Clinical Executive Committee Chair''s Report - NHS Haringey by TY50pb


									Meeting                   Date                       Agenda Item

Trust Board               25th March 2009            7

Title of paper:

Clinical Executive Committee Chair’s Report


Minutes from the December 2008 meeting, plus the February 2009 meeting
are attached, as well as the agenda of the March 2009 meeting. A summary
of the output from the latter meeting is included – detailed minutes will be
available at the May Board.

Board action:

For information.

Lead Officer information:

Name:     James Slater
Position: Director of Performance & Primary Care
Contact details: 020 8442 6789
Fit with:
Operating Plan Strategic Priorities:

The CEC provides clinical & primary care leadership to the TPCT as it addresses its

Assurance and governance:

The CEC is a key part of the TPCT’s governance mechanisms.

Implications for:
Performance and quality:

The CEC provides clinical & primary care expertise to performance management.


The CEC provides clinical & primary care expertise to resource management.

Corporate Risk:

The CEC is a key part in managing clinical & primary care aspects of risk.

Stakeholder involvement/public relations:

The CEC is a key part of our relationship with clinical stakeholders in Primary Care.

                           MINUTES OF THE
                       EXECUTIVE COMMITTEE
                    HELD ON 10th DECEMBER 2008


Dr Mayur Gor             Chair
Penny Thompson           Acting Deputy Chief Executive
Judy Allfrey             Non Executive Director
Sue Rubenstein           Non Executive Director
Dr Jackie Mansfield      GP
Dr Sejal Pandya          GP
Dr Nalliah Sivananthan   GP
Dr Alex Tsilegkeridis    GP
Kristina Petrou          Pharmacist Lead
Delia Thomas             Allied Healthcare Professional
James Slater             Director of Performance and Primary Care
Sue Tokley               Executive Nurse
Jill Shattock            Deputy Director, PBC and Acute Commissioning
Eugenia Cronin           Director of Public Health

In attendance:

Steve Beeho, Helen Donovan.

Dr Mayur Gor welcomed Members to the first meeting of the Clinical
Strategy and Primary Care Executive Committee.

1.    Apologies

      Apologies were received from Tracey Baldwin and Mun Thong Phung
      and Vicky Hobart.

2.    Minutes of Previous Meeting

      The Minutes of the previous Meeting were agreed, subject to Jill
      Shattock being added to the list of attendees.

3.    Matters Arising

      Any matters arising were picked up on the agenda.
4.   Executive Report

     Penny Thompson noted that the Executive Report was largely self-
     explanatory. However the following points regarding the update on the
     Influenza Pandemic Plan were highlighted:
          A successful simulation exercise was held on 14th November,
            attended by a good mix of health and social care staff, including
            two 2 GPs
          The draft plan was due to be brought to the January Board
          The PCT was about to complete its annual self-assessment,
            confirming that it was compliant in approximately half the areas
            of the assessment. According to NHS London, the PCT was
            currently ranked as ‘middling’ in comparison to the progress
            made by other PCTs.
          It was clear that more work was needed in particular on
            business continuing planning.
          Tamara Djuretic had recently been appointed as lead for
            Influenza Pandemic Planning.

     The CEC noted the Executive Report.

5.   Notes From Clinical Executive Awayday

     Penny Thompson provided an overview of the notes from the
     discussion of child protection at the recent Clinical Executive awayday.

     It was agreed that an expanded version of the notes should be taken
     to the Safeguarding Board. In particular, more detail was needed
     regarding quality assurance.

     CEC members discussed how GPs participate in practice in decision-
     making relating to child protection. It was noted that it was often
     impractical for them to attend case conferences and the form which
     they are asked to complete was often too generic for individual cases
     and did not always elicit the necessary information.

     Dr Mansfield expressed concern about how the loose ends in cases get
     tied up. She cited a case where she had responded to a request for
     information by phoning the officer in question, as a result of which
     more crucial information came to light which might not otherwise have
     been shared.

     Mayur Gor highlighted that the Haringey population is extremely
     mobile, with high numbers of patients deregistering and reregistering.
     It was therefore critical that every child is seen by a GP when they are
     registered. The LMC was equally adamant that this should be the case.
     Any communications issues which arise also needed to be addressed
     proactively. He observed that it was essential that these messages are
     discussed by the collaboratives and suggested that Dr Mansfield work
     up the incident she mentioned as a case study.

     Penny Thompson agreed with Dr Mansfield that issues often emerge
     via two-way conversations that would not otherwise come to light via

     Dr Sivananthan echoed this and stated there needed to be a
     commitment from GPs that telephone calls from social workers should
     be prioritised.

     Penny Thompson noted that this strong message would be welcomed
     by the Safeguarding Board.

     Mayur Gor reaffirmed the need for more openness and information-
     sharing among professionals. He noted that it would be constructive for
     all four collaboratives to hold an educational event, with representation
     from children’s services. Assurance was also needed that practices are
     adhering to mandatory child protection training. In any cases where
     this was not happening, it would need to be followed up by James
     Slater’s team.

     The CEC agreed the actions in the notes from the Clinical
     Executive Awayday, subject to the comments above.

6.   Baby P Update

     Penny Thompson provided an overview of the Joint Area Review of
     Haringey Children’s Services.

     The Local Safeguarding Board had had an initial discussion of its
     findings the previous week and would be drawing up a series of actions
     to address it in another pre-Christmas meeting. It was important that
     all agencies shouldered their own responsibility for the tragic death of
     Baby P and looked carefully at what lessons should be learned and
     what could be done better in future. CEC’s input into this process
     would also be welcomed.

     Kristina Petrou highlighted regarding point 56 that child protection
     training is in fact not mandatory for pharmacy staff and she had raised
     this as an issue previously.

     Penny Thompson observed that due to the tight timescales, there had
     not been any opportunity given to local agencies for pre-checking of
     the report before it went to the Secretary of State so it was possible
     that parts of it might contain over-simplifications. Sue Rubenstein
     observed that not knowing how individual conclusions were reached
     could potentially make it difficult to fully address particular issues.

     The CEC noted the Joint Area Review of Haringey Children’s

7.   Recommendation 3

     Penny Thompson provided an overview of Recommendation 3 from
     the Child A/Baby P action plan developed by the LSCB which pertained
     in particular to Health and Primary Care. All health partners had
     agreed the actions and these will be implemented accordingly. A
     further Serious Case Review would follow but in the meantime there
     was a particular onus on clinicians to take this work forward.

     The CEC noted Recommendation 3.

8.   Implementing World Class Primary Care Update

     James Slater provided an overview of the update on the World Class
     Primary Care programme. Dr Tsilegkeridis and Dr Pandya declared an
     interest regarding the update on The Laurels in section 7 as their
     practices were jointly bidding to run the GP-led Health Centre and Dr
     Mansfield also noted that she would be sitting on the procurement
     panel. James Slater thanked them for this and said that as this only
     represented an update on The Laurels, no substantive conflicts of
     interest were involved.

     The Neighbourhood Plan was currently the main priority. The draft
     documents were due to be handed over to at the end of January but
     there would be an opportunity for scrutiny by CEC members

     The CEC noted the Primary Care update.

9.   Renegotiation of PMS Contracts

     James Slater provided an overview of the paper on the renegotiation of
     PMS Contracts, which had previously been taken to the Board and the
     Commissioning Committee. It was noted that all CEC GP members
     were PMS contractors.

     It was acknowledged that the development of the arrangements for
     the new model had taken a long time but the work had benefited from
     clinicians’ input. He also thanked Helen Poole for her work on
     developing the new model.
      Mayur Gor suggested in relation to the Growth Money that the
      ‘neighbourhood team’ should not be the final signing-off point. James
      Slater agreed to explore this.

      The CEC noted the paper on the renegotiation of PMS

10.   Performance Report

      James Slater provided an overview of the Performance report which
      had previously gone to the Board. He noted that future Performance
      reports would be more tailored to the CEC. The following points were
          In the 2007/08 Annual Healthcheck the PCT had been rated
             ‘excellent’ for its use of resources and ‘fair’ for its quality of
          The PCT received a “green” risk rating for Q1 which was likely to
             go to “amber” for Q2, primarily due to new targets where it
             lacked information

      Mayur Gor stated that it was particularly important that the CEC was
      kept updated on progress against the smoking and alcohol targets.
      Eugenia Cronin agreed, noting that Haringey has the highest mortality
      rate of alcohol-related deaths in London. Dr Tsilegkeridis observed that
      the new Alcohol LES would make a significant difference.

      Dr Sivanathan noted that more could be done to progress key issues
      when patients first register with practices.

      James Slater agreed that checks carried out on new patients were an
      ideal opportunity to progress key targets but sufficient resource was
      needed to support the Enhanced Service. However, when new
      Enhanced Services are introduced late by the Dept of Health, there was
      a limit to how much support can initially be put behind it. It was better
      to make a start and then finesse it accordingly.

      Dr Mansfield queried whether there were issues at the hospital end
      relating to Choose and Book. James Slater confirmed that the PCT had
      just taken on Narda Das as a new dedicated project manager and
      Choose and Book would be part of the aforementioned tailored report
      in future.

      Dr Sivananthan and Dr Tsilegkeridis observed that GPs’ computer skills
      and commitment to the programme were also contributory factors to
      take-up levels.

      Dr Pandya observed that her practice had added an additional read
      code to the EMIS sytem with a text box to record the reason for not
      'choosing and booking' a referral. This enabled her practice to audit
      the number of secondary care referrals that were not able to be
      booked via choose and book. Mayur Gor recommended that this was
      shared with the collaboratives.
      ACTION: James Slater to arrange for Narda Das to contact Dr

      The Board noted the Performance Report.

11.   Update on Childhood immunisation (including MMR)

      Helen Donovan provided an overview of the childhood immunisation
      update, highlighting the following points:
          In order to increase childhood immunisation in line with local
            and national requirements, it was proposed to run a further LES
            in conjunction with the one launched in August 2008
          The original LES would be extended to run until March 2009
          Where necessary, data system and nursing support will be
            provided to give advice to practices

      Dr Sivananthan observed that there is an issue with accurate data,
      particularly over the plethora of patient aliases. Dr Mansfield agreed,
      and expressed concern that GPs could potentially carry out a lot of
      work resulting in relatively few injections, which would restrict the cost-
      effectiveness of the LES.

      Helen Donovan assured CEC that the LES would provide additional
      administrative support, in terms of an administrative fee and clinical
      and IT support to help establish systems. The PCT need to ensure that
      practices report to Child Health (CHIA), so that our coverage data
      reports are accurate. Once the new Child Health System, RIO, is in
      place practices will receive information on unimmunised children.

      Dr Mansfield expressed concern about patients who come from abroad
      and claim that their children have had all of the necessary injections,
      without any corroboration. Helen Donovan noted that in this situation it
      was recommended that GPs start again from scratch. Dr Sivananthan
      observed that it is often difficult to convince parents of the merits of

      Helen Donovan noted that it was unclear whether the current low
      uptake recorded is the result of the existing reporting systems. It was
      therefore vital to get good records in place and then improve the
      uptake. This would be done in part through local and pan-London
      social marketing.
Although the exact number of practices participating in the LES was
not known, Helen Donovan confirmed that 36 practices had requested
the password to date.

Dr Tsilegkeridis observed that the new nurse who had recently been
taken on at the Laurels was making a significant difference and the
number of immunisations was rising as a result. The practice was also
participating in the LES.

In response to a query from Penny Thompson, Helen Donovan
confirmed that the PCT had been working with children’s centres, while
also looking at other possibilities. An article would be run in the
January issue of Haringey People, following on from an earlier one in
the August issue. There would also be advertising on London
Transport, as well as leaflet drops and advertising in Yellow Pages.

Mayur Gor highlighted the Q3 data would need to be disaggregated for
the collaboratives.
ACTION: Helen Donovan

Helen Donovan observed that Health Visitors do not generally carry out
this work pro-actively. Dr Pandya noted that via the six-weekly
review meetings her practice had organised for Health Visitors to target
children at home through the LES. Meetings are minuted and have
child-specific actions.

Penny Thompson welcomed this and suggested that good practice
should be rolled out further.
ACTION: Dr Pandya to forward details to Helen Donovan.

Mayur Gor observed that Health Visitors will be a difficult position to fill
so clinicians needed to look at creating an effective system which
people would want to participate in and take forward. It was up to
senior clinicians to find solutions to this.
Dr Sivananthan stated that proactivity needed to be embedded into a
protocol, to ensure that practices perform more effectively.

Dr Mansfield observed that the reorganisation of the Health Visiting
service had led to GPs’ links with Health Visitors being considerably
weakened and this needed to be addressed.

Summing up, Mayur Gor made the following points:
   it was essential that regular six-weekly meetings were held
     between Health Visitors and GP teams
   A structure for ensuring that practices are proactively engaged
     needed to be drawn up
   A GOSH representative should come to a future meeting to
     present a brief paper on current structures
      ACTION: James Slater to organise

      The CEC noted the childhood immunisation update.

12.   Strategic Plan

      Penny Thompson noted that the cover sheet for the Strategic Plan was
      self-explanatory. The plan was a living document and would be
      refreshed annually, along with the Operational Plan. Mayur Gor
      highlighted that it had already been subjected to close scrutiny by the

      Penny Thompson observed that useful comments on it had already
      been received. The focus was now on the operational plan which had
      to be submitted to NHS London by 15th January.

      Sue Rubenstein queried whether the CEC agenda should in future be
      more closely aligned to the Strategic Plan, to enable the CEC to provide
      more advice to the Board from a clinical perspective.

      James Slater agreed. He also pointed out that the CEC was to act as a
      programme board for implementing World Class Primary Care which
      was one of the PCT’s strategic initiatives, along with the Strategic Plan,
      and it would also provide clinical input into the other initiatives.

      The CEC noted the Strategic Plan.

13.   PBC Governance Framework

      Jill Shattock provided an overview of the revised PBC governance
      framework which would be reviewed annually. This had previously
      been agreed by the PBC and Demand Management Group, as well as
      the Trust Board.

      The CEC noted the revised PBC Governance Framework.

14.   Clinical Strategy and Primary Care Executive Committee
      2008/10 Workplan

      James Slater noted that this was still in development and would be
      circulated by email.

15.   Tiverton Medical Practice

      James Slater provided an overview of the plans to disperse patients at
      Tiverton Medical Practice, following the termination of Dr Ghosh’s
      practice. This action was being proposed in light of the fact that the list
      size was small, the premises were not fit for purpose and the lease was
      due to expire shortly.

      The CEC approved the plan for patients on the registered list
      to be dispersed at patient request between local practices by
      31st January 2009.

16.   Violent Patients – Directed Enhanced Service

      James Slater provided an overview of the revised draft service
      specification for the Directed Enhanced Service to cover support
      services to staff and the public in respect of the care and treatment of
      patients who are violent.

      Penny Thompson observed that the policy was rather passive and did
      not refer to subsequent referrals or actions that might be taken.
      James Slater observed that the policy could expressly consider violent
      patients being referred to either children’s or adult’s services.

      Penny Thompson then queried whether a consultation should also take
      place with the designated nurse or doctor in the event of a patient’s
      violent behaviour.

      Delia Thomas highlighted the importance of ensuring that all health
      staff who may be involved and visiting the patient or their family at
      home are made aware of any risks or associated safeguarding issues.

      The CEC approved the draft service specification for the
      Directed Enhanced Service, with the proviso that further
      consideration should be given to safeguarding issues.

17.   Fertility Services Commissioning Policy

      Jill Shattock provided an overview of the Fertility Services
      Commissioning Policy. A shorter version with the eligibility criteria was
      also due to be produced for GPs, with the full paper as back-up.
      Dr Mansfield noted that there had already been extensive discussion of
      the policy at the Exceptional Treatments Panel.

      Judy Allfrey highlighted that there were a number of stylistic
      ambiguities (such as the lack of definition of a ‘cycle’ in section 4.1)
      which needed to be looked at more closely.
      ACTION: Jill Shattock to discuss with Tamara Djuretic.

      Jill Shattock confirmed that the policy was consistent with other PCTs
      and would in due course be placed on the intranet. The review date
      would also be switched to April 2010, as highlighted by Sue Tokley.
      The CEC approved the Fertility Services Commissioning Policy,
      subject to the above clarification.

18.   Dr Cohen – Retirement

      James Slater provided an overview of the paper on Dr Cohen’s planned
      retirement. Her practice currently has a list size of 799 patients and a
      decision needed to be made about where patients will receive their GP
      services once she has retired.

      Sue Rubenstein queried whether GPs often retire at such short notice.
      James Slater stated that GPs with PMS contracts usually have to give
      three months’ notice and ‘single-hander’ practices usually have to give
      six months, but PCTs can be flexible where appropriate.

      Dr Mansfield observed that the CEC needed to be sure that it was
      satisfied with the practices which it would be allocating patients to and
      sought assurance that particular care would be taken regarding
      patients with learning difficulties. She also highlighted that the Bounds
      Green practice was located 1.1 miles away from Dr Cohen’s practice
      but was not included on the list of nearby practices for potential

      James Slater noted that the PCT needed to strike a balance between
      granting patients ‘infirmed consent’ while protecting those who were

      The PCT was developing a standard template to address this issue as it
      expected to see more cases in future. This was one stage in the
      evolution of a policy which would be brought to the CEC in due course.
      While the small practice list and inadequate premises made dispersing
      the existing patients the obvious solution in this instance, the PCT
      would need to be clearer about other options in future.

      Penny Thompson highlighted that the PCT needed to be sure that any
      actions which it takes are in accordance with equalities legislation.

      The CEC approved option 3, to disperse the list while also
      allowing patients to choose which new practice they would
      sign up with.

19.   Any Other Business

      Mayur Gor thanked CEC members for their contributions in what had
      been a busy year, and welcomed in particular Penny Thompson’s input.
Date of Next Meeting

11 February 2009.
                                NHS HARINGEY

                           MINUTES OF THE
                       EXECUTIVE COMMITTEE
                     HELD ON 11th FEBRUARY 2009


Dr Mayur Gor              Chair
Penny Thompson            Acting Deputy Chief Executive
Judy Allfrey              Non Executive Director
Sue Rubenstein            Non Executive Director
Dr Sejal Pandya           GP
Dr Nalliah Sivananthan    GP
Dr Alex Tsilegkeridis     GP
Kristina Petrou           Pharmacist Lead
Delia Thomas              Allied Healthcare Professional
Jill Shattock             Deputy Director, PBC and Acute Commissioning
James Slater              Director of Performance and Primary Care
Sue Tokley                Executive Nurse
Dr Fiona Wright           Assistant Director of Public Health

In attendance:

Steve Beeho.

Dr Mayur Gor welcomed Members to the meeting.

1.    Apologies

      Apologies were received from Tracey Baldwin, Mun Thong Phung and
      Jackie Mansfield.

2.    Minutes of Previous Meeting

      The Minutes of the previous Meeting were agreed, subject to the
      following amendment:

      Under item 13, the PBC Governance framework would be reviewed
      when needed, rather than annually.

3.    Matters Arising

      3.1     Childhood Immunisation
      Mayur Gor noted that since the last meeting Helen Donovan had been
      to all four collaboratives’ practice managers fora and had also met with
      individual practice managers. This kind of proactive work was crucial
     for obtaining more information and this was reflected in the new
     performance data.
     ACTION: James Slater to arrange for the Executive Team to
     send an email to Helen Donovan, commending her on her

     3.2    Dr Cohen
     James Slater noted that Dr Cohen had retired on 31st January and Dr
     Gosh’s practice had closed the previous Wednesday. Both sets of
     patients had been dispersed to new practices – Dr Gosh’s had gone
     mainly to the Laurels while Dr Cohen’s had gone predominantly to Dr
     Dave at Stuart Crescent.

     Mayur Gor welcomed this update but requested a more detailed audit
     of the patient dispersal for the May meeting.
     ACTION: James Slater

4.   Executive Report

     Penny Thompson noted that the Executive Report was largely self-
     explanatory. She noted that since the report had been produced the
     PCT had received its World Class Commissioning (WCC) panel report.
     Its scores were generally either ‘one’ or ‘two’ (on a scale of one to
     four) which placed it in a fairly median position compared to other
     London PCTs.

     Sue Rubenstein noted that the feedback raised issues about how the
     PCT engages and builds relationships locally. She expressed surprise at
     how often the PCT rated itself higher than its actual assessment.

     James Slater stated that he would email the report to committee
     members and clinical directors. In response to Dr Sivananthan
     querying what the PCT would be doing to address these results, James
     Slater observed that a Board/CEC/PBC Clinical Directors seminar would
     be organised to consider the ratings. He noted that Tracey Baldwin
     believed that the PCT had to certain extent paid the price for diverting
     senior management resource to Enfield PCT in the previous year and it
     now needed to get on the front foot to rectify this.

     With regards to engagement, Penny Thompson highlighted that the
     PCT had brought in Nick Samuels as interim Communications Director
     to carry out a review of the PCT’s capabilities and make
     recommendations for the future. The commissioning of Healthlink to
     run patient events was also bearing fruit.

     Penny Thompson observed that WCC was a developmental programme
     and therefore there was not an expectation that PCTs would be scoring
     highly in the early years. Sue Rubenstein said that it was clear that
     PCTs across the country had not scored highly in the more commercial

     The CEC noted the Executive Report.

5.   Performance Report

     James Slater provided an overview of the Performance Report which
     was now tailored to make it more relevant to the CEC. The addendum
     contained immunisations information for the first time but further work
     was also needed to make the data more robust. There were no
     indications that the recent temporary suspension of elective activity
     had had a significant impact on acute performance. He also highlighted
     that the report referred erroneously to “private dentist patients” as
     opposed to “primary care dentist patients”.

     Fiona Wright highlighted that work was being carried out on the A&E
     data to establish what had caused the recent rises.

     It was noted that the PCT had a lot of ground to make up on its
     Chlamydia figures. Mayur Gor queried who was responsible for taking
     this forward to the collaboratives. James Slater stated that this was a
     joint Haringey/Enfield piece of work which would need to be ‘unpicked’.

     Dr Pandya observed that the Chlamydia LES had been relaunched at
     the South East collaborative.

     Figures for breastfeeding at 6-8 weeks were improving but still fell
     short of the PCT’s target. A number of initiatives had been
     commissioned to address this.

     Performance against the target for patients with diabetes whose last
     HbA1c is 7.5 or less continued to decline due to the fact that the ratio
     is adversely affected by the increasing number of diabetic patients
     being identified by practices. This data would be broken down by
     practice and locality for future meetings.

     Dr Sivananthan observed that his practice was not experiencing any
     benefit from the recent introduction of the nurse practitioners. Sue
     Tokley noted that they are currently training staff at present, rather
     than seeing patients.

     Mayur Gor stated that as increasing numbers of diabetic patients are
     identified, it will take time to address. As diabetes is a long term
     condition it is inevitable that some patients will see a deterioration in
     their condition so it is crucial that the PCT works more closely with the
     Whittington and NMUH while the collaboratives focus on practice data.
     He agreed that in the long run the CEC also needed to have more
detail of the impact of the nurse practitioners, including the volume of
training carried out.

Penny Thompson highlighted that there had been a detailed discussion
of performance issues at a recent GRIP meeting, where it was evident
that there are a number of targets where the PCT could make a
significant impact relatively easily.

Sue Rubenstein said that she shared this frustration as the Board had
seen a number of these under-performing targets on a regular basis.
She observed also that a significant number of targets had a woman
and child dimension.

CEC members then discussed what could be done to address these key

Dr Pandya noted that information had been sent round to practices
detailing the processes they should follow and suggested that the
collaboratives should take a lead in reinforcing this.

Dr Sivananthan commended the use of comparative data as a spur to
practice performance and suggested that an accompanying A4 sheet
listing potential actions which can be taken would be particularly

Sue Rubenstein observed that the CEC also needed to consider how it
managed the performance of the committee itself. The lack of a work
plan was a major issue and she volunteered to participate in the
drawing up of one.

Dr Tsilegkeridis expressed concern about the lack of action taken
against under-performing practices. James Slater observed that the
new PMS contracts were more rigorous and this would help to address

Mayur Gor stated that he had met with Stephen Deitch to discuss the
need for a systematic approach to progressing the key targets and
requested in future that Stephen Deitch’s and James Slater’s teams
produce practice-based and collaborative-based data on either a
monthly or bimonthly basis.
ACTION: James Slater to speak to Stephen Deitch to arrange
reports as above and co-ordinate communication to practices.

James Slater observed that the fact that one-third of practices are
currently using out-dated systems hampered the collection of data but
the IT budget was now being funded centrally and this would
accelerate the future migration to more modern systems.
     Delia Thomas stated that it would be useful if the GP scorecard was
     more focused rather than being all-encompassing.

     Mayur Gor observed that clear ownership was needed for the
     commissioning of diabetic screening/retinopathy. It was agreed that he
     would discuss with James Slater for further investigation.
     ACTION: Mayur Gor/James Slater

     Mayur Gor noted that it was important that this was also included in
     the workplan for next year.

     Fiona Wright said that she would also highlight this to Tamara Djuretic
     in her capacity as public health lead.
     ACTION: Fiona Wright

     Mayur Gor requested that the Performance paper should also be added
     to the next PBC/Demand Management meeting.
     ACTION: Jill Shattock

     The CEC noted the report and risks to key areas of

6.   “World Class Primary Care” Update

     James Slater tabled a primary care update which covered the current
     key projects. He highlighted the following key points:
         The PCT was due to receive the Transport and Access Survey on
           Friday, after which it would be circulated to CEC members, as
           would the Residents Health Survey
         The Neighbourhood Development Plans would be reviewed in
           detail at the March CEC meeting
         The construction of Hornsey Central was on track, with hand-
           over scheduled for March – a more detailed report was
           appended separately. The consulation work, which had been
           organised by Healthlinks on behalf of the PCT, was now
           complete, with the final event taking place the previous night.
           The events had been well-received and would be a model for
           future consultations.
         Two consultations with patients at The Laurels had also been
           completed. Five tenders had been received and interviews would
           take place the following week. Once a provider had been
           selected, a paper would be taken to the May Board for
         PCT officers are now pursuing PMS practices to obtain final sign-
           off on the new contracts

     Mayur Gor requested an update from the clinical leads on their co-
     opted collaboratives. Dr Pandya noted that the north east collaborative
was currently reviewing how it can best meet local health needs. Dr
Tsilegkeridis observed that the western collaborative was making swift
progress. Dr Sivananthan stated that there was not currently anything
substantive to report from the central collaborative.

Sue Rubenstein observed that in light of comments made at the
January Board that the collaboratives would not have enough
information to make considered judgements regarding the
neighbourhood development plans, it would be helpful to hear from the
clinical leads how helpful they had found the residents survey. Dr
Pandya stated that she had found the summary particularly helpful.

Fiona Wright noted that Public Health had looked at the survey and
were of the opinion that its findings needed to come with a health
warning on account of the questions asked and the methodology used.

Sue Rubenstein reiterated that the Board appreciated that a lot was
being asked of the collaboratives and it would therefore be helpful
during the discussions at the March CEC meeting to have a clear idea
about what had helped collaboratives to formulate their decisions.

James Slater noted that the gateway review is a review of the World
Class Primary Care implementation programme, rather than the plans
themselves, focusing on the governance, planning and management

Jill Shattock observed that the neighbourhood plans would not contain
the level of detail that the public might be expecting and the PCT
needed to do some forward thinking regarding how it would manage
this message.

Penny Thompson stated that the PCT needed to be clear about the
distinctions between communicating, engaging and consulting, as well
as what exactly was ‘up for debate’.

She then highlighted that the neighbourhood development project
plans did not make any reference to local authority participation, which
was a missed opportunity.
ACTION: James Slater to discuss with Mun Thong Phung

Sue Tokley noted that the project teams included staff from provider
services and the document should therefore reflect this.
ACTION: James Slater to amend project plans.

James Slater observed that the project managers would be providing
specific monthly updates for email circulation, before being brought to
the Board and CEC for formal noting.
     The CEC noted the “World Class Primary Care” Update.

7.   Pandemic Flu Update

     Fiona Wright provided an overview of the Pandemic Flu update. She
     noted that the draft Pandemic Flu Plan had previously been taken to
     the January Board.

     The key priorities for 2009 were as follows:
         To finalise pandemic flu policies and plans
         To ensure that different partners engaged in planning,
           specifically health and social care services, understand how they
           will coordinate with each other during a pandemic in order to
           maximise the effectiveness of the overall response
         To develop business continuity plans for pandemic influenza in
           primary care
         To develop Pandemic Influenza specific Human Resources policy
           for NHS Haringey
         To develop coordinated plan for pandemic-specific immunisation
         To develop robust recovery plans
         To roll out relevant training to managers and to raise awareness
           of the implications on workers of a pandemic throughout the
         To develop the information systems and communications
           strategies that be used in the event of a pandemic
         To put in place a small stockpile of essential medical equipment
           to increase resilience

     She highlighted that it would be helpful if there could be some GP
     representation on the multi-agency Influenza Pandemic Committee
     (IPC). It was agreed that Dr Tsilegkeridis would join the IPC as the GP
     lead on behalf of the CEC and Kristina Petrou would join it as the
     pharmacy lead.

     James Slater noted that clarity was needed over what payments the
     PCT would be able to offer attendees.
     ACTION: James Slater to confirm to Fiona Wright

     Mayur Gor requested that the paper should also be added to agenda
     for the next PBC/Demand Management meeting.
     ACTION: Jill Shattock

     The CEC noted that the Influenza Pandemic Plan is in
     developing phase and will be finalised by June 2009 and
     supported the planning process which has been developed.
8.   Safeguarding Update

     Penny Thompson provided a verbal update. The Serious Case Review
     was still progressing while the Health Management Review was now
     virtually finished. The reviews which had been carried out to date were
     all substantial and the cross-agency determination to put together
     change plans had been exemplary. It was essential now that working
     practices improve as a result of the learning, leading to a genuine
     cultural change. This learning applies just as much to Adult Services as
     it does Children’s Services.

     The draft action plan was now in the public domain and an
     accompanying generic presentation had also been produced. This
     would be taken to the Overview and Scrutiny committee the following

     It was agreed that Penny Thompson would forward the presentation to
     James Slater for circulation to CEC members.
     ACTION: Penny Thompson/James Slater

     James Slater noted that as a result of the Verita review, Dr Ikwueke
     had been suspended from his practice.

     Penny Thompson stated that she should be able to bring the headlines
     from the Serious Case Review to the March Board meeting, and in May
     the CEC would be able to look at progress against the action plan.

9.   Clinical Effectiveness

     9.1    Commissioning Policy For Elective Endovascular Repair of
     Infrarenal Abdominal Aortic Aneurysm (EVAR) With Aortic Stent
     9.2    Commissioning Policy For Small Bowel Enteroscopy and Capsule
     Endoscopy in Adults

     The CEC approved the above policies which had both been approved
     previously by the Clinical Effectiveness Group.

     9.3   Vascular Checks Programme

     Fiona Wright provided an overview of the paper on the Vascular
     Checks Screening Programme. She noted that it was useful to enable
     CEC members to input into the planning at an early developmental
     stage. The programme would potentially have a huge impact on health

     The PCT aimed to begin screening in Haringey in 2009/10, with a
     complete roll-out by 2012/13.
Dr Sivananthan observed that there had been concern previously that
action should be taken once patients are identified. Fiona Wright was
fully aware of this and agreed it was important to build up local
services to support patients identified. This was also consistent with
Dept of Health guidance. A care pathway is being developed to support
the programme and identify actions and sign posting of services to
ensure systematic follow up.

James Slater noted that the PCT will review the local target relating to
establishing risk registers to ensure consistency.

In response to a query from Dr Tsilegkeridis, Fiona Wright confirmed
that that the screening programme would focus on primary prevention
and identifying and managing those with risk factors for disease.
People already on disease registers would not be part of this

Mayur Gor requested that an initial pilot should be carried out by a
practice in the North East, along with a pharmacy pilot, with the
learning rolled out later in the year. Leads for this would need to be
identified through collaboratives.
ACTION: Fiona Wright

Mayur Gor observed that the programme would also need to be added
to the CEC workplan and any locally enhanced service taken to the
ACTION: James Slater

The CEC noted the implementation of the programme in

9.4    Patient Safety Alert: Clean Hands Save Lives

Sue Tokley provided an overview on the report of the implementation
of the Patient Safety Alert: Clean Hands Save Lives. The report showed
the need for resources to support practices on infection control over
and above what is already in place.

It was agreed that a report would be brought to the May CEC meeting
detailing proposals for addressing the need for additional resources for
primary care and what the PCT was planning to achieve in this area
over the coming year.

ACTION: Susan Tokley/Tamara Djuretic

CEC members discussed various options to make the review process
for practices more robust. Dr Sivananthan observed that self-
assessments, backed up by spot-checks, would be the most effective
approach. Dr Tsilegkeridis expressed concern that this process was not
rigorous enough. Penny Thompson suggested that ‘mystery shopping’
and general patient engagement were also rich seams to mine. Mayur
Gor asked Dr Sivananthan to think this issue through further.

Fiona Wright observed that other independent contractors, such as
optometrists, would also need to be monitored. This would become
even more of an issue once the APO is established.

The CEC noted the report of the implementation of the Patient
Safety Alert: Clean Hands Save Lives.

9.5    Clinical Effectiveness Group

Fiona Wright noted that the CEC were being asked to endorse the
revised Terms of Reference for the CEG. The CEG develops and
oversees due process for issues relating to clinical quality and clinical
effectiveness and it was proposed that the group should be
accountable to the CEC.

Mayur Gor noted that this also needed to be captured in the CEC
ACTION: James Slater

CEC was also being asked to agree on two GP nominees to sit on the
group. Jill Shattock highlighted that the CEG would link to the
Commissioning Committee rather than report to it. As it had already
been operating in some form for some time, the CEG had already
developed links with the collaboratives.

Sue Rubenstein queried whether the CEG would also link to the Board
for further assurance.

It was suggested that Dr Sivananthan should be one of the GP
representatives. Fiona Wright would follow up with the Central and
South East collaboratives. James Slater would speak to Fiona Wright
regarding GP representation outside the meeting.
ACTION: Fiona Wright/James Slater

James Slater highlighted that he had discussed with Mayur Gor the
need for the CEC to input into clinical development at an earlier stage
and the CEG’s work would help to reinforce this.

Penny Thompson suggested that as the group was charged with a
number of significant responsibilities, it might find it helpful to consider
success criteria for their work.
      It was agreed that minutes of CEG meetings, as well as a workplan and
      six-monthly reports on the work of the group, should be brought to
      future CEC meetings.
      ACTION: Fiona Wright

      Mayur Gor requested that the paper should also be added to the
      agenda for the next PBC/Demand Management meeting.
      ACTION: Jill Shattock

      The CEC approved the revised CEG Terms of Reference.

10.   CEC 2009/10 Workplan

      James Slater apologised for the delay and said he would be circulating
      the workplan electronically. Sue Rubenstein volunteered to assist in
      developing this.
      ACTION: James Slater

11.   Any Other Business

      Judy Allfrey gave her apologies for the next meeting.

      Date of Next Meeting

      11 March 2009.
                Summary of Clinical Executive Committee Meeting
                                11th March 2009

James Slater and Mayur Gor introduced proceedings with initial scene setting.

There then followed presentations by each collaborative on the progress to date on
each Neighbour hood Development Plan:

      Clare Hodgson/David Lyons (North East)
      Jatin Pandya (South East)
      Pauline Taylor (Central)
      Helen Poole/Dr Alex Tsilegkeridis (West)

There was then a detailed discussion of the issues raised by the presentations,
during which the following points were made:

      Recent Dr Foster research had proved invaluable
      It is important that the NDPs take into account emerging themes (eg
       services for women) and are prepared to be bold when it is called for
      Similarly, it is vital that the planning process doesn’t duck any thorny issues
       – perhaps external facilitation would help to address the ‘elephants in the
       room’ (JS to discuss with SR)
      Further thought should be given to cross-border working where appropriate
      More explicit reference needs to be given to other published plans when
       delivering external plans in order to encourage buy-in
      Sharing of unanonymised data by individual doctors will help to reinforce
       learning at collaborative level
      Plans need to have clearer sense of ambition/vision
      Further work needed to ensure that GPs are in the most appropriate
      NDPs need to explicitly address the PCT’s goal to drive down inappropriate
       use of A&E
      Opportunities presented by the reprovisioning at NMH and the potential
       THFC redevelopment
      The plans should also be viewed in part as a prospectus and highlight what
       is positive about primary care
      In light of the fact that the SE and NE clinical priorities are so similar, there
       could be more information pooling etc between the two collaboratives
      It would be helpful for more data to be made available in graphic form to
       make it easier to engage the local community
      Lack of an identified hub for central Haringey provides an opportunity to
       consider creative solutions
      Need to place emphasis on ‘fair shares’
      Lead ‘drivers’ behind the plans should present them individually to the HSP
       in May, (along with over-arching issues) prior to Board sign-off later that
      Implementation plans will then need to be drawn up
      Public-friendly documents to be worked up for the summer
   Nick Samuels keen to offer media training to ensure consistency in core

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