MEETING OF THE - NHS Rushcliffe Clinical Commissioning Group fileCC/16/242 Deep Vein Thromb osis proposal as shareholders in NEMS Healthcare pat hways declarations CC/16/240 Minutes

NHS Rushcliffe Clinical Commissioning Group Page 1 of 12 1 December 2016 - Minutes Chair – Dr. Stephen Shortt CS/NHS Rushcliffe CCG Clinical Cabinet

MEETING OF THE RUSHCLIFFE CLINICAL COMMISSIONING GROUP

CLINICAL CABINET HELD ON THURSDAY 1 DECEMBER 2016 AT 1.30PM EASTHORPE HOUSE, 165 LOUGHBOROUGH ROAD

RUDDINGTON, NOTTINGHAM NG11 6LQ

All attendees should be aware of NHS Rushcliffe CCG’s participation in the Freedom of Information Act. The minutes and papers from this meeting will be published in the Publication Scheme with all names included, unless notified to the Chair before the meeting commences or included in a pre-agreed confidential section due to the sensitive nature of the debate.

Membership: ‘A’ Denotes absence

Stephen Shortt Clinical Leader (GP Chair) (SS)

Jeremy Griffiths Governing Body GP member – Health & Wellbeing (JG)

Gavin Derbyshire Governing Body GP member – Membership (GD)

A Ram Patel Lead - Primary Care Quality (RP)

Neil Fraser Lead - Long Term Conditions (NF)

A Alex Macdonald Lead - Prescribing (AM)

Lynn Ovenden Lead - Community Services Commissioning (LO)

Matt Jelpke Lead - Acute Specialist (elective) (MJ)

Chris Cope Lead - Acute Specialist (non-elective) (CC)

Nick Page Lead - Mental Health (NP)

A Ann-Marie Stewart Lead - Education (AMS)

A Sean Ottey Lead - Clinical Innovation (SO)

Louise Bevan Lead - Children & Young People (LB)

Vicky Bailey Chief Officer (VB)

Helen Griffiths Assistant Chief Operating Officer (HG)

A Jonathan Gribbin Consultant in Public Health (JoG)

A Jonathan Bemrose Director of Finance or nominated deputy (JB)

Sheila Hyde Governing Body Lay Member Representative (SH)

Kathryn Chambers Practice Manager Representative (KC)

In attendance:

A Prof. Chris Hawkey Secondary Care Doctor, Nottingham University (CH)

A Ian Trimble Independent GP Advisor (IT)

Richard Stratton GP, Belvoir Health Group (RS)

A Jag Rai GP, Ruddington Medical Centre (JR)

A Linda Kandola GP, Gamston Medical Centre (LK)

Nigel Cartwright GP, Orchard Surgery (NC)

Louise Glasgow GP, Keyworth Medical Practice (LG)

Andrew Wrench GP, East Leake Medical Group (AW)

Clare Hopewell Assistant Chief Finance Officer (CHo)

A Andy Hall Director of Outcomes & Information (AH)

Fiona Callaghan Head of Strategy and Service Development (FC)

John Kemp Health Development Officer (JK)

Marie Crowley Mental Health Commissioning Manager (MC)

Julie Theaker Assistant Programme Director – Urgent Care (JT)

Helen Jones Head of Urgent Care (HJ)

Caroline Stevens Governance Officer (minutes) (CS)

RCCG/GB/17/020 ii)


ACTION

CC/16/237 Welcome

SS welcomed everyone to the meeting of the Clinical Cabinet. The Cabinet noted that JK, MC, JT, HJ and FC would attend the meeting for their items only.

CC/16/238 Apologies for Absence

Apologies were received from RP, LK, SO, AM, AH, JoG, CH and IT.

CC/16/239 Declarations of Interest

A standing general declaration of interest was acknowledged in respect of: (i) All participants who have provider contract(s) with the Clinical Commissioning Group

(CCG) (ii) All participants with membership of Nottingham Emergency Medical Services (iii) All participants with membership of Partners Health (iv) All participants with roles and responsibilities within the Multi-specialty Community

Provider Declarations of interest were also made for JG, GD, NF, LO, MJ, NP, NC and HG in relation to item CC/16/242 Deep Vein Thrombosis proposal as shareholders in NEMS Healthcare pathways declarations

CC/16/240 Minutes of the Last Meeting held on 3 November 2016.

The minutes of the previous meetings were agreed as an accurate record.

CC/16/241 (i) Action List

The Cabinet reviewed the schedule of actions CC/16/181 Fracture Liaison Service Update. AMS was scheduled to attend the following Clinical Cabinet meeting to provide an update CC/16/207 Substance Misuse Services (including Alcohol Skype services). Website searches for CGL now identified Rushcliffe clinics. CC/16/223. Declarations of Interest. Future minutes would reflect members’ interests in the Multi-specialty Community Provider (MCP). All members would need to update their declaration of interest forms to reflect this. These interests would be mirrored in the MCP’s Clinical Delivery Group and Governance Group meetings. CC/16/232 Clinical Contract Board (CCB). There had not been a further meeting of the CCB to feedback regarding a mechanism was needed for disseminating information from meetings to GPs. Action: JG to feedback

JG


All other actions were noted as complete

CC/16/241 (ii) Matters Arising not elsewhere on the agenda

VB reported that she and other CCG colleagues would meet with NHS England Midlands and East on the following Tuesday regarding the CCG’s financial position. This meeting had been escalated and brought forward due to the worsening financial situation. VB noted that the Sustainable Transformation Plan for Nottinghamshire had been published and this was now available on the CCG’s website. VB reported that for the first time, NUH had reported a black alert on Tuesday that week due to waiting times in Accident and Emergency (A&E). The trust’s performance for the four hour wait target fell and was rated 126 out of 129 trusts nationally. The black alert triggered a review, VB and other local CCG leaders attended the department to support performance on the day and the Trust would now receive mandated specific targeted improvement from NHS Improvement and the Quality Commission. Cabinet members recognised that patients entering A&E received a good clinical service, the department was unable to deliver the service within the target times and noted that this resulted from system wide challenges, rather than just within the A&E department. The Cabinet discussed the need for culture to change across the hospital and system to encourage patient discharges to other care facilities or home when possible. VB noted that a Project Management Office (PMO) team had been established to address the financial gap. This team was co-ordinated by Andy Hall, Director of Outcomes and Information. VB highlighted that part of this work included an upcoming engagement event around prescribing medication available over the counter (OTC). The Cabinet noted that West Leicestershire CCG had previously engaged around this and had made changes to their prescribing and asked if feedback could be requested regarding experiences of GPs.

CC/16/242 Deep Vein Thrombosis Proposal

CC presented an overview paper of the Deep Vein Thrombosis (DVT) Proposal to the Cabinet for approval. The Cabinet noted that JG, GD, NF, LO, MJ, NP and HG had an interest in this item as shareholders in NEMS Healthcare pathways. The meeting Chair agreed that those members with an interest could participate in discussion as clinical experts, however, would withdraw from voting. Due to apologies, there were not enough members remaining for the meeting to be quorate for the item, therefore, no decision could be made at that meeting, a discussion would be held and the item included on the following meeting agenda. NEMS Community Benefit Services Ltd had been commissioned from July 2015 to provide an assessment of patients with suspected DVT in hours. The aim of the service was to divert patients away from Nottingham University Hospitals. It was expected that there would be up to 10 assessments required per day Monday to Friday and contract value was based on this modelling. Modelling by the provider recently had shown they were seeing an average of 16 patients per day. Due to the increase in patients being referred to the service, and the volume of scan slots available


each day, there were occasions when the service was not able to arrange a scan appointment for a patient until the following day. On these occasions the patient was provided with a supply of the drug Enoxaparin, which was administered to prevent and treat deep vein thrombosis or pulmonary embolism. The costs for these drugs were not included in the original service specification because it was not envisaged that volumes of patients would be more than the number of available scans per day. The service was not able to consistently source Enoxaparin from the Queen’s Medical Centre, instead needing to use the Community Pharmacy and were now incurring costs of £1,000 per month for Enoxaparin. NEMS Community Benefit Services Ltd had indicated that they were unable to continue providing the service in its expanded form without additional funding. This business case presented to the Cabinet requested non-recurrent funding of £32,844 to cover the period of September 2016 – March 2017 based on £25,844 for additional staffing costs and £7,000 for Enoxaparin. The £32,844 of non-recurrent funds that were being requested would be split between four CCGs, Rushcliffe would fund 15.5 percent of this at £5,090. In addition, the business case requested additional recurrent funding of £56,303 per annum from April 2017, based on £44,303 for additional staffing costs and £12,000 for Enoxaparin. CC noted that if the extra six patients per day were treated in ED the cost per annum would be £137,000. The £56,303 of recurrent funds that were being requested would be split between four CCGs, Rushcliffe would fund 15.5 percent of this at £8,727. This Business Case reflected the shared understanding across the health community of the importance of a timely and effective Primary Care led DVT service, and as such would be presented at each CCG`s Clinical Cabinet or equivalent, in order to consider the case for additional funding and the risks to continuation of the service if additional funding was not agreed. The Cabinet noted that if staffing were increased to accommodate 16 patients per day, the service should no longer require Enoxaparin. Action: HG to clarify with Nottingham City CCG lead The Cabinet discussed the use of d-dimer testing to potentially reduce the number of patients requiring appointments The Cabinet ACKNOWLEDGED the paper and agreed to discuss further and approve at the following meeting when quorate.

HG

CC/16/243 Parity of Esteem briefing

MC presented a Parity of Esteem briefing to the Cabinet for discussion and approval. Parity of Esteem (POE) set the agenda for CCGs to ensure that patients with a severe Mental Illness (SMI) had a life expectancy that matched that of the wider community. Recent reports recommended actions for a system wide approach in tackling the Parity Agenda. The report presented set out recommendations for the CCG to acknowledge and put into place an action plan in order to meet the objectives of Parity of Esteem and to appoint a clinical board member who had responsibility for overseeing the implementation and review of the action plan to reduce the increased mortality of patients with a SMI in the Rushcliffe CCG area. MC noted that patients with a SMI were twice as likely to have a heart attack and three times more


likely to suffer from a respiratory condition. Current registers showed that 61 percent of patients in Rushcliffe with a SMI had not had an annual health check. The Cabinet discussed opportunities to capture this information across primary, secondary care and community mental health clinicians. The Cabinet noted a gap between community physical health teams and community mental health teams and that this would take time to establish. Members also discussed the importance of smoking cessation advice being provided by all clinicians at every contact with patients, however, did not feel that all clinicians would feel appropriately trained to deliver this advice. Members highlighted that NP was leading work around this agenda through the MCP and NF was also involved on most issues through Long Term Conditions work for the MCP. The Cabinet noted that data had been collected and reviewed over several years, however, this had been difficult to convert into actions. The MCP wanted to complete a deep dive into this to understand what the barriers are to improvement and develop an action plan. The Cabinet APPROVED the development of a POE action plan to cover the responsibility of the CCG, Primary care and our providers and agreed Nick Page would have responsibility for the action plan and report back on its implementation to the Clinical Cabinet as part of his role in the MCP

CC/16/244 Care Delivery Group Update

HG presented an update for the Care Delivery Group (CDG) to the Clinical Cabinet for information. Following a pilot in South Rushcliffe, the decision had been made to roll out the Care Delivery Groups to North and Central Rushcliffe. A CDG was the extension of the community ward concept, including social care and the voluntary sector working as part of the integrated community teams and primary care. The Rushcliffe pilot of the CDG started in December 2015 had shown a slight reduction in emergency admissions compared to the rest of Rushcliffe practices. It had always been the ambition to extend the integrated community services to include social care and the voluntary sector and funding had now been allocated from the Better Care Fund to extend the current pilot to include North and Central Rushcliffe. Each community ward, now called Care Delivery Group, would consist of the integrated community nursing and therapy staff, a local authority community care officer, an Age UK Living well Co-ordinator, allocated volunteers within Age UK and a social worker dedicated to work within the community teams across Rushcliffe. The same pilot was being replicated at Nottingham North and East CCG. In answer to a question, CC confirmed that all clinicians and patients could self-refer to the service through the Single Point of Access (SPA). The Cabinet NOTED the update.

CC/16/245 EMAS Community Car

CC presented a paper on the EMAS Community Car to the Cabinet for information. Many projects had contributed to avoiding non elective admissions, however, a significant area of


activity at both Accident and Emergency (A&E) and unplanned admissions was from EMAS conveyance. Through discussions with the Health Care in Older People (HCOP) in-reach team, data showing 80 percent of urgent admissions were from A&E, and results from a very small trial (as part of the ‘breaking the cycle’ scheme) in January 2016, it was felt a larger project to support the reduction of ambulance conveyance would have a positive outcome for patients and the wider health system, including EMAS and A&E targets. Funding was secured from the Principia MCP enabling two EMAS technicians to be employed and ring fenced to Rushcliffe to provide a 999 response. Rushcliffe had been divided into North and South with a service running Monday to Friday from nine am to six pm. The service commenced on 3 October 2016, with three days community service induction, and a go live date of 6 October 2016. The project has the primary focus of reducing ambulance conveyance to A&E, when an alternative to hospital care was safe and appropriate to do so. The technicians work closely with community services, utilise the 10 minute protocol and the GP bypass numbers to provide a safe and supportive alternative to conveyance. The technicians are also supported by GP clinical weekly supervision and teaching sessions to increase their confidence and knowledge. In the first six weeks Rushcliffe had seen an improvement on EMAS 999 response performance, there had been a reduction in conveyance, there was a reduction of A&E attendances and a significant improvement on job satisfaction reported by the technicians. The Clinical Cabinet noted that the outputs of the project, at this point, required further monitoring to draw any statistically relevant conclusions. In answer to a question, CC confirmed that technicians could administer adrenalin and oxygen, although did not have advanced skills. The technicians did not carry defibrillators, however, could use if they were available in the community. Action: Elizabeth Harris to confirm to Cabinet how many care homes have defibrillators The Cabinet noted the positive impact of the scheme The Cabinet NOTED the paper.

Elizabeth Harris

CC/16/246 Self-care Management

JG presented a Self-care Management paper to the Cabinet for approval. Nottinghamshire County Council had launched an online information and advice centralised resource to support citizens in Nottinghamshire to be independent and self-care. The Notts Help Yourself website was a partnership between health, the voluntary sector and Nottinghamshire County Council to bring information and advice together in one central place so people can find the information they need easily. The paper outlined proposals for embedding the online resource within practice systems to enable GPs, and nurses to sign-post patients to the information resource or provide information to patients. This supported the delivery of the Multi-speciality community provider (MCP) workstream one for self-care. JG explained that this was an opportunity for primary care to work together with secondary care and third sector organisations and asked practices to add the link to their webpages. The Cabinet noted


that Notts Help Yourself was also now linked to the national One You Campaign website and anyone accessing the One You campaign online with a Rushcliffe postcode would be redirected to the Notts Health Yourself website. Linked to STP – key aims. Patients supported to be independent and self-care. Preventative care. This work supports. Notts Help Yourself website. Integrate between health and social care. Asking practices to add to their websites. In time think about common front page for self-care. Opportunity to work together, primary, secondary and third sector. Influenced the one you campaign, changed centrally so anyone accessing with Rushcliffe postcode will link to Notts Help Yourself. The Cabinet APPROVED the adoption and promotion of this online resource across CCG/stakeholders and PRACTICES AGREED to embed the online resource into practice clinical systems and websites. VB highlighted that Rushcliffe Borough Council’s annual dinner for their councillors this year had a focus on health and wellbeing and a representative from each practice and guest was invited to attend. The Cabinet noted that this was an opportunity to build relationships and share experiences and information about the practices

CC/16/247 County CCGs’ Research Activity Report 2016/17 Q2

VB presented the County CCGs’ Research 2016/17 quarter two Activity Report to the Cabinet for information. The Cabinet NOTED the report.

CC/16/248 Cosmetic Procedures Report 2016/17 Q2

VB presented the Cosmetic Procedures 2016/17 quarter two report to the Cabinet for information. Where the East Midlands Commissioning Policy for Cosmetic Procedures (all ages) stated that prior approval was needed, requests from the five Nottinghamshire County Clinical Commissioning Groups (CCGs), and NHS Nottingham City were assessed by the Individual Funding Request (IFR) Officer and a Specialist Nurse Practitioner in line with the eligibility criteria set out in the policy. The report detailed the total number of referrals received and assessed against the cosmetic procedures policy, for each specific procedure where there was eligibility criteria for access to NHS funded treatment during quarter two of 2016/17. The Cabinet NOTED the report.

CC/16/249 Urgent Care Vanguard Update

JT and HJ attended the Cabinet to present an update on the Urgent Care Vanguard to the Cabinet for information. JT and HJ explained that Integrated Urgent Care (IUC) was integrating pathways and developing a clinical hub to support patients to access the right advice or treatment first time. This would be achieved through an enhanced NHS111 service providing improved patient information for call responders. A Comprehensive Directory of Services with mobile application, greater levels of clinical


input through a ‘decision support hub’ (mental health, dental heath, paramedic, pharmacist, GP) and booking systems for GPs, UCCs, dentists, pharmacy. There were eight key element of the IUC:

A patient could make an appointment out of hours in a single call

A patient could make an appointment during the in hours period

Data could be transferred between providers

The Summary Care Record (SCR) was available in the hub and elsewhere

Care plans and patient notes were shared

The number of patients speaking to a clinician increased above the current level of 22 percent by the implementation of a Clinical Hub

The capacity for NHS111 and out of hours was jointly planned

There was joint governance across Urgent and Emergency Care providers The project was progressing with the development of a clinical advisory service operating at both regional and local level that would include:

• Re-assessment of 111 green calls across Nottinghamshire to reduce conveyance (Green four calls live from October 2016, green two calls live before Christmas)

• Warm transfer of calls from 111 to mental health crisis team across Nottinghamshire (in place)

• GP led clinical hub operating 24/7 to re-assess A&E calls, Primary care ‘speak to’ dispositions (OOHs live on 5 December, in hours due in January 2017)

• Direct booking offer for patients requiring an appointment to primary care services (December 2016)

• End to End Call Review policy developed and implemented October 2016 • Data sharing enabled through ‘Connected Notts’ development of Medical Interoperability

Gateway (MIG) The service was also working to deliver:

• Mental health navigation, including access to mental health advice and guidance for GPs and quick onward referral pathways

• Primary Care Front door, including new triage/ treatment process to increase number of patients attending treated by primary care (12 December 2016)

The expected outcomes of the IUC were:

• Activity reduction at A&E on 111 dispositions of 75% • Activity reduction of green four ambulance dispositions see, treat, convey of 100 percent • Activity reduction of green two ambulance dispositions see, treat, convey of 11 percent • Primary Care at the front door, new streaming model to deliver an increase from 13 percent

seen treated and discharged to 20 percent in line with national guidance • 111 pharmacist to deliver 47 percent reduction in medication query/ repeat prescription

activity in out of hours The Cabinet noted the need for a thorough clinical assessment as part of the 111 triaging system and need for changes to be communicated to patients about a more integrated system. Members agreed that GP practices needed to be the first point of contact for patients and that allowing the 111 service to book appointments into primary care would work against this as patients. The Cabinet NOTED the update.


CC/16/250 Finance Report

CH presented the Finance Report to the Cabinet for information. There were a number of significant financial pressures emerging in the year to date position. These gave rise to a continued risk that the 1 percent surplus target would not be delivered and a further risk that the statutory duty to remain within the revenue resource limit may be breached. A significant deterioration in the planned underlying position had been reported NHS England. The Chief Officer and Chief Finance Officer have agreed to place the CCG into Internal Financial Recovery. The CHC turnaround group continued to meet bi-weekly to control spend on the CHC budget area. CH highlighted that £2 million was required by the end of March 2017 and the Cabinet noted that as a result of the financial position the CCG was now required to provide more information to NHS England to provide assurance of recovery. VB noted that PartnersHealth had implemented a referral triage system since the last meeting. MJ had triaged approximately 100 referrals so far and between 10 and 12 referrals had been redirected. The Cabinet noted that information provided in referral letters was usually different to the discussion a doctor would have with a colleague when deciding whether to refer as the decision had not been made at that point. Members would discuss an alternative of discussion within practices before referral rather than triaging referrals at the following PartnersHealth meeting. The Clinical Cabinet NOTED the report

CC/16/251 QIPP Group Highlight Report

CH presented the QIPP Group Highlight Report to the Cabinet for information. The Chief Officers of the Greater Nottingham CCGs (Rushcliffe, Nottingham North and East, Nottingham West and Nottingham City) had informed NHS England that the CCGs were now in “Internal Turnaround” to recover the financial position for 2016-17. The Clinical Cabinet NOTED the report

CC/16/252 Performance Report

In AH presented the Performance Report to the Clinical Cabinet for information. For the CCG, the indicators out of trajectory were -

Performance for September 2016 highlighted that Rushcliffe CCG was below standard for the following cancer pathways:

- 62 Day Urgent RTT (75.76 percent against a standard of 85 percent) - 31 Day DTT (95.08 percent against a standard of 96 percent) - 2ww – Breast Symptoms (83.33 percent against a standard of 93 percent)

Rushcliffe CCG failed to achieve the Accident and Emergency (A&E) standard for September 2016 with performance at 78.52 percent against a standard of 95 percent.

For NUH, the indicators out of trajectory were:

The following cancer pathways failed to meet their respective standards during September 2016:

- 62 Day Urgent RTT – 70.78 percent (standard is 85 percent)


- 62 Day Urgent RTT: Screening Service – 69.70 percent (standard is 90 percent)

For 18 Week RTT NUH achieved the 92 percent Incomplete standard in October 2016, however were below standard for the following specialties:

- General Surgery – 91.60 - Trauma and Orthopaedics – 90.98 percent

In October 2016 Accident and Emergency performance was below the 95 percent standard at 79.20 percent

In October 2016 the 95 percent standard of patients waiting less than seven working days to arrange an appointment was not met with performance at 51 percent. The 100 percent standard for patients waiting less than 14 workings days was also missed with NUH achieving 83 percent

Performance for September 2016 showed that 1503 ambulance handovers took longer than 30 minutes and 113 exceeded 60 minutes. This was against a standard of 0

NUH experienced two Never Events in September 2016 against a standard of 0

The target for reduction of pressure ulcers graded two to four was not met in August 2016 The report noted that Red one and Red two performance for EMAS remained below standard for the eight and 19 minute targets. VB noted that performance for Cancer 62 day waits was being scrutinised and a Remedial Action Plan was in place for this. The Clinical Cabinet NOTED the update

CC/16/253 Multi-specialty Community Provider Update

FC provided an update on the Multi-specialty Community Provider (MCP) to the Cabinet for information. The 2017/18 funding proposal had been submitted the week before, this had applied for £3.8 million for Principia MCP in Rushcliffe and £14 million for roll out to wider CCGs. An application was also made for £8 million for primary and community services. These applications would be reviewed by an NHS England Committee the following Tuesday and decisions should be announced before Christmas. The MCP was going through a procurement process for an evaluation partner and this was hoped to be awarded by January 2017. The Cabinet noted their thanks to FC and Liz Kaufman for their hard work progressing the MCP. The Cabinet NOTED the update

CC/16/254 Health and Wellbeing Board

JG highlighted the Health and Wellbeing Board update to the Cabinet for information. JG urged members to be aware of the Sustainable Transformation Plan (STP) and look at the summary as will impact General Practice. The Clinical Cabinet NOTED the update.


CC/16/255 Clinical Contract Board

JG noted there had not been a meeting of the Clinical Contract Board since the last Clinical Cabinet meeting. The Clinical Cabinet NOTED the update.

CC/16/256 Individual Funding Request Panel

In SO’s absence, this item was deferred to the following meeting.

CC/16/257 Prioritisation panel

In SO’s absence, this item was deferred to the following meeting.

CC/16/258 Messages to Practice Managers’ Forum, Governing Body and Patient Cabinet

The Cabinet agreed the following key items for the highlight report:

CC/16/241 (ii) Matters Arising not elsewhere on the agenda CC/16/242 Deep Vein Thrombosis Proposal CC/16/243 Parity of Esteem briefing CC/16/244 Care Delivery Group Update CC/16/245 EMAS Community Car CC/16/246 Self-care Management CC/16/249 Urgent Care Vanguard Update

CC/16/259 Any Other Business

NF noted that the CCG was applying to Bayer for equipment costs for 20 items to monitor Atrial Fibrillation, the expected value of this would be £2000. Quotes had been obtained to ensure that this was a competitive rate and that if more units were purchased this would be done through NHS Supplies. A sponsorship agreement and further details would be presented at the following meeting for approval. The Cabinet noted that now some Clinical Cabinet functions were moving into PartnersHealth, Cabinet meetings could be shortened and all future meetings would aim to finish at 3.30 pm.

Meeting closed at 3-45pm.

DATE OF NEXT MEETING The next meeting will be held on: Thursday 5 January 2017 at 1.30pm Clumber Room Easthorpe House 165 Loughborough Road Ruddington Nottingham NG11 6LQ


Members should inform the meeting secretary of any apologies and deputies attending on their behalf at least 10 working days prior of the next meeting. This is to ensure that the meeting is quorate and any action from potential declarations of interest are handled appropriately in advance

Signed by………………………………… Chair – Dr. Stephen Shortt

Date …………………………………

Documents

MEETING OF THE - NHS Rushcliffe Clinical Commissioning Group fileCC/16/242 Deep Vein Thromb osis proposal as shareholders in NEMS Healthcare pat hways declarations CC/16/240 Minutes