GP COMMISSIONING EXECUTIVE
Minutes of the GP Commissioning Executive held on 8th February 2012 in the Boardroom
at the Wembley Centre for Health and Care
Present: Dr Ethie Kong Chair and Co-Clinical Director, Harness Consortium
Dr Amanda Craig Clinical Director, Kilburn Consortium
Dr Jahan Mahmoodi Co-Clinical Director, Wembley Consortium
Mr Chandresh Somani Non Executive Director
Mr Mansukh Raichura Chair, Brent LiNk
Ms Jo Ohlson Borough Director, NHS Brent
Mr Jonathan Wise Director of Finance and Performance
Ms Senel Arkut, Head of Service Care Management & Review
(on behalf of Ms Alison Elliott)
Mr Rob Larkman Chief Executive
From Item 4.1 Dr Sami Ansari Co-Clinical Director, Harness Consortium
Dr Cherry Armstrong Co-Clinical Director, Willesden Consortium
Dr Ajit Shah Clinical Director, Kingsbury Consortium
Apologies: Mr Simon Bowen Acting Director of Public Health and Regeneration
Mr Andrew Goodman Joint Director of Commissioning and Performance
Dr Ashwin Patel Co-Clinical Director, Wembley Consortium
Dr Sarah Basham Co-Clinical Director, Willesden Consortium
Ms Alison Elliott Director of Adult Social Care, Brent Council
In Attendance: Ms Jenny Campbell Corporate Admin Support (minute taker)
For item 3.2 Mr Charles Allan Commissioning Support Consultant
For item 3.3 Mr Ian Winstanley Interim Deputy Borough Director
For item 4.1 Ms Sarah Mansuralli Deputy Borough Director
The minutes of the meeting on 25th January 2012 were recorded as
accurate following the amendment to paragraph 5.3:
2. Matters Arising
2.1 2.1 Outer North West London ICP
Following the workshop on the 26th January Ms Ohlson shared the
presentation with the Brent CCG. This was followed up by a meeting held
with the Brent and Harrow teams to work to consider financials
underpinning the business case. Mr Wise reported that additional JW
information was required from McKinsey and we were awaiting their
2.2 Ms Ohlson said the Cluster Board required an approved business case by
mid-March and we therefore required the business case be returned to
the GPCE by 22nd February for consideration.
2.3 It was agreed that care for older people was like to be of the most interest
but Dr Craig expressed concerns around the focus of secondary care.
2.4 Mr Somani expressed his concerns as to whether a full business case
would be made available within the timescale with expected______
S:/PA Admin/GP Executive Commissioning/Minutes/Final/GPCE minutes 8 February 2012
outcomes and adequate governance arrangements adequately identified.
Mr Wise confirmed that numbers and the analysis were available to work
from. Ms Ohlson reported that firstly in terms of governance, the agreed
arrangements were that each borough would have its own IMG
(Integrated Management Group) and the proposal submitted by Brent was
the CCG Chair would be the co-Chair with the Local Authority’s Director of
Adult Social Care.
2.5 Dr Armstrong stated that some caution should be taken so that duplication
of services, i.e STARRS, case management and community mental
health and requested that she would like to see a clinical model and/or
patient history built into the business case.
2.6 It was agreed the business case is brought back to the GPCE on
22 February 2012.
It was agreed that the business case will include governance
arrangements. It was agreed that the CCG Chair would be Co-
Chair with the Director of Social Care.
It was agreed to discuss the nominations sought from the Cluster
for mainstreams once the business case was signed off.
3 Item 2.2 Improvement Funding for A&E and 18 week LES
3.1 The GPCE received the inter practice agreement for approval. It was
noted that Dr Mahmoodi had some concerns about seeing patients from
another practice without medical notes or background medical history.
3.3 Dr Kong confirmed that although IT software was not available to provide
the patient’s medical history at another practice, the short term method
would be to register the patient temporarily and following consultation the
notes would be faxed back to the patients permanent GP. Dr Kong also
stated that payment would be £ 9 per patient for slot availability, plus an
extra £13 if a consultation is undertaken and if the allocation is not spent
this would be clawed back.
3.4 Ms Ohlson stated that Care UK and Northwick Park Hospital would
continue to receive payments for patients they re-direct during the period
to 31st March but if the CCG wished to continue a in 2012/13, difference
arrangements would need to be agreed with providers.
3.5 Ms Ohlson confirmed that Care UK and A&E at North West London
Hospital had been notified of the scheme.
3.6 The GPCE approved the Inter Practice Agreement.
4 Item 3.1 Finance and Performance – Month 8
4.1 Mr Wise reported that GP Commissioning cumulative position as at Month
8 shows an overspend of £3,367k (2.3%) (last month £1,967k overspend,
an adverse movement of £1,400k).
4.2 Of £1,400k movement in variance, £1,260k related to an increase in PbR
patient activity level mainly in Elective, Non Elective and OP Procedures.
The rise has been seen at NWLH £661k, followed by Imperial £197k,
Royal Free £110k and all other Trusts £291k.
4.3 At Month 8, NWLHT have incorporated a number of the Acute
Commissioning Vehicle’s contract challenges. However, other challenges
are still outstanding and the reported position above does not reflect the
impact of outstanding ACV contract challenges, financial caps or the
PCT’s in-year risk reserve and we expect the position to improve as a
result of these factors.
4.4 Appendix 1 contains the North West London Acute Commissioning
Vehicle’s analysis of the NWLHT M8 contract position. Slide 4 showed a
summary of the reported position indicating an over performance of £811k
at M8 before contract challenges, and an underperformance of £1,907k
after contract challenges. Once contract caps with NWLHT and Imperial
are applied, the financial position moves from an overspend of £3,367k to
4.5 In terms of actual delegated budgets, the bottom line showed £289
overspend, however once the 45% reserve was applied this would bring
this back brought back the budget into balance.
4.6 Ms Ohlson stated that in terms of elective planned care initiative would
have an impact on outpatients. In relation to urgent care we need to do
more work around STARRS as the incentives were not working. Anne
Rainsberry had raised at this morning’s meeting on what basis would
NHS Brent Clinical Commissioners support the full business case for the
merger of NWLHT and Ealing Hospital. It was agreed that it was
imperative that the merged organisation supported our out of hospital
pathways particularly urgent care. It was agreed we would set out our
requirements and how we would like these incorporated into contracts
going forward. We would establish these requirements through JO
discussion with Dr Ansari, Rob Larkman and Andrew Goodman.
5 Item 3.2 STARRS Governance
5.1 Mr Allan reported that Dr Burch had been in place since 3rd January 2012
and the purpose of this report was to approve Dr Burch’s GPwSI SLA and
to note the governance arrangements and management of the Willesden
step up beds. The post will operate under the Ealing ICO Clinical
Governance Framework and Clinical Supervision will be conducted by Dr
Charles Cayley, Consultant Geriatrician and the Post will be managed by
James Walters, General Manager Adult Community Nursing & Inpatient
Services Ealing ICO. He will also liaise regularly with Dr Armstrong,
Clinical Director for Unplanned Care.
5.2 A draft form of the pathway was still being worked on and Dr Kong CAll
requested that the pathway is disseminated to all GP practises on
The GPCE approved the GPwSi SLA and governance arrangements.
6 Item 3.3. Kilburn MSK Enhanced Pathway
6.1 Dr Craig stated that the business case was a build up the current services
and for funding for which did extend after 31 March. A consultancy
intermediate service has been up and running and physiotherapy waiting
times have reduced from 6-9months to 3 weeks. A recent introduction to
the pathway of consultant rheumatologist sessions has produced an
immediate saving against secondary care referral tariffs.
6.2 There is also the education service with consultant led sessions
shadowed by GPs for the joint injection clinic and this has proved to be
6.3 Option 3 would deliver Physio 33 having its contract extended until
January 2013 to ensure continuity of service, but to ease the pressure on
the current ICO service; all Kilburn GPs would refer only into the Physio
33 service. For the period of the notice the equivalent of £240k of
appointments would be released reducing some of the demand placed on
the ICO service and enable the service to deliver much improved waiting
times for the other 4 localities.
6.4 Ms Ohlson said that she supported the business case on the basis that
it now had extended scope and the savings are what were expected
from the planned care. However, there is a risk of not being able to
extract the full cost of physiotherapy savings from the Ealing ICO QIPP
6.5 Dr Mahmoodi raised an on-going concern about the waiting time for
other residence in Brent of up to 9 months. Dr Craig informed the group
to roll this out across Brent would cost an additional £700k.
6.6 It was agreed to examine the options of improving access to
physiotherapy for the other four localities in Brent in
6.7 It was agreed to bring a business case which include JO
identified benefits and timescales of realisation to a future
7 Item 3.4
7.1 Shaping a Healthier Future.
An event will be taking place on the 15th February to which GPs, local
Councillors and stakeholders have been invited. Ms Ohlson asked if the
co-ordinators for each consortia could filter this down to all practices as JO
NHS NWL would like to secure a wide range of GP colleagues. Clinical
Directors confirmed that this had been done.
7.2 Mr Raichura confirmed that he had been invited to the event.
7.3 Out of Hospital Delivery Standards
Ms Ohlson reported the Clinical Executive Committee (CEC) had
requested that CCGs agreed out of hospital standards.
7.4 It was agreed to work on this locally at the Primary Care
Development Programme Board. Sign off by the Cluster was
required on the 1st March. CDs/IW/JO
8 Item 3.5 Contract Negotiation Update
Dr Craig reported that she had been attending up to 2 meetings per week.
Discussions are taking place about activity and productivity linked into the
specifications. Currently there is a £9 million gap between provider and
Ms Mansuralli reported that CNWL have responded formally to the
baseline figures. Changes around efficiencies are required. There is a
small gap and work is being carried out to re-align with the QIPP targets.
8.3 PbR for mental health is currently being undertaken by Dr Craig and Dr
Armstrong. Current discussions are ongoing about what care package
would work best in Brent.
9 Item 4.1
9.1 CCG OD update
Ms Mansuralli updated the meeting about events that were being
organised across the five localities. The events would be facilitated and
issues to be covered included on how the constitution would be
9.2 In relation to the practice barometer, comments were received and these
would be fed back to all GPs. It was agreed that support of the practice
barometer would be the responsibility of the CCG Project Manager.
9.3 An additional two events that would include all practices about the vision
and strategy would need to take place in March and April and before May SM
2012 and these dates will be confirmed by Ms Mansuralli.
9.4 Ms Mansuralli informed the group the Ashridge would like to undertake a
research project with NHS Brent about gathering the evidence towards
authorisation. The research would monitor the changes made by the
CCG and would require structured interviews, one to one meetings,
attending meetings, telephone interviews and using PDP developments.
These would need to take place between February and April 2012 and the
report would be produced in June and used as evidence towards
9.5 The GPCE agreed in principle to participate in the research
Mr Wise left the meeting at 4.00pm
9.6 Update on CCG Development
Ms Mansuralli said that the authorisation process had three phases and
phase 1 which encompassed the governance process is currently being
worked on. Phase 2 would be the formal phase when the application
would be completed along with the self-certification and the evidence.
Phase three would require confirmation of the evidence like the core
business for the operating plan, and how NHS Brent would align against
QIPP and governance arrangements. These areas were continually
9.7 The authorisation process overview had 6 key milestones and these
included building and consulting on the constitution. Authorisation cannot
be applied for until the constitution was in place.
9.8 Ms Mansuralli reported a full project plan was being worked on and this SM
would be presented to the GPCE at a later meeting.
9.9 A further assessment on where the Brent CCG were in terms of
development and the governance process was being worked on and SM
would be brought to the GPCE on 14th March 2012 and NHS Brent Board
Dr Ansari joined the meeting at 4.10pm
9.10 Mr Larkman said the four CCGs had agreed to collaborate and the areas
to be considered were:
9.11 1. The shape of shared management
2. What would the collaboration mean in terms of buying in from the CSO
3. How the separate governing bodies might share functions
9.12 It was agreed there was insufficient time to consider how governing
bodies could work together and this would be considered at next SM
week’s workshop on the constitution. The three other CCGs were
keen to collaborate on some functions and we needed to establish
the Brent position shortly.
Ms J Campbell left the meeting at 4.25pm.
10. Date of next meeting
The next meeting will take place on Wednesday 22th February 2012 in
the Boardroom at the Wembley Centre at 2 to 4.00pm. This will be
followed by a QIPP Programme Board for the Clinical Directors.