Controlling / Accounting

(Cumbria)

6 – C-FCA1

Geoffrey Winrow

Senior Finance Officer –

Controlling / Accounting

(Cumbria)

5 – C-FCA2

Rebecca Khouri

Finance Officer – Controlling /

Accounting (Cumbria)

4 – C-FCA3

Lewis McAtear

Finance Director

VSM – CORP02 (Tees)

Neil Nicholson


Commissioning

8c – CF02 (Tees)

Lynne Walton

David Craig

Patrick Pearce

Finance Manager Commissioning

8a – CF03 (Tees)

Marion Owens


Commissioning

6 – CF05 (Tees)

David Austin

VACANCY


Commissioning

5 – CF06 (Tees)

Wendy Jefferson

Finance Officer Commissioning

4 – CF07 (Tees)

Sarah Jones


3 – CF08 (Tees)

Michael King

Head of Commissioning Finance

9 – CF01 (Durham)

Chris Sharpe


7 – CF04 (Tees)

Victoria Bell

Leanne Armstrong

Finance – Commissioning Finance


Commissioning

8c – CF02 (Durham)

Beverley Carswell

Kevin Scollay


8a – CF03 (Durham)

Susan Steele


Commissioning

6 – CF05 (Durham)

Kirsty McGregor-Towers (0.8)


Commissioning

5 – CF06 (Durham)

Justin Ridings


4 – CF07 (Durham)

Nicole Milne

VACANCY


3 – CF08 (Durham)

Kevin Stiff


7 – CF04 (Durham)

Helen Cameron (0.8)


Commissioning

8c – CF02 (Newburn)

Andrew Robson

VACANCY


8a – CF03 (Newburn)

Steven Clark

David Wilson


Commissioning

6 – CF05 (Newburn)

Sarah Bailey

VACANCY


Commissioning


Mark McKay

VACANCY



Marc Read

Conan Tam

VACANCY

VACANCY



Angela Southern

VACANCY



Maurice Baynham

VACANCY

As at 25 Apr

Senior Finance Officer – Finance

Commissioning CHC (Cumbria)

6 – F-CHC1

Neil Trevaskis

Senior Finance Officer – Finance

Commissioning CHC (Cumbria)

5 – F-CHC2

Ken Wynne

Julie Sloan

Bus Devt & Healthcare Procurement

(all Tees)

Business Development Director

VSM – CORP10

David Randall

Head of Healthcare Procurement &

Market Management

9 – NEPS01

Tracy Hickman

Business Strategy Manager

8c – BD01

Brian MacGregor

Business Development Support

Officer

7 – BD02

VACANCY

Senior Account Manager

8d – BD04

Lisa How

Senior Procurement and Market

Development Manager

8c – NEPS02

VACANCY

Procurement & Market Development

Manager

8b – NEPS03

Janice Martin

Procurement Officer

7 – NEPS04

Dean Burns

Maxine Elstob

Lesley Hetherington

Tracey Murray

Angela Lathan

VACANCY

Procurement Support Officer

5 – NEPS05

Linda Brady

Helen Gash

As at 25 Apr

Human Resources & Organisational

Development (all Durham excl CORP05)

Organisational Development &

Corporate Services Director

VSM – CORP05 (Newburn)

Michelle McGuigan

Head of Human Resources

8d – HR01

Janine Lutz

Senior Manager HR

8c – HR02

Lesley Currer

Manager HR

8a – HR03

Sherryll Davison

Janice Chalmers

HR Senior Officer

6 – HR04

Kay Fletcher

Katie Yokom

Jenna McGuiness

HR Officer

5 – HR05

Joanne Duffy

HR Assistant

3 – HR06

Gloria Fairless

VACANCY

Head of Organisational

Development & Continuous

Improvement

8c – OD01

Carrol Martin

Senior OD & CI Manager

8b – OD04

Martin Howe

OD & CI Manager

8a – OD03

Ushma Bhatt

OD & CI Officer

5 – OD02

Rebecca Parkinson

OD & CI Admin Assistant

3 – OD05

Susan Stephenson (0.8)

As at 25 Apr

Communications & Engagement




Michelle McGuigan

Head of Communications &

Engagement

8d – COMM09 (Durham)

Mary Bewley

Senior Communications Manager

8a – COMM03 (Durham)

Samantha Harrison

Communications Officer

6 – COMM04 (Durham)

Lee Hogan

Simon Clayton

Involvement Officer

6 – COMM05 (Durham)

Nicola Gardiner

Senior Locality C&E Manager

(Northumberland, Tyne & Wear)

8b – COMM08 (Newburn)

Caroline Latta

Graphics Officer

6 – COMM02 (Newburn)

Michael Barlow Senior Communications Officer


Helen Fox


Assistant


Shirley Redgrave

Senior Communications Officer

7 – COMM10 (Tees)

Gail Seymour


Assistant

4 – COMM01 (Tees)

Nicola Easby

Involvement Manager

8a – COMM07 (Tees)

VACANCY

Senior Locality C&E Manager

(Durham & Tees)

8b – COMM08 (Tees)

Siobhan Jones

As at 25 Apr

Research & Development




Michelle McGuigan

Senior R&D Manager

8b – RD01 (Newburn)

Shona Haining

Research Manager (RM&G)

7 – RD02a (Newburn)

Catherine Adams (0.6)

R&D Admin

4 – RD03a

Gillian Wake (0.55) (Newburn)

VACANCY (0.45)

As at 25 Apr

Research Manager

7 – RD02b (Newburn)

Gillian Johnson

Research Manager

7 – RD02c (Durham)

Richard Errington

Research Nurse

6 – RD05

Jill Ducker (0.85) (Newburn)

Rachel Nixon (Newburn - South of

Tyne)

Research Facilitator

6 – RD06

ON HOLD (North)

Cheryl Rigg (Newburn – South of

Tyne)

RM&G Facilitator

5 – RD04

Laura Brown (Newburn)

Governance




Michelle McGuigan

Senior Governance Manager

8a – Gov04 (Durham)

Debra Hartley

Senior Governance Officer (E&D)

6 – Gov02 (Newburn)

Gillian Stanger-Crone

Senior Governance Officer (IG)

6 – Gov06 (Durham)

Christopher Whitehill

Senior Governance Officer

(General)


Katherine Watson

Governance Officer


Julie Anderson


8a – Gov04 (Tees)

Ben Murphy


8a – Gov04 (Newburn)

Liane Cotterill

Information Governance Officer


Donna Walker

Kevin Graham

VACANCY

Information Governance Officer


Hilary Murphy (0.61)

Governance Officer

4 – Gov08 (Tees)

Meryl Painting

Governance Officer


Janice Thwaites

Laura Witters

As at 25 Apr

Senior Governance Officer (H&S)


Lee Crowe

Administration




Michelle McGuigan

Senior Administration Support

Officer

6 – AD03 (Durham)

Gillian Irving

Personal Assistant (PA)

4 – AD01 (Tees)

Susan Cureton

Joanne Chakai

Administrative Assistant

3 – AD02 (Tees)

Laura Smith

Kerry McKluskey

Aimee Tunney

VACANCY


4 – AD01 (Durham)

Catherine Reid

Susan Parr


4 – AD01 (Newburn)

Doris Wilkinson

Janet Profit


3 – AD02 (Durham)

Janet Kennedy (0.8)

Ria Boulton

Jean Bell


3 – AD02 (Newburn)

Dawn Sinclair

As at 25 Apr

Receptionist

AD04 - 2 (Tees)

Rachael Dixon (0.64)

Janis Davison (0.5)

Receptionist

2 – AD04

Sandra Hughes (Durham JSH)

Andrew Hall (Appleton)

Tom Smith (Appleton)

Norma Pattison (0.53) (Durham JSH)

BIS – Data Management

and Customer Liaison

Business Information Services

Director


Ian Davison

Head of Data Management

8b – BIS45 (Appleton)

Richard McLeod

Data Architect

8a – BIS46 (Appleton)

Graeme Wright

Senior Database

Administrator

7 – BIS47 (Appleton)

Nathan Brown

Data Manager


Christopher Taylor

Paul Donnelly

VACANCY

Senior Data Analyst


David Knight

Katherine Slattery

* Sean Curry

* VACANCY

VACANCY (BIS-C02:

Cumbria)

Database Administrator


Stephen Douglas

VACANCY

Primary Care Data Quality

Manager


Billie Moyle

Julie Hanson

Senior Primary Care Data

Quality Analyst

6 – BIS51a (Tees)

Ross Gallagher

Azim Dinsdale


Analyst


Michelle Coglan

Gillian Moyle

Kathryn Muckles

Head of Information Services

8b – BIS53

Head of Infrastructure

8d – BIS1

Head of ICT Service Delivery

8d – BIS15

Head of ICT Programmes &

System Development

8d – BIS31

ICT Customer Liaison Manager

8a – BIS43

Danielle Young (Tees)

Mario Bernardi (Newburn)

ICT Customer Liaison Lead

6 – BIS44

Michelle Cunningham (Tees)

Steven Jackson (Newburn)


Manager

7 – BIS51 (Tees)

Christine Walker


Manager

7 – BIS51 (Newburn)

Rachel Wright


Analyst

5 – BIS52 (Tees)

VACANCY


Analyst


Sandra Rogers

Jill Dickey

As at 25 Apr

* Additional post not in the

original NECS

organisation structure

Systems & Product

Development Manager


Lisa Moran

Systems & Product

Development Lead


Ben Patterson

VACANCY

Systems & Product Developer


Paul Lancaster

Paul Diston

Christopher Hewitson

Glenn Atherton

Christopher Pattison

VACANCY

Systems & Product

Development Officer


Bertie Hazell

BIS – Information Services


Director


Ian Davison


8b – BIS45

Information Analysis Manager

7 – BIS54 (Tees)

Paul Bell

Senior Information Analyst

6 – BIS55 (Tees)

Alison Barber

Information Analyst

5 – BIS56 (Tees)

Nigel Howson

Information Solutions

Manager

8a – BIS57 (Newburn)

Sandra Thompson

Information Solutions Lead


Barnaby Ulyatt

Helen Deevy

* Erica Whalley

Information Solutions Analyst


David Kent

Paul Maitland

VACANCY

VACANCY

* VACANCY


8b – BIS53 (Appleton)

Valerie Maddison


8d – BIS1


8d – BIS15


System Development

8d – BIS31


8a – BIS43



* Marie Walls

Paul Leake



Christine Clark (0.67)

Pauline Snowball

Glenn Smith

Richard Sims

VACANCY

Information Analyst


Naomi Rutherford

Angie Hoggett

VACANCY



Neil McCarthy

Robert Gaffney



Andrew Haxton

Adam Fearing

Information Analyst


Linda Reed (0.8)

Anisa Laws

As at 25 Apr

* Additional post not in the

original NECS

organisation structure

Implementation & Support

Officer

Band 4

* VACANCY

Senior BI Information Analyst

6 – BIS-C03 (Cumbria Hub)

Philip Bertram

BI Information Lead

7 – BIS-C04 (Cumbria Hub)

Linda Aspinall (0.5)

Senior BI Information Analyst

6 – BIS-C05 (Cumbria Locality)

David Marr (Allerdale & Copeland)

Emma Finlinson (Carlisle & Eden)

Selina Gregg (South Lakes & Furness)

Business Information Manager

8a – BIS-C01 (Cumbria Hub)

VACANCY

Information Solutions Analyst

6 – BIS-C06 (Cumbria / NECS

NE)**

Paul Layte** Although based in the North East

these posts will be required to

spend some time in Cumbria

BIS – Infrastructure (all Newburn)


Director


Ian Davison


8b – BIS45

Infrastructure Security Manager

8a – BIS2

Alison Emslie


8b – BIS53


8d – BIS1 (Newburn)

Brian Lonsdale


8d – BIS15


System Development

8d – BIS31


8a – BIS43

Senior Infrastructure Security

Engineer

6 – BIS3

Jan Abdulgani

Infrastructure Systems Manager

8a – BIS4

Darren Fickling

Infrastructure Systems Lead

7 – BIS5

Robert Dawson

Steven Masson

Senior Infrastructure Systems

Engineer

6 – BIS6

David Lorraine

Lee Robinson

Paul Coyne

Infrastructure Systems Engineer

5 – BIS7

Michael Charlton

Andrew Marshall (0.85)

Philip Birkett

Michael Moore

Janaka Witharamalage

Lewis Charlton

ICT Architecture & Design Manager

8a – BIS8

John Lumley

Technical Design Engineer Project

Implementer

7 – BIS9

Andrew Ferguson

VACANCY

Infrastructure Network Manager

8a – BIS10

Mark Sharman

Infrastructure Network Lead

7 – BIS11

David Ashworth

Moin Qaimkhani

Senior Infrastructure Network

Engineer

6 – BIS12

Adrian Henderson

Christopher Lau

Anthony Laycock

Christopher Lawrence

Hayley Dorian

Infrastructure Network Engineer

5 – BIS13

Daniel Going

Graham Barrett

Michael Armstrong

VACANCY

Infrastructure Support Officer

4 – BIS14

Carolyn Fenton

As at 25 Apr

BIS – ICT Service Delivery


Director


Ian Davison


8b – BIS45


8b – BIS53


8d – BIS1


8d – BIS15 (Appleton)

VACANCY


System Development

8d – BIS31


8a – BIS43

ICT Support Services Manager


Paul Stamper

Service Desk Manager


Ian Harrison

RA Manager


Pamela Robertson

RA Agent

3 – BIS25 (Tees)

Zamurad Ramzan

Julie Kennedy

Senior Support Service Engineer


Helen Craggs

Jonathan Maguire

Adam Morris

Support Service Engineer


Adam Smith

Shaun Guffick

Peter Ingham

Stuart Ferguson

Wayne Donegan

Alexander Airey

Simon Reay

Anthony Brown

Liam Cross

Mark Beadling

Jessica Morris

Adam Ingleson

VACANCY


5 – BIS17 (Tees)

Alex Bruce

Dean Cox

David Smith

Alex Smith

Simon Leonard

Paul Tucker

VACANCY



Craig Scott

Robert Linzey

Michael Logan

Arran Taylorson

Gary Patterson

Anthony Shaw

VACANCY

VACANCY

Service Desk Supervisor

6 – BIS26 (Tees)

Wayne Rodgers

Senior Service Desk Analyst


Ryan Proudfoot

Martin Spencer

Andrew White

ICT Asset Controller


Gemma Burdon

ICT Officer


Archibald McKillop

Steven Gordon

John Bulmer

Janette Halliday

Marc Tervitt

Service Desk Analyst (Appleton)

4 – BIS28

Lee Stokoe

Gemma Anderson

Marc Watson

VACANCY

VACANCY

VACANCY

VACANCY

VACANCY

VACANCY

Service Desk Analyst (Tees)

4 – BIS28

VACANCY

Senior Support Service Engineer

6 – BIS18 (Tees)

Marc Livall

RA Agent


Nicholas Murray (0.6)

Maureen Thomson

RA Agent


Helen Grant

Joanne Burke

Senior Service Desk Analyst

5 – BIS27 (Tees)

Graham McCarroll

As at 25 Apr

BIS – ICT Programmes & Systems

Development


Director


Ian Davison


8b – BIS45


8b – BIS53


8d – BIS1


8d – BIS15


System Development

8d – BIS31 (Appleton)

Jacqui Fawcett


8a – BIS43

Programme Manager

8b – BIS32 (Tees)

Paul Calvert

Senior Project Manager

8a – BIS33

Gillian Pringle (Appleton)

Louise Campbell (Newburn)

Project Manager

7 – BIS34

Maria Williams (Tees)

Clarie Flanders (Tees)

Julie McDonald (Appleton)

Janet Turner (Appleton)

Andrea Adams (0.8) (Appleton)

Paul Bell (Newburn)

Amerjit Kahlon (Newburn)

John Carr (Appleton)

Joanne O’Donnell (Appleton)

Project Leads

6 – BIS34a

Stephen Harris (Newburn)

Maria Armstrong (Appleton)

David Embleton (0.5) (Tees)

Senior Business Analyst

7 – BIS35

John Snaith (Newburn)

Joanne Blackburn (Appleton)

Business Analyst

6 – BIS36

Stella Harding (Tees)

Scott Graham (Tees)

Gary Walton (Appleton)

Alexandra Plunton (Newburn)

Business Change & Benefits Lead

7 – BIS37

Lesley Bruce (Tees)

Ruth Marshall (Newburn)

Tracey Cowan (0.8) (Newburn)

Training Manager


Robin Warrilow

Training Lead

7 – BIS20

Nicola Murray (Tees)

Susan Herbert (Newburn)

Clinical Systems Trainer

6 – BIS21

Asma Rashid (Tees)

Catherine Waters (Tees)

David Blanchard (Tees)

Catherine Addy (0.8) (Newburn)

Scott Greenwood (Appleton)

Mandy Shotton (0.8) (Appleton)

Jennifer Wearmouth (Appleton)

Julie Ingram (Appleton)

Beverly Hunt (Appleton)

VACANCY (Newburn)

VACANCY (Newburn)

ICT Applications Trainer

5 – BIS22

Anthony Langan (0.64) (Tees)

Paul Cowgill (Newburn)

Karen Kewen (0.5) (Newburn)

Dawn Purdy (0.5) (Newburn)

Mark Hume (Appleton)

Project Support Officer

5 – BIS38

Denise Connelly (0.8) (Tees)

Janine Gillespie (Appleton)

Paula Docherty (0.6) (Newburn)

As at 25 Apr

CSO – Senior team & Admin

Commissioning Support Operations

Director

VSM – CORP03 (Durham)

Jackie Park

Head of Customer

Programme

9 – CPM01 (Tees)

Joanne Dobson

Head of Clinical Quality

8d – CQ01 (Durham)

Anne Greenley

Head of Medicines

Optimisation

8d – MO01 (Durham)

Janette Stephenson

Head of Customer

Programme

9 – CPM01 (Durham)

Mike Brierley

Head of Customer

Programme

9 – CPM01 (Newburn)

Khalid Azam

As at 25 Apr

Head of Customer

Programme

9 – C-CPM01 (Cumbria)

* Eleanor Hodgson

Senior Operations Admin

Assistant

4 – CSO02 (Durham)

Claire McVay


Assistant

4 – CSO02 (Newburn)

Sylvia Hudson


Assistant

4 – CSO02 (Tees)

Dianne Hough

Operations Admin Assistant


Linda Bosher

Jacqueline Thomas

Lorraine Cooper



Gillian Mason

Fiona Thow

Naomi Tinnion


3 – CSO03 (Tees)

Amanda Goring (0.8)

Alison McClelland

VACANCY

Admin Assistant (MO & CQ)

4 – CQMO1 (Durham)

Serena Bowens


3 – CQMO2 (Durham)

Lisa Jackson (0.8)

Laura Walker (0.72)


3 – CQMO2a (Newburn)

VACANCY

VACANCY


3 – CQMO2a (Tees)

Ann Croft (0.5)

Denise Welsh (0.8)


3 – CQMO2 (Tees)

Leanne Thompson (0.53)

Nicola Christison (0.87)

Joanne Bryan (0.4)

Head of Customer

Programme


*Ailsa Nokes

* Not yet taken up post

CSO – Tees

Senior Manager Provider

Management

8c – PM01 (Tees)

Kirsty Kitching

VACANCY


Management (MH)

8c – PM01 (Tees)

John Stamp

Manager Provider Management

8a – PM02 (Tees)

Helen Muscroft

Katie McLeod

Manager Provider Management (MH)

8a – PM02 (Tees)

David Welch

Senior Officer Provider Management

7 – PM03 (Tees)

Emma Whitworth

Kathryn Kirby

VACANCY

VACANCY


(MH)

7 – PM03 (Tees)

Dean Cuthbert

Andrew Rowlands

Commissioning Support Officer

5 – PM05 (Tees)

Shirley Stephenson

Sudhir Jayakrishna

Grace Rosbotham

Commissioning Support Officer (MH)

5 – PM05 (Tees)

VACANCY

VACANCY

Head of Customer Programme

9 – CPM01 (Tees)

Joanne Dobson


Director


Jackie Park

Provider Management

Senior Manager Service Planning & Reform

8c – SPR01a (Tees)

Nicola Jones

Manager Service Planning & Reform

8a – SPR02 (Tees)

Deborah Bowden (0.93)

Julie Stevens

Susan Prout

Paul Whittingham

Deborah Ward

Jayne Robson

VACANCY

Senior Officer Service Planning & Reform

7 – SPR03 (Tees)

Iain Marley

Yvonne Watson

Melissa Graham

Victoria Donegan

Helen Metcalf

Katie Davis

VACANCY


5 – SPR05 (Tees)

Susan Kirkham

Karen Eastwood

Shaun Taylor

Senior Manager Service Planning & Reform

(Process Lead)

8d – SPR04 (Tees)

VACANCY

Service Planning & Reform

Commissioning Manager – CHC

Locality Lead

8a – CHC01 (Tees) - Durham

Yvonne Fagg

Joint Commissioning & CHC

As at 25 Apr

CSO – Tees (other)


9 – CPM01 (Tees)

Joanne Dobson


Director


Jackie Park

As at 25 Apr

MARS/TIS – Centre Manager

5 – (Tees)

Lynne Egglestone

MARS/TIS - Access & Referral Officer

3 – (Tees)

Claire Redgrave

Ruth Harger

Sophie Armstrong

MARS/TIS – Transport Information Call

Handler

2 – (Tees)

Angela Short

Alexandra Garrity (0.51)

June Pretty

Laura Dunn (0.5)

Lucy Colligan (0.5)

MARS /TIS

Commissioning Manager - Personal Health

Budgets/Care Management

7 – PHB1 (Tees)

Kirsty Freeman

Personal Health Budgets

Personal Health Budgets/Care Management

Coordinator

6 – PHB2 (Tees)

Rosemary Thompson

Ellen Singh

Personal Health Budgets/Care Management

Officer

5 – PHB3 (Tees)

Rachel Jones

Julie Wilkinson

Samantha Azam


3 – PHB4 (Tees)

VACANCY

CSO – Durham

Senior Manager Service Planning &

Reform

8c – SPR01 (Durham)

Richard Harrety

Andrew Stainer


8a – SPR02 (Durham)

Julie Humphries

Eileen Carbro

Lorrae Rose

Jonathan Wrann

Tony Byrne (0.8)

Matthew James

Kathleen Berry


7 – SPR03 (Durham)

Ruth Frostwick (0.85)

Philip Ray

Ella Fielding

Sara Woolley

Gill Smith

Helen Stoker (0.8)

Malcolm Moralee


5 – SPR05 (Durham)

Jacqueline Storey

Andrea Patterson

Geoffrey Taylor

As at 25 Apr



Mike Brierley


Director


Jackie Park


Management (Process Lead)

8d – PM04 (Durham)

VACANCY


8a – PM02 (Durham)

Alison Chapman

VACANCY


7 – PM03 (Durham)

Cheryl Crampton

Rowena Howard

Katrina Bage

VACANCY


5 – PM05 (Durham)

Angela Hornsey

Lisa Forster

Claire Richardson


Management

8c – PM01a (Durham)

Darren Archer

Senior Commissioning Manager –

JC & CHC

8c – JC01 (Durham)

Louise Okello

Commissioning Manager – JC

(Mental Health)

8a – JC02a (Durham)

Ben Smith


(Learning Disability)

8a – JC02b (Durham)

Donna Owens


(Childrens)

8a – JC02c (Durham)

Emma Thomas

Senior Commissioning Support

Officer – JC

7 – JC03 (Durham)

David Linsley

Kathryn Henry (0.69)

Commissioning Support Officer – JC


Jemma Robson

Claire Garner-Harris


Locality Lead

8a – CHC01 (Durham)

Sandra Larkin

Service Planning & Reform Joint Commissioning & CHC


Locality Lead

8a – CHC01 (Tees)

Yvonne Fagg

Provider Management

CSO – Newburn


JC & CHC (Process Lead)

8d – JC04 (Newburn)

Christopher McEwan (0.9)


(Mental Health)

8a – JC02a (Newburn)

Leslie Gray


(Learning Disability)

8a – JC02b (Newburn)

Lynn Bradford


(Childrens)

8a – JC02c (Newburn)

Rhiana Nelson

Senior Commissioning Support

Officer – JC

7 – JC03 (Newburn)

Sean Halliday (0.8)

Stephen Barratt

Commissioning Support Officer – JC


David Britton

VACANCY


Locality Lead

8a – CHC01 (Newburn)

Jacqueline Welsh

As at 25 Apr



Khalid Azam


Director


Jackie Park


8a – SPR02 (Newburn)

Marc Hopkinson

Gillian De’Ath

Mark Girvan

VACANCY


7 – SPR03 (Newburn)

Michael Lydon

Joan Charlton

Kimberley Reah

Janine Ogilvie (0.8)


5 – SPR05 (Newburn)

Beverley Lockett

VACANCY

VACANCY

Senior Manager Service Planning &

Reform

8c – SPR01 (Newburn)

Sheila Alexander


Management (Process Lead) (MH)

8d – PM04a (Newburn)

Rebecca Eadie


(MH)

8a – PM02 (Newburn)

VACANCY

Senior Officer Provider

Management (MH)

7 – PM03 (Newburn)

Anthony Gowland

Louise Graves


(MH)


Reuben Dodds

Julie Crowther


Management

8c – PM01 (Newburn)

Tricia Errington

VACANCY


8a – PM02 (Newburn)

Gary Collier

VACANCY



Angela Brown

Mark Caizley

Mathew Thomas

VACANCY



Linda Duncan

Elaine Stephenson (0.8)

Carl Short

Julian Bench

Provider Management Service Planning & Reform Joint Commissioning & CHC



* Ailsa Nokes* Not yet taken up post

CSO – Continuing Healthcare

Nurse Assessor Teams

As at 25 Apr


Director


Jackie Park


JC & CHC

8c – JC01 (Durham)

Louise Okello


JC & CHC (Process Lead)

8d – JC04 (Newburn)

Christopher McEwan (0.9)


Locality Lead

8a – CHC01 (Newburn)

Jacqueline Welsh


Locality Lead

8a – CHC01 (Durham)

Sandra Larkin


Locality Lead

8a – CHC01 (Tees)

Yvonne Fagg


9 – CPM01 (Tees)

Joanne Dobson



Mike Brierley



Khalid Azam

Band 3

Caroline Stones

Deborah Lancaster

VACANCY

VACANCY

Band 6

Susan Wyer

Nicola White (0.8)

Mark Tibbett

Susan Rumis

Deborah Ridley

Shunara Quinn (0.6)

Maureen Plowman

Helen McCallan (0.6)

Angela Kidd

Jennifer Jameson

Michael Herring

Dawn Gowland

Sarah Bint

VACANCY

VACANCY

Band 7

Victoria McGurk

Amanda Jones

Gordon Bentley

Ruth Kimmins

CHC Nurse Assessor teams

Band 7

Lesley Birkett

Steven Downie (0.4)

Helen Wood

Band 4

Jayne Elliot

NoTWCDDBand 7

Linda Haines

Nora Day

Sarah Golightly

VACANCY

Band 6

Susan Burnhope

Rose Walls (0.49)

Marie Sirrell

Charlie Read

Mary Nixon (0.6)

Joan Murray (0.5)

Fiona Kane

Karen Hitchen

Karen Hepple

Angela Graham

Christine Dunn

Kirsty Crozier

Mark Corbett (0.5)

Julia Connor

Patricia Bolton

Moira Baggott (0.5)

Jacqueline Adamson

Yewande Lee

VACANCY (2.4)

Band 4

Samantha Ward

Marie Newton

Carolyn Hardy (0.4)

VACANCY (0.6)

Band 3

Tanya Watson

Katrina Dunning (0.8)

Barbara Carling (0.6)

Terri Bodley

Paul Buckley

Wendy Burgess

VACANCY (1.5)

Tees



* Ailsa Nokes* Not yet taken up post


9 – C-CPM01 (Cumbria)

* Eleanor Hodgson

Senior Manager – Mental Health,

Children’s Commissioning & CHC

8c – C-CS1 (Cumbria)

VACANCY

CSO - Cumbria

Commissioning Manager –

Mental Health / LD

8a – C-CS3 (Cumbria)

Rachel Chapman

Commissioning Manager –

Children’s

8a – C-CS2 (Cumbria)

Greg Everatt

Senior Support Officer

Commissioning – Mental

Health / LD

7 – C-CS5 (Cumbria)

Tania Desborough

Senior Support Officer Commissioning – Children’s

7 – C-CS4 (Cumbria): Jenny Weaver

Senior Support Officer Commissioning - Childrens

CHC & Complex Packages

7 – C-CS7 (Cumbria): Brad Palmer



Carolynne Foulkes



Jean Stewart

Senior Commissioning Manager


8c – C-SPR01 (Cumbria)

Ros Berry

Commissioning Manager

Service Planning

8a – C-SPR10 (Cumbria)

Cate Swift

Senior Commissioning Officer

Service Planning

7 – C-SPR11 (Cumbria)

Sharon Cornwell




Susan Collins


IFR


Elspeth Godwin (0.8)


Assistant

4 – C-CSO02 (Cumbria)

Susan Mann


3 – C-CSO03 (Cumbria)

Lesley Ann Wilkinson (0.67)

Tracey Harrison

Christine Nicholson

Hannah Clark

As at 25 Apr

Commissioning Manager


8a – C-SPR02 (Cumbria)

Mandy Kennedy (0.91) (Carlisle & Eden)

Gary Malone (South Lakes/Furness)

Senior Commissioning Officer



Ed Hutton (Allerdale & Copeland)

Lisa Sewell (Carlisle & Eden)

Suzanne Lofthouse (South Lakes/Furness)

Tony Dewes (South Lakes/Furness)




Steph Mallinson (0.8) (Allerdale & Copeland)

Richeldis Messam (Carlisle & Eden)

Miriam Baird (South Lakes/Furness)

Manager – Locality Lead CHC

8a – C-CHC01 (Cumbria)

Clare Burdon

Janet Porthouse

Sharon Henderson (0.8)

** Band 7

Wendy Dixon

Sandra Foster (0.6)

** Band 6

Gary Bradshaw

Vanessa Dutton

Joanne Fell

Kim Graham (0.6)

Lesley Hubbold (0.8)

Brenda McDonald

Deborah Miller-Robinson

Lesley Wills (0.8)

Pauline Wren (0.4)

Bernadette Dainton (0.8)

Sharon Owen

Laura Mason (0.2)

** Band 5

Dorothy Bingley (0.5)

Laura Mason (0.5)

Carolyn Chapelhow

Charlotte Sievewright (0.4)

** Band 4

Christine Dixon (0.8)

Joyce Jasper (0.4)

Rosemarie Robb (0.68)

Rona Scott (0.58)

Helen Wainwright

Sarah Hide (0.32)

** Band 3

Ruth Kendall (0.6)

Note: this structure includes the hub and locality

based teams. Unless otherwise indicated individuals

are based in the hub location.

** Commissioning CHC and Nurse

Assessor teams


Director


Jackie Park

* Not yet taken up post

CSO – Clinical Quality


Director


Jackie Park

Head of Clinical Quality

8d – CQ01 (Durham)

Anne Greenley

Senior Manager Clinical Quality

8b – CQ02 (Durham)

Kirstie Hesketh


8b – CQ02 (Newburn)

Gregor Miller


8b – CQ02 (Tees)

Linda Neeley

Manager Clinical Quality

8a – CQ07 (Durham)

VACANCY


8a – CQ07 (Newburn)

VACANCY


8a – CQ07 (Tees)

Susan Goulding

Senior Officer Clinical Quality

7 – CQ03 (Durham)

Katharine Humby

Kirsty Atkinson


7 – CQ03 (Newburn)

Christa Thompson


7 – CQ03 (Tees)

Michelle Waugh

Officer Clinical Quality

5 – CQ08 (Durham)

Helen Osborn

Daniel Webber


5 – CQ08 (Newburn)

Gillian Airey


5 – CQ08 (Tees)

VACANCY

Senior Officer – Adult

Safeguarding

7 – CQ09a (Tees)

Patricia Johnson

As at 25 Apr

Senior Officer – Childrens

Safeguarding

7 – CQ09b (Tees)

Alison Ferguson

Manager – Clinical Quality

8a – C-CQ07 (Cumbria Hub)

James Fraser

Senior Officer – Clinical Quality

7 – C-CQ03 (Cumbria Hub)

Michelle Church

Officer – Clinical Quality

5 – C-CQ08 (Cumbria Hub)

Nicola Duers

Kate Coulthard (0.6)

VACANCY

CSO – Medicines Optimisation

Core and Practice Support teams

Head of Medicines Optimisation

8d – MO01 (Durham)

Janette Stephenson

Senior Medicines Optimisation

Pharmacist

8c – MO02 (Tees)

Susan Weatherhead (0.6)

Helen Fish (0.4)


Pharmacist

8c – MO02 (Durham)

Ian Morris


Pharmacist

8c – MO02 (Newburn)

Anne-Marie Bailey


Pharmacist

8c – MO02 (Newburn)

Helen Seymour (0.55)

Andy Reay (0.45)

As at 25 Apr


Director


Jackie Park


Pharmacist

8c – C-MO02 (Cumbria)

Andy Reay (0.2)

Medicines Optimisation Support

Pharmacist

8a – C-MOP2 (Cumbria)

Susan Bennett (0.7)

Peter Clough

Paul Elwood

Melanie Graham (0.8)

Fiona Gunston (0.8)

Susan Hawker (0.7)

Anne Leveson (0.4)

James Loudon

Judith Matthews

Katie Jane Mellor (0.52)

Ruth O'Neil (0.57)

Lynne Palmer (0.65)

Jannette Pieri (0.8)

Maria Portmann (0.74)

Susan Saunders (0.53)

Fiona Spence (0.2)

Sally Styles (0.56)

Anita Wilson

Medicines Optimisation Pharmacist

8b – MO03 (Tees) *

Joanna Bushnell

Michaela Robinson

Angela Dixon (0.63)

Helen Fish (0.4)

Lucy Wilson (0.8)

Kathy Thornton (0.44)

Hira Singh


8b – MO03 (Durham)

Joan Sutherland (0.8)

Alastair Monk

Andy Reay (0.35)

VACANCY (0.6)


8b – MO03 (Newburn)

Marie Thompkins

Neil Frankland

Susan Turner (0.5)

Deborah Giles

Sarah Tulip

Band 8b

Lindsay Caulfield

Elizabeth Mallett

Susan White (0.53)

Medicines Optimisation - Practice teams

Band 3

Rachel Sercombe

Band 6

Carolyn Jackson (0.45)

Band 8a

Gayle Atchia (0.4)

Sarah Bateman (0.8)

Juliet Fletcher (0.32)

Steven Llewellyn

Samantha O'Connell

Christine Rivett

Barry Todd

Vanessa Collins (0.72)

Christophe Ollerenshaw

Sarrah Seldon

Laura Self

Band 5

Deborah Brownlee (0.96)

Angie King (0.8)

Band 2

Gavin Charlton

Lorraine Carr (0.43)

CDD

Band 8a

Shelley Calkin (0.8)

Julie Cottee (0.61)

Barbara Nimmo

Band 5

Anna Swadling (0.64)

Victoria Watson

Claire Young

Tees

Band 8a

Sarah Bryson (0.55)

Valerie Dawes (0.8)

Joanne Madden

Alyson McGivern (0.62)

Deborah McLeary (0.63)

Helena Nettleton (0.6)

Kathy Thornton (0.26)

Ann Watson (0.53)

Band 7

Vanessa Conley

Karen Luck (0.7)

Kristi Potter (0.8)

Band 5

Marie Allison (0.9)

Lesley Callaghan (0.8)

Jacqueline Stephenson (0.53)

Pamela Willis

Ann Parker (0.66)

Joanne Bailey (0.4)

Nth Tyneside; Newcastle; N’land

Band 8a

Elizabeth Weledji

Kay Holden (0.64)

Heather Bunce (0.4)

Alan Cranke (0.9)

Rebecca Ellis (0.13)

Christine Moulder (0)

Richard Thompson (0.7)


8b – C-MO03 (Cumbria)

Tim Slaughter

Lesley Angell

Technician Medicines

Optimisation

5 – MO11 (Tees)

Lisa Twigger (0.67)


Optimisation

6 – MO10 (Tees)

Louise Dunn


Optimisation

6 – MO10 (Durham)

Vicki Vardy


Optimisation

5 – MO11 (Newburn)

Claire Graham

* This includes

2.1 wte practice

based

pharmacists


GOVERNING BODY 14th May 2013

Item No: DDES GB/13/28

Clinical Quality Summary Report

March 2013 1. Introduction

The purpose of this report is to provide Durham Dales, Easington and Sedgefield

Clinical Commissioning Group with a monthly briefing of the headline issues relating

to clinical quality them with assurance that actions are being undertaken with

providers where necessary. This report covers all information and issues received in

March 2013.

Please note that information received from providers still relates to County Durham

primary care trust. It is expected that this will have been resolved in quarter one.

2. Implications and risks

The focus of this report looks at the issues, incidents and complaints raised by

healthcare workers and service users about the care and experience they have

received during the month of March across the health system. It also includes

information relating to compliance against national and local standards and matters

raised about professional performance and safeguarding.

The report is structured, following the clinical quality themes; patient safety, patient

experience and clinical effectiveness. The information gathered against these

sources of information is essential to assessing whether our patients are at risk from

harm and whether they have a positive experience of care.

The continued efforts being made by member practices to report commissioning

concerns and incidents in practice, is providing the CCG with greater insights about

the services they commission.

The primary areas of concerns for DDES CCG are:

2

111 serious incidents involving call handlers and failure to recognise patient

symptoms has been escalated to the area team and oversight management

group. An extra ordinary root cause analysis panel has been held involving

CCG representation to put remedial actions in place.

The current NEAS and 111 clinical quality review mechanisms do not provide

all CCGs with assurance that services are being managed in a safe manner.

A review and reconfiguration of the clinical quality infrastructure is about to

commence. DDES CCG will be part of these developments.

Discharge issues remain a common them for GP practices this month, who

are reporting them both as clinical and contractual issues. The contract and

clinical quality review group continues to challenge CDDFT for improvement

in the quality and timeliness of reporting.

CDPCT exceeded Cdiff trajectory for March with 20 cases against a target of

13

The revised Working Together to Safeguard Children was published in March

2013

From April 2013 the management of primary care complaints will no longer

involve the local NECS team. They have been advised that any complaint

received (both verbal and written) with a primary care component should be

directed to the NHS Commissioning Board’s (NHSCB) Customer Contact

Centre based in Reddich.

3. Recommendations

The DDES management executive is asked to:

Note the content of this summary report.

Support the actions being taken forward through the CQRG to improve quality

and experience for patients.

4. Author and sponsor director

Author: Kirstie Hesketh, Senior clinical quality manager, North East

Commissioning Support (NECS)

Director: Gill Findley, Director of nursing/ nurse advisor, DDES CCG

Date: 24th April 2013


Development / discussion

Decision / action





Transition: Implementing Equity and Excellence x

Performance Measures All performance measures from the operating framework apply

QIPP N/A

NHS Constitution Principle 4 – NHS Services must reflect the needs and preferences of patients, their families and their carers. Principle 5 – the NHS works across organisational boundaries and in partnership with other organisations in the interest of patients, local communities and the wider population.

Equality and Diversity Following assessment: no specific impact or details of impact and actions to address


CDDFT; Independent Contractors, TEWVFT

Other policies / Issues Clinical Quality Strategy

Durham Dales, Easington and Sedgefield (DDES) CCG

Clinical Quality Summary Report – March 2013

1 Introduction

The purpose of this report is to provide DDES CCG with a monthly briefing of national

updates and issues relating to the quality of services and their impact on patient

experience. Where possible the incidents, PALS and complaints have been broken down

into the DDES CCG area and its constituencies.

2 Primary Care

The information provided about primary care, relates to information received by NHS North

of England Commissioning Support (NECS) clinical quality team, via the Safeguard

Incident Reporting & Management System (SIRMS).

The information shared below is critical to measuring quality. The drive to increase

incident reporting across DDES practices is pivotal to understanding quality concerns

across providers and commissioned services and impacts on our increased ability to take

appropriate action.

2.1 Serious Incidents

In March, 4 serious incidents (SIs) were reported via NHSCDD. They were:

Three were reported as ‘other’ and were all relating to domestic homicides.

One related to a grade 3 pressure ulcer which was acquired in a care home.

The domestic homicide incidents are following the domestic homicide process, led by the

local authority. The CCG is represented by the safeguarding adults and children leads.

The outcomes of which will be shared in due course.

2.1.1 Primary Care Patient Safety

There were 147 incidents reported via the SIRMS during March 2013, a decrease of 7 on

February’s figure of 154 incidents.

The following table details the number of incidents reported by locality area, subject

organisations and types of incident.

Sedgefield reported the highest number in March and reporting rates have remained

consistent, as have Durham Dales. Easington have had a slight decrease this month. For

comparative purposes the previous month’s figures are also presented in the table.

5

DDES Reporting Rates Number of Incidents Reported

Durham Dales Sedgefield Easington

54 (54) 59 (59) 34 (41)

Subject Organisations Number of Incidents Reported

GP Practices Pharmacy CDDFT TEWV NTHFT CHSFT UCC/OOH/111 Other Acute Trusts/independent providers

25 (83) 5 (7)

68 (19) 2 (3) 13 (*)

10 (19) 10 (*)

14 (11)

Incident Types Numbers reported

Access, Admission, Transfer, Discharge (AATD) 28 (45)

Consent/ Communication 7 (5)

Contracting Issue 1(0)

Medication 24 (24)

Documentation 60 (33)

Clinical Assessment / Implementation of Care 6 (12)

Patient Experience 3 (0)

Information Governance 3 (2)

Security 2 (0)

Self harm 9 (15)

Medical Device 3 (0)

TOTAL 147 (154) * data cleanse carried out on SIRMS and incidents listed under practices re-categorised to reflect subject organisation

2.1.1 Key Themes & Trends

From the incident analysis the following themes or issues are of specific interest:

An emerging theme relates to the 111 service and the volume of paperwork being

issued; in a number of cases the practice received the same forms, 4 times in one day

creating unnecessary duplication. Other CCG areas are also starting to highlight issues

with the volume of 111 reports and difficulties in deciphering their content. This concern

will be fed back into the 111 leads for information and also will be discussed at the 111

quality group.

A small number of incidents are being reported in relation to the OOH /UCC centres

concerning diagnosis and treatment. In one incident a young patient passing blood in

urine was treated for a UTI however due to diligence of own GP practice was later

diagnosed with Wilms tumour with metatstasis.

Despite repeated reporting by practices on choose and book issues the trend continues

to increase, there is no indication that systems and processes are changing and the

senior clinical quality manager in NECS will be discussing this concern with the

contract lead to ensure the necessary actions are taken.

6

Documentation continues to be a significant theme; these incidents relate to delays in

receiving clinical letters, misfiling of letters and letters/ discharge information being

received in error.

Medication errors are a significant theme and the volume relates to discrepancies in

medication in discharge summaries and clinical letters. Reported incidents involving

inappropriate loading of anti coagulation patients and dispensing errors. One practice

highlighted a significant event for the purpose of sharing in which a patient on Warfarin

who attends for monitoring had an INR of 8 due to being given nitrofurantoin for a UTI.

Guidelines were followed and vit K was administered. The INR had risen from 2.5 to 8

with the co-prescription of an antibiotic. At the review meeting a few GPs highlighted.

they would not routinely recheck INR under this situation and wanted to share with

other practices as was surprised at such a dramatic effect of co-prescribing.

The timeliness of discharge summaries remains a concern and although significant

improvements have been made by CDDFT to address the 24hr performance target

practices report it is still a major issue. This will continue to be monitored by the

contract group.

2.1.2 Key Actions

CDDFT are still completing the review into a number of serious incidents reported

relating to nighthawk. An update on findings is expected at the May quality review

group.

GP Clinical Quality Locality Leads now receive a monthly overview of all incidents

reported on SIRMS from their individual locality to enable them to support the

quality agenda.

DDES Head of Medicines Management and NECS Medicines Optimisation (MO)

Lead for the CCG are now included in the triggers for medication incidents

(previously the Head of MO and Assistant Medical Director)

2.2 Patient Experience

2.2.1 Primary care complaints

In March, a total of 5 complaints were received by NHSCDD. Since January 2013, the

number of complaints received has continued to significantly decrease from previously

months where the average number of complaints being received was 25. It is not clear at

this stage why the numbers of complaints being received has drastically reduced.

Out of the 5 complaints received 2 were from residents of DDES CCG, their primary

complaints related to:

1 complaint related to the care provided to patient by GP in Easington. Pt reports that

GP misdiagnosed condition which resulted in severe infection requiring surgery. This

complaint was passed to GP practice for investigation and response.

7

In Sedgefield 1 complaint related to North East Ambulance Service and County

Durham and Darlington NHS Foundation Trust (CDDFT). Relative raised concern

about the 111 triage process and delay in being contacted by out of hours GP.

Complaint was passed to NEAS to lead in handling of complaint with input from

CDDFT.

During this month no hotspots/trends were identified.

Ombudsman’s Investigations: A request for records was received from the Ombudsman

relating to a Continuing Health Care complaint which was responded to in January 2013.

The complaint relates to a relative being unable to pursue a CHC claim, as they did not

hold the appropriate documentation (ie grant of probate/copy of will). A decision on

whether the Ombudsman will investigate the complaint is pending.

2.2.2 Key Issues

NECS has been advised that any complaint received (both verbal and written) with a

primary care component from April 2013 should be directed to the NHS England Customer

Contact Centre based in Reddich.

The process will be as follows:

Tier 1 - Upon receipt of the complaint the Customer Contact Centre will do an initial triage

and if the person is contacting them about a provider they will be encourage to go to them

directly (if they do not want to do this the Customer Contact Centre will deal with it). If the

complaint is resolved the complaint will be closed, if not it will go to Tier 2 in Quarry House,

Leeds.

Tier 2 – the complaint will be assigned to a case manager who will inform the complainant

that they will be handling the case ‘to resolution’. The case manager will undertake an

initial assessment of the complaint (ie number of parties involved and prepare a case

resolution plan) and seek additional input from the CSU/Area Team for local knowledge

and investigation resource.

Tier 3 – the complaint will be forwarded to the Area Team/CSU for investigation. If case

only has one element of response then the Area Team/CSU can contact complainant

directly. For cases with multiple elements to a response the main complainant contact will

be via case manager.

It is not clear at this stage what level of local support is expected from NECS in relation to

primary care and specialist services complaints. We are currently seeking clarification on

this from NHS England.

2.2.3 Primary Care Patient Advice and Liaison Service (PALS)

8

There were 129 queries/concerns reported to PALS during the month, 43 of which were

raised by DDES CCG clients.

PALS activity pan CCG

CCG Number of PALS Contacts

Durham Dales 17

Sedgefield 14

Easington 12

These include issues relating to primary care (18), commissioning (10) and other NHS or

non-NHS organisations (15).

Primary Care

The top themes related to: access to routine/emergency dental care, registration with a GP

practice and clinical treatment. No pattern was identified in relation to any specific

practice.

Commissioning

The top theme was the closure of the Durham Dales practice.

No other significant themes or hot spots were identified from PALS cases during the

month.

NHS County Durham and Darlington’s PALS service closed on 31 March 2013. From this

date, advice and support with queries or concerns is available via Local Healthwatch and

the NHS Commissioning Board’s Customer Contact Centre. PALS teams within NHS

provider organisations continue to provide support regarding issues relating to Trust

services.

2.4 Clinical Effectiveness

2.4.1 Central Alerting System (CAS)

19 alerts were issued of which 16 were relevant to independent contractors and are

detailed below:

CEM/CMO/2013/03 2ci, 2ce And The 2c Family Of Drugs

EL (13)A/08 Drug Alert Class 2, Action Within 48 Hours, Mylan, Montelukast 5mg Chewable Tablets, Recall Due To An Error On The Carton

EL (13) A/09 Hospira Uk Limited, Cytarabine Injection 100mg/Ml (1g/10ml)

EL (13)A/10 Drug Alert Class 4, Caution In Use, Rad Neurim Pharmaceuticals Eec Limited, Distributed By Flynn Pharma Limited, Circadin 2mg Prolonged-Release Tablets, Error Concerning Dosage Instructions On The Patient Information Leaflet.

MDA/2013/010 Metal-On-Metal (Mom) Total Hip Replacements: Adept® 12/14 Modular Head (Finsbury Orthopaedics Ltd). All Lots.

MDA/2013/012 Diagnostic Test Strips And Cassettes For Urinalysis, Pregnancy Testing, Menopause Testing And Opiates Testing, Manufactured By: Ind Diagnostics Inc, Canada; Alere International Ltd; Barrier Healthcare Ltd; E-Pharm Ltd

MDA/2013/014 Oxoid Antimicrobial Susceptibility Testing Discs (Ast) Manufactured By Thermofisher Scientific.

9

MDA/2013/016 Infusion Pumps: Gemstar Infusion System. Manufactured By Hospira. All List Numbers Are Affected.

MDA/2013/017 Infusion Pump: Alaris® Gp Volumetric Pump. Product Refs: 80063un01, 80263un01, 80263un01-G, 9002med01, 9002med01-Gmanufactured By Carefusion. All Serial Numbers Are Affected.

MDA/2013/018 Aquarius Haemofiltration Machine Using Software Version 6.01. Supplied And Supported By Baxter Healthcare Ltd. Manufactured By Edwards Lifesciences Ltd (Now Nikkiso Europe Gmbh).

MDA/2013/019 Detergent And Disinfectant Wipes Used On Reusable Medical Devices With Plastic Surfaces.All Manufacturers.

MDA/2013/020 Acrobat Swing (Ac Swing) Arm. Manufactured By Ondal. Supplied By Various Companies To Support Operating Lights And Monitors. Delivered From 1999 To 2008 Inclusive.

Met Office Severe Winter Weather - Level 2 - Alert and Readiness alert - Regions affected: NEE NWE YH WM EM EE

Met Office Cold Weather Alert Level 2 8/3/13

Met Office Cold Weather Alert Level 2 18/3/13

Met Office Severe Winter Weather - Level 3 - Cold Weather Action alert - Regions affected: NEE NWE YH WM EM EE

From 1st April compliance against their implementation will be undertaken by the North

East of England area team.

2.4.2 Clinical Audit

Five major audits reported in March:

Cancer Two Week Wait audit: The final report has been presented to the Cancer

Locality Group, where the uptake of the ‘two week wait’ leaflet was considered. The

information has been shared with practices, key actions for practices will be

addressed by the local choose and book meeting in May.

Safeguarding Children and Young People Toolkit audit: Supported by the quality

improvement scheme, there has been a very good response. The draft report is

being considered by the designated and named GP safeguarding leads, so that

areas for improvement can be built into the 2013/14 improvement scheme..

Phase II Discharge Summary and Medication Error audit: Supported by the quality

improvement scheme. The draft report has been complied and will be discussed

with CDDFT at a future CQRG meeting.

Anti-Psychotic prescribing in patients with Dementia: The draft report has been

compiled and disseminated for comment. The clinical quality working group will

consider the findings and improvement actions

Value Based Clinical Commissioning audit: The draft report has been compiled and

disseminated for comment. The clinical quality working group will consider the

findings and improvement actions.

2.4.3 NICE

12 pieces of guidance were published, 1 of which was relevant to independent

contractors according to NICE, as detailed below:

10

Reference Title Type of Guidance

QS28 Hypertension Quality Standards

Compliance against these standards will be monitored by the NHS England area team.

3 Acute & Community Services

This report provides, where known, the quality intelligence for CDDFT, CHS and NTHFT

acute providers. It is pertinent to highlight that the providers only provide quality reports on

a quarterly basis, therefore the monthly reports focus on the information owned and

monitored by the clinical quality team in NECS.

3.1 County Durham and Darlington Foundation Trust (CDDFT)

3.1.1 Serious Incidents (SIs)

In March, CDDFT reported 9 SIs, all of which are reviewed against a standard root cause

analysis process. The incidents reported relate to:

Incident Type Number of Incidents

Confidential Information Leak 3

Child Death 1

Pressure Ulcer Grade 4 1

Slips/Trips/Falls 1

Other 2

Delayed Diagnosis 1

Non- compliance against CDDFT information governance standards will be addressed

through the CQRG, as this is a repetitive theme.

The child death is following the standard child death review process, defined by the local

safeguarding children process, any such learning will be considered by the Safeguarding

leads meeting and appropriate quality forums.

3.1.2 Never Events

There were no new never events reported in March 2013.

3.1.3 Quality Issues

Concern has been raised regarding discharge of a patient without sufficient

discharge information. Patient had undergone surgical management of acute bowel

http://guidance.nice.org.uk/QS28

11

obstruction and on discharge from hospital had a significant surgical open wound

with obvious nursing needs; however the home were told patient was ready for

discharge and had no nursing needs. Feedback from the trusts investigation is

awaited.

A recent mental capacity act & deciding right audit raised concerns around

healthcare professionals understanding of the MCA. The report recommends that

CDDFT engages in wider regional activities in respect of deciding right and that

further implementation of advance care planning and emergency healthcare plans

is required.

3.2 City Hospital Sunderland NHS Foundation Trust

3.2.1 Serious Incidents (SIs)

2 SIs were reported relating to an outbreak of C diff and a Grade 3 pressure sore.

Never event reported regarding retained foreign object post operation reported in

April. End of temperature probe missing following sleeve gastrectomy.Patient

returned to theatre on 10/03/13 due to complications and found in anastamosed

staple line. DDES CCG representatives have requested that details of the findings

are fed back to the quality group.

3.2.2 Quality Issues

CQC Outpatient department survey indicated that overall performance against the

national benchmarks is very good at CHSFT, with only 3 scores from CHSFT falling

into the worst 20% of trusts.

As reported previously 2 County Durham patients were discharged from A&E with

missed raised Troponin levels and as a result CHSFT were requested to complete

an audit to provide assurances that safe systems and processes were in place. The

audit highlighted that 30 cases discharged with a raised troponin subsequently died

but the feedback from the audit failed to identify if the deaths were attributable to

the raised troponin. As a result a further meeting has since been held and the

results of the audit discussed in detail by the deputy medical director and

cardiologist in attendance. The findings highlighted the 30 deaths were not a

consequence of missed raised troponin. CHSFT have put fail safe mechanisms in

place which entails daily consultant review of all raised Trop T levels and there have

been no further reported incidents. A sample of patients were identified as

potentially being at risk from undiagnosed ischemic heart disease and may be

missing appropriate management. Further assurances are being sought from the

CHSFT cardiologists and feedback will be highlighted in the April monthly report.

The responsiveness of the trust to the incidents has raised questions as significant

time delay in actions being taken is apparent, this is currently under internal review.

12

The ‘Organisational Patient Safety’ report from the National Reporting and Learning

System indicates that incident reporting has increased over a six month period; this

is consistent with a campaign to promote reporting being launched last year.

3.3 North Tees and Hartlepool NHS Foundation Trust (NTHFT)

There was no CCG quality representation at the March QRG and the minutes have not yet

been disseminated. Therefore it has not been possible to provide an extract this month.

A schedule of further QRG meetings is to be determined once the Tees Board Nurse is in

post.

There are no immediate quality concerns in relation to NTHFT.

4 Mental Health


In March, 6 SIs were reported by the Mental Health trust in March. Of this 5 related to the

unexpected deaths of patients (suspected suicide) and 1 related to a non-accidental fire.

The management of the inpatient unexpected deaths, continues to be considered by

external clinical review. An update will be received at the May CQRG.

5 North East Ambulance Service (NEAS) and 111 Service

5.1 111 Feedback Forms

During March, 11 incidents were reported via SIRMS about NEAS through the 111

feedback process, all of which related to failure or concerns with the referral process. The

clinical quality review mechanism associated with NEAS and 111 has raised concerns for

CCGs. This issue has been raised at the Northern CCG forum and new arrangements will

be out into place. NEAS have welcomed this.


There were 3 SI’s reported by NEAS in March related to call handling within the 111 and

999 call handling centre. The SI’s concerned patients who were suffering from breathing

difficulties and whose calls were incorrectly triaged by the call-handlers. These 3 incidents

are thematically very similar to another patient incident which was reported as an SI at the

end of February 2013.

These incidents have been the subject of a preliminary Root Cause Analysis Panel Review

conducted by NEAS on 3 April 2013. Investigations are on-going and reports will be

managed through the agreed SI Panel process. An oversight management group with the

area team has also been established.

13

5.3 Key Issues

In March, the 111 Project Team at John Snow House was disbanded as a result of the

NHS reorganisation. This team was the focal point for the co-ordination of the 111/Urgent

Care specific clinical governance agenda, management of the 111 GP Clinical Leads and

the 111 Professional Feedback process which captured and acted upon incidents and

issues reported about the 111 service from GP Practices, Urgent Care Centres and other

sources. This way of working now needs to form part of the mainstream clinical quality

processes.

In order to maintain the management of the high volume of feedback being reported

through SIRMS and other sources, a temporary project resource has been secured

process to include the learning lessons and improving practice, through the End 2 End

Care Groups, to ensure the quality of service improves. This resource, is however, also

required to manage these processes across the other 111 services being rolled out across

the North of England and work continues within NECS to establish how this can work in

the medium-long term. Planned changes to the clinical quality review mechanism will be

an import factor in CCGs having assurance about the on-going capability and competence

of the service as it expands.

6 Other Sources of Assurance

6.1 Commissioning for Quality and Innovation (CQUIN)

All CQUIN schedules for 2013/14 have been agreed. A summary report will be shared

with the CCGs in May.

6.2 Healthcare Acquired Infections (HCAI)

6.2.1 Clostridium Difficile

There were 3 cases of Clostridium Difficile reported in March 2013 in DDES CCG, 1 case

occurred in a care home and remaining 2 were practice specimens.

The GP specimens involved patients recently discharged from hospital the history is as

follows,

Patient recently discharged from hospital. Reason for last admission was cellulitis.

Over past 6 months has received 6 courses of antibiotics, 5 episodes related to

infected leg ulcers, but no wound swabs taken. 1 course for UTI, but again no

sample taken.

Patient recently discharged from hospital. Reason for admission was

haempneumthorax due to multiple fractured ribs.

14

The Care home resident resides in the Easington locality. No diarrhoea reported by care

staff. Stool sample sent due to PR bleeding. Home was visited and concerns raised with

infection control precautions.

The number of specimens across DDES for the period April 1st 2012 to 31st March 2013 is

reflected for both practice and care home specimens in the graphs below.

Graph 1: GP Practice c diff specimens (This includes patients in their own home, care homes and In

Patients who have been in hospital for less than 3 days)

Graph 2: Care home only C diff specimens

A meeting has been arranged with Gill Findlay, Kate Huddart, Jean Armstrong and Tim McGuire to discuss the current situation and formulate an action plan for the way forward.

6.2.2 MRSA Bacteraemia

No new cases reported in March.

15

6.2.3 PVL

One confirmed case of PVL in March. GP was contacted and questionnaire completed and

returned to Health Protection Agency. The patient and family members were decolonised

once acute infection had resolved.

6.2.4 Other Infections

The health protection agency has been investigating respiratory illness in a care home in

Bishop Auckland since 9th April. 5 symptomatic residents were swabbed and all results

were positive for influenza A virus (typing awaited).

HPA informed GP’s that it was too late to offer antiviral prophylaxis to all residents. HPA

stated that no further action is required other than if they have newly ill residents (or those

with chest infection / pneumonia) and require a GP that they should notify that influenza A

is circulating within the home. GP can then decide whether to give antivirals if new case or

consider antibiotics if chest infection/pneumonia.

6.2.5 Health Protection Update

Between December 2012 and March 2013 there has been an increase in numbers of

confirmed cases of PVL staphylococcus community acquired pneumonia (41 cases). The

national figures are 30 – 40 cases per year and the age range is between 1 and 84 years.

Of the 41 cases 9 patients have died and at least 3 household clusters have been

identified. The cases and close contacts are being investigated to better describe the

clinical epidemiological and microbiological characteristics and potential risk factors for

disease.

The recommendations for health care workers are to remain vigilant for such cases

especially during the influenza/respiratory virus season. Isolated of MSSA or MRSA from

suspected cases can be forwarded to the Colindale Laboratories for analysis.

6.2.6 Audits

There continues to be on-going concerns with standard of cleanliness and infection control

practices of a care home in DDES, especially poor practice of manually cleaning commode

pots and urinals. These have been highlighted with Durham County Council

commissioning team.

Routine GP audits is not in the work programme for the coming year however of those who

have outstanding re audits the HCAI team will continue to visit to ensure good practice.

6.3 Independent Contractor Performance Triage Group

16

There were no formal referrals to the North East Primary Care Services Agency in March.

7 Safeguarding Children & Adults

7.1 Safeguarding children

7.1.1 Practice Issues

Easington: Domestic Homicide Review (DHR) 1 (providers NT+H, CDDFT, GP

Practice) The Overview Report was presented at the Safe Durham Partnership

Board meeting in January 2013 and agreed. The report is to be published on the

Safer Durham Partnership website. The Designated Nurse is not aware of the date

for this but a reactive media statement has been prepared.The action plan to

implement the recommendations from the DHR is to be monitored by the Domestic

Abuse Executive Group.

Durham Dales: Domestic Homicide Review 2 (providers GP Practice, TEWV,

CDDFT) A Domestic Homicide Review Panel was to be held on 1 February to agree

the Overview Report. The Designated Nurse has not been informed of whether this

has been presented to the Safe Durham Partnership.

Domestic Homicide Review 3 (providers GP Practice, TEWV) This was a

historical case where a son killed his mother. This occurred in April 2012. This case

is included in the wider definition of domestic homicides which includes child on

parent and sibling murder. DHR Panels were held on 23 November 2012 and 19

December 2012 where, having considered the multi-agency information it was felt

that while the case met the criteria for a DHR there was no indication that there

would be lessons to learn from undertaking a DHR. However, the Home Office

recommended that a DHR should be done. DDES Board Nurse is to chair the DHR

Panel for this case.

Domestic Homicide 4 (providers GP Practice) This was the case where a woman

was killed by their partner on in December 2012. A DHR Panel was held on 16

January 2013. The Home Office has again advised that a DHR must be undertaken.

A DHR Panel meeting has been arranged on 10 May 2013.

Sedgefield: Domestic Homicide Review 5 (providers GP Practice, TEWV,

CDDFT) Further to the December Report, another Domestic Homicide Panel was

held on 19 December 2012 to consider the case involving siblings. The panel

recommended that the criteria were met for a domestic homicide review. This

recommendation was ratified by the Chair of the Safer Durham Partnership and the

Home Office. The first panel meeting was held on15 March 2013 where the terms of

reference and timeframe for the review were agreed.

17

Serious Case Review: The criminal case involving Child C (a case where a baby

died from non-accidental head injury bruising where there had been previous

bruising when the baby was pre-mobile) has concluded. The Serious Case Review

can now be published. A media strategy meeting is to be held on 23 April 2013 to

agree a date for publication and a reactive media statement.

7.1.2 Performance Issues

Durham Local Safeguarding Child Board (LSCB) Child protection performance

statistics: Durham LSCB monitors the performance around child protection conferences

and the information is collated by the LSCB Performance Manager. In quarter 4 there were

63 Initial Child Protection Conferences s relating to 116 children. The information relevant

to GP practices and CDDFT is highlighted. The LSCB now highlight where performance

falls below 60% (indicated in red) and agencies are required to take action to address poor

performance.

The LSCB monitors attendance at Child Protection Conferences. The difficulties faced by

GPs in attending conferences, for example, when convened at short notice have been

raised with the LSCB. However, where GPs are unable to attend conferences it is

essential that their reports are provided. The statistics however, show only whether reports

were shared: they do not reflect the number of reports actually sent in which will be higher.

The principle is that reports should be shared prior to conference but this is not always

possible due to late invitations. It should be noted that when the monitoring first started

percentage of reports shared was in single figures so a lot of progress has been made with

improving practice.

The LSCB similarly monitors performance regarding Review Child Protection Conferences.

In quarter 4 there were a total of 151 review child protection conferences involving 315

children.

From 1 June the Local Authority will not be sending out invitations to RCPCs: the minutes

from the previous conference will have the date of the next conference and will be deemed

the invitation. The LSCB will be sending out a briefing for agencies to notify them of this

and will be monitoring what impact this has on performance.

Overall, whilst the performance of GPs is still below that of other agencies, there has been

a significant improvement over the last two years and the LSCB have acknowledged this.

This improvement will continue to be closely monitored by the LSCB and needs to be

maintained.

Audits of the RCGP Safeguarding Children Toolkit are being undertaken in North Durham

and Darlington CCGs. It has been agreed that this will be included in DDES quality

improvement scheme.

18

7.1.3 Service Issues

CDDFT: Further to the meeting held on 20 December 2012 with Durham PCT

Commercial Lead to look at information flows for the monitoring of the service specification

and KPIs, a meeting was held with the Associate Director of Children’s Services, CDDFT

on 15 March 2013 to agree how the information will be provided. The Designated Nurse

has also requested a meeting with the new Contracting Lead to progress this as soon as

possible.

Recent Documents: The revised Working Together to Safeguard Children was published

in March 2013 with an implementation date of 15th April 2013:

http://www.education.gov.uk/childrenandyoungpeople/safeguardingchildren/protection/a00

210235/consultation

The LSCB has a meeting arranged to consider what changes will be required to the multi-

agency procedures.

The final Assurance and Accountability Framework was published at the same time:

http://www.commissioningboard.nhs.uk/wp-content/uploads/2013/03/safeguarding-

vulnerable-people.pdf

A paper will be tabled at the next meeting to inform the CQWG of the implications and

changes that will be required following the publication of these documents.

7.2 Safeguarding adults

Durham County Council have informed the quality team that there were 3 homes in March

under executive strategy, 2 homes in Easington and 1 in Durham Dales. The presenting

issues related to concerns with medication, care plans and risk assessments.

Information on safeguarding adults to date has been limited to number of homes under

strategy. However following the appointment of the safeguarding adult’s team, hosted by

North Durham CCG, it is anticipated that more detailed analysis of safeguarding referrals

and serious case reviews will now be shared.

https://web.nhs.net/owa/redir.aspx?C=taCSPwu1cUKBMnIhXI7Je4uWwj-HDdBI4C7Iatjke5JfWxgkdnudeiOygMUWVZIuhR_dW-k_EEY.&URL=http%3a%2f%2fwww.education.gov.uk%2fchildrenandyoungpeople%2fsafeguardingchildren%2fprotection%2fa00210235%2fconsultation

https://web.nhs.net/owa/redir.aspx?C=taCSPwu1cUKBMnIhXI7Je4uWwj-HDdBI4C7Iatjke5JfWxgkdnudeiOygMUWVZIuhR_dW-k_EEY.&URL=http%3a%2f%2fwww.education.gov.uk%2fchildrenandyoungpeople%2fsafeguardingchildren%2fprotection%2fa00210235%2fconsultation

https://web.nhs.net/owa/redir.aspx?C=taCSPwu1cUKBMnIhXI7Je4uWwj-HDdBI4C7Iatjke5JfWxgkdnudeiOygMUWVZIuhR_dW-k_EEY.&URL=http%3a%2f%2fwww.commissioningboard.nhs.uk%2fwp-content%2fuploads%2f2013%2f03%2fsafeguarding-vulnerable-people.pdf

https://web.nhs.net/owa/redir.aspx?C=taCSPwu1cUKBMnIhXI7Je4uWwj-HDdBI4C7Iatjke5JfWxgkdnudeiOygMUWVZIuhR_dW-k_EEY.&URL=http%3a%2f%2fwww.commissioningboard.nhs.uk%2fwp-content%2fuploads%2f2013%2f03%2fsafeguarding-vulnerable-people.pdf


Finance Report for the year ended

31 March 2013

Overview of position at 31 March 2013

•Appendix 1 shows the complete financial position for the CCG as at 31 March 2013, with an outturn over-spend

of £8,345k, before the deployment of reserves.

•After utilisation of available reserves there is an under-spend of £420k, in line with the target agreed with the

PCT Cluster.

•The figures above are subject to audit scrutiny.

Movements in position at 31 March 2013

• The following areas are showing a movement from the forecast outturn position presented at month 11.

The figures are subject to audit scrutiny.

• Acute – the favourable movement of £84k reflects the end of year agreements reached with the main

providers, the agreements protect the CCG from any impact additional year end activity being charged in

2013/14.

• Community – the unfavourable movement of £26k reflects the end of year agreement with CDDFT and

covers the impact of increased activity in Urgent Care.

• Continuing Health Care – the unfavourable movement of £215k reflects the provision for restitution

claims. These costs have previously been allowed for within reserves, the reserves have been released

to the budget lines.

• Prescribing – the unfavourable movement of £155k is based on PPA data received to January and 2

months of accruals.

• Corporate Budgets – there is an unfavourable movement of £83k.

Risk sharing across County Durham and

Darlington

• A risk sharing approach was agreed by the CCG earlier in the year (along with the other two CCGs within County Durham and Darlington), with the costs of all individual cases with in excess of £100k agreed to be shared across the three CCGs.

• The implications of this risk sharing agreement has now been reflected in the month 12 position in this report.

• The agreement relates to individual packages of care in excess of £100k. At month 12 there are 20 Mental Health and Learning Disability packages and 19 Continuing Health Care which are above £100k across County Durham and Darlington.

• As a result of the risk sharing arrangement, DDES CCG have received additional costs to date of £142k.

• Although DDES currently ‘lose’ in this arrangement, the agreement is designed to mitigate the risk faced by all three of the CCGs and DDES may ‘gain’ in future months, depending upon the numbers of high cost cases identified by all CCGs.

Appendix 1 – Financial Position at 31 March 2013

– DDES CCG

Finance Report for the period ending YEAR END POSITION

Mar-13 Budget Actual Variance Variance

£'000 £'000 £'000 £'000 £'000

Commissioning Budgets

Acute Services 223,223 223,223 229,392 6,169 -84

Mental Health/ Learning Disabilities 53,063 53,063 52,908 -154 -132

Community/Primary Care Services 55,672 55,672 56,832 1,161 26

Continuing Health Care/Funded Nursing Care 17,787 17,787 19,034 1,246 215

Children' Services 1,407 1,407 1,820 413 60

Prescribing 52,046 52,046 51,556 -490 155

Total Commissioning Budgets 403,197 403,197 411,543 8,345 239

Corporate Budgets & Reserves

Corporate Budgets 3,289 3,289 3,079 -210 83

Reserves 8,555 8,555 0 -8,555 -322

Total Corporate Budgets and Reserves 11,844 11,844 3,079 -8,765 -239

Total Revenue Expenditure 415,041 415,042 414,622 -420 0


Annual

Budget

Movement

QIPP Delivery

6

The latest allocative QIPP target for DDES for the year is shown above.

As a result of this change, the allocative QIPP target stands at £2.541m which has been delivered

in full in 2012/13.

The CCG is showing an over-delivery of £1,221k (48%), which will contribute to targets for

2013/14 QIPP targets.

Allocative QIPP Target £2,541k

QIPP Delivered in-year £3,762k Over-delivery against target £1,221k (F)

QIPP Delivery 2012/13

Updated 11/04/13

1


GOVERNING BODY

ACTION LOG

No Date/meet

ing action agreed

Action Responsible officer

Agreed completion date

Progress Outcome

1. 27/11/12 SC-GB/12/82 Ambulance NEAS update Queries on the ambulance report to be submitted to Berenice Groves by email. Berenice Groves to provide details of the percentage of unnecessary category A calls being undertaken. Further report to the executive committee and governing body in March 2013.

JC/BG

February 2013 February 2013 March 2013

9/1 carried forward to February. 12/2 report to be received in March 2013. Deferred to May. Need to link in with NECS as further clarity is needed on the future of the reporting

Updated 11/04/13

2

No Date/meeting action agreed



Progress Outcome

2. 19/2/13 SC-GB/13/37 Finance report for the nine months ended 31 December 2013 Issues relating to weighted population figures to be discussed at the finance and performance sub-committee.

MP

March 2013 April 2013

This is now nearly complete, but not in all localities as yet. Update at next meeting. Finance figures have been discussed within all localities now. Presentation of information will be reviewed for 13/14 reports.

Complete

3. SC-GB/13/50 - Matters arising from meeting held 12 February The Winterbourne Out of Area repatriation report awaited

GF May 2013

4. 12/03/13 SC-GB/13/50 – Matters arising from meeting held 12 February DTG to link with Sue Carty & Liam Cairns at DCC in connection with the already established groups for young people.

DTG April 2013 DTG had not yet linked with DCC, but will do this week in connection with linking into already established groups. Now covered in item GB 13/13

Updated 11/04/13

3




Progress Outcome

5. 12/03/13 SC-GB/13/52 Durham Dales, Easington & Sedgefield (DDES) Clinical Commissioning Group Constitution To establish whether the Constitution can be put on website without all signatures on. To follow up with the 2 Easington Practices that have not signed up to the revised constitution.

MT JC

April 2013 April 2013 May 2013

MT was not in attendance, therefore will update at May meeting. JC was not in attendance, therefore will update at May meeting

6. 12/03/13 SC-GB/13/53 – Clinical quality summary report Details about the PALS service from the Area Team

GF Ongoing This was picked up in agenda item DDES-GB/13/04

Complete

7. 12/03/13 SC-GB/13/53 - – Clinical quality summary report In connection with the Clinical quality summary report for March 2013, the clinical leads would ensure onward dissemination to the respective DDES quality Groups

Clinical Leads April 2013 Confirmed Complete

8. 12/03/13 SC-GB/13/54 - Antenatal and Postnatal depression protocol

SS/SM April 2013 Confirmation that the protocol was disseminated

Complete

Updated 11/04/13

4




Progress Outcome

In connection with the Antenatal and Postnatal depression protocol, assurance is needed around the dissemination to their members practices.

9. 12/03/13 SC-GB/13/55 Chief Officers Progress Report including Structure DR to produce a report on the staff survey and circulate the survey results to the group

DR April 2013 DR wasn’t at the previous meeting so this will be deferred to May.

10. 12/03/13 SC-GB/13/60 High Level Budget Report Prescribing Costs issues – To look into any way of GP’s being notified if and when medication is released for use.

Kate Huddart April 2013 DR to link with Kate Huddart in connection with this issue

Complete

11. 12/03/13 SC-GB/13/61 Performance Report DDES CCG need confirmation from NECS on who will be providing the performance support and reports from 1st April

JC

April 2013

We now have confirmation that DW will continue to provide support and reports until June 2013. Uncertainty after this

Updated 11/04/13

5




Progress Outcome

12. 12/03/13 SC-GB/13/62 Risk Management Report Locality leads to ensure their updated risk registers go to MT

Locality Leads April 2013 Governing body agreed to send updates

Complete

13. 12/03/13 SC-GB/13/63 – Public Health Core Offer Public Health Core Offer. Agreement that the final MOU should be shared with localities and member practices

Clinical Leads/Locality Leads

May 2013 Complete

14. 27/03/13 SC-GB/13/71 - County Durham Primary Care Trust & Darlington Primary Care Trust Transfer Documents To compile a letter to confirm receipt of the transfer documents for the final cluster Board

LJG 27th March 2013

Complete

15. 27/03/13 SC-GB/13/72 - Final Version of County Durham Primary Care Trust & Darlington Primary Care Trust Quality Handover Document for Clinical Commissioning Groups, National Commissioning Board & North East Commissioning Support

LJG 27th March 2013

Complete

Updated 11/04/13

6




Progress Outcome

To compile a letter to confirm receipt of the QHD to the final cluster board

16. 09/04/13 DDES-GB/13/01 – Conflicts of Interest Register The group were asked to liaise directly with LJG update the current register before the next meeting

All

May 2013

17. 09/04/13 DDES-GB/13/05 Matters arising from governing body – 12 March Provider quality was discussed and as part of the quality surveillance group the governing body asked for a quality pathway chart to assure how all the groups fit together.

DR

May 2013

18. 09/04/13 DDES-GB/13/05 Matters arising from governing body – 12 March PALS replacement service. GF to speak with Beverley Reilly, Director of Nursing & Quality at the AT to update the governing body on a PALS replacement service.

GF

May 2013

19. 09/04/13 DDES-GB/13/09 Review of the Governing Body Terms of

Updated 11/04/13

7




Progress Outcome

Reference The membership section (4) within the ToR to be reviewed at the next planned review date.

MT

October 2013

20. 09/04/13 DDES-GB/13/11 Clinical Quality update John Maguire will meet with GF to discuss 111 and future plans. GF will speak with Kirstie Hesketh (NECS) in connection with the incident reporting system remaining the same and the generic inbox address

GF/JM GF

May 2013 May 2013

21. 09/04/13 DDES-GB/13/12 Chief Officers Report Durham Dales Nursing Home Service – The service did not go live when agreed and SF will link with NECS to look at re-procurement of the service as CDDFT are in breach.

SF

May 2013

22. 09/04/13 DDES-GB/13/13 PPE Activity DE to send the project lead appointed in Healthwatch to HM

DE

May 2013

Updated 11/04/13

8




Progress Outcome

DTG will link with LW around other various youth forums once the report from the school meeting is collated

DTG/LW

Ongoing

23. 09/04/13 DDES-GB/13/14 Performance Report Discussion took place around amending the performance indicator document to include quality and to have one comprehensive list. DW to link with TM around the performance indicators DE to send list of DCC performance indicators to DW Clarity is needed on the inclusion of CQUIN in the reporting on the contracts.

DW DE DW

May 2013 May 2013 May 2013

24. 09/04/13 DDES-GB/13/19 Minutes received To ensure weekly executive meeting minutes and locality minutes are received for the governing body

LJG

Ongoing

1

GOVERNING BODY Tuesday 14 May 2013

Item no: DDES-GB/13/31


CLINICAL COMMISSIONING GROUP SUB-COMMITTEE/GOVERNING BODY

Chief Clinical Officer - Progress Report

May 2013 1. Introduction

This report includes an update on national policy and summarises the progress we have made as a Clinical Commissioning Group (CCG) over the previous month.

The end of the last financial year has been an extremely busy time with the main focus being on finalising our contracts with our provider organisations. I am delighted that we have now reached agreement with all providers and apart from North East Ambulance Services, all have agreed to a block contract this year. This gives us all financial certainty over this first year of clinical commissioning and removes financial disincentives that in the past have prevented us working together and created a barrier to moving services in to community settings.

The three year contract for community services will end in March 2014 and we are now engaged in working with County Durham and Darlington FT to review the 52 services that make up this contract. We now have a unique opportunity to work with our community staff to integrate services across primary, community and social care and to work with them to develop an outcomes-based contract that will ensure we judge this service on performance rather than on numbers of contacts as we do now. Our district nursing service is held in high regard by primary care across DDES and it is important to reassure staff that there is no threat to their jobs as a result of this. We are in the process of setting up joint meetings between CCGs and the FT over the coming month.

We have

now also signed our final contract with North of England Commissioning Support and we are beginning to work closely with our aligned staff.

Document Management




Sponsor Director

Approved

1.0 12/03/13 Governing body

Not applicable Not applicable S Findlay

2

2. National Update

The following section lists national updates and provides access by hyperlink as well as the web addresses:

Reclaiming a population health perspective: future challenges for primary care New report written by the Nuffield Trust and commissioned by the National Association of Primary Care.

Government launches care comparison website Information to help people choose, compare and comment on residential care homes and home care services is now available on NHS Choices.

Frontline first: nursing on red alert The number of district nurses in England fell by 39 per cent between 2002 and 2012, while preventable emergency admissions rose by 40 per cent over the same period.

Final quality premium guidance published

Final guidance has now been published which confirms that the maximum amount payable to CCGs in 2014/15 for improving outcomes against the national and local measures will be £5 per head of population.

The guidance also confirms that CCGs will have flexibility to decide how best to use money earned from the quality premium – provided that it is spent in ways that improve patient care or health outcomes.

The guidance also clarifies that NHS England is committed to include a national measure on mental health in the 2014/15 quality premium.

The final guidance can be found here.

NHS England unveils ‘compassion’ plan NHS England has unveiled plans to improve health and social care. “Please read each of the implementation plans and discuss these with your boards, governing bodies, teams and in your work with patients and people using your services, to understand and identify how you can contribute towards the delivery of Compassion in Practice and the 6Cs”.

Compassion in Practice: Action areas

▪ Action area 1: helping people to stay independent, maximising well-being and improving health outcomes

▪ Action area 2: working with people to provide a positive experience of care ▪ Action area 3: delivering high quality care and measuring impact ▪ Action area 4: building and strengthening leadership ▪ Action area 5: ensuring we have the right staff, with the right skills, in the right

place ▪ Action area 6: supporting Positive Staff Experience

Business Plan NHS England has published its Business Plan for 2013/14 - 2015/16, called Putting Patients First can be found on the following link

http://www.networks.nhs.uk/networks/news/reclaiming-a-population-health-perspective-future-challenges-for-primary-care

http://www.networks.nhs.uk/networks/news/government-launches-care-comparison-website

http://www.networks.nhs.uk/networks/news/frontline-first-nursing-on-red-alert

http://www.commissioningboard.nhs.uk/wp-content/uploads/2013/03/qual-premium.pdf

http://www.networks.nhs.uk/networks/news/nhs-england-unveils-2018compassion2019-plan

http://www.england.nhs.uk/nursingvision/actions/area-1/








3

www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

It explains how NHSE will deliver its mandate for the Government and ensure the best possible outcomes for patients. A full set of organisation structure charts for NHS England have also been published.

Kings Fund’s 10 priorities for commissioners The King’s Fund has revised its paper setting out 10 priorities for commissioners in the new NHS.

3. DDES CCG Progress 3.1 Almost all staff based in our Sedgefield administration office are now in post full

time. We have retained the locality bases in the Dales and Easington for our locality staff and are looking for alternative accommodation for the Sedgefield team who are currently working out of Merrington House, Spennymoor.

3.2 Reviews

We are committed to undertaking a large number of reviews this year including:

Urgent Care

Intermediate Care

PTS ambulance services

Rural ambulance services

Community Nursing

Acute Quality Services review across Durham, Darlington and Tees 3.3 NECS

Most recent structure attached at Appendix 1. We are still waiting for a structure that shows which staff are aligned solely to DDES.

3.4 GP IT Systems

At present around half of our practices are on SystmOne and half on EMIS. The majority of those with EMIS wish to move to EMIS web. CDDFT have installed SystmOne in their A+E departments and this is the system that all of the community nursing staff use. Darlington CCG has just converted 100% of their practices to SystmOne.

Although the ability to access patient records across both clinical systems will be possible in the future it will always be an easier process if everyone uses the same system. In addition installing EMIS Web will be a significantly more expensive option and we have yet to have the Area Team budget confirmed. It is this budget that the Area Team will pass to the CCG to fund the work done by NECS. I have asked NECS to produce a comparison of the 2 systems and this shows that there is no appreciable difference between the two.

http://www.england.nhs.uk/wp-content/uploads/2013/04/ppf-1314-1516.pdf

http://www.commissioningboard.nhs.uk/about/structure

http://www.networks.nhs.uk/networks/news/kings-fund2019s-10-priorities-for-commissioners

4

I have therefore sent this to all DDES practices and have asked them to think about which clinical system they wish to use in the future. The choice of system remains with practices.

3.5 Commissioning

Work with TEWV and CDDFT – We have set up a clinical programme board to manage the new way of working with the two FTs. The top two priorities for this group have been identified as:

Emergency Care

Community Contract

We have no such arrangement in place yet with NTH and CHS and we now need to review how we work with them and their block contracts this year.

3.6 Commissioning our 13/14 priorities

Although we are still finalising the 2013/14 locality budgets it is important that locality project leads continue work on brought forward schemes as well as start work on this year’s commissioning intentions without delay.

4. Recommendations

The DDES CCG governing body is asked to:

receive this report;

note the progress made to date.


Author: Dr Stewart Findlay Title: Chief Clinical Officer

Director: Dr Stewart Findlay Title: Chief Clinical Officer Date: May 2013



5

Decision / action


DDES Strategic Priorities




TBC

QIPP N/A

NHS Constitution

N/A

Equality and Diversity No specific impact


N/A

Other policies / Issues

Governing Body 14th May 2013



GOVERNING BODY MEETING

Public and Patient Engagement Update

1. Introduction

This report is to update governing body members on the aspects of public and patient engagement that have been undertaken in April 2013.

2. Implications and Risks

The document attached is a summary of the work undertaken by NECS and the CCG over the period. The main focus in April has been reactive response to queries, development of the website and branding and preparation for the Francis II/NHS Constitution public meeting being held on 30th April 2013. A verbal update on this event will be given at the meeting. This meeting will be the start of a series of listening events to engage members of the public in line with our engagement strategy.

3. Recommendations

The Committee is asked to:

Accept the paper and note the progress

4. Author and Sponsor Director

Author and Director: Gill Findley Title: Director of Nursing Date: 29.4.13

2


Development / discussion x

Decision / action



Delivery: x

Maintenance: x

Transition:


Delivery:

Maintenance:

Transition:

QIPP N/A

NHS Constitution

The event on 30th April is to inform members of the public about the NHS Constitution

Equality and Diversity Further work is required to ensure that we are listening to and engaging all our communities


Embedded in the paper

Other policies / Issues N/A

3

Durham Dales, Easington and Sedgefield CCG Communications and Engagement update: March/April 2013 Prepared by North of England Commissioning Support Unit

Action Comments NECS locality lead has presented communications and engagement plan for next 12 months

Discussions ongoing

Media coverage: Supplements in Northern Echo and Advertiser series http://www.thenorthernecho.co.uk/news/health/focusonhealth/ Press releases re Annual public meetings, authorisation, and Francis 2 public event Interview with Dr Stewart Findlay on Star Radio on 2 April 2013

Need to identify ‘good news’ stories for media on an ongoing basis

Newspaper supplements Recommendation and costs provided for production of regular health pages in local news titles and local authority magazine

Awaiting CCG decision

Design style Developed a new design style to support DDES branding activity. DDES received new statutory logo from DH identity team.

Style has been agreed. NECS locality lead developing a range of branded material incorporating this new style and statutory logo.

Website Content on CCG website has been reviewed and a series of changes recommended. Next phase of development will be to introduce the new design style across the site and implement a range of technical improvements.

Content has been amended/updated. Timetable for development to be provided to CCG.

Events A series of ‘you said, we did’ public events were held across the locality.

Further local event to discuss Francis Report to be held on 30 April

Stakeholder engagement Work underway to establish relationship with the three local Health Networks. In particular, how they can support the CCG’s engagement/involvement objectives. Updating of the CCG’s stakeholder distribution list is underway, to ensure that it is robust and up-to-date and able to underpin a programme of stakeholder engagement activity

Initial meeting has taken place, with further discussion planned in May.

Mental Health A review of the mental health engagement model is underway via Age UK.

Findings and recommendations will be brought forward to the CCG for discussion/decision

4

Action Comments Governing body meetings Press release and advertising planned to promote next meeting.

Campaigns NECS locality team providing support to the ongoing medicines waste campaign

1

Governing Body 14th May 2013

Item No: DDES/13/29


GOVERNING BODY MEETING

Report on Commissioning for Quality and Innovation (CQUIN) Schemes

1. Introduction

The purpose of this report is to update the Governing Body on the CQUIN schemes between the

Clinical Commissioning Groups and providers for the 2013 / 2014 financial year. The negotiations

of the final schemes and financial weightings have been determined by the contract management

groups and the CQUIN sub-groups with providers as detailed in the Contract Mandate Process. A

position statement on the 2012/13 CQUIN schemes is also included.

2. Implications and risks

The CQUIN schemes for 2012/13 that were agreed with the providers are not due to complete

until all data are received in June 2013. Meeting with each provider including BMI Woodlands and

the hospices have been arranged to discuss the schemes and sign off. A full report on the 2012/13

schemes will be provided to the July Governing Body meeting.

The key aim of the CQUIN framework for 2013/14 is to secure improvements in quality of services

and better outcomes for patients, whilst maintaining strong financial management.

The lead Commissioners for the contracts has ensured that providers have in place measures that

meet pre qualification criteria and have reviewed evidence of how they will satisfy at least 50 per

cent of the pre-qualification criteria that apply to them.

All respective providers met the criteria for pre qualification for 2013/14.

The forward plan for CQUIN 2013/14 commenced in September 2012 and NHS County Durham

and Darlington worked collaboratively with CCG clinical leads and Board Nurses. This included a

consultation phase with all stakeholders including GP practices to develop a number of draft

schemes for consideration and negotiation with providers.

2

The CQUIN schemes include a number of indicators that address safety, clinical effectiveness,

patient experience, innovation, national goals and reflect local priorities. CQUIN should not include

best practice, minimum expectations and reward measurement only. Therefore each suggestion

received was reviewed and assessed against these criteria and other criteria for example such as

whether the information was already a requirement through contracting routes, had the suggestion

already been measured in previous schemes.

Where suggestions for improvement did not fully meet the criteria for CQUIN, alternative methods

were considered such as monitoring through the Clinical Quality Review Groups, inclusion in

penalty schemes or quality improvement plans with providers.

CQUIN for 2013/14 is set at a level of 2.5 per cent for all health services commissioned through

the standard NHS Contract. One fifth of this value (0.5 per cent of overall contract value) are

linked with the National CQUIN Goals where applicable. Other financial weightings have been

negotiated according to CCG priorities. A Bar will be set for all sliding scales which apply (e.g.

partial payments for partial achievements) and dates and timelines for the submission of data.

CCGs are required to share agreed schemes with the NHS Commissioning Board and publish

them on the NHS Institute web site. The financial allocations are not included in the sharing of

information with the Institute due to the commercial sensitivity of such detail.

All CQUIN Schemes are monitored through the Clinical Quality Review Groups, Contract

Management Groups, and via contract performance.

3. Recommendations The Governing Body is asked to:

note the content of this summary report

note the position for the 2012/13 scheme

receive as summary of the final schemes for information

support the monitoring of the 2013/14 scheme

support the development , consultation, negotiation, monitoring and approval of the 2014/15

CQUIN schemes.


Author: Kirstie Hesketh

Title: Senior Clinical Quality Manager

North of England Commissioning Support Unit

Director: Gill Findley

Title: Director of Nursing/Nurse Advisor Date: April 2013

3


Development / discussion x

Decision / action x





Transition: Implementing Equity and Excellence x

Performance Measures All performance measures from the operating framework apply

QIPP N/A

NHS Constitution All principals within the constitution apply

Equality and Diversity Following assessment: no specific impact or details of impact and actions to address


-County Durham and Darlington NHS Foundation Trust Acute

Contract

County Durham and Darlington NHS Foundation Trust

Community Contract

North Tees and Hartlepool NHS Foundation Trust

City Hospital Sunderland NHS Foundation Trust

Tees, Esk and Wear Valley NHS Foundation Trust

North East Ambulance NHS Foundation Trust

BMI Woodlands Independent Hospital

Local Hospice Providers

Oxygen Assessment Contract (in development)

North East Quality Observatory Service (NEQOS)

Continuing Health Care (CHC)

Independent Providers

Local Authorities

Public Health

Other policies / Issues NHS CDD Commissioning for Quality and Innovation (CQUIN) Policy CO068

NHS CDD Quality Review Groups Terms of Reference

NHS Quality Accounts 2010/11 Audit Commission

NHS Mandate 2013

Commissioning for Quality and Innovation (CQUIN) 2013/14 Draft-December 2012 NHS Commissioning Board

The Health Act March 2012 (Liberating the NHS) DoH

4

1 Introduction

The key aim of the CQUIN framework for 2013/14 is to secure improvements in quality of services

and better outcomes for patients, whilst maintaining strong financial management.

The implementation of the CQUIN schemes with providers has developed over the last four years,

which incorporates the development, consultation, negotiation, monitoring and approval of

individual CQUIN indicators and the schemes in totality. The Government’s Mandate for the NHS

Commissioning Board, effective from April 2013, set out the objectives and outcomes that the

NHS must deliver on, including the NHS Outcomes Framework 2013/14 and CQUINs.

The CQUIN schemes include a number of indicators that address safety, clinical effectiveness,

patient experience, innovation, national goals and reflect local priorities. CQUIN should not include

best practice, minimum expectations and reward measurement only.

2 Innovation Health and Wealth (Pre-qualification Criteria)

Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS set out that from

April 2013 compliance with high impact innovations would become a pre-qualification requirement

for CQUIN. Commissioners have ensured that providers have in place measures that meet certain

criteria in order to qualify for the release of any 2013/14 funding.

Providers provided their responses and action plans to clinical commissioners back in February

2013 on how they will satisfy at least 50 per cent of the pre-qualification criteria that apply to them,

an example of which is included in appendix 1. All respective providers have met this standard.

3 National, Regional and Local CQUINs

National CQUIN goals apply to services commissioned by CCGs using the NHS Standard

Contract. 0.5 per cent of the value for all healthcare services commissioned is to be linked to the

national CQUIN goals, where these apply. Where a national CQUIN goal does not apply to the

contract type, a locally adapted goal based on the national goals have been developed as

applicable. Table 1 below sets out the contract types to which national CQUIN goals apply.

Table 1: The Contract Types to which national CQUIN Goal Applies

National CQUIN Scheme

Acute Community Ambulance Mental Health or Learning Disability

Friends and Family Test

√ Not applicable Not applicable Not applicable

NHS Safety thermometer

√ √ Not applicable √

Dementia √ Not applicable Not applicable Not applicable

Venous thromboembolism (VTE)

√ Not applicable Not applicable Not applicable

5

Regionally suggested indicators, for consideration by commissioners, were developed by the

Regional Clinical Networks, Mott MacDonald (advisory role and Department of Health link) and the

North East Quality Observatory Service (NEQOS).

Local, productivity and innovation indicators were developed by CCGs based upon local strategic

and public health priorities, incidents, Patient Advisory Liaison Service (PALS) issues, complaints,

GP Clinical Commissioning Groups, contract leads, planning and performance leads, providers

and previous CQUIN achievements.

CQUIN 2013/14 schemes have been developed by the CCGs for the following providers of NHS

Services and the schemes are included in Appendix 2;

County Durham and Darlington NHS Foundation Trust Acute Contract

(CDDFT)

County Durham and Darlington NHS Foundation Trust Community Contract

(CDDFT)

North Tees and Hartlepool NHS Foundation Trust (NTHFT)

City Hospital Sunderland NHS Foundation Trust (CHSFT)

Tees, Esk and Wear Valley NHS Foundation Trust (TEWVFT)

North East Ambulance NHS Foundation Trust (NEAS)

BMI Woodlands Independent Hospital

Local Hospice Providers

Oxygen Assessment Contract

Where suggestions for improvement did not fully meet the criteria for CQUIN, alternative methods

were considered such as monitoring through the Clinical Quality Review Groups, inclusion in

penalty schemes or quality improvement plans with providers.

4 CQUIN Goals, Weightings, Financial Value and Monitoring

Each CQUIN scheme contains a number of goals and each goal has a percentage weighting

attached to it. The weighting reflects the maximum percentage of the scheme which will result in

payment upon achievement of the goal. The percentage weighting has been attributed by

commissioners in negotiation with providers and reflects the amount of work required to be

undertaken by providers to achieve the goal.

The number of indicators and goals chosen by the commissioners for individual providers is

proportionate to the size of the contract and reflects the financial benefits for individual CQUIN

schemes.

Each goal contains one or more targets which detail the measurement methods, the target

achievements and payment thresholds assigned to each individual indicator, goal and target.

CQUIN for 2013/14 is set at a level of 2.5 per cent for all health services commissioned through

the standard NHS Contract. One fifth of this value (0.5 per cent of overall contract value) is linked

6

with the National CQUIN Goals where these apply. Other financial weightings have been set

according to CCG priorities. A Bar will be set for all sliding scales which apply (e.g. partial

payments for partial achievements) and dates and timelines for the submission of data.

Table 2 below details the financial allocations, were known for each providers 2013/14 CQUIN

scheme. For a number of schemes the financial values are still to be determined.

Payment of 50% of the allocated values is paid in monthly intervals alongside payment of regular

income. Adjustments to payments are made quarterly and at the year end to reflect activity levels

and/or progress towards achieving the agreed goals, depending on the availability of data.

Table 2: CQUIN Schemes Indicative Financial Allocation 2013/14

Provider CQUIN Value 13/14

CDDFT Acute Still in consultation

CDDFT Community Still in consultation

TEWV FT £2,253,870

CHSFT To be confirmed

NTHFT To be confirmed

NEAS £530,050

BMI Woodlands 120,000

Local Hospice Providers To be confirmed

Oxygen Assessment contract 16,780

All CQUIN Schemes will be monitored through the Clinical Quality Review Groups and Contract

Management Groups. For the larger contracts separate CQUIN monitoring meetings have been

scheduled to monitor achievement and address any issues that arise in year. Approval for

payment on achievements is made by the Contract Management Groups. The final CQUIN

Schemes for 13/14 are provided in the appendices of this report (appendix 2).

CCGs will be required to share agreed schemes with the NHS Commissioning Board and publish

them on the NHS Institute web site. The financial allocations are not included in this sharing of

information with the Institute due to the commercial sensitivity of such detail.

5 Conclusion

All CQUIN Schemes are monitored through the Clinical Quality Review Groups and Contract Management Groups, and via contract performance. CCGS need to give consideration as how they will support the development, consultation, negotiation, monitoring and approval of the 2014/15 CQUIN schemes.

7

Appendix 1

Pre qualification requirement for TEWV FT

TEWVFT February 2013 Commissioning for Quality and Innovation (CQUIN) 2013/14 Prequalification

Innovation Health and Wealth, Accelerating Adoption and Diffusion in the NHS set out that from April 2013 compliance with high impact innovations would become a prequalification requirement for CQUIN. By March 2013 providers will need to have put in place measures to meet the criteria set out below in order to qualify for the release of any 2013/14 CQUIN funding. Whilst the minimum requirements for providers are set nationally, providers will need to work with commissioners to ensure that plans are aligned with local commissioning strategies. The table below sets out which criteria apply to which type of service:

Innovation Acute Community Ambulance Mental Health /

Learning Disabilities

3 million lives n/a

Intra-operative fluid management (IOFM)

n/a n/a n/a

Child in a chair in a day n/a n/a

International and commercial activity

Digital first

Carers for people with dementia

n/a n/a

Local commissioners are responsible for assessing whether providers meet the prequalification criteria. In order for providers to qualify for CQUIN payments, they will need to satisfy at least 50% of the criteria that apply to them. The criteria for each innovation are set out in the table below:

Innovation Criteria for Provider Commissioner

assurance

3 million lives Set trajectory for 2013/14 for increasing planned use of telehealth/telecare technologies In order to do this, providers will need to demonstrate that they have:

Set a baseline for 2012/13

Based their planning assumptions on the evidence available

from the Whole System Demonstrator programme (available on

www.3millionlives.co.uk) or give evidence as to why this

evidence has not informed the planning process

Providers will need to demonstrate their intention to use the framework and resources provided on www.3millionlives.co.uk to work with technology providers to agree new model of technology provision for telehealth/telecare. Supporting materials can be found on www.3millionlives.co.uk and www.innovation.nhs.uk

Ensure trajectory is robust and in line with commissioning strategy for 2013/14

http://www.3millionlives.co.uk/



http://www.innovation.nhs.uk/

8

Intra-operative fluid management (IOFM)

Demonstrate to commissioners that 2013/14 trajectories for the technology are in place which are constituent with National Technology Assessment Centre (NTAC) guidance Providers will need to:

Establish 2012/13 baseline use

Put in place trajectories for 2013/14. Plans will need to be based

on the number of specific procedures listed in appendix 3 of the

NTAC guidance. Based on the number of relevant local OPCS

coded procedures, providers will need to identify a target of at

least 80%. Whilst the target itself is based on the OPCS coded

procedures listed in the NTAC guidance, the actual planned

uptake can either be for procedures listed in NTAC appendix 3

or for other relevant high risk surgery

Relevant NTAC guidance can be found on www.innovation.nhs.uk

Ensure provider plan for 2013/14, including baseline assessment, is robust

Child in a chair in a day

Review the provision of wheelchair services to ensure outcomes similar to those achieved by the best-performing providers of mobility services for children In order to do this, providers should develop an action plan for improvement. Supporting national guidance will be published shortly on www.innovation.nhs.uk

Assure robustness of service review in line with local commissioning strategy

International and commercial activity

Demonstrate that clear plans are in place to exploit the value of commercial intellectual property – either standalone or in collaboration with Academic Health Science Network

Assure that clear plans are in place

Digital First Establish a 2012/13 baseline and a trajectory for improvement to reduce inappropriate face-to-face contact In order to do this, providers will need to:

Identify which of the 10 digital initiatives identified in the

report Digital First – the Delivery of Choice for England’s

population (see www.innovation.nhs.uk) apply to them

Identify any other local initiatives aimed at reducing

inappropriate face-to-face contact

Work with local commissioners to establish ambitious

trajectories for 2013/14 corresponding with needs and priorities

for the local healthcare economy

Use the benchmarking tool which will be available early in

2013 on www.innovation.nhs.uk to assess the initiatives that

they are undertaking to reduce inappropriate face-to-face

interactions and the potential savings that could be attained.

Assure robustness of baseline and trajectory

Carers for people with dementia

Demonstrate that plans have been put in place to ensure that for every person who is admitted to hospital where there is a diagnosis of dementia, their carer is sign-posted to relevant advice and receives relevant information to help and support them

Assure that provider plans are in line with local commissioning strategy and 2013/14 national dementia CQUIN

In order to provide commissioners with the required assurance, providers are asked to complete the following templates for each of the high impact innovations:





9

Area of Innovation

3 Million Lives - Set trajectory for 2013/14 for increasing planned use of telehealth/telecare technologies

Organisational Lead

2012/13 Baseline

Investment in beginning use of technology for telehealth, there are current priorities within business plan (existing technology work already identified) for social media uses.

Description of current position

2013/14 Trajectory

2013/14 Objectives Impact on target delivery Timescale 1.

2.

3.

Any other comments

Area of Innovation

International and commercial activity - Demonstrate that clear plans are in place to exploit the value of commercial intellectual property – either standalone or in collaboration with Academic Health Science Network

Organisational Lead

2012/13 Baseline Position

Trust - through the Kaizen Production Office have an active national marketing plan to promote commercial value of the Quality Improvement System. This is already showing positive outcomes and generating income with evidence of external organisations purchasing TEWV KPO support package. Plans will expand to international activity . R&D Department advising on intellectual property within new framework. New ideas scheme established further plans for increase of R and D capacity and culture. Evidence of innovative product design within Trust being developed into patent for exploitation of commercial use. Trust has been involved with the establishment of the AHSN through the set-up steering group and will have a member on the board.

2013/14 Target

Commercial research activity has increased by more than 100% per year. A planned development for 2013 is the opening of the new clinical trials unit at DMH. This will provide a central resource to help clinicians and staff apply for funding, to design studies and provide a dedicated space to carry out commercial trials.

2013/14 Objectives Impact on target delivery Timescale Lead clinician/ manager

1.

10

2.

3.

Any other comments

Area of Innovation

Digital First - Establish a 2012/13 baseline and a trajectory for improvement to reduce inappropriate face-to-face contact

Organisational Lead


New technologies being implemented include: E-referral and discharge, social media projects to increase therapeutic contact and communication with service users. (eg. Big White Wall, and use of facebook) The Trust has established a baseline of current activity

Please identify which of the following 10 digital initiatives identified in the report Digital First – the Delivery of Choice for England’s population will apply to your organisation:

Applies: Y / N

Minor ailments online assessment Appointment booking online Primary Care pre-assessment Appointment reminders Mobile working in community nursing Pre-operative screening online Post-surgical remote follow up Remote follow up in Secondary Care Remote delivery of test results Secondary Care clinic letters

2013/14 Target


1.

2.

3.

Any other comments

11

Area of Innovation

Carers for people with dementia - Demonstrate that plans have been put in place to ensure that for every person who is admitted to hospital where there is a diagnosis of dementia, their carer is sign-posted to relevant advice and receives relevant information to help and support them

Organisational Lead


CPA process includes a carer assessment. MHSOP services are able to offer the services to carers to evidence compliance with NICE SCIE guidance on supporting people with dementia. Feedback and experience data collection systems can capture carer feedback and Trust has active Carer Strategy. Acute Hospital liaison services will ensure that carers of those with dementia are identified during acute admissions as well. Carers can access IAPT services for psychological interventions elated to their role as a carer

2013/14 Target


1.

2.

3.

Any other comments

12

CQUIN Schemes 2013-14

Appendix 2

NHS County Durham and Darlington and County Durham and Darlington Foundation Trust Draft acute CQUIN scheme 2013/14 CQUIN 2013/14 value is 2.5% value for all healthcare services commissioned through the NHS Standard Contract. One fifth of this value (0.5% of overall contract value) is to be linked to the national CQUIN goals, where these apply.

Goal Number/ action

Goal Name/Origin

Description of Goal

Proposed Goal Weighting/ priority

Expected financial value of goal

1 Friends and Family Test

To improve the experience of patients in line with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test will provide timely, granular feedback from patients about their experience. The 2011/12 national inpatient survey showed that only 13% of patients in acute hospital inpatient wards and A&E departments were asked for feedback

Total = 10%

£701,695

1.1 National Friends and family test - phased expansion Deliver the nationally agreed roll out plan to the national timetable. Maternity by end Oct 2013 and additional services yet to be defined by end March 2014. Missing any element will result in non payment of the CQUIN

30% of 5% 105,254

1.2 Friends and family test - increased response rate in the acute in patient and A&E areas Achieve a response rate in the top 50% which also improves on the Q1 response rate

40% of 5% 140,339

1.3 Friends and family test - improved performance on the staff friends and family test Increasing the score of the friends and family test question within the 2013/14 staff survey compared with 2012/13 survey

30% of 5% 105,254

1.4 Local CCG

To capture patient experience of targeted groups for patients with more than 1 long term condition; i) Q1; agree methodology, co-hort and sample size; Target groups are CVD, COPD and Diabetes; ii) Q2 Analyse information, agree performance improvement & actions plan for each area; iii) Q3 implement improvement plans 1v) Q4 evidence changes are in place - plan to re-measure

5% 350,847

2 NHS Safety Thermometer

To reduce harm. The power of the NHS Safety Thermometer lies in allowing frontline teams to measure how safe their services are and to deliver improvement locally.

Total = 7% £491,186

2.1 National NHS Safety Thermometer - data collection; Undertake a survey on one day per month, of all appropriate patients, using the NHS Safety Thermometer , to collect data on pressure ulcers, falls and urinary tract infections

2.00% 140,339

2.2 National NHS Safety Thermometer - improvement. Reduction in the prevalence of reported harms using data from the NHS Safety Thermometer in (i) pressure ulcers; (ii) falls (iii) falls resulting in harm (iv) Catheter associated Urinary Tract Infections. The targets for improvement to be agreed at the end of Q1 2013.

2.50% 175,424

13

2.3 Pt safety A reduction in the number of unobserved inpatient falls which result in harm. Q1 agree baseline assessments and plan to remeasure improvements in Q4

2.50% 175,424

3 Dementia

To incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their medical conditions, to prompt appropriate referral and follow up after they leave hospital and to ensure that hospitals deliver high quality care to people with dementia and support their carers.

Total = 7% 491,186

3.1 National Dementia - Find, Asses, Investigate and Refer. 90% of patients aged 75 and over admitted as an emergency for >72 hours are assessed for dementia; and; 90% of those with a potential diagnosis of dementia are appropriately assessed and where appropriate referred to specialist services

60% of 5% 210,508

3.2 Dementia - Clinical Leadership Confirm a named lead clinician for dementia and this role is clearly documented in the individuals job plan; and; the development and implementation of a planned training programme for dementia

10% of 5% 35,085

3.3 Dementia - Supporting Carers of People with Dementia. Undertake a monthly audit of carers of people with dementia to test whether they feel supported; agree cohort size Q1

30% of 5% 105,254

3.4 Local CCG Implementation of a carer care plan in line with the trusts Dementia Strategy Q1 scope and agree 2% 140,339

4 VTE To reduce avoidable death, disability and chronic ill health from venous thromboembolism (VTE)

Total = 5% 350,847

4.1 National VTE risk assessment - 95% of all adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool (NM 4.1)

1% 70,169

4.2 VTE root cause analyses- Root cause analyses carried out on % ( 50 year end stretch to be agreed) of confirmed cases of hospital associated pulmonary embolism or deep vein thrombosis. There will be a payment scale for partial achievements; to be agreed Q1

4% 280,678

5 Long Term Conditions

To Improve the Treatment and Outcomes of patients with Long Term Conditions: COPD; CVD; Diabetes

15% 1,052,542

5.1 Local PCT and CDDFT

To scope, implement and evaluate a notification process for the specialist nurses to be notified when one of their patients on their case load (CVD; COPD; Diabetes, is (i) To have a planned admission to hospital (pre-admission) (ii) Has an unplanned admission to hospital (iii) Is to be discharged from hospital; Q1 scope, Q2 phased implementation to be agreed

3% 210,508

5.2 regional and CCG

( No Decision About Me Without Me)To introduce shared decision making (SDM) within 3 clinical areas (COPD; CVD; Diabetes) where there are choices to be made between treatment options. i) Q1; scoping exercise to identify the appropriate clinical pathways and teams for SDM and determine implementation time scales as below Ii) Develop and disseminate the SDM materials. iii) Implement SDM and raise awareness among the patient population. iiii) Evaluation including a survey of patients regarding the experience of their involvement and perception of the decision process, with audit and out patient letters.

6% 421,017

5.3 Local CCG To increase the capacity of independent non medical prescribing to deliver care at the point of decision making, Cohort and phased introduction to be agreed Q1.

6% 421,017

14

6 Health Promotion

Every Contact Counts - to include young people & children 2% 140,339

6.1 Local Public Health

To develop, implement and evaluate the use of a code of practice with regard to 'every health contact counts' for smoking cessation, alcohol misuse and obesity. Q1 develop; Q2-3 implement; Q4 measure

2% 70,169

7 Learning disabilities

Implementation of regional learning disabilities pathways (Winterbourne View; ) 2% 140,339

7.1 Regional Compliance with regional learning disabilities pathways 1% 70,169

7.2 Coding and flagging of learning disability status with reasonable adjustments to services delivered in acute services. (Maintenance)

0% 0%

7.3

Number of Children with LD aged between 14-17 years who are active on a paediatrician caseload and for whom there is a documented transition plan to adult services. Roll over from 2012/13)

1% 70,169

8 Nutrition To improve the discharge of patients (to community services) from hospital who are at risk & receiving nutritional support

2% 140,339

8.1 CDDFT; CCG To develop & implement an agreed pathway for the incremental escalation and de-escalation of patients in hospital on nutritional supplements. ( linked to Community), using best practice tools.

1% 70,169

8.2 Measure compliance with the protocol through assessment of an agreed number of patient records. Number to be agreed Q1

1% 70,169

9 Paediatric Respiratory

To Improve the Treatment and Outcomes for Paediatric Patients with lower respiratory tract infections

5% 350,847

linked to contract discussions

9.1 CDDFT; CCG To improve the assessment and initial review of paediatric patients in order to reduce lower respiratory tract infections admission rates.

5% 350,847

10 Right Test, FIRST Time

To reduce the use of inappropriate diagnostics (PRODUCTIVITY) 12% 842,034

10.1 CDDFT Q1 To develop recommendations for 'the right test first time" to include radiology referrals requests for primary care

3% 210,508

10.2 CDDFT Q1-Q2 Determine baseline and phased introduction; to be agreed with commissioners; Q4 measure 3% 210,508

10.3 Q1 To develop recommendations for 'the right test first time" to include pathology requests for primary care

3% 210,508

10.4 Q1-Q2 Determine baseline and phased introduction; to be agreed with commissioners; Q4 measure 3% 210,508

11 A&E; OOH; UCC To improve the management of frequent attenders to A&E departments 4% 280,678

11.1 To scope the proactive management of frequent attenders at A&E departments, who have attended as a result of alcohol misuse, domestic violence, or depression. Q2 agree developments with commissioners

4% 280,678

12 Safe Transition of Care

To Improve the transfer of care from the acute trust when patients are discharged from hospital 2% 140,339

12.1 To pilot and engage with nominated practices the production and transfer of electronic out patient recommendation letters Q1 scoping

1% 70,164

12.2 CDDFT To pilot the production of FP10 prescriptions electronically in medicine at DMH 1% 70,164

15

13 End of life To improve the experience of patients & carers 5% 350,847

13.1 Regional To register for End of life Quality Assessment Tool; ELCQua.nhs.uk 1% 70,164

13.2 CCG Identify and implement areas for improvement from analysis of data for those patients who have died in hospital within 8 days of admission and were known to be in their last year of life. Q1-Q2 determine baseline; Q3-Q4 implement and measure

4% 280,678

14 Maternity to improve the management of depression in pregnancy 2% 140,339

CCG To implement assessment for depression in pregnancy and ensure referral to other services/ notification to GP is actioned

2% 140,339

15 Productivity To agree improvements by innovation in an agreed pathways 20% 1,403,389

15.1 Choose and Book Advice

To increase the use of Choose and Book Advice and Guidance

1,403,389

Paediatric emergency admissions

to improve the pathway for emergency admissions (front of house) for paediatric attendances.

Acute Medical Emergency Admissions

to improve the pathway for emergency admissions (AMEC)

16

NHS County Durham and Darlington and County Durham and Darlington Foundation Trust COMMUNITY CQUIN scheme 2013/14

CQUIN 2013/14 value is 2.5% value for all healthcare services commissioned through the NHS Standard Contract. One fifth of this value (0.5% of overall contract value) is to be linked to the national CQUIN goals, where these apply.

Goals and indicator summary

Goal Number

Goal Name/Origin Description of Goal

Suggested Goal Weighting/ priority


1 Patient experience

To improve the experience of patients in line with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test will provide timely, granular feedback from patients about their experience.

Total = 5 % 108,306

1.1 Local based on national

Friends and family test - phased expansion Implementation of and agreed roll out plan in (i)Community Hospitals and (ii) Urgent Care by the end March 2014. to receive progess reports Q2;Q4

2% 43,344


Friends and family test - improved performance on the staff friends and family test Increasing the score of the friends and family test question within the 2013/14 staff survey compared with 2012/13 survey. Target for improved response rate to be agreed in Q1.

1% 21,672

1.3 Local

To capture patient experience of targeted groups for patients with more than 1 long term condition (links to acute); i) Q1; agree methodology, co-hort and sample size; Target groups are CVD, COPD and Diabetes; ii) Q2 Analyse information, agree performance improvement & actions plan for each area; iii) Q3 implement improvement plans 1v) Q4 evidence changes are in place - plan to remeasure

2% 43,344



Total = 8% 173,376

2.1 National Community Hospitals; NHS Safety Thermometer - data collection; Undertake a survey on one day per month, of all appropriate patients, using the NHS Safety Thermometer , to collect data on pressure ulcers, falls and urinary tract infections; phased expansion

2.00% 43,344

2.2 National

Community Hospitals; NHS Safety Thermometer - improvement. Reduction in the prevalence of reported harms using data from the NHS Safety Thermometer in (i) pressure ulcers; (ii) falls (iii) falls resulting in harm (iv) Catheter associated Urinary Tract Infections. The appropriate harms and targets for improvement (based on 2012/13 reported areas) to be agreed at the end of Q2 2013.

2.00% 43,344

2.3 National Community Nursing; NHS Safety Thermometer - data collection; Undertake a survey on one day per month, of all appropriate patients, using the NHS Safety Thermometer , to collect data on pressure ulcers, falls and urinary tract infections; phased expansion

4.00% 86,688

17

3 Dementia

To incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their medical conditions, to prompt appropriate referral and follow up after they leave hospital and to ensure that hospitals deliver high quality care to people with dementia and support their carers. Though not mandatory for community hospitals/nursing can use locally.

Total = 10% 216,720


Community Hospitals; Dementia - Find, Asses, Investigate and Refer. 90% of patients aged 75 and over admitted to community hospitals for >72 hours are assessed for dementia; and; 90% of those with a potential diagnosis of dementia are appropriately assessed and where appropriate offered a referred to specialist services.

1% 21,672


Community Hospitals ; Dementia - Clinical Leadership (JC to confirm wording) Confirm a named lead clinician for dementia and this role is clearly documented in the individuals job plan; and; the development and implementation of a planned training programme for dementia. (Phased introduction in line with the providers Dementia Strategy)

1% 21,672


Community Nursing; Dementia - Strategic Leadership (JC to confirm wording) Develop a strategic clinical leadership role and development and phased implementation of a training programme for dementia. In Line with the Trusts Dementia Strategy.

2% 43,344


Community Nursing; Dementia - Supporting Carers of People with Dementia. Undertake a pilot study to implement care plans in order to support carers; methodology to be agreed Q1.

3% 65,016


Community Nursing; Dementia - Find, Asses, Investigate and Refer; Dementia % (agree locally) of appropriate patients aged 75 and over on community district nurse case load who are assessed for dementia; and; 90% of those with a potential diagnosis of dementia are appropriately referred to GP for review; phased introduction in line with the Trusts Dementia Strategy.

3% 65,016

4 VTE To reduce avoidable death, disability and chronic ill health from venous thromboembolism (VTE) Though not mandatory for community hospitals/nursing can use locally.

Total = 5% 108,306

4.1 Local based on National

Community Hospitals; VTE risk assessment - 95% of all adult inpatients who have had a VTE risk assessment on admission to community hospital using the clinical criteria of the national tool

1% 21,672

4.2 Local based on National

VTE root cause analyses- Root cause analyses carried out on % ( 50% year end - stretch to be agreed) of confirmed cases of community hospital associated pulmonary embolism or deep vein thrombosis. There will be a payment scale for partial achievements; to be agreed Q1

4% 86.688

18

5 Long Term Conditions To improve the treatment and outcomes of patients under the care of specialist nurses

15% 325,080

5.1 Regional

( No Decision About Me Without Me)To introduce shared decision making (SDM) within 3 clinical areas (COPD; CVD; Diabetes) where there are choices to be made between treatment options. i) Q1; scoping exercise to identify the appropriate clinical pathways and teams for SDM and determine implementation time scales as below Ii) Develop and disseminate the SDM materials. iii) Implement SDM and raise awareness among the patient population. iiii) Evaluation including a survey of patients regarding the experience of their involvement and perception of the decision process, with audit and out patient letters.

6% 130,032

5.2 Local

To scope, implement and evaluate a notification process for the specialist nurses to be notified when one of their patients on their case load (CVD; COPD; Diabetes) is admitted to hospital (aiming to reduce length of stay and put post discharge support in place). Q1 scope, Q2 phased implementation to be agreed

3% 65,016

5.3 Local To increase the capacity of independent non medical prescribing, cohort to include specialist palliative care and OOH/urgent care. Cohort and phased introduction to be agreed Q1

6% 130,032

6 Patient Safety To improve patient safety in the community 14% 303,408

6.1 CDDFT To scope and implement a model for improvements in the detection, recognition and response to patient deterioration in the community setting. (Q1 scope and agree phasing and measurement. Commence in Q2)

6% 130,033

6.2 CDDFT Continued implementation of Falls prevention interventions in community nursing service - Implementation of Tool (Target improvement to be determined from 2012/13 out turn)

4% 86,688

6.3 to achieve 50% reduction on avoidable pressure ulcers, grade 2 (50% funding upfront) on 2012/13 outturn/target

2% 43,334

6.4 to achieve 50% reduction on avoidable pressure ulcers, grade 3,4 based on 2012/13 outturn/target

2% 43,344

7 Nutrition To improve the transfer of care of patients from the acute setting to community who are at risk and receiving nutritional supplements

5% 108,306

7.1 Local To develop & implement an agreed pathway for the incremental escalation and de-escalation of patients discharged from hospital on nutritional supplements. ( linked to ACUTE), using best practice tools.

3% 65,016

7.2 Local Measure compliance with the protocol through assessment of an agreed number of patient records. Number to be agreed Q1

2% 43,344

19

8 Stroke To Improve the rehabilitation of patients who have experienced a stroke 10% 216,720

8.1 Local & CDDFT Continued implementation of protocols for bladder and bowel control to support patients when discharged from acute care, following a stroke. Benchmarks to be agreed Q1 using 2012/13 data.

5% 108,360

8.2 Local &CDDFT Continued implementation of protocols for rehabilitation services (OT, Physio and SALT) to support patients when discharged from acute care, following a stroke. Benchmarks to be agreed Q1 using 2012/13 data.

5% 108,360

9 Community IV therapies

Extend the use of IV therapies into community nursing services 20% 433,440

9.1 Local To role out the IV therapy at home pathway for cellulitis, bronchiectasis and IV diuretic therapy at home for heart failure; roll out to all areas by Q2. No CQUIN payment for partial achievement

5% 108,360

9.2 Local Q1; To develop pathway for the delivery of IV therapy at home for diabetic foot ulcer treatment commence by end of Q2; Q4 Measure

7% 151,704

9.3 Local Q1; To develop pathway for the delivery of IV therapy at home for orthopaedic patients; Commence by the end of Q2; Q4 Measure

7% 151,704

9.4 Local Q1; To develop a system for individual management plans to deliver IV therapy at home which do not fit into above categories. Implementation ability to respond by end of Q2; Q4 measure

1% 21,672

10 Home Loans Equipment

To improve the access to equipment to avoid delayed discharges and acute admission to hospital

8% 173,376

10.1 Local To develop a 48 hour delivery target for a specified piece of equipment ; equipment to be agreed Q1

4% 86,688

10.2 Local To develop a 24 hour delivery target for a specified piece of equipment; equipment to be agreed Q1

4% 86,688

TOTAL 100

20

NHS County Durham and Darlington - TEWV FT CQUIN scheme 2013/14



Goal Number

Goal Name Description of Goal Goal Weighting %

Expected Financial value of goal


Friends and family test 5%

Indicator number

Indicator Indicator weighting

1a To have established an equivalent question in the inpatient discharge survey to the Friends and Family Test for all inpatient areas

2% Tbc

1b To have achieved a minimum agreed response rate for uptake of the inpatient survey ensuring data is maintained of those who refuse to participate.

1% Tbc

1c To have established a staff question on the inpatient survey system and agreed an improvement plan for outcomes 2% Tbc

Goal Number

Goal Name Description of Goal CDD Goal Weighting

Safety

2 Meaningful Activity 8%

Indicator number


2a To increase the levels of meaningful and culturally appropriate activity for all inpatients 4% Tbc

2b To establish schedules of meaningful activities for inpatient areas 4% Tbc

21

Goal Number


Safety

3 Safety Thermometer 5%

Indicator number


3a To maintain the NHS Safety Thermometer data collection on one day per month for falls, pressure ulcers and UTIs 2.5% Tbc

3b To deliver improvement in the level of falls using data from NHS Safety Thermometer *MHSOP and LD 2.5% tbc

Goal Number


Safety

4 Dementia 20%

Indicator number


4a To develop an adapted end of life pathway for those with diagnosis of dementia and implement in inpatient services

5% Tbc

4b To implement the relevant Deciding Right principles and documentation across the MHSOP inpatient services 5% Tbc

4c To implement the ‘This is Me’ approach and documentation for those with a diagnosis accessing MHSOP services 5% Tbc

4d To improve access to support for service users and carers from the point of diagnosis of dementia to support them in coming to terms with the impact of the condition and the losses they experience

5% Tbc

Goal number

Goal name Description of goal CDD Goal Weighting

Safety

5 Learning Disabilites 12%

5a To increase the number of service users with Health Action Plans in place as a direct result of receiving an annual health check

3% Tbc

5b To increase number of service users who have contemporary Health passports 3% Tbc

5c

Provider to ensure that LD patients with Epilepsy who experience prolonged or serial seizures have an epilepsy rescue medication protocol in place. The protocol should be signed by a prescriber and a copy sent to the GP

3% Tbc

5d To improve and implement the LD LIFE STAR recovery model across LD services 3% Tbc

22

Goal number


Safety

6 Safe transfer of Care 9%

Indicator Number

Indicator Indicator Weighting %

6a To develop an improved method of delivering discharge information through electronic measures 3% Tbc

6b To increase the use and quality of the discharge letters from in-patient and community services to GPs 3% Tbc

6c To improve the discharge information for service users and carers 3% Tbc

Goal number


Safety

7 Common Assessment Framework 2%

Indicator Number


7a To improve the CAMHS clinical assessment framework to integrate with the Common Assessment Framework (CAF) as recommended within Safeguarding legislation

1% Tbc

7b To improve the identification of unmet needs and risks of those children who have parents or carers with MH and/or substance misuse diagnoses.

1% Tbc

Goal Number


8 Self Harm 10%

Indicator Number


8a To improve the uptake of a self harm care pathway for frequent self harm presenters at A&E departments 5%

8b To improve the implementation of the Borderline Care Pathway in A&E services by improving the implementation of the Borderline Personality Disorder Integrated Care Pathway

5%

23

Goal Number


Safety

9 Health Promotion 21%

Indicator Number


9a To refresh the smoking cessation strategy for service users 7% Tbc

9b To improve compliance with the Trust Obesity/weight management policy 7% Tbc

9c To review the alcohol misuse strategy for service users 7% Tbc

Goal number


Safety

10 Care Pathways and Packages 7%

Indicator Number


10 Accelerate and improve reporting mechanisms through PBR 7%

Goal number


Safety

11 CAMHS 1%

Indicator Number


11a Ensure all CAMHs patients have a transition care plan in place by the age of 17.5 0.5% Tbc

11b LD CAMHS - transitions review in place by +/- 3 months 14th birthday and a transition care plan in place by 16th birthday

0.5% tbc

Nationally mandated CQUIN measure

Regionally suggested

Local suggestion

24

NHS County Durham and Darlington and CHSFT Draft acute CQUIN scheme 2013/14


Goals and indicator summary FINAL Expected Financial value of goal

Goal Number



To improve the experience of patients in line with Domain 4 of the NHS Outcomes Framework. The Friends and Family Test will provide timely, granular feedback from patients about their experience. The 2011/12 national inpatient survey showed that only 13% of patients in acute hospital inpatient wards and A&E departments were asked for feedback.

9% TBC

Indicator number Indicator Indicator weighting

1a Friends and family test - phased expansion (NM 1.1 New) 1%

1b Friends and family test - increased response rate (NM 1.2 New) 2%

1c Friends and family test - improved performance on the staff friends and family test (NM 1.3 New) 3%

1d

i) share a forward plan of patient experience work for 13/14 (L 12/13) ii) plan to include real time feedback and CCG presence on patient experience visits as well as other methods across a range of services (L, New) iii) Each quarter demonstrate where improvement have been made as a result of feedback from patients (L 12/13)

2%

1e Acute paediatrics - patient experience collected, reviewed and improvements made based on feedback. (L, New)

1%

Goal Number


Safety



2% TBC


2a NHS Safety Thermometer - data collection (NM2.1) - applicable 2%

2b NHS Safety Thermometer - improvement. Reduction in the prevalence of pressure ulcers (NM 2.2 New)

0%

25

Goal Number


Safety

3 Dementia

To incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their medical conditions, to prompt appropriate referral and follow up after they leave hospital and to ensure that hospitals deliver high quality care to people with dementia and support their carers

14% TBC


3a Dementia - Find, Asses, Investigate and Refer (NM 3.1) 2%

3b Dementia - Clinical Leadership (NM 3.2 New) 2%

3c Dementia - Supporting Carers of People with Dementia (NM 3.3 New) 2%

3d

Implementation of an improvement plan linked to organisational dementia strategy (L 12/13) (Reference D Nicholson letter and Alzheimers society guidance. significant gains if reduce LOS by one week)

8%

Goal Number


Safety

4 VTE To reduce avoidable death, disability and chronic ill health from venous thromboembolism (VTE) 5% TBC


4a VTE risk assessment - % of all adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool (NM 4.1)

3%

4b VTE root cause analyses- number of root cause analyses carried out on cases of hospital associated thrombosis (NM 4.2 New)

2%

Goal number


Safety

5 Emergency department

To improve service within the emergency department particularly patient flow 8% TBC

5 Implementation of a collaborative improvement plan with NEAS - link to implementation of recommendations from RPIW planned for March 2013 (New)

8%

26

Goal number


Safety

6 Communication Improve communication 11% TBC

Indicator Number Indicator Indicator Weighting %

6a Communication - outpatient clinic letters issued within X days (L, New) 0%

6b Collaborative discharge planning (L, New) 4%

6c

i) Implementation of discharge communication improvement plan to include (L 12/13 CHSFT) ii) increase % of summaries issued within 24 hours (goal TBC) (specific target for acute paediatrics 13/14) iii) improve quality of content and iv) progression toward electronic summaries

4%

6d

Communication of results (L 12/13) Identifying best practice/what’s done elsewhere · Document improved system/process for communicating results · Implement in one clinical area · Evaluate from trust/patient/GP perspective (including benefits and resource implications) · Identify recommendations

3%

Goal number


Safety

7 Appointments Improvements in appointments systems 4% TBC


7

Implementation on an improvement plan over 12/13 and 13/14 to: i) reduce DNA rates (goal TBC) ii) reduce the number of cancellations (goal TBC) iii) improve the timeliness of review appointments

i) 1% ii) 1% iii) 2%

27

Goal Number


8 Long term conditions

Effective management of LTC to improve patient outcomes and minimise readmissions 22% TBC


8a i) Percentage of inpatients with a primary diagnosis of heart failure receiving all 7 indicators from the heart failure bundle (RS1, L 12/13)

3%

8b COPD - proportion of patients receiving all elements of discharge bundle (RS3c, L12/13) (Amended to reflect local pathways if necessary)

3%

8c

Diabetes - identify cluster of indicators linked to NICE(L, New) i) % of patients under care of hospital receiving the 9 care processes each year ii) HbA1c assessment for glycaemia control within 3 months for all patients (over 19) admitted to CHSFT with a known diagnosis of diabetes (emergency and elective) (TBC) iii) foot care risk assessment (Goal TBC)

0%

8d

Parkinsons Disease - cluster of indicators (L, New) i) To ensure all patients diagnosed with Parkinson’s disease are reviewed in a combined clinic ii) To ensure all patients diagnosed with Parkinson’s disease who ring the Nurse Specialist iii) To increase the proportion of Emergency Parkinson disease patients seen within 1 working day by the PD Team iv) To ensure all Parkinson’s Disease inpatients receive the correct medication on time v) To ensure all patients diagnosed with Parkinson’s disease are reviewed in a combined clinic

3% across i) ii) iii) iv) v)

8e Review best practice for paediatric asthma and spread & share; i.e.access, paediatric asthma nurse work (New)

13%

Goal Number


Safety

9 Falls Reduce harm from falls 5% TBC


9a

(a) Capture of falls information in A&E (b) Evidence of timely referral to falls service for patients who present to A&E with: a fall, blackout or a fracture relating to a fall (c) Evidence of timely and appropriate assessment by falls services including initial falls assessment and screening for osteoporosis (RS12 12/13, L11/12, 12/13)

2%

9b Percentage of patients 65 and over admitted to hospital as an emergency to have all 9 indicators within the falls bundle within 24 hours of admission (L, New)

3%

28

Goal number


Safety

10 Health improvement - alcohol

To identify patients that drink alcohol and provide brief advice aimed at reducing alcohol consumption as appropriate

4% TBC


10a Proportion of patients attending preassessment who have alcohol status recorded (RS9, ref 16, L12/13) - extend to A&E

2%

10b Proportion of those patients reporting higher levels of alcohol who have received a brief intervention (RS9, ref 16, L12/13) (12/13 Preassessment CHSFT) extend to A&E

2%

Goal number


Safety

11 End of life To improve the standard of end of life care for patients in an acute setting 0% TBC


11a Deciding right - % of clinical staff trained in the contents and principles of ‘Deciding Right’ and use of new standard documentation (L, New TBC)

0%

Goal number


Safety


Implementation of regional learning disabilities pathways 1% TBC


12a Compliance with regional learning disabilities pathways (L 12/13) (RS4 11/12) 1%

Goal number


Safety

13 Medicines Management

Appropriate and effective use of medicines/supplements 2% TBC


13a Dietetics - enteral nutrition (L, New) 2%

13b All suspected Neurtpaenic patients are entered on the patient pathway and receive antibiotics within 1 hour of being diagnosed (L, New)

0%

29

Goal number


Safety

14 T&O Trauma and Orthopaedics 0% TBC


14a Improvement in Oxford Hip– Casemix adjusted health gain, as defined by PROMs documentation (R, New)

0%

14b Improvement in Oxford Knee Score – Casemix adjusted health gain, as defined by PROMs documentation (R, New)

0%

14c Patients with hip fracture –Mortality (R, New) 0%

14d Patients with hip fracture aged 70 or over - return to theatre for a hip or wound related procedure within 30 days of the index operation (R, New)

0%

14e Revision of hip or knee replacement within 1 year of the primary joint replacement (R, New) 0%

14f Increase the proportion of cemented replacements performed in patient's over 65 (R, New) 0%

14g Implementation of shared decision making tool in hip/knee pathway (R, New) 0%

Goal number


Safety

15 MH in pregnancy Management of depression in pregnant women 8% TBC


15a To implement assessment for depression in pregnancy and ensure referral to other services/ notification to GP is actioned

8%

Goal number


Safety

16 Right Test 1st time To improve the performance of Right Test First Time (Productivity) 5% TBC


16a Develop recommendations for the right test first time' for radiology referrals (New) 5%



Local suggestion

30

NHS County Durham & Darlington and NTHFT Draft acute CQUIN scheme 2013/14



Goal Number

Goal Name Description of Goal Goal

Weighting




12%

TBC


1a Friends and family test - phased expansion (NM 1.1 New) 2%

1b Friends and family test - increased response rate (NM 1.2 New) 3%

1c Friends and family test - improved performance on the staff friends and family test (NM 1.3 New) 3%

1d

i) Q1 to capture patient experience of agreed targeted groups e.g.. to capture patient experience of patients with more than 1 long term condition & high intensity users (>3/year) with know LTCs. (COPD, Diabetes, CHD) ii) Q2 Analyse information, agree performance improvement & actions plan for each areas iii) Q3 implement improvement plans iv) evidence changes are in place - plan to remeasure (new)

4%

Goal Number


Weighting Safety



5% TBC


2a NHS Safety Thermometer - data collection (NM2.1) - NOT applicable 0%

2b NHS Safety Thermometer - improvement. Reduction in the prevalence of pressure ulcers (NM 2.2 New) Reducing goal to be set

5%

31

Goal Number


Weighting Safety

3 Dementia

To incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their medical conditions, to prompt appropriate referral and follow up after they leave hospital and to ensure that hospitals deliver high quality care to people with dementia and support their carers

15%

TBC


3a Dementia - Find, Asses, Investigate and Refer (NM 3.1) 2%

3b Dementia - Clinical Leadership (NM 3.2 New) 2%

3c Dementia - Supporting Carers of People with Dementia (NM 3.3 New) 3%

3d

Implementation of an improvement plan linked to national dementia audit outcomes and to reduce length of stay (or DEMENTIA STRATEGY?) (L 12/13) (Reference D Nicholson letter and Alzheimers society guidance. significant gains if reduce LOS by one week) i) Q1 to determine the average LOS for patients admitted with hospital with a diagnosis of dementia ii) Q2 identify aread for improvement and commence delivery iii) remeasure Q4 - to decrease the average LOS in hospital for patients with a diagnosis of dementia; all causes.

8%

Goal

Number Goal Name Description of Goal

Goal Weighting

Safety

4 VTE To reduce avoidable death, disability and chronic ill health from venous thromboembolism (VTE) 5% TBC


4a VTE risk assessment - % of all adult inpatients who have had a VTE risk assessment on admission to hospital using the clinical criteria of the national tool (NM 4.1) = 95%

3%

4b VTE root cause analyses- number of root cause analyses carried out on cases of hospital associated thrombosis (NM 4.2 New)

2%

Goal

number Goal name Description of goal

Goal weighting

Safety

5 Shared Decision Making

Shared Decision Making 6% TBC

5a

( No Decision About Me Without Me)To introduce shared decision making (SDM) within 3 clinical areas (COPD; CVD; Diabetes) where there are choices to be made between treatment options. (new) i) Identify appropriate clinical pathways and teams. Ii) Develop and disseminate the SDM materials. iii) Implement SDM and raise awareness among the patient population. iiii) Evaluation including a survey of patients regarding the experience of their involvement and perception of the decision process, with audit and out patient letters. (New)

6%

32

Goal


Goal weighting

Safety

6 Communication Improve communication 9% TBC

Indicator Number Indicator Indicator

Weighting %

6a Discharge bundle for dementia patients over 65/75 (L, New) 5%

6b

Implementation of discharge communication improvement plan to improve quality of content with focus on prescribing information

4%

Goal Number


Weighting Safety

7 Improve appointments

Improve appointments systems 7% TBC


Weighting %

7

Implementation on an improvement plan over 12/13 and 13/14 to: i) reduce the number of Trust initiated cancellations (goal TBC) - cancellation of appointments <6weeks for non-clinical reasons ii) improve the timeliness of review appointments

7%

Goal Number


Weighting Safety

8 Long term conditions Effective management of LTC to improve patient outcomes and minimise readmissions

8% TBC


Weighting %

8a

i) Percentage of inpatients with a primary diagnosis of heart failure receiving all 7 indicators from the heart failure bundle (RS1, L 12/13) (New) ii) Potential to add new indicator for target dosage (L, New)

4%

8b

COPD - proportion of patients receiving all elements of discharge bundle (RS3c, L12/13) (Amended to reflect local pathways if necessary) Target to be 75% by year-end

4%

33

Goal Number


Weighting Safety

9 Falls Reduce harm from falls 7% TBC


Weighting %

9a Understanding of unobserved falls within Trust that result in fracture of the neck of femur and how they can be reduced

7%

Goal number

Goal name Description of goal Goal

weighting Safety

10 Health promotion Every contact counts to include young people, children and adults 6% TBC


Weighting %

10a Develop a code of practice with regard to 'every health contact counts' for smoking cessation, alcohol misuse and obesity. (New)

3%

10b Develop an action plan and measured implementation of 'the code' in practice (New) 3%

Goal number


weighting Safety

11 End of life To improve the standard of end of life care for patients in an acute setting 5% TBC


Weighting %

11a To register for the End of Life Quality Assessment Tool; ELCQua.nhs.uk (New) 2%

11b To measure the number of patients dying in hospital within 8 days of admission, known tro be in their last year of life, identifying areas for improved support of preferred place of care and deciding right

3%

Goal number


weighting Safety


Implementation of regional learning disabilities pathways 3% TBC


Weighting %

12a Compliance with regional learning disabilities pathways (L 12/13) (RS4 11/12) 3%

34

Goal number

Goal name Description of goal - local productivity Goal

weighting Safety

13 Diagnostics Right diagnostics / capacity 12% TBC

13a To develop recommendations for 'the right test first time" to include radiology & pathology referrals (new) 12%

100%



Local suggestion

35

NHS County Durham and Darlington NEAS CQUIN scheme 2013/14



Goal Number



Involvement in whole system reviews TBC

Indicator number


1 This indicator relates to NEAS engagement with Clinical Commissioning Groups (CCG) and involvement in any pathway review set out in CCG commissioning intentions for 2013/14.

TBC

Goal Number


Safety

2 Alternative dispositions other than A&E TBC

Indicator number


2 Demonstrate measures to increase the use of alternative dispositions other than A&E, which includes Hear & Treat, See, Treat and Refer (CARe) and See Treat & Leave (Enhanced CARe)

TBC

Goal Number


Safety

3 Patient Experience

Patient Experience TBC

Indicator number


3a This indicator is a continuation of a three year programme to capture and measure patient experience in the contact centre, A&E and PTS service lines.

TBC

3b Capturing patient experience through patient stories TBC

Goal number


Safety

4 Improvement in response times for patients outside of national target TBC

Indicator Number

Indicator

4 This indicator focuses on initiatives required to support NEAS to improve its average response times for those patients who currently experience the longest waits for an emergency response.

TBC

36

Goal number


Safety

5 Improvements in response times to GP Urgents TBC

Indicator number

Indicator

5 This indicator focuses on initiatives required to support NEAS to improve its responses times to GP urgent transport requests, of which engagement with primary care colleagues is key.

TBC

Goal number


Safety

6 PTS – Reduction in the level of aborted journeys TBC

Indicator number

Indicator

6 This indicator involves engagement with Commissioners and acute hospital providers to reduce the number of journeys that are cancelled on the day of travel (known as aborts).

TBC



Local suggestion

37

NHS County Durham and Darlington BMI Woodland CQUIN scheme 2013/14 CQUIN 2013/14 value is 2.5% value for all healthcare services commissioned through the NHS Standard Contract. One fifth of this value (0.5% of overall contract value) is to be linked to the national CQUIN goals, where these apply.


Goal Number


Weighting %



15% £18,000

Indicator number


1a Friends and family test - phased expansion (NM 1.1 New) 5% £6,000

1b Friends and family test - increased response rate (NM 1.2 New) 5% £6,000

1c Friends and family test - improved performance on the staff friends and family test (NM 1.3 New) 0% NB. This has been set at 0 given BMI aren’t part of the NHS survey. 1.4 has been added to ensure BMI gather baseline information in 2013/14

0% £0

1d Friends and Family Test – Improved Performance on the Staff Friends and Family Test 5% £6,000

Goal Number


Safety



2% £42,000

Indicator number


2a NHS Safety Thermometer - data collection (NM2.1) - applicable 0% £0

2b NHS Safety Thermometer - improvement. 5% £6,000

2c Surgical Care Bundle Audits – Catheters: Completion of Monthly Audits 10% £12,000

2d Surgical Care Bundle Audits – Catheters: Implementation of action plans 10% £12,000

2e Surgical Care Bundle Audits – Catheters: To increase or maintain best practice use of catheters 10% £12,000

38

Goal Number


Safety

3 VTE To reduce avoidable death, disability and chronic ill health from venous thromboembolism (VTE) 10% 12,000

Indicator number


3a VTE risk assessment 5% 6,000

3b VTE root cause analyses 5% £6,000

Goal


CDD Goal Weighting

Safety

4 Every health contact counts 40% £48,000

4 Code of practice with regard to ‘every health contact counts’ for smoking cessation 40% £48,000



Local suggestion

39

NHS County Durham and Darlington and County Durham HOSPICE CQUIN scheme 2013/14



Goal Number

Goal Name Description of Goal Goal Weighting

Expected Financial value of goal



Total at least 5%

TBC

1a National NHS Safety Thermometer - data collection using DoH web site; Undertake a survey on one day per month, of all appropriate patients, using the NHS Safety Thermometer , to collect data and complete on pressure ulcers, falls and urinary tract infections

1b NHS Safety Thermometer - improvement. Q3 Identify an area for improvement e.g. pressure ulcers from the Safety Thermometer data and agree a target for improvement with commissioners.Q4 Assess if the agreed improvement target has been achieved

2 Dementia To incentivise the identification of patients with dementia and other causes of cognitive impairment alongside their medical conditions, to ensure that hospices deliver high quality care to people with dementia and support their carers

Total at least 5%

TBC

New local To produce an action plan and implementation of 100% appropriate staff receive dementia awareness training

Local PCT Dementia - Assesment, coding and flagging patients with a diagnosis of dementia

Local PCT Dementia - Baseline assessment of the environment and any reasonable adjustments required to improve the experience of dementia patients and their carers.

Local PCT Dementia - Dementia - Supporting Carers of People with Dementia. Undertake an audit of carers of people with dementia to test whether they feel supported

3 Carer Experience

To improve the standard of palliative and end of life care for patients in a hospice setting TBC

Local PCT To ensure patient and carer/family experience of end of life care is measured and acted upon

Local PCT Q1 Propose and agree an improvement plan from 2012/13 results and commence implementation; Q2, Q3 Implementation; Q4 Evaluate if improvements have been achieved (roll over from 2012/13

4 Prevent Admissions to Hospital

To scope what support is required to prevent admission to hospital at end of life in nursing homes TBC

Local CCG Identify; Develop; Implement; Measure

40

5

Increase the capacity of independent prescribing

To scope the needs for increasing the idependant nurse prescribing in order to provide specific support to Nursing Homes to prevent admission to hospital at end of life

TBC

Local CCG Measure the number of staff who are independent prescribers - baseline; Assess the capability of Nurse prescribers - baseline; Identify training needs to increase capability to prescribe at end of life



Local suggestion

41

NHS County Durham and Darlington Home Oxygen CQUIN scheme 2013/14



Goal Number


£16,780


Referrer Satisfaction

Indicator number


1 Referrer satisfaction survey at 12 months with actions plans in place based on results – the survey would take place in month 9.

50% £8,390

Goal Number


2 End of Life Care Pathway

Indicator number


2

The development of a pathway with the palliative team to include discussions covering end of life care with an appropriate Health Care Professional (HCP), onward referral and collaboration, and data capture. Training and development for Air Liquide teams in this area.

50% £8,390



Local suggestion


14 May 2013 Item No: DDES-GB/13/35


CLINICAL COMMISSIONING GROUP GOVERNING BODY

Revenue and Capital Budgets Update 2013/14

1. Introduction The Governing Body approved the initial revenue budgets for the financial year 2013/14 on 12th March 2013. At that time there was some uncertainty around potential allocation adjustments for specialised services, and ongoing contract negotiations with some providers. It was agreed that a further paper would be presented to Governing Body once greater clarity was available in respect of provider contracts and allocations. This paper provides that detail. This report summarises the CCG’s overall financial budgets for 2013/14, which have been incorporated into the final financial plan submitted to the Durham Darlington and Tees NHS England Area Team during April 2013.

2. Implications and risks This paper outlines the CCG’s approach to budget setting for its first year of independent commissioning. Additional contextual information is available in the CCG’s Clear and Credible Plan and 2013/14 Commissioning Intentions It is essential that budgets set are agreed within the CCG’s allocations and can deliver a balanced outturn in order to ensure that the CCG fulfils its statutory financial duties. The CCG will be held accountable for delivery of a balanced outturn position by the Area Team and therefore effective management of these budgets will form a key element of assurance and risk management in-year.

Document Management




Owner’s Name

Approved

1.0 12/03/13 CCG Governing Body

Mark Pickering Mark Pickering Mike Taylor Yes

2.0 07/05/13 CCG Executive Mark Pickering Mark Pickering Mike Taylor

The CCG has discussed the potential for capital expenditure with the Area Team and has agreed to include a notional figure of £268k to cover GP IT costs and the risk of capital costs arising from the Business Transfer Agreement (BTA) inherited from County Durham PCT. At present, the CCG has not been set a specific Cash Limit for 2013/14 although current cash-flow plans support the use of both recurrent and non-recurrent allocations to secure a balanced outturn position.

3. Recommendations The DDES CCG Governing Body is asked to:

approve the updated revenue budgets for 2013/14,

note the position in respect of capital and cash-flow planning for 2013/14,

approve the areas of budgetary delegation to localities,

note the list of major contractual agreements for 2013/14.

4. Author and sponsor director Author: Mark Pickering Title: Head of Finance and Performance Director: Mike Taylor Title: Chief Finance and Operating Officer Date: May 2013



Decision / action X





Transition: Implementing Equity and Excellence X


Performance against key financial targets, including revenue resource limit, cash limit, capital limit and better payment practice code.

QIPP Delivery of QIPP is integrated into the budget setting process

NHS Constitution

Sound financial management supports adherence to principles.

Equality and Diversity Sound financial management supports PCTs to address equality and diversity issues.

Impact on / Involvement Sets out the process by which budgets will be set which

2.0 14/05/13 CCG Governing Body

Mark Pickering Mark Pickering Mike Taylor

of partners will determine spend with partners and providers.

Other policies / Issues Achievement of key financial targets supports delivery of all PCT policies.

DDES CCG - REVENUE BUDGETS 2013/14

1. Introduction The budget setting process is a key component of the annual business cycle. The Governing Body agreed and signed off the initial revenue budgets of the CCG before the start of the financial year. At that time there remained some uncertainty in respect of specialised services adjustments and agreement of contract values. Since that meeting, an increase of £8m to DDES CCG’s allocation has been agreed to correct the specialised services defund in 2013/14 and ensure affordability of contracts with providers. In addition, most major contract values have now been agreed, and work is ongoing on supporting documents including heads of terms and underlying activity levels to enable final sign-off. The latest information in respect of our major contracts is shown at appendix 2. This paper identifies the overall notified financial allocations that support the CCG’s plans and includes an analysis of CCG budgets. The budget setting process is fully aligned to the financial planning included in the CCG’s clear and credible plan (CCP). The process also incorporates guidance from the NHS Commissioning Board’s Area Teams. CCG funding for 2013/14 consists of two distinct separate allocations:

Programme Expenditure - revenue budgets for CCG healthcare programme expenditure which relate to healthcare commissioned services, including secondary care commissioning, community services and prescribing budgets

Running Costs - revenue budgets for CCG running costs. These include pay, non-pay costs and overheads including the cost of support from North of England Commissioning Support (NECS).

2. Summary Revenue Budgets 2013/14 DDES CCG has received confirmation of its allocation for 2013/4. The allocations are loosely derived from a baseline mapping exercise carried out at the start of 2012/13 financial year, which sought to map service costs to their anticipated future commissioning organisation.

The total funding available for DDES CCG is shown in the table below:

Forecast allocations for 2013/14 Recurrent Non -

recurrent Total resources

available

£000 £000 £000

Total Programme Resources 405,137 5,464 410,601

Total Running Costs Resources 7,070 0 7,070

Grand Total Resources available 412,207 5,464 417,671

The allocation figures have been agreed with the Area Team as an integral element

of the financial planning process. However, there may be a need for further

allocation adjustments to be actioned during the financial year in respect of

specialised services risk-sharing arrangements.

Modelling work has been undertaken to determine the funding required for each element of programme expenditure. This analysis is shown below. Appendix 1sets out how the CCG plans to spend a revenue budget of £417,671,000 for 2013/14 which the Governing Body is requested to approve.

Healthcare Programme Expenditure £'000

Acute services 213,664

Mental Health/LD services 52,148

Community services 49,300

Continuing Care / FNC services 16,529

Primary Care services 57,947

Readmissions funding 1,921

Clinical Support Costs 2,944

Contingency (Minimum 0.5%) 1,992

Re-admissions credit 1,700

2% Non Recurring (Subject to AT Approval) 7,967

Total Programme Expenditure 406,112

Organisation Running Costs 7,070

Grand Total Application of Funds 413,182

1% Surplus requirement 4,489

TOTAL FUNDS AVAILABLE 417,671

The allocation of revenue resources set out above delivers a balanced budget in 2013/14, and complies with guidance related to contingency funding.

3. Financial strategy and context The scale of the financial challenge facing the CCG in the future is great, particularly at this time of significant change in the NHS. Every year the NHS faces additional pressure on the funding received due to inflation, demographic changes of an aging and growing population and the cost of innovative new technologies and drug advancements. This means that there is a need to drive high levels of efficiency out of the current system in order to maintain a stable and high performing health service that can meet the growing needs of the population and allow continued investment in new services. The financial planning assumptions used to derive the revenue budgets for 2013/14 have been driven by a range of issues. These include the following:

Government Spending Review

Impact of tariff changes

Potential changes to funding allocations in future years

Implications of the QIPP initiative on the local health economy

Current year activity pressures

Assumptions over which services are expected to fall within the scope of

public health or the NHS Commissioning Board and which will be the

responsibility of CCGs

Taken together these changes represent an increased level of risk in financial planning for 2013/14.

4. Quality, Innovation, Productivity and Prevention (QIPP) It is expected that, in 2013/14 building on the success of previous years, Quality Innovation, Productivity and Prevention (QIPP) initiatives will generate savings through innovation, tariff changes and service redesign, which will be used to fund strategic investments and cost pressures arising from demographic changes for example. Demand led cost pressures will need to be robustly managed for this methodology to be successful and to ensure that the increased activity levels experienced in the current year do not continue to absorb a significant element of the anticipated efficiency savings. A high level breakdown of the QIPP plan for 2013/14 is shown below:

Healthcare Programme £'000

Acute services 9,166

Mental Health/LD services 2,735

Community services 2,087

Continuing Care / FNC services 847

Primary Care services 3,314

Clinical Support Costs 80

Total QIPP Plan (Technical & Allocative) 18,229

Technical QIPP plan 14,672

Allocative QIPP plan 3,557

Total QIPP Plan (Technical and Allocative) 18,229

To ensure the expenditure plans are affordable, the CCG is required to deliver nationally identified efficiency savings of 4%, along with significant additional allocative efficiency savings identified as part of the QIPP agenda. Together these will support delivery of financial balance and continued achievement of the CCG’s objectives in future years when financial pressures are expected to increase.

5. Key planning assumptions The following key planning assumptions have been applied during the setting of budgets for 2013/14:

a) DDES CCG will receive the allocations shown above for 2013/14, inclusive of an uplift of 2.3% from historic baseline mapping workings and reablement funding;

b) All contracts are expected to deliver a net 1.3% reduction. A 2.7% gross

uplift will be offset by efficiency savings of 4.0%. This will be applied to both acute and non-acute services;

c) A sector by sector approach will be applied in respect of the re-investment

of these efficiency savings, as part of the CCG’s overall investment prioritisation process;

d) Practice prescribing costs are expected to be maintained within a zero net uplift (including 4.0% efficiency savings), taking into account the underspending position in the previous financial year;

e) CQUIN on NHS standard contracts will be maintained at 2.5% on top of

contract outturn value; f) DDES CCG will generate a surplus of at least 1% of their Programme

Funding, consistent with guidance from the NHS Commissioning Board, i.e. circa £4m;

g) DDES CCG will hold a contingency sum of at least 0.5% of Programme

Funding, consistent with guidance from the NHS Commissioning Board, i.e. circa £2m.

h) 2% of recurrent allocations to be committed on a non-recurrent basis (with

approval of any spending plans required by the NHS Commissioning Board’s Area Team);

i) Costs of services to be commissioned by other organisations (e.g. NHS

Commissioning Board, Local Authority) will be picked up by those organisations.

j) QIPP plans will be delivered as per the financial plan totalling £18,229m.

6. Usage of 2% Non-recurring funding In accordance with national guidance, the CCG has developed plans to utilise 2% of its recurrent allocation on a non-recurring basis only. For DDES CCG this equates to £7.967m in 2013/14. The table below sets out the plans for deployment of this 2% funding. However, at present, discussions with the Area Team have enforced a reduced initial commitment against these funds to 25% of the annual value. Therefore, the plans shown below demonstrate both usage of one quarter only, and usage based upon full deployment, anticipating further release of this funding during the financial year.

Area of Expenditure 25% usage £’000s

100% usage £’000s

Acute sector transformation schemes 121 3,297

Mental health sector transformation schemes 971 1,470

Community/Primary Care transformation schemes 0 1,900

Continuing Healthcare restitution costs 0 300

Prescribing transformation schemes 0 100

Locality transformation funding 900 900

Total deployment of 2% NR funding 1,992 7,967

7. Delegation of programme budgets

Appropriate budgetary delegation is a key strand of effective financial governance within the CCG. The Audit and Assurance Committee met on 24th April 2013 and agreed revised financial limits and an initial scheme of delegation for 2013/14. The Chief Finance and Operating Officer will cascade delegation to the most appropriate level in accordance with this framework. The arrangements to confirm exact delegation of budgetary responsibility to localities must be re-considered in the light of revised contractual agreements for 2013/14. For the financial year 2013/14, our three main acute provider contracts, namely County Durham and Darlington NHS Foundation Trust, City Hospitals Sunderland NHS Foundation Trust, and North Tees and Hartlepool NHS Foundation Trust use a block/risk share approach. The implications of this agreement are that there should be no unexpected financial variances from agreed contract values in year. Whilst this provides some welcome certainty during times of considerable change, it also challenges the historic approach of financial monitoring and budgetary delegation to localities and practices. This is because there is unlikely to be a financial variance for any of these contracts in-year. An alternative approach the Governing Body is requested to consider is to replace financial monitoring with activity monitoring for these areas. Discussions with North of England Commissioning Support Unit support the view that this method of monitoring will enable continued focus on variation between practices and localities, without focussing on areas of minimal financial variation. Support for this approach from the Governing Body will enable further scoping and example formats to be explored and shared with localities as soon as possible.

Existing areas of delegation for prescribing budgets, and non-recurring transformation funds will continue as in previous financial years. Predominantly block based contracts for Mental Health and Community Services will not be delegated to localities and will be monitored at a CCG level. Discussions with localities in respect of Continuing Healthcare and Funded Nursing Care also supported a centralised approach to budget monitoring of these areas, although supplementary locality information will be made available in year for monitoring purposes. Action in respect of financial pressures in these areas are likely to be required at a CCG level with local partners. Therefore, the table below sets out the planned budgetary delegation to localities for 2013/14 financial year:

Programme Area Information Source Level of Delegation

Acute Services Combination of Block and PbR contracts

Practice / Locality level based upon activity information

Prescribing Information from PPA Practice / Locality level

Transformation Funds (non-recurring)

Non-recurring transformation schemes initiated by localities

Delegated to localities.

The monitoring of acute services contracts using an activity basis is currently under development with the North of England Commissioning Support Unit. The monitoring of prescribing budgets is expected to be based upon information from the Prescription Pricing Authority (PPA), and the methodology for calculation of these budgets is under discussion with the Head of Medicines Optimisation. The locality transformation funds for 2013/14 have initially been set at £900k. These may be used on a non-recurring basis to pump-prime projects for innovation and pathway changes to help identify future QIPP delivery. A number of schemes that commenced during 2012/13 are still underway and will be evaluated during 2013/14, and the costs of these schemes will also need to be covered from this funding. The proposed split of this funding across the three localities based upon weighted capitation figures as per previous financial years, and is shown in the table below:

DDES Locality £’000

Durham Dales 279

Easington 328

Sedgefield 293

Total 900

8. Running Costs The CCG has been advised of it’s running cost allowance. This amounts to £7.07m or £24.94 per head of population. The CCG is required to contain it’s running costs within this limit as a standing financial duty of the organisation. This allowance needs to cover all staff costs, non-staff costs, and payments for services received from North of England Commissioning Support (NECS). A high level breakdown of these running costs is shown below:

Area of Running Cost Expenditure £’000

Staffing Costs 1,973

SLA with NECS 4,168

Other non-staff costs 626

Contingency (approx 4%) 299

Total 7,070

There remains some uncertainty around exact costs for some areas:

precise staffing costs owing to ongoing filling of vacancies;

non-staff costs for precise agreement of audit plans;

rental costs of premises;

costs not covered by NECS, e.g. insurance, legal fees;

precise audit plans.

Therefore, the deployment of the contingency will be agreed with the Chief Finance and Operating Officer as this certainty becomes available over the coming months. It is proposed to delegate to localities the budgets which they can directly control. During the year the level of contingency funding will be reviewed and non-recurrent expenditure opportunities developed with the three localities should the financial risk faced permit this.

9. Capital programme

Current guidance for CCGs suggests that there is a minimal requirement for capital expenditure within a CCG. However, IT expenditure for GP Practices is expected to be passed from the Area Team to the CCG fund NECS support for member practices. With this responsibility comes the potential for capital expenditure, and to accommodate this eventuality the Area Team has requested an inclusion of a notional sum within our financial planning forms. In addition, DDES CCG is the host for the Business Transfer Agreement, a legacy agreement associated with Transforming Community Services, and the transfer of community services from the former PCTs to County Durham and Darlington NHS Foundation Trust. One of the obligations under this agreement is to replace a number of capital items of equipment. The exact values of this equipment have recently been finalised as part of the PCT final accounts process, and replacement costs on a year-by-year basis are expected to be low. In order to accommodate the implications from both GP IT capital expenditure, and potential BTA capital expenditure, DDES CCG has included £268k within its capital plan for the year as submitted to the Area Team. This position will be kept under

review, and should a detailed capital expenditure plan be required during the year, this will be included in a separate paper to the Governing Body later in the financial year. Mark Pickering Head of Finance and Performance May 2013

APPENDIX 1 – DDES CCG Baseline Budgets 2013/14:

DDES CCG - Financial Plan v3 - 12th April 2013

PLAN

£418m £418m £418m

1% Surplus £4m

Contingency £2m

Re-admissions Credit £2m

2% Non-recurring Headroom £8m

Pro

gram

me

Re

sou

rce

s £

41

1m

Pro

gram

me

Exp

en

dit

ure

£4

07

m

Acute £214m

Mental Health £52m

Community £49m

Continuing Healthcare £17m

Primary Care £58m

Reablement £2m

Clinical Support Costs £3m

RCA £7m RCA £7m Running Cost Allowance (RCA) £7m

Note: Totals may vary slightly owing to roundings to nearest £m.

EXPLANATORY NOTES

1.0% Surplus £4m

National Requirement in financial planning, expected to be returned in 14/15 financial year.

0.5% Contingency £2m

National Requirement in financial planning. Awaiting further guidance regarding in-year usage.

Re-admissions Credit £2m

Financial benefit to commissioner arising from non-payment for patients readmitted into

secondary care within 30 days of original admission.

2% Non-recurring Headroom £8m

National Requirement in financial planning. This funding may be used on a non-recurring basis

only. Likely source of funds for locality transformation work.

Acute £214m

Includes secondary care contracts, patient transport including A&E, 111, and non-contract activity.

Includes both NHS (£209m) and non-NHS (£5m) providers.

Mental Health £52m

Includes major contracts with TEWV FT and NTW FT, but also non-NHS provision for high cost

cases.

Community £49m

Includes NHS community contracts with CDDFT and NT&H (£40m) , plus non-NHS (£9m) providers.

Continuing Healthcare £17m

Includes both Continuing Healthcare (£14m) and Funded Nursing Care (£3m). Includes cases

of both a long-term and short-term nature.

Primary Care £58m

Main element is prescribing budgets, but also includes local enhanced services (LES) and

out of Hours services within CDDFT community contract.

Reablement £2m

National Requirement - within main allocation, targeted for use in the initial 6 weeks following

discharge from secondary care.

Clinical Support Costs £3m

Includes recharges from 'Propco' for clinical space in community premises including Seaham PCC

and Sedgefield Community Hospital. Also includes charges for CHC staff, Medicines mgmnt

and safeguarding services. All excluded from running costs.

Running Cost Allowance (RCA) £7m

The costs of running the CCG organisation. Includes £4.2m for charges from North of England

Commissioning Support Unit, plus CCG employed staff, non-staff costs and statutory

requirements including insurances and internal and external audit.

DDES CCG - Financial Plan v3 - 12th April 2013

Appendix 2 – Major Contractual Agreements

Update on Major Contractual Agreements 2013/14 - April 2013

Type of Contract Contract Status DDES CCG

as at 16/04/2013 £'s

ACUTE HEALTHCARE CONTRACTS >£500k

County Durham and Darlington NHS Foundation Trust Block/Risk Share £value agreed 110,865,192

City Hospital Sunderland NHS Foundation Trust Block/Risk Share £value agreed 32,371,565

North Tees and Hartlepool NHS Foundation Trust Block/Risk Share £value agreed 35,433,022

Newcastle Hospitals NHS Foundation Trust PbR Not yet agreed 4,863,676

South Tees Acute Hospitals NHS Foundation Trust PbR £value agreed 9,703,826

Gateshead Hospitals NHS Foundation Trust Block/Risk Share Not yet agreed 672,759

Northumbria Healthcare NHS Foundation Trust PbR £value agreed 244,619

Spire Healthcare - Independent Sector PbR £value agreed 498,308

BMI Healthcare (Woodlands) - Independent Sector PbR £value agreed 1,192,526

Alliance Healthcare (Diagnostics) - Independent Sector PbR £value agreed 897,362

MENTAL HEALTH CONTRACTS >£500K

Tees, Esk and Wear Valleys NHS Foundation Trust - Main Block/Risk Share £value agreed 43,448,790

Tees, Esk and Wear Valleys NHS Foundation Trust - CAMHS Block/Risk Share £value agreed 968,290

Tees, Esk and Wear Valleys NHS Foundation Trust - IAPT Block/Risk Share £value agreed 1,143,310

Northumberland, Tyne and Wear NHS Foundation Trust Cost & Volume £value agreed 1,550,989

PATIENT TRANSPORT CONTRACTS >£500k

NEAS NHS Foundation Trust- A&E Transport Block/Risk Share £value agreed 7,779,211

NEAS NHS Foundation Trust- PTS Non Emergency Block/Risk Share £value agreed 2,202,606

NEAS NHS Foundation Trust - Dales Rural Ambulance Block/Risk Share £value agreed 674,206

NEAS NHS Foundation Trust- Urgent Care Transport Block/Risk Share £value agreed 579,645

COMMUNITY HEALTHCARE CONTRACTS >£500k

County Durham and Darlington NHS Foundation Trust Block/Risk Share £value agreed 41,035,047

North Tees and Hartlepool NHS Foundation Trust Block/Risk Share £value agreed 2,087,952

NEAS NHS Foundation Trust- 111 Services Block/Risk Share £value agreed 1,002,543

NON-HEALTHCARE CONTRACTS >£500k

North of England Commissioning Service Block/Risk Share £value agreed 4,168,000

All figures including MFF and CQUIN where appropriate

SUB-COMMITTEE GOVERNING BODY 14 May 2013



SUB-COMMITTEE/GOVERNING BODY

Purpose of Report 1. This report presents the joint 2011/12 annual report of the Director of Public

Health, County Durham and the Director of Public Health, Darlington. Background

2. The annual report for 2011/12 is the final joint report of the Directors of Public

Health for County Durham and Darlington.

The theme focuses on both looking backwards and forwards and wherever possible makes reference to the report of the County Medical Officer in 1973, the last time public health was a local authority responsibility. In addition, the reader is directed to the two joint strategic needs assessments, both available on the PCTs’ and the local authorities’ website. Further information on all public health programmes can also be found in the public health business plan. Former reports included a chapter provided by the health protection agency north east (HPA NE) on local health protection related issues. The HPA NE has changed its reporting method and for 2011/12 has published two north east-wide reports which are available on request. These are “Protecting the population of the north east from communicable diseases and other hazards, annual review 2011” and “Protecting the population of the north east from communicable diseases immunisation report 2011”. The reports and updates highlighted above are available to organisations to inform their commissioning plans, service developments and assessment of need when submitting funding requests.

The independent Director of Public Health annual report is a statutory requirement that will transfer to DCC on 1 April 2013, and the local authority will have a duty to publish the report under the Health and Social Care Act 2012.

As the report is deemed independent, the Director of Public Health has the autonomy to consider any aspect of the population’s health that he/she feels warrants highlighting. Issues highlighted by the Director of Public Health should be identified for action in the Joint Health and Wellbeing Strategy published by the Health and Wellbeing Board. The key messages are reflected within the first County Durham Joint Health and Wellbeing Strategy.

Key Challenges identified in each chapter Chapter 1 The health of people in County Durham and Darlington

The health of the people in County Durham and Darlington has improved significantly over recent years but remains worse than the England average. Health inequalities remain persistent and pervasive. Levels of deprivation are higher and life expectancy is lower than the England average. Chapter 2 The impact our lifestyles have on health

Following the launch of the Government’s alcohol strategy in 2012, Durham County Council and Darlington Borough Council will need to review and update their local strategies and action plans.

Respond to national consultation documents and lobby for a 50p minimum unit price for alcohol and restriction on alcohol advertising to young people.

Continue to implement the social norms work.

Ensure integration with other strategies including sexual violence, teenage pregnancy, violent crime, anti-social behaviour, domestic abuse and reducing reoffending.

Work with the local safeguarding children’s boards to deliver work on the relationship between alcohol, drugs and sexual exploitation.

Undertake further work to understand drug and alcohol misuse in groups such as gypsies and travellers, people who are homeless, pregnant women, veterans, those with dual diagnosis and lesbian, gay, bisexual and trans (LGBT).

Ensure a seamless transfer of the commissioning of drug and alcohol services into the local authority.

Evaluate alcohol screening and delivery of brief advice in primary care and pharmacies.

Work with clinical commissioning groups to provide increased support for those individuals who are repeatedly admitted to hospital as a result of alcohol.

Continue to develop the harm reduction services and improve links to mental health services.

Ensure pathways into, through and out of prison have clear opportunities for those using drugs or alcohol to receive support to overcome their addiction, achieve sustained recovery and live crime free lives.

Improve links with housing, education and employment to optimise opportunities which enhance and support individuals and communities.

Continue to raise the profile of smoking and pregnancy across all agencies to ensure pregnant smokers seek access to support. Explore new approaches to engaging with women in order to understand why some pregnant smokers do not make contact with the service, and if they do why a high number do not stop smoking.

Continue to work with partner agencies to reduce the risk to children of second-hand smoke.

Continue to commission services that influence tobacco issues at a national, regional and local level.

Maintain the two tobacco control alliances so they can co-ordinate work to reduce tobacco consumption locally and respond to national initiatives such as the consultation for standardised plain packaging.

Develop the model already used in Darlington to engage more local communities in activities that will reduce the number of children and adults who smoke.

Work with County Durham and Darlington NHS Foundation Trust to support people with a planned surgical operation to stop smoking before they are admitted to hospital.

Deliver consistent healthy lifestyle messages through the change4life social marketing campaign.

Through awareness raising and joined up service provision, work with partners to reduce the incidence of type 2 diabetes.

Improve access to weight management services for those who are clinically obese.

Enhance existing pathways into physical activity from primary care.

Improve access to healthy food and nutritional advice to those people who are at particular risk from the harms associated with an unhealthy diet, such as people with diabetes, young children and women who are pregnant.

Lobby for environmental improvements such as limiting the density of fast food outlets via the health and wellbeing boards.

Chapter 3 Improving our mental health and physical health

The mindfulness programme is a popular choice for clients and the future scale of the service will require review.

There remains significant work to do to tackle inequalities for those with mental health problems. A partnership approach with service users and carers is essential to address this.

Develop and improve social prescribing opportunities. Improve the range of social prescribing options available and develop local evidence and pathways to enable social prescribing to become part of the mainstream offer to our communities.

Clinical commissioning groups will be supported to become involved in the work to prevent people taking their own lives.

There is a worrying trend, with some evidence, that the CVD mortality rate in younger adults in England and Wales is levelling off. Levels of smoking in young people, particularly among young women; rising levels of obesity and the earlier development of type 2 diabetes are contributing to this.

To maintain the reduction of CVD mortality rates and reduce the health inequalities caused by these conditions there needs to be a change of emphasis. Therapeutic interventions such as revascularisation and thrombolysis will make only a modest impact.

The biggest impact will come from population-wide changes in lifestyle and diet. The impact of all the efforts on tobacco control has resulted in dramatic falls in smoking rates but this must be maintained, especially toward preventing young people taking up smoking. Fresh – the North East regional tobacco control office – has led the way in developing integrated policies across the region resulting in the biggest fall in smoking rates in England. The same effort must be given to encourage and support changes in people’s diet and to promote more exercise.

Engage with clinical commissioning groups, health and wellbeing boards and local authorities on the cancer agenda, particularly on earlier diagnosis.

Promote cancer screening uptake through social marketing activities and monitoring rates, aiming to improve uptake rates to be among the best in England.

Push for accurate staging data from foundation trusts (hospitals).

Reduce cancer services waiting times and ensure excellent performance.

Undertake regular oral health needs assessment of children to determine their levels of dental disease. A survey22 of 12 year old children’s oral health in 2008/09 showed that 27% of 12 year old children in County Durham and 33% in Darlington had active dental decay. It is disappointing that despite good uptake of care for children in this age group, particularly in Darlington where over 70% of children had seen a dentist in the last 12 months, levels of active disease remain high.

Ensure all areas have adequate access to dental care. Utilisation of NHS dental services is only at or above the English average of 56% in 16 out of 135 wards in County Durham, and 4 out of 24 wards in Darlington. In County Durham in 2010/11, 48% of the population of County Durham attended an NHS dentist. In Darlington 50% of the population had attended a dentist in the North East23. There is still work to be done to secure access to dental care for all residents.

The transfer of public health to the local authorities of County Durham and Darlington provides the opportunity to effectively reach children and families in the more socially excluded and hard to reach sections of our community who have the highest levels of dental disease. We know that in both County Durham and Darlington, as nationally, when the level of deprivation in a community increases, the use of dental services decreases.

Chapter 4 The impact of social and economic factors on health

Health literacy should be included in any emerging Lifelong Learning strategy.

The work on community learning and inclusion has shown that early work needs greater understanding and embedding in any life learning strategy or plan.

The concept of scaling up innovative interventions that are shown to work is also critical.

During an economic downturn, when employers’ resources are stretched, engaging new workplaces in health programmes can prove a challenge. The support of strategic and business partnerships will be crucial in ensuring businesses achieve the benefits of investing in workplace health.

The mental health first aid accredited trainers need to be maintained and supported to ensure mental health first aid is available in our communities.

There is still stigma attached to mental health issues so campaigning and education within communities, schools, workplaces and within our own services must continue.

As the new public health system develops in our local authorities, there will be more opportunities to engage with a wider workforce who have direct contact with local people and who can have a positive impact on individual health and wellbeing.

Explore opportunities to link the health trainer programme to the work of the 14 area action partnerships and health networks in County Durham and the strategic partnership in Darlington.

Link to local authority anti-poverty strategies to consolidate and provide a more focused approach to income, debt and welfare provision, regeneration and financial inclusion.

Integrate the services that provide transport to hospitals in County Durham and Darlington.

Evaluate the schemes trying to reduce excess winter deaths to see if they are targeting those who most need the service and to assess what impact the service has had on their health and wellbeing.

Evaluate what effect the investment in building social capital has had on local communities.

Chapter 5 Working with people in communities

Commission children’s and young people’s obesity reduction programmes based on evidence of effectiveness.

Provide public health support to health visitor services post-2013 when they will be commissioned by the NHS Commissioning Board.

Review the range of commissioned sexual health services, including teenage pregnancy.

Ensure an effective handover of commissioning responsibility for antenatal screening programmes to the NHS Commissioning Board.

Develop the public health role of school nurses.

Health and wellbeing boards should be aware of the needs and co-ordinate service provision for military health.

Increase awareness among primary care providers and GPs of the particular mental health needs of the ex-service personnel and particularly of the need for priority treatment for health care needs arising from their service.

Primary care services and hospital trusts should take steps to improve awareness of veteran’s mental health issues among health workers generally, including appropriate training and supervision.

Some groups within the ex-service community may need special attention, including prisoners and early service leavers (those who leave the service after less than four years).

Recommendations DDES is requested to:

receive the annual report of the Director of Public Health, County Durham and the Director of Public Health, Darlington

note this is the final joint report of the Directors of Public Health for County Durham and Darlington

note that additional reports published by HPA NE are available on request

Contact: Anna Lynch, Director of Public Health, County Durham Tel: 03000 268146

1

DURHAM COUNTY COUNCIL PUBLIC HEALTH

-and-


CLINICAL COMMISSIONING GROUP

MEMORANDUM OF UNDERSTANDING

2

PUBLIC HEALTH DIRECTORATE – DURHAM DALES, EASINGTON AND SEDGEFIELD CLINICAL COMMISSIONING GROUP

MEMORANDUM OF UNDERSTANDING

Date April 2013 to 31 March 2014

Introduction 1. The purpose of this Memorandum of Understanding is to

establish a framework for relationships between County Durham Public Health Directorate and Durham Dales, Easington and Sedgefield Clinical Commissioning Group for 2013/14 and beyond.

Context Aims

2. Since 1974, within the NHS, specialist public health staff have assumed the lead for the three core public health responsibilities on behalf of the NHS and local communities:

Health improvement e.g. lifestyle factors and the wider determinants of health.

Health protection e.g. preventing the spread of communicable diseases, the response to major incidents, and screening

Population healthcare e.g. input to the commissioning of health services, evidence of effectiveness, care pathways.

3. With the implementation of the Health and Social Care Act

2012, primary responsibility for health improvement and health protection will transfer at the national level from the NHS to Public Health England, and at local level from PCTs to Local Authorities. Responsibility for strategic planning and commissioning of NHS services will transfer to the NHS Commissioning Board and to Clinical Commissioning Groups.

4. The aim of this agreement is to facilitate, develop and enhance

collaborative working between Durham County Council Public Health and Durham Dales, Easington and Sedgefield CCG in respect of:

Reducing Health Inequalities and improving health outcomes.

Commissioning programmes for health Improvement and to address health inequalities through the development of partnership working.

Provision of evidence based public health specialist advice and support to commissioning of healthcare interventions to improve patient outcomes.

Supporting CCG to improve the quality of the services they commission and ensuring that the patients’ perspective is taken into consideration in all

3

commissioning intentions.

Ensuring that all commissioning decisions take into consideration evidence of clinical and cost effectiveness.

Health improvement 5. The Health and Social Care Act gives Durham County Council statutory duties to improve the health of the population from April 2013.

6. CCGs are also given duties to secure improvement in health

and to reduce inequalities, utilising the role of health services, which will require action along the entire care pathway from prevention to tertiary care. Therefore, Durham County Council and the CCG have a collective interest, and have individual and collective responsibility for health improvement.

Durham County Council Public Health Team will:

Refresh its delivery and lead role in current strategies and action plans to improve health and reduce health inequalities, with input from the CCG.

Maintain and refresh as necessary metrics to allow the progress and outcomes of preventive measures to be monitored, particularly as they relate to delivery of key NHS and LA strategies.

Work with members and officers of the Council to further embed ownership and leadership of health improvement through the relevant service programmes.

Support primary care with health improvement tasks appropriate to its provider healthcare responsibilities - for example by offering training opportunities for staff, targeted behaviour health change programmes and services.

Lead health improvement partnership working between the CCG, local partners and residents to integrate and optimise local efforts for health improvement and disease prevention.

Embed public health work programmes around improving lifestyles into frontline services towards improving outcomes and reducing demand on treatment services

Jointly commission health improvement services with the CCG

Advise the CCG on best practice with social marketing for health improvement programmes.

Durham Dales, Easington and Sedgefield CCG will:

Contribute to strategies and action plans to improve health and reduce health inequalities.

Encourage constituent practices maximise their contribution to disease prevention – for example by taking every opportunity to address smoking, alcohol, and obesity in their patients and by optimising management of long term conditions.

4

Encourage all practices to take part in public health commissioned services e.g. Stop Smoking services, NHS Health Check.

Encourage all practices to collaborate with the commissioning support service and public health on an information sharing agreement to access practice data for health profiling and health equity audits.

Ensure primary and secondary prevention is incorporated within commissioning practice

Commission to reduce health inequalities and inequity of access to services

Support and contribute to locally driven public health campaigns

Health protection 7. The Health and Social Act is backed up by regulations which

give Durham County Council and the Director of Public Health responsibilities in respect of health protection. These include preventing and responding to outbreaks of communicable disease, planning for and mitigating the effects of environmental hazards, and NHS resilience.

8. The Act gives CCGs a duty to ensure that they are properly

prepared to deal with relevant emergencies. The Secretary of State retains emergency powers to direct any NHS body to extend or cease functions, and is likely to discharge these through Public Health England and the local office of the NHS Commissioning Board.

Durham County Council Public Health Team will:

Support the Local Resilience Forum and the Local Health Resilience Partnership (LHRP) and provide assurance that local strategic plans are in place for responding to the full range of potential emergencies – e.g. pandemic flu, major incidents.

Provide assurance that these plans are adequately tested.

Provide assurance that any preparation required – for example training, access to resources - has been completed.

Provide assurance that the capacity and skills are in place to co-ordinate the response to emergencies, through strategic command and control arrangements in the health sector.

Ensure adequate advice is available to the clinical community via Public Health England and any other necessary route on health protection and infection control issues.

Further clarity is likely to be provided on the role of the DPH in health emergency planning, resilience and response and this MOU will be updated accordingly.

5


Familiarise themselves with strategic plans for responding to emergencies.

Participate in exercises when requested to do so.

Ensure that provider contracts include appropriate business continuity arrangements.

Ensure that constituent practices have business continuity plans in place to cover action in the event of the most likely emergencies.

Assist with co-ordination of the response to emergencies, through local command and control arrangements.

Ensure that resources are available to assist with the response to emergencies, by invoking provider business continuity arrangements and through action by constituent practices.

Population healthcare

9. The Health and Social Care Act establishes CCGs as the main local commissioners of NHS services and gives them a duty to continuously improve the effectiveness, safety and quality of services.

10. The Health and Well-being Board is the primary mechanism to

ensure the responsibilities around health improvement and health and social care provision are addressed by identifying the needs of the population and ensuring that these are taken account of through Clinical Commissioning Groups, public health and social care commissioning plans and activities.

11. Public health specialists will provide a range of support to the

CCG for specific NHS commissioning functions. Durham County Council Public Health Team will:

Provide specialist public health advice to the CCG ensuring comprehensive public health support.

Assess the health needs of the local population, and how they can best be met using evidence-based interventions

Ensure the reduction of health inequalities are prioritised in the commissioning of services, including utilising health equity audit

Support the Clinical Commissioning Group in developing evidence based care pathways, service specifications and quality indicators to improve patient outcomes

Set out the contribution that interventions make to defined outcomes (modeling) and the relative return on investment across the portfolio of commissioned services

Design monitoring and evaluation frameworks, collect and interpret results

6

Providing a legitimate context for setting priorities using ‘comparative effectiveness’ approaches and public engagement and identify areas for disinvestments including using programme budgeting and marginal analysis (PBMA) in this process.

Support clinical validation of data where necessary for commissioning purposes

Support the CCGs in the achievement of the indicators in the NHS outcomes frameworks for Domain One – preventing people from dying prematurely

Promote and facilitate joint working with local authority and wider partners to maximise health gain through integrated commissioning practice and service design

Support the clinical effectiveness and quality functions of the CCGs including input into assessing the evidence e.g., NICE guidance

Support the development of public health skills for CCG staff

Through the Joint Strategic Needs Assessment (JSNA), refresh the needs assessment of the population and ensure that this is relevant to the population. The production of the JSNA will be complemented by a programme of targeted needs assessments (e.g., health of prisoners, and the pharmaceutical needs assessment). CCGs will be co-participants in the production of the JSNA.

Support development of the Joint Health and Wellbeing Strategy and ensure that the CCG is fully involved in the development of this strategy and action plans

Lead the co-ordination of appropriate health commissioning work between the NHS, PHE and LA at a local level.

Work on care pathways, including review of the evidence of effectiveness, predictive modelling of effects, and supporting documentation to aid clinicians in decision-making.

Provide specialist technical reports and support in relation to named patient funding requests.

Share with CCGs quality and safety information that support the assurance of clinical governance.

Support CCGs at the Quality Review Groups and Clinical Quality Working Groups.


Consider how to incorporate specialist public health advice into decision making processes, in order that public health skills and expertise can inform key commissioning decisions.

Utilise specialist public health skills to target services at greatest population need and towards a reduction of health inequalities

Contribute intelligence and capacity to the production of the JSNA

7

Share quality and safety information for provider services that support the assurance of clinical governance including CQUIN indicators.

Specifying the quality of the public health team Wider working arrangements

12. The Director of Public Health for Durham County Council will ensure that an appropriately skilled public health workforce is available to ensure delivery of the technical and leadership skills required of the function. This will include:

All Public Health Consultants will be appointed according to the Faculty of Public health guidance.

All Public Health Consultants to be fully qualified and accredited with the Faculty of Public Health and (where relevant) be subject to all existing NHS clinical governance rules, including those for continued professional development

13. The details of the support for the CCG provided by the Public Health Specialists are set out in Appendices 1 and 2.

14. The specialist staff will, as necessary, contribute to the developing commissioning support arrangements at different population levels which may be wider than a local CCG / LA base, including working with PHE and the NHS CB as required as part of the overall support function for the CCG and health community.

15. The DPH will continue to explore delivery of the public health advice to the CCG in the context of the service level agreement with the commissioning support service.

16. This Memorandum of Understanding will be reviewed annually.

Signature Date: 21.3.13 Anna Lynch, Director of Public Health, County Durham

Signature ……………………………………….………… Date 23 March 2013 Stewart Findlay, CCG Accountable Officer

8

Appendix 1 Public health support for NHS commissioning

1. Public health intelligence

Provision of public health intelligence to assess the health needs of populations and how they can be best met using evidence based interventions and various intelligence and analytical tools.

Provision of expert epidemiological and public health intelligence advice to support and inform an evidence-based approach for commissioning, and to increase the equity of access to services.

Support the production and development of the Joint Strategic Needs Assessment

Support commissioning practice towards the reduction of local health inequalities and the specific needs of vulnerable and marginalised groups

Analysis and utilisation modelling of service activity including health equity audit, health impact assessment and comprehensive needs assessments.

Predictive modelling of activity against outcomes

Geo-demographic profiling to identify association between need and utilisation and outcomes for defined target population groups.

Identification of service and organisational outcome measures towards the improvement of the public’s health and achievement of indicators within the NHS and public health outcomes frameworks.

2.Clinical Commissioning and service planning

2.1 Clinical effectiveness

Critical appraisal of the research evidence to support the CCG in developing evidence-based care pathways, service specifications and quality indicators to improve patient outcomes and in particular in the absence of NICE or other national guidance

Establishing and evaluating indicators and benchmarks to map service performance and outcomes

Identify and assess population impact of implementing NICE guidance

Support the CCG in the identification, assessment and implementation of national policy, best practice guidelines and national strategies

Design monitoring and evaluation frameworks, collect and interpret results

Predictive modelling of activity against outcomes for locally designed and populated care pathways.

9

2.1 Quality improvement

Support the CCG work programme on the quality improvement and QIPP agenda

Provide public health input to the development of quality indicators

Support the development of public health awareness and competencies of the CCG

Facilitate and provide support towards the CCG strategy for health improvement and disease prevention

3.Prioritisation and resource allocation

Apply health economics and a population perspective to provide a legitimate context and technical evidence-base for the setting of priorities

Identify the contribution that interventions make to defined outcomes and the return on investment across the portfolio of commissioned services

Identify areas for disinvestment and enable the relative value of competing demands to be assessed

Critically appraise the evidence and provide clinical support to appropriately respond to individual funding requests

3. Engagement - Public and Partners

Through objective analysis, providing the impartiality necessary to communicate and defend difficult decisions to the public

Support the CCG to progress joint commissioning and provision plans with the local authorities and other statutory and non-statutory organisations to maximise health gain through commissioning practice and service design

4. Objective independence

Providing through the JSNA or other technical material, and in an independent role, to act as broker in relation to deciding on competing demands for funding as required.

5 Research, innovation and teaching

To provide a professional source of expertise for research and evaluation of local health care as required and to contribute to innovation and development of locally sensitive solutions to help meet healthcare need.

To provide teaching and support for the use of public health science skills in the appropriate functional domains of CCG responsibility

10

6. Health Protection

To provide local leadership and support for key NHS health protection functions:

o Childhood vaccination

o Adult vaccination including influenza immunisation programmes

o Blood borne virus prevention and case identification (Hepatitis B, C and HIV)

o Tuberculosis strategy and disease prevention

To provide support for the CCG in all dealings with local health protection issues handled by Public Health England including infectious and non-infectious hazards

To provide leadership and co-ordination for a health community approach to Emergency Planning and Response

11

Appendix 2 Public Health support for Individual Funding Requests and Exceptional Cases This paper sets out:

1. The decision-making pathway for Individual Funding Requests as agreed by CCGs with NECS

and included in the Standard Operating Procedure

2. The definitions of key decision makers in the process

3. The roles and responsibilities of decision makers

1. IFR Decision-making process

12

2. Definitions:

Clinical Advisors: A nominated advisor of the respective CCG areas who will provide

additional support, advice and expertise for funding requests where requested. Dr Mike

Lavender, Consultant in Public Health Medicine (CPHM) will provide this support.

NECS IFR Admin: The administrator, employed by NECS, who will manage the day to day

running and administration of the IFRP and carry out the duties as outlined in this SOP for

their respective CCG areas.

CCG Delegated Representative: A member of the CCG Board who has been given the

delegated authority to make funding decisions on behalf of their CCG.

Policy/Protocols: Documents which outline a set of criteria that must be met in order for a

said treatment/procedure to be provided.

3. Roles and responsibilities

Step in IFR Process

Note CCG Delegated Representative

Clinical Advisor

IFR Clinical Policy

The Value Based Clinical Commissioning Policies are the basis of the web-based IFR system. Public Health Specialists devoped these policies and review them regularly

CCG representatives will provide the CPHM with views from their practices on the VBCC policies. CCGs will ensure that the VBCC policies are included in the contacts with all acute providers.

The CPHM will represent the CCG on the group that reviews the VBCC policies. This may involve consulting local specialists on the policies.

Step 8: Endorsement of an IFR decision

On the web based system, many cases can be approved automatically as the criteria are clearly fulifilled. The IFR administrator cannot make this decision on behalf of CCGs, the decision will need endorsement by a CCG representative. It will be handled by the web-based system and involves a daily email reminder from the IFR administrator of any decisions pending.

CCGs to nominate clinicians with delegated responsibility. The CCG will need more than one person to ensure cover for annual leave and in cases where a decision is needed urgently. CCG representatives will need training in the web based system.

The CPHM will be available to support CCG representatives in urgent cases.

Step 11: IFR Admininstrator requests input from a clinical advisor

The decision at this point is if the IFR is covered by the clinical policies. The clinical advisor can either refer to the CCG representative with a recommended decision or suggest a referral to the panel to be considered as an exceptional case.

CCG nominated clinicians will need to provide some back up for this role during 2013/14 with a view to taking on the role from 2014/15 onward.

The CPHM to mainly fulfill this role during 2013/14.

13

Step 17: Preparation of a case for panel

Each exceptional case referred to the panel for a decision will need working up including a review of the literature on evidence for effectiveness and cost effectiveness for the proposed intervention.

CCGs to nominate someone to be a panel member. This person will need to have experience as a panel member or attend a training workshop.

CPHM to provide technical support in working up the case and advising the panel. In exceptional cases the CPHM will attend the panel with the CCG representative.

H:\Policy Development\Independent Practitioner Performance Page 1 of 38

Author: NECS Clinical Quality

North Durham, Durham Dales Easington and Sedgefield, Darlington Clinical Commissioning Groups

Local Policy and Procedure for the Management of Independent Contractor and Practitioner Professional

Performance

Corporate Policy CO071

Version Number: Version 2; April 2013

Issued Date: TBC

Review Date: April 2014

Prepared By: Clinical Quality Officer, North of England Commissioning Support

Consultation Process:

The Accountable Officers and the GP Clinical Quality Leads

Formally Approved: TBC

Policy Adopted From: NHS County Durham and Darlington Local Policy and Procedure for the Management of General Practitioner Professional Performance Corporate Policy CO071

Approval Given By: TBC - CCGs

Document History

Version Date Significant Changes

1 April 2013 First Issue

Equality Impact Assessment

Date Issues

4 September 2011 See section 9 of this document

POLICY VALIDITY STATEMENT This policy is due for review on the latest date shown above. After this date, policy and process documents may become invalid.

Policy users should ensure that they are consulting the currently valid version of the documentation.



Local Policy and Procedure for the Management of Independent Contractor and Practitioner Professional

Performance

Contents Section Title Page

1

Introduction

3

2

Definitions

4

3

Procedure for Management of Independent Contractor Concerns

4

4

Duties And Responsibilities

5

5

Implementation

8

6

Training Implications

8

7

Documentation

8

8

Monitoring, Review And Archiving

9

9

Equality Impact Assessment Statement

11

Appendices

1 Terms of Reference Independent Contractor Performance Triage Group

13

2 Performance Concern Referral Triage Flowchart 16

3 Incident Decision Tree 17

4 Risk Matrix Assessment 18

5 Referral Letters 19

6 Model Matrix 31

7 The Incident Decision Tree: Guidelines for Action 33

8 The Department of Health 25 ‘Never Events’ 38



Local Policy and Procedures for Management of Independent Practitioner Performance Concerns

1. Introduction and background

For the purposes of this policy, North Durham, Durham Dales, Easington and Sedgefield, and Darlington Clinical Commissioning Groups will be referred to as ‘the CCGs’ The Clinical Commissioning Groups (CCG) aspire to the highest standards of corporate behaviour and clinical competence, to ensure that safe, fair and equitable procedures are applied to all organisational transactions, including relationships with patients, their carer’s, public, staff, stakeholders and the use of public resources. In order to provide clear and consistent guidance, the CCGs will develop documents to fulfil all statutory, organisational and best practice requirements and support the principles of equal opportunity for all. Healthcare professionals are responsible for complying with the relevant standards set by their regulatory or professional bodies (e.g. the GMC’s good medical practice), contract requirements and duties in accordance with the relevant Performers List Regulations. A breach of such standards, contract or regulations might indicate a performance concern, which may be dealt with through this policy and procedure, independent of any action taken by the regulatory or professional body concerned. In such cases, performance concerns will be investigated fairly using a supportive approach with appropriate steps being taken to address the issues and prevent a recurrence. Failure to meet accepted standards of professional clinical practice in healthcare is not a common occurrence and can be manifested in diverse ways. For example, poor clinical performance can be associated with an error or delay in diagnosis, use of outmoded tests or treatments, failure to act on the results of monitoring or testing, technical errors in performance of a procedure, poor attitude and behaviour, inability to work as a member of a team or poor communication with patients. In some cases, several aspects of these areas of poor performance may be present in one service. In other cases, there may also be underlying ill-health problems contributing to a failure to perform to an acceptable standard

1.1 Status This is a corporate policy and procedure for the management and handling of performance concerns related to general practitioners working within the CCGs.



1.2 Purpose and scope NHS England is the responsible body for professional performance issues. The CCGs have a formally constituted General Practitioner Performance Triage Group (GP PTG). The GP PTG has a responsibility to triage general practitioner concerns to identify if it’s potentially a professional performance issue and therefore requiring referral to the NHS England Area Team for further consideration.

2. Definitions Definitions used are contained in the body of the document.

3 Local Policy and Procedures for Management of Independent Practitioner Performance Concerns

This policy and procedure applies to management, support and handling of performance concerns in respect of general practitioners working within the CCGs. Additionally all relevant Human Resource Policies and Procedures will be applied to those directly employed by the CCGs.

3.1 The General Practitioner Performance Triage Group Duties

and Functions

The Terms of Reference and processes for the GP PTG are detailed in Appendix 1. The duties and functions of the GP PTG are:-

To receive information and data relating to general practitioners from a variety of sources and to process this information and or data in accordance to the data protection act.

To ensure all relevant corporate policies and procedures are applied with specific regard to Safeguarding Children, Information Governance and maintaining confidentiality.

To use the information and data to make an informed decision relating to the concerns raised, through use of the approved tools and methodologies.

To use the NPSA Incident Decision Tree combined with the Risk Matrix to facilitate discussion and document these decisions (see appendices 2, 3 & 4).

To keep action logs of all decisions made for the minimum retention period in accordance to Information Governance retention schedules.



To complete documentation relating to the decision making process as detailed in appendix 1.

To refer any practitioner to the NHS England Area Team in accordance with the developed framework (see appendix 5)

To track all referrals made to the NHS England Area Team.

To receive information from the NHS England Area Team regarding referrals made to them about general practitioner professional performance concerns.

Adhere to the NHS England Area Team Policy and Procedures for Assuring High Standards of Contractors and Performers.

3.2 Reporting and Communication Details

Action logs identifying issues and decisions will be treated in the strictest confidence and NECS will include anonymous details of referrals made to the NHS England Area Team as part of the quarterly and monthly quality reports to the CCG quality groups. A 6-monthly report detailing referrals made to the NHS England Area Team will be presented in the confidential section of the CCG Management Executive by the CCG GP Quality Lead. The GP PTG will receive information from the NHS England Area Team relating to all the performance concerns they are considering and ensure triangulation with local CCG Incidents, Complaints and Serious Incidents reported via the STEIS mechanism and local soft intelligence captured on the electronic incident reporting system Safeguard

4. Duties and Responsibilities

4.1 CCG Accountable Officer The Accountable Officers have overall responsibility for the strategic direction and operational management, including ensuring that CCG process documents comply with all legal, statutory and good practice guidance requirements.

4.2 GP Quality Lead

The CCG GP Quality Leads have overall strategic and operational responsibility for the local policy and procedures for assuring high standards of professional performance. The GP Quality Lead is responsible for ensuring that:

The document is drafted, approved and disseminated in accordance with the Policy for the Development and Approval of Policies.



The necessary training or education needs and methods required to implement this policy are identified and resourced or built into the delivery planning process.

Mechanisms are in place for the regular evaluation of the implementation and effectiveness of this policy.

Reports are presented to the CCG Management Executive on a six monthly basis.

A seamless and coordinated approach is maintained in relation to performance concerns working with the NHS England Area Team.

Recommendations from National Reviews and Coroners directives which impact on independent contractor performance concerns are implemented.

The CCGs maintain a culture of an organisation with a memory in relation to performance concerns in order to ensure patient safety.

4.3 Senior Clinical Quality Manager . The Senior Clinical Quality Manager, North of England Commissioning Support, is responsible for ensuring that;

The process detailed in appendix 1 is implemented, reviewed and audited on an annual basis.

NECS will include anonymous details of referrals made to the NHS England Area Team as part of the quarterly and monthly quality reports to the CCG quality groups.

A 6-monthly report detailing referrals made to the NHS England Area Team will be presented in the confidential section of the CCG Management Executive by the CCG GP Quality Lead.

Support is given to the CCGs ensuring that a seamless and coordinated approach is maintained in relation to performance concerns, working with the NHS England Area Team, including the implementation of Liberating the NHS, national reviews, ombudsman and coroners reports/directives.

The CCGs maintain a culture of an organisation with a memory in relation to performance concerns in order to ensure patient safety.

Practitioner performance concerns from all data basis, issues logs, soft intelligence, complaints, serious incident reports, incidents and near miss reports and patient experience within the CCG and concerns from external sources are considered by the GP PTG.

4.4 GP PTG Administrator

The GP PTG administration is provided by the NECS Clinical Quality team and is responsible for ensuring that;

Meetings are arranged monthly.



An accurate record of the meetings is made and disseminated within 3 working days of the meetings.

Actions recommended by the GP PTG are recorded accurately.

Communications and referrals to the NHS England Area Team are processed within 3 working days.

An accurate database of the actions and referrals to the NHS England Area Team are maintained.

All data in the referrals to the NHS England Area Team is scrutinised and any unnecessary patient and staff identifiable information is redacted.

4.5 All staff All staff, including temporary and agency staff, are responsible for:

Compliance with relevant process documents. Failure to comply may result in disciplinary action being taken.

Co-operating with the development and implementation of policies and procedures and as part of their normal duties and responsibilities.

Identifying the need for a change in policy or procedure as a result of becoming aware of changes in practice, changes to statutory requirements, revised professional or clinical standards and local/national directives, and advising their line manager accordingly.

Identifying training needs in respect of policies and procedures and bringing them to the attention of their line manager.

Attending training / awareness sessions when provided The CCGs maintain a culture of an organisation with a memory in

relation to performance concerns in order to ensure patient safety.



5. Implementation 5.1 This policy will be available to all Staff for use in relation to the specific

function of the policy. 5.2 All directors and managers are responsible for ensuring that relevant staff

within the CCG have read and understood this document and are competent to carry out their duties in accordance with the procedures described.

6. Training Implications

It has been determined that there are no specific training requirements associated with this policy/procedure.

7. Documentation 7.1 Other related policy documents.

NHS England Area Team Primary Care services Agency Policy and Procedures for Assuring High Standards of Professional Performance of Contractors and Performers

CCG CO18 Serious Incidents (SIs) Management Policy

CCG CO08 Incident Reporting and Management Policy

CCG CO02 Complaints Policy and Procedure

7.2 Legislation and statutory requirements

The overarching legal duty is to assure, monitor and improve the quality and safety of services in accordance with the Health and Social Care (Community Health and Standards) Act 2003 and the Health and Social Care Act 2012. There is a wide range of other legal requirements relevant to the management and handling of performance concerns, which are amended from time to time, related to general practitioners. These are listed below in relation to this policy and can also be found on the Department of Health website. These legal duties, and any statutory re-enactment, amendment or modification of them during the currency of this policy, will be observed in the application of this policy and procedure.

General Regulations Cabinet Office (2008) The NHS Act 2008. London. HMSO Cabinet Office (2004) The NHS (Performers Lists) Regulations 2004 (as amended). London. HMSO Cabinet Office (2004) The NHS (General Medical Services Contracts) Regulations 2004. London. HMSO



Cabinet Office (1992) The NHS (Services Committees and Tribunal) Regulations 1992 (as amended) . London. HMSO Cabinet Office (1998) The Human Rights Act 1998. London. HMSO Cabinet Office (2004) The NHS (Personal Medical Services Agreements) Regulations 2004. . London. HMSO Cabinet Office (2003) Health and Social Care (Community Health Standards) Act 2003. London. HMSO Cabinet Office (2012) Health and Social Care Act 2012. London. HMSO Cabinet Office The NHS Act 2006 Department of Health. London. HMSO

The procedures and processes relevant to this policy are included in appendices

7.3 Best practice recommendations Supporting Doctors, Protecting Patients, London 1999 NPSA Incident decision making tree, see appendix 7 & 8

7.4 References Department of Health. Supporting Doctors, Protecting Patients. London 1999

The National Reporting and Learning Service. National Patient Safety Agency Guidance for Risk Managers. www.npsa.nhs.uk

8. Monitoring, Review and Archiving The governing body will agree a method for monitoring the dissemination and implementation of this policy. Monitoring information will be recorded in the policy database.

8.1 Review 8.1.1 The Accountable Officer, will ensure that each policy document is reviewed in

accordance with the timescale specified at the time of approval. No policy or procedure will remain operational for a period exceeding three years without a review taking place.

8.1.2 Staff who become aware of changes in practice, changes to statutory requirements, revised professional or clinical standards and local/national directives that affect, or could potentially affect policy documents, should advise the sponsoring director as soon as possible, via line management arrangements. The sponsoring director will then consider the need to review the policy or procedure outside of the agreed timescale for revision.

8.1.3 If the review results in changes to the document, then the initiator should inform the policy manager who will renew the approval and re-issue under the next “version” number. If, however, the review confirms that no changes are required, the title page should be renewed indicating the date of the review and date for the next review and the title page only should be re-issued.

http://www.npsa.nhs.uk/



8.1.4 For ease of reference for reviewers or approval bodies, changes should be

noted in the ‘document history’ table on the front page of this document. NB: If the review consists of a change to an appendix or procedure document, approval may be given by the sponsor director and a revised document may be issued. Review to the main body of the policy must always follow the original approval process.

8.2 Archiving The governing body will ensure that archived copies of superseded policy documents are retained in accordance with Records Management: NHS Code of Practice 2009.



9 Equality Impact Assessment Statement

Equality Analysis Screening Template (Abridged)

Title of Policy:

CO071 Local Policy and Procedure for the Management of Independent Contractor and Practitioner Professional Performance

Short description of Policy (e.g. aims and objectives):

Failure to meet accepted standards of professional clinical practice in healthcare is not a common occurrence and can be manifested in diverse ways. For example, poor clinical performance can be associated with an error or delay in diagnosis, use of outmoded tests or treatments, failure to act on the results of monitoring or testing, technical errors in performance of a procedure, poor attitude and behaviour, inability to work as a member of a team or poor communication with patients. In some cases, several aspects of these areas of poor performance may be present in one service. In other cases, there may also be underlying ill-health problems contributing to a failure to perform to an acceptable standard.

Performance issues may arise out of the annual appraisal process for general practitioners and require addressing through these professional performance processes. This is of particular importance due to the relationship between appraisal and the future relicensing and recertification. The clinical lead for appraisal and revalidation will provide the governance link between the Professional Performance Review Group and the appraisal and revalidation processes.

In order to comply with the memorandum of understanding set out in the service level agreement and the Primary Care Organisation Cluster functions and responsibilities, NHSCDD have a formally constituted Independent Contractor Performance Triage Group (GP PTG). The GP PTG has a responsibility to ensure fair, equitable and auditable decisions regarding Independent Contractors referred to the NEPCSA are made, including those on the NHSCDD Performers List.



Directorate Lead: Head of Clinical Quality and Patient Safety

Is this a new or existing policy? New

Equality Group Does this policy have a positive, neutral or negative impact on any of the equality groups?

Please state which for each group.

Age Neutral

Disability Neutral

Gender Reassignment Neutral

Marriage And Civil Partnership

Neutral

Pregnancy And Maternity

Neutral

Race Neutral

Religion Or Belief Neutral

Sex Neutral

Sexual Orientation Neutral

Carers Neutral

Screening Completed By

Job Title and Directorate

Organisation Date completed

Jeffrey Pearson Policy and Corporate Governance Lead

NHS County Durham and Darlington

4 September 2011

Directors Name Directors Signature Organisation Date

Mike Guy

NHS County Durham and Darlington

4 September 2011



Appendix 1

Terms of Reference Independent Contractor Performance Triage Group

1. Constitution

1.1 North Durham, Darlington and Durham Dales Easington and Sedgefield

(DDES) CCGs have resolved to establish the General Practitioner Performance Triage Group (GP PTG).

1.2 The role of the GP PTG is to provide a forum to ensure concerns raised about general practitioners can be discussed internally within the CCGs, with the support of North of England Commissioning Support (NECS), to determine whether further investigation by the NHS England Area Teams is required.

2. Membership

2.1 Membership of the GP PTG comprises: GP Quality Lead North Durham CCG GP Quality Lead Darlington CCG GP Quality Lead DDES CCG Senior Clinical Quality Manager - NECS GP PTG Administrator (notes) Chair arrangements to be agreed within the GP PTG Quorum

A quorum shall be when a minimum of two CCG GP Clinical Quality Leads and the NECS Senior Clinical Quality Manager or their deputy is present. 3. Attendance at Meetings 3.1 Other members of the CCGs, NECS and the NHS England Area Team Lead

for Co Durham and Darlington may attend meetings when requested by the Chair.

4. Frequency of Meetings 4.1 Meetings shall be held monthly and will normally be one hour in duration. The

meetings will be stood down if there are no performance concerns to consider. The chair may request additional meetings according to operational or business requirements. If there are no practitioners to discuss, the meeting will be cancelled no later than one day prior to the meeting.

4.2 For urgent cases requiring immediate escalation to NHS England Area Team,

meetings and decisions may be held and made ‘virtually’, i.e. through telephone



calls and emails. The decision and justification for referral will be recorded in writing in all circumstances.

5. Authority The GP PTG is formally constituted within North Durham, Darlington and DDES CCGs and have delegated responsibility to ensure fair, equitable and auditable decisions regarding the referral of practitioners to the NHS England Area Team are made. 6. Duties and Functions

The duties and functions of the GP PTG are:

To receive information and data relating to independent contractors from a variety of sources and to process this information and/or data in accordance to the Data Protection Act.

To ensure all relevant corporate policies and procedures are applied with specific regard to Safeguarding Children, Information Governance and maintaining confidentiality.

To use the information and data to make an informed decision relating to the concerns raised, through use of the approved tools and methodologies.

To use a set of adapted tools based on the NPSA Incident Decision Tree and a standardised Risk Matrix to facilitate discussion and document these decisions (see appendices 2, 3 & 4).

To keep minutes of the meetings and all decisions made for the minimum retention period in accordance to NHS retention schedules.

To complete documentation relating to the decision making process as detailed in 4.

To refer any practitioner to the NHS England Area Team in accordance with the developed framework (see appendix 5).

To ensure that all information considered by the GP PTG is forwarded to the NHS England Area Team so that one organisation has an overview of all actual and potential performance concerns.

To track all referrals made to the NHS England Area Team.

To receive information from the NHS England Area Team regarding referrals made to them about independent contractor and professional performance concerns.

Adhere to the NHS England Area Team Policy and Procedures for Assuring High Standards of Contractors and Performers.

7. Reporting and Communication Arrangements



A copy of the action log of meetings identifying issues and decisions will be treated in the strictest confidence.

NECS will include anonymous details of referrals made to the NHS England Area Team as part of the quarterly and monthly quality reports to the CCG quality groups. A 6-monthly report detailing referrals made to the NHS England Area Team will be presented in the confidential section of the CCG Management Executive by the CCG GP Quality Lead.

The GP PTG will receive information from the NHS England Area Team relating to all the performance concerns they are considering to ensure triangulation with local Incidents, Complaints and concerns, Serious Incidents reported via the STEIS mechanism and local soft intelligence captured on the electronic incident reporting system (Safeguard).

8.0 Review

These Terms of Reference will be reviewed after a period of twelve months.

Appendix 2



Performance Concern Referral Triage Flowchart

Stage 1

Is the concern confirmed to have involved any of the following?

1. SI/Never Events 2. Safeguarding Children or Adult 3. Criminal Actions (informed by Police) 4. Suspected Criminal Actions (including fraud

and theft)

Immediate referral to the NHS England Area Team

Risk assess concerns based on all information.

Stage 3

Refer for consideration to the Interim Performance Review and Triage Group.

GP PTG utilises NPSA Incident Decision Tree to determine level of potential risk of concerns.

Is further information required to make an informed assessment and referral decision?

2 weeks to gather further information as defined by the GP PTG.

Seek written confirmation of the concerns as a minimum or seek further information (reconsider in 2 weeks)

Stage 2

Have there been or are there any of the following?

1. Previous significant performance concerns in the last 24 months?

2. Significant related incidents, complaints or soft intelligence in the last 12 months?

3. Concerns raised by a whistle-blower? 4. Written evidence of the concerns?

No confirmation received or no further Stage 2 information available – Do not consider further

Info received?

Risk Rating = Orange/Red

Formal referral to NHS England Area Team

Risk Rating = Green/Yellow

Case sent to NHS England Area Team for information only

Second case meeting at GP PTG. Is there sufficient information to make an informed assessment and referral decision?

Refer to NHS England Area Team for full information gathering and/or investigation.

No

Yes

Yes

No

Yes

No

No

Yes

Yes

No

Appendix 3



Risk Assess and RAG-rate Refer to NHS England Area

Team

Risk Assess and RAG-rate Refer to NHS England Area Team

Risk Assess to determine RAG-rating and referral status.

Risk Assess to determine RAG-rating and referral status.

No formal referral to NHS England Area Team Information gathered to be forwarded for

their records



Independent Contractor Performance Concern Risk Matrix Assessment This assessment should be made in conjunction with discussion facilitated by the use of the NPSA Incident Decision Tree.

Personal Details

Performer Name

Profession

Location/Base Registration No.

Risk Assessment

Likelihood Consequence

1 – Negligible 2 - Minor 3 - Moderate 4 - Major 5 - Catastrophic

1 – Rare 1 2 3 4 5 2 – Unlikely

2 4 6 8 10

3 – Possible

3 6 9 12 15

4 – Likely 4 8 12 16 20 5 – Almost Certain

5 10 15 20 25

Risk Rating Action Tick

Low Risk No formal referral to be made to NHS England Area Team. Case information forwarded to contact at NHS England Area Team for their records (letter template 2)

Medium Risk

No formal referral to be made to NHS England Area Team. Case information forwarded to contact at NHS England Area Team for their records (letter template 2)

High Risk Formal referral to be made to Medical Director at NHS England Area Team (letter template 1)

Extreme Risk

Formal referral to be made to Medical Director at NHS England Area Team (letter template 1)

Date of Assessment

Date of Referral

Signed

Print Name / Position



APPENDIX 5

Our Ref: Direct line

Dr Piper House

King Street Darlington

DL3 6JL

Tel: 01325 364271 Fax: 01325 746101

www.darlingtonccg.nhs.uk

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] Formal referral for consideration for NHS England performance investigation procedures. Following an internal review of concerns raised about [practitioner name], Darlington Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team is required. The purpose of this referral is to notify the NHS England Area Team that the GP PTG considers the attached concerns of potentially sufficient seriousness to require further formal consideration by the NHS England Area Team performance team. This conclusion follows an assessment of the following information; [List details] The concerns have been risk-rated as [high/extreme risk] on our Practitioner Performance Risk Matrix which requires subsequent formal referral to the NHS England Area Team.

http://www.darlingtonccg.nhs.uk/



Where the CCG retain responsibility for overseeing the local resolution of the issues referred (for example, through the NHS Complaints Regulations) the North of England Commissioning Support Clinical Quality Team will continue to liaise with the NHS England Area Team to ensure that they are kept up to date with the outcomes of that resolution. Under the memorandum of understanding: - 1. The CCG Independent Contractor Performance Triage group request the NHS

England Area Team to .......... [action as a performance issue and investigate according to Assuring High Standards of Professional Performance Policy]

2. The CCG will ........... [ e.g Continue to investigate/action the complaint/SUI/CD

incident/prescribing analysis etc] 3. Additional actions agreed are ........ [Complete sections 1 – 3] I would be grateful if you would confirm receipt of this information, and confirm the next steps to be taken in light of this referral, with the Senior Clinical Quality Manager, North of England Commissioning Support at John Snow House, Durham University Science Park, Durham, DH1 3YG. Yours sincerely

Dr Richard Harker GP Quality Lead Darlington CCG

Enc: Practitioner Performance Concern Framework: Individual and Overall Assessment Additional information as follows: [State information]




Dr Piper House

King Street Darlington

DL3 6JL

Tel: 01325 364271 Fax: 01325 746101

www.darlingtonccg.nhs.uk

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] For information only Following an internal review of concerns raised about [practitioner name], Darlington Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team was not required. In order to maintain a single record of potential concerns and prevent fragmentation of information on performers, please find enclosed the information on the case for future reference should further concerns arise about the practitioner. This conclusion follows an assessment of the following information; [List details] The concerns have been rated as [low/medium risk] on our Practitioner Performance Risk Matrix and as such did not require formal referral to the NHS England Area Team, based on the information that we have at this time.

http://www.darlingtonccg.nhs.uk/



If this information is triangulated to other performance concerns you may have received regarding this practitioner I would appreciate it if you could inform us of the action that the NHS England Area Team intends to take. I would be grateful if you would confirm receipt of this information, and confirm the next steps to be taken in light of this referral, with the Senior Clinical Quality Manager, North of England Commissioning Support at John Snow House, Durham University Science Park, Durham, DH1 3YG. Yours sincerely

Dr Richard Harker GP Quality Lead Darlington CCG





Sedgefield Community Hospital

Salters Lane

Sedgefield

TS21 3EE

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] Formal referral for consideration for NHS England performance investigation procedures. Following an internal review of concerns raised about [practitioner name] Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team is required. The purpose of this referral is to notify the NHS England Area Team that the GP PTG considers the attached concerns of potentially sufficient seriousness to require further formal consideration by the NHS England Area Team performance team. This conclusion follows an assessment of the following information; [List details] The concerns have been risk-rated as [high/extreme risk] on our Practitioner Performance Risk Matrix which requires subsequent formal referral to the NHS England Area Team. Where the CCG retain responsibility for overseeing the local resolution of the issues referred (for example, through the NHS Complaints Regulations) the North of England



Commissioning Support Clinical Quality Team will continue to liaise with the NHS England Area Team to ensure that they are kept up to date with the outcomes of that resolution. Under the memorandum of understanding: - 1. The CCG Independent Contractor Performance Triage group request the NHS




Dr Dinah Roy Director of Clinical Quality and Primary Care Development DDES CCG





Sedgefield Community Hospital

Salters Lane

Sedgefield

TS21 3EE

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] For information only Following an internal review of concerns raised about [practitioner name], Durham Dales, Easington and Sedgefield (DDES) Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team is required was not required. In order to maintain a single record of potential concerns and prevent fragmentation of information on performers, please find enclosed the information on the case for future reference should further concerns arise about the practitioner. This conclusion follows an assessment of the following information; [List details] The concerns have been rated as [low/medium risk] on our Practitioner Performance Risk Matrix and as such did not require formal referral to the NHS England Area Team, based on the information that we have at this time. If this information is triangulated to other performance concerns you may have received regarding this practitioner I would appreciate it if you could inform us of the action that the NHS England Area Team intends to take.



I would be grateful if you would confirm receipt of this information, and confirm the next steps to be taken in light of this referral, with the Senior Clinical Quality Manager, North of England Commissioning Support at John Snow House, Durham University Science Park, Durham, DH1 3YG. Yours sincerely

Dr Dinah Roy Director of Clinical Quality and Primary Care Development DDES CCG




Reference KH/?? Your Reference Main number Fax E-mail

01207 285 514 [email protected]

Stanley Primary Care Centre Clifford Road

Stanley DH9 0AB

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] Formal referral for consideration for NHS England performance investigation procedures. Following an internal review of concerns raised about [practitioner name], North Durham Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team is required. The purpose of this referral is to notify the NHS England Area Team that the GP PTG considers the attached concerns of potentially sufficient seriousness to require further formal consideration by the NHS England Area Team performance team. This conclusion follows an assessment of the following information; [List details] The concerns have been risk-rated as [high/extreme risk] on our Practitioner Performance Risk Matrix which requires subsequent formal referral to the NHS England Area Team. Where the CCG retain responsibility for overseeing the local resolution of the issues referred (for example, through the NHS Complaints Regulations) the North of England




Commissioning Support Clinical Quality Team will continue to liaise with the NHS England Area Team to ensure that they are kept up to date with the outcomes of that resolution. Under the memorandum of understanding: - 1. The CCG Independent Contractor Performance Triage group request the NHS




Dr Ian Davidson GP Quality Lead North Durham CCG




Reference KH/?? Your Reference Main number Fax E-mail

01207 285 514 [email protected]

Stanley Primary Care Centre Clifford Road

Stanley DH9 0AB

[Date] Strictly Confidential Dr Hilton Dixon Medical Director North-East Primary Care Services Agency Rapier House Colima Avenue Sunderland SR5 3XB Dear Hilton, Re: [Practitioner Name and Address] For information only Following an internal review of concerns raised about [practitioner name], North Durham Clinical Commissioning Group Independent Contractor Performance Triage Group (GP PTG) has concluded that a formal referral to NHS England Area Team was not required. In order to maintain a single record of potential concerns and prevent fragmentation of information on performers, please find enclosed the information on the case for future reference should further concerns arise about the practitioner. This conclusion follows an assessment of the following information; [List details] The concerns have been rated as [low/medium risk] on our Practitioner Performance Risk Matrix and as such did not require formal referral to the NHS England Area Team, based on the information that we have at this time.




If this information is triangulated to other performance concerns you may have received regarding this practitioner I would appreciate it if you could inform us of the action that the NHS England Area Team intends to take. I would be grateful if you would confirm receipt of this information, and confirm the next steps to be taken in light of this referral, with the Senior Clinical Quality Manager, North of England Commissioning Support at John Snow House, Durham University Science Park, Durham, DH1 3YG. Yours sincerely

Dr Ian Davidson GP Quality Lead North Durham CCG




Appendix 6

Model matrix For the full Risk matrix for risk managers, go to www.npsa.nhs.uk

Table 1 Consequence scores

Choose the most appropriate domain for the identified risk from the left hand side of the table Then work along the columns in same row to assess the severity of the risk on the scale of 1 to 5 to determine the consequence score, which is the number given at the top of the column.

Consequence score (severity levels) and examples of descriptors

1 2 3 4 5

Domains Negligible Minor Moderate Major Catastrophic

Impact on the safety of patients, staff or public (physical/psychological harm)

Minimal injury requiring no/minimal intervention or treatment. No time off work

Minor injury or illness, requiring minor intervention Requiring time off work for >3 days Increase in length of hospital stay by 1-3 days

Moderate injury requiring professional intervention Requiring time off work for 4-14 days Increase in length of hospital stay by 4-15 days RIDDOR/agency reportable incident An event which impacts on a small number of patients

Major injury leading to long-term incapacity/disability Requiring time off work for >14 days Increase in length of hospital stay by >15 days Mismanagement of patient care with long-term effects

Incident leading to death Multiple permanent injuries or irreversible health effects An event which impacts on a large number of patients

Quality/complaints/audit Peripheral element of treatment or service suboptimal Informal complaint/inquiry

Overall treatment or service suboptimal Formal complaint (stage 1) Local resolution Single failure to meet internal standards Minor implications for patient safety if unresolved Reduced performance rating if unresolved

Treatment or service has significantly reduced effectiveness Formal complaint (stage 2) complaint Local resolution (with potential to go to independent review) Repeated failure to meet internal standards Major patient safety implications if findings are not acted on

Non-compliance with national standards with significant risk to patients if unresolved Multiple complaints/ independent review Low performance rating Critical report

Totally unacceptable level or quality of treatment/service Gross failure of patient safety if findings not acted on Inquest/ombudsman inquiry Gross failure to meet national standards

http://www.npsa.nhs.uk/



Human resources/ organisational development/staffing/ competence

Short-term low staffing level that temporarily reduces service quality (< 1 day)

Low staffing level that reduces the service quality

Late delivery of key objective/ service due to lack of staff Unsafe staffing level or competence (>1 day) Low staff morale Poor staff attendance for mandatory/key training

Uncertain delivery of key objective/service due to lack of staff Unsafe staffing level or competence (>5 days) Loss of key staff Very low staff morale No staff attending mandatory/ key training

Non-delivery of key objective/service due to lack of staff Ongoing unsafe staffing levels or competence Loss of several key staff No staff attending mandatory training /key training on an ongoing basis

Statutory duty/ inspections

No or minimal impact or breech of guidance/ statutory duty

Breech of statutory legislation Reduced performance rating if unresolved

Single breech in statutory duty Challenging external recommendations/ improvement notice

Enforcement action Multiple breeches in statutory duty Improvement notices Low performance rating Critical report

Multiple breeches in statutory duty Prosecution Complete systems change required Zero performance rating Severely critical report

Adverse publicity/ reputation

Rumours

Potential for public concern

Local media coverage – short-term reduction in public confidence Elements of public expectation not being met

Local media coverage – long-term reduction in public confidence

National media coverage with <3 days service well below reasonable public expectation

National media coverage with >3 days service well below reasonable public expectation. MP concerned (questions in the House) Total loss of public confidence

Business objectives/ projects

Insignificant cost increase/ schedule slippage

<5 per cent over project budget Schedule slippage

5–10 per cent over project budget Schedule slippage

Non-compliance with national 10–25 per cent over project budget Schedule slippage Key objectives not met

Incident leading >25 per cent over project budget Schedule slippage Key objectives not met

Finance including claims

Small loss Risk of claim remote

Loss of 0.1–0.25 per cent of budget Claim less than £10,000

Loss of 0.25–0.5 per cent of budget Claim(s) between £10,000 and £100,000

Uncertain delivery of key objective/Loss of 0.5–1.0 per cent of budget Claim(s) between £100,000 and £1 million Purchasers failing to pay on time

Non-delivery of key objective/ Loss of >1 per cent of budget Failure to meet specification/ slippage Loss of contract / payment by results Claim(s) >£1 million

Service/business interruption Environmental impact

Loss/interruption of >1 hour Minimal or no impact on the environment

Loss/interruption of >8 hours Minor impact on environment

Loss/interruption of >1 day Moderate impact on environment

Loss/interruption of >1 week Major impact on environment

Permanent loss of service or facility Catastrophic impact on environment



Appendix 7

The Incident Decision Tree: Guidelines for Action

(Adapted from guidance issued by the NPSA. The original guidance can be found at www.npsa.nhs.uk)

The IDT and Performance Concerns

In the context of assessing a performance or contract concern, the Incident Decision Tree is not intended to be a fool-proof tool to provide a definitive outcome for a referral decision. It is intended to facilitate informed discussion for the performance group around the potential factors involved in performance concerns and provide an approved methodology within an agreed format for doing so.

Introduction

The National Patient Safety Agency has developed the Incident Decision Tree to help National Health Service (NHS) managers in the United Kingdom determine a fair and consistent course of action toward staff involved in patient safety incidents. Research shows that systems failures are the root cause of the majority of safety incidents. Despite this, when an adverse incident occurs, the most common response is to suspend the clinician(s) involved, pending investigation, in the belief that this serves the interests of patient safety.

The Incident Decision Tree supports the aim of creating an open culture, where employees feel able to report patient safety incidents without undue fear of the consequences. The tool comprises an algorithm with accompanying guidelines and poses a series of structured questions to help managers decide whether suspension is essential or whether alternatives might be feasible. The approach does not seek to diminish health care professionals’ individual accountability, but encourages key decision makers to consider systems and organizational issues in the management of error.

Initial findings show the Incident Decision Tree to be robust and adaptable for use in a range of health care environments and across all professional groups. It is hoped that applying the tool throughout the NHS will encourage open reporting of actual and prevented patient safety incidents and promote a uniformly fair and consistent approach toward the staff involved.

How the tool works

The user is guided through a series of structured questions about the individual’s actions, motives, and behaviour at the time of the incident. These may need to be answered on the balance of probability—i.e., determining the most likely explanation—taking into account the information available at the time, although the importance of pausing to gather data is emphasized. The questions move through four sequential “tests”:

Deliberate harm

Incapacity

Foresight

Substitution

Possible reasons for the individual’s action are reviewed and the most likely explanation identified. A list of recommended options is then provided for the manager’s consideration. The further the route travelled through the Incident Decision Tree, the more likely the underlying cause is to be a systems failure. The tool does not seek to take away the manager’s judgment by imposing firm answers or solutions. Rather, it emphasizes that



the outcome of a particular incident needs to be based on the investigation of individual circumstances. Indeed, the importance of the manager applying judgment rather than slavishly following the tool is emphasized.

The tool can be used for any employee involved in a patient safety incident, whatever his or her professional group. Ideally it should be applied as soon as possible after the incident, while the facts are still fresh in people’s minds. If new information comes to light, it can be worked through again and may or may not indicate a different outcome.

The four tests

The deliberate harm test

In the overwhelming majority of patient safety incidents, the individual had the patient’s well-being at heart. However, the deliberate harm test helps to identify at the earliest possible stage those rare cases where harm was intended.

The test asks the manager to consider whether the individual’s actions were as intended and whether the outcome was as intended. In the majority of cases, the actions will be as intended, but the outcome will not. The Incident Decision Tree is not a “wrongdoer’s charter.” When it appears deliberate harm was intended, the importance of immediate suspension, together with referral to the police and/or the relevant disciplinary and regulatory bodies, is flagged.

The incapacity test

If intent to harm has been discounted, the incapacity test helps to identify whether ill health or substance abuse caused or contributed to the patient safety incident. The tool can be used whether or not the individual is absent on sick leave. Advice is given on assessing the degree of impact illness might have had on the individual’s behaviour. The whole spectrum of substance abuse is considered, including inappropriate self-medication.

The manager is asked to consider whether the employee was aware of their condition at the time, whether they realized the implications of their condition, and whether they took proper safeguards to protect patients.

The foresight test

If intent to harm and incapacity have been discounted, the foresight test examines whether protocols and safe working practices were adhered to. Our preliminary findings indicate the majority of patient safety incidents involve protocol violation. Users tend to find this section the most challenging to work through, and the need for careful judgment and assessment of the facts is emphasized.

The test asks the manager to consider whether the incident arose because:

No protocol or safe procedure existed.

The protocol was poor.

There were conflicting protocols.

Good protocols were misapplied, routinely violated, or not in regular use.

The individual decided to ignore protocols.

In particular, managers are alerted to the fact that what at first sight appears to be a workable protocol may be problematic in practice. Where the individual violated a sound protocol, the manager is advised to look at a range of factors, such as motivation, information available at the time, the speed with which a decision had to be reached, and



the degree of awareness the individual had of the risk being created. Generally, the more control the individual had over the situation, the more likely it is that the risk was unacceptable. Conversely, in emergency situations where the individual was under extreme pressure and had little time to think through the consequences, the more understandable their action is likely to be.

Guidance is also provided regarding situations where the individual violated a sound protocol for no apparent reason. Such cases often involve a “perceptual slip,” such as picking up the wrong medication or ticking the wrong box on a form.

It is emphasized that there are some circumstances where no further action is required, such as when the individual acted heroically in extreme circumstances or when nothing could have prevented the mishap. In other situations, the incident highlights the need for the individual to receive corrective training, improved supervision, medical support, or adjustment to his or her role.

The substitution test

Finally, if protocols were not in place or proved ineffective, the substitution test helps to assess how a peer would have been likely to deal with the situation.

James Reason advises:

“Substitute the individual concerned, for someone else coming from the same domain of activity and possessing comparable qualifications and experience. Then ask the question ‘In the light of how events unfolded and were perceived by those involved in real time, is it likely that this new individual would have behaved any differently?’”

This test also highlights any deficiencies in training, experience, or supervision that may have been a factor in the patient safety incident and helps to assess whether the individual was properly equipped to deal with the situation. Managers are advised to avoid deducing behavioural norms from blanket judgments and prejudices, such as “All surgeons have temper tantrums,” or “Radiographers find talking to patients difficult,” and to consider what a “reasonable” peer acting sensibly, maturely, and sensitively would have done.

Unacceptable risk

The Incident Decision Tree has one purpose - to guide initial management action following a patient safety incident. It does not explore the standards of proof legally required to support claims of “recklessness,” “reckless behaviour,” or “negligence”. The term “unacceptable risk” has been used instead to describe the concept of an individual taking a risk that would normally be considered unreasonable. This has been found to help users focus on the employee’s motivation and circumstances rather than on the potential consequences of their action.



Table 2 Likelihood score (L)

What is the likelihood of the consequence occurring?

The frequency-based score is appropriate in most circumstances and is easier to identify. It should be used whenever it is possible to identify a frequency.

Likelihood score 1 2 3 4 5

Descriptor Rare Unlikely Possible Likely Almost certain

Frequency How often might it/does it happen

This will probably never happen/recur

Do not expect it to happen/recur but it is possible it may do so

Might happen or recur occasionally

Will probably happen/recur but it is not a persisting issue

Will undoubtedly happen/recur, possibly frequently

Note: the above table can be tailored to meet the needs of the individual organisation.

Some organisations may want to use probability for scoring likelihood, especially for specific areas of risk which are time limited. For a detailed discussion about frequency and probability see the guidance notes.

Table 3 Risk scoring = consequence x likelihood ( C x L )

Likelihood

Likelihood score 1 2 3 4 5

Rare Unlikely Possible Likely Almost certain

5 Catastrophic 5 10 15 20 25

4 Major 4 8 12 16 20

3 Moderate 3 6 9 12 15

2 Minor 2 4 6 8 10

1 Negligible 1 2 3 4 5

Note: the above table can to be adapted to meet the needs of the individual trust.

For grading risk, the scores obtained from the risk matrix are assigned grades as follows

1 - 3 Low risk 4 - 6 Moderate risk

8 - 12 High risk

15 - 25 Extreme risk

Instructions for use

1 Define the risk(s) explicitly in terms of the adverse consequence(s) that might arise from the risk.

2 Use table 1 (page 13) to determine the consequence score(s) (C) for the potential adverse outcome(s)

relevant to the risk being evaluated.

3 Use table 2 (above) to determine the likelihood score(s) (L) for those adverse outcomes. If possible,

score the likelihood by assigning a predicted frequency of occurrence of the adverse outcome. If this is

not possible, assign a probability to the adverse outcome occurring within a given time frame, such as

the lifetime of a project or a patient care episode. If it is not possible to determine a numerical probability

then use the probability descriptions to determine the most appropriate score.



4 Calculate the risk score the risk multiplying the consequence by the likelihood: C (consequence) x L

(likelihood) = R (risk score)

5 Identify the level at which the risk will be managed in the organisation, assign priorities for remedial

action, and determine whether risks are to be accepted on the basis of the colour bandings and risk

ratings, and the organization’s risk management system. Include the risk in the organisation



Appendix 8

The Department of Health 25 ‘Never Events’

There are 25 "never events" on the expanded list. This includes the original eight events from previous years, some of which have been modified, and builds on the draft list published in October 2010. Any independent contractor that is directly involved in an incident that features on this list should be referred immediately to the NHS ENGLAND AREA TEAM:

1. Wrong site surgery (existing)

2. Wrong implant/prosthesis (new)

3. Retained foreign object post-operation (existing)

4. Wrongly prepared high-risk injectable medication (new)

5. Maladministration of potassium-containing solutions (modified)

6. Wrong route administration of chemotherapy (existing)

7. Wrong route administration of oral/enteral treatment (new)

8. Intravenous administration of epidural medication (new)

9. Maladministration of Insulin (new)

10. Overdose of midazolam during conscious sedation (new)

11. Opioid overdose of an opioid-naïve patient (new)

12. Inappropriate administration of daily oral methotrexate (new)

13. Suicide using non-collapsible rails (existing)

14. Escape of a transferred prisoner (existing)

15. Falls from unrestricted windows (new)

16. Entrapment in bedrails (new)

17. Transfusion of ABO-incompatible blood components (new)

18. Transplantation of ABO or HLA-incompatible Organs (new)

19. Misplaced naso- or oro-gastric tubes (modified)

20. Wrong gas administered (new)

21. Failure to monitor and respond to oxygen saturation (new)

22. Air embolism (new)

23. Misidentification of patients (new)

24. Severe scalding of patients (new)

25. Maternal death due to post-partum haemorrhage after elective Caesarean section (modified)