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									MINUTES OF THE MEETING OF THE PROFESSIONAL EXECUTIVE COMMITTEE HELD ON WEDNESDAY 9 JULY 2008 MOOR LANE MILLS, LANCASTER Present: Dr J Gardner Ms J Aldridge Dr F Atherton Dr D Bradley Mr P Hutchence Ms C Lewis Mr S Mackey Dr A Maddox Mr K McGee Dr P Rees Dr M Spencer In attendance: William Bingley Nigel Crew Mark Youlton Sarah Beattie Hilary Fordham Mrs G Carey 1. APOLOGIES Apologies were received from Ian Cumming, Kevin Parkinson, Sally Parnaby, Jeremy Marriott and Blair McPherson 2. 2.1 DECLARATIONS OF INTEREST Declarations of interest were requested. Drs Gardner, Maddox, Rees and Spencer declared interests in Item 5 ”Benchmarking in General Practice”. Dr Rees and Sean Mackey declared interest in Item 9 ”Long Term Conditions”. Dr Spencer declared an interest in Item 8 ”Unscheduled Care”. It was agreed there was no need for them to be excluded from the meeting. MINUTES OF THE LAST MEETING HELD ON 14 MAY 2008 The minutes of the last meeting held on 14 May were approved as a correct record with the proviso that Dr Andy Maddox is shown as attending the meeting. Matters Arising Diabetes – Update (4.2.2) Mark Spencer reported that contact had been made with Dr Ahmed, Diabetes Lead Consultant at Blackpool Victoria Hospital with regard to progressing the Map of Chairman Psec (for item 5) Deputy Director of Finance (for Kevin Parkinson) Senior Commissioning Manager (Long Term Conditions) Head of Commissioning (Unscheduled Care and Children’s Services PA to Jim Gardner/Administrator Chair of Professional Executive Committee Nurse Lead Director of Public Health General Dental Practitioner Optometrist Allied Health Professional Representative Pharmacy Representative Clinical Director of Education Director of Commissioning and Performance GP Representative - Fylde GP Representative - Wyre

3. 3.1 4. 4.1

Medicine for Diabetes. A team has been put together and the first meeting is scheduled for Wednesday 16 July. 4.2 CVD Commissioning (Enhanced Services) Dr Rees commented that in view of the new NICE Guidelines relating to lipid management, perhaps the PCT would need to revisit the age criteria set for the CVD Local Enhanced Service (LES). Further discussion was deferred to the next meeting so as to include Jeremy Marriott who is the PEC lead for Cardio-vascular Disease. 4.3 Action Learning Sets for PEC and Clinical Leads (7.1) Dr Gardner confirmed that Paul Hutchence, Claire Lewis, Andy Maddox and Jeremy Marriott have been accepted on the first Health Leadership Academy Course at Lancaster University. 4.4 Research and Development Bursaries (8.3) 11 applications have been received for the six bursaries of £10,000 each and short listing will take place on 28 July. Shortlisted candidates may be asked to do a presentation to a small group. Roz Way, newly appointed Research and Development Manager, will commence work for the PCT Monday 14 July 2008. 4.5 Venous Thrombo-embolic (VTE) Risk Programme Ian Cumming has received a letter formerly confirming that North Lancashire Teaching Primary Care Trust has been selected to be a national pilot site for the VTE Risk Programme. Jim Gardner will bring further details to the next PEC meeting in order to explore how the PEC can take a lead on this project. 5. 5.1 BENCHMARKING GENERAL PRACTICE Nigel Crew from Psec, a consultancy firm based in Northwich, Cheshire, gave a presentation about his company’s system for benchmarking in GP Practices. The presentation demonstrated comparisons between Regions and PCTs and between individual practices within a specimen PCT. It compared relative funding to practices per weighted patient (using the Carr Hill Formula) with relative performance for a series of indicators. The purpose of the benchmarking exercise is to identify areas that need to be investigated further, rather than to draw hard and fast conclusions at the outset. It highlighted deprivation and health inequalities and the extent to which funding is directed to these areas. To enable Psec to provide a package for the PCT, contacts would be required for the information and raw data. Turnaround is usually within 6 to 8 weeks of receipt of information. The cost is a fixed price of £7k plus VAT. Issues highlighted    Unsheduled hospital admissions – could these be included as another useful indicator? Longitudinal data would be useful to demonstrate evidence of redistribution taking place Links with PBC would be beneficial




     5.5

QOF – isolated indicator or part of a balanced scorecard? How to build capacity to build this work in ongoing way Secondary Care – look at all secondary care not isolated admissions Useful tool to allow debate on shift of resources from practice to practice Prescribing data is also valuable and linkable Any PEC recommendations of support would need to go to the Operational Management Executive Group. Attention was drawn to ongoing work that the Finance Directorate are doing regarding indicative fair share budgets for practices in the Lancaster/Morecambe/Carnforth/Garstang PBC consortium. The method used could be applied on a wider scale to include the whole PCT area. Members indicated that they would like to see any data received made available on the PCT’s web site. Psec’s proposal gained the support of PEC members on the process but a decision was deferred pending further discussions at the Operational Management Executive Group. David Bradley brought attention to a national system that was used in Dental Practices “Practice in Profile”. Following a general discussion around whether the PCT could implement this system, David Bradley was asked if he could present this information formally at a future PEC dental session. This was agreed. GP APPRAISAL – ANNUAL REPORT Dr Maddox presented the GP Appraisal Annual Report. The report sets out the process and quality assurance of the Annual GP Appraisal System, provides some additional detail about the progress with GP appraisal in North Lancashire Teaching PCT (NLTPCT) during 2006/07. The process has worked very well with regard to activity levels and using the national tool for self assessment, NLTPCT has improved significantly in most areas. Issues arising in discussion:





6. 6.1

6.2   

GP Model – could it be adapted for Practice Nurses? Business Plan for Pharmacy along the lines of GP model – PEC approval first? Business Cases – PEC not expecting to see every single business case but the PEC role is to provide clinical advice to the commissioning process. Approval of a plan to develop appraisal for pharmacists or optometrists would be entirely appropriate. The PEC noted the content of the report and members congratulated Dr Maddox on an excellent piece of work. JOINT STRATEGIC NEEDS ASSESSMENT Dr Atherton presented and gave background information on the Joint Strategic Needs Assessment (JSNA) and how it relates to the County wide function. JSNA is a process that will identify the current and future health and wellbeing needs of the local population, informing the priorities and targets set by Local Area Agreements and leading to agreed commissioning priorities that will improve outcomes and reduce health inequalities. It is a repository for collecting information from different sources to become a data warehouse and is a rolling work programme.


7. 7.1


A general discussion took place and questions were raised around how to access the information and how to use it. Dr Atherton agreed to circulate the web link to members. WORLD CLASS COMMISSIONING AND STRATEGIC PLANNING Kevin McGee presented and provided background information on World Class Commissioning and Strategic Planning. This presentation builds on the presentation from the last PEC meeting in May and makes links to the 12 Strategic Intentions and the work required for strategic planning and how this fits in with World Class Commissioning. The presentation covered the following areas:       Designing Healthcare for the Future Our twelve Commissioning Strands Unscheduled Care Long Term Conditions Scheduled Care Strategic Planning Process – need to set objectives that are challenging but deliverable. Health outcomes need to be evidenced based, measurable in a robust way and capable of being compared both with others and ourselves over time and supportable by a set of actions or initiatives. Key Components of World Class Commissioning – this links in with the Strategic Plan. The PCT needs a good strong rationale for what has been chosen. The PCT will not move up the framework if no improvement can be demonstrated and therefore will not be able to be classed as World Class Commissioners. The five key areas proposed by the Operational Management Executive Committee for the PCT are as follows: Child Health Cancer Mental Health Vascular disease End of Life Care

8. 8.1




This choice is based upon wide discussion within the PCT and with PBC colleagues and is underpinned by the health needs assessment of our local population. The PEC agreed with the choice of the five key areas. Proposed metrics have been listed that could be used to set stretch targets and this would need further debate by the PEC at the next meeting. 9. 9.1 UNSCHEDULED CARE – COMMISSIONING INTENTIONS Hilary Fordham, Head of Commissioning (Unscheduled Care and Children’s Services) joined the meeting and presented a paper on the commissioning intentions for Unscheduled Care. This has been developed from two groups, one for the North and one for the South of the patch to reflect the different health communities and pathways. The Unscheduled Care work-stream has been approved by the Board but it is a working document and expected to develop as thinking and systems move on. The PCT’s Affiliate Scheme has been used to populate two focus groups in order to gain user and patient involvement.


9.3 10. 10.1

An invitation was extended to Hilary Fordham to give a presentation on Children’s Services at the PEC’s September meeting. LONG TERM CONDITIONS – COMMISSIONING INTENTIONS Sarah Beattie, Senior Commissioning Manager (Long Term Conditions) joined the meeting and presented a paper on the commissioning intentions for Long Term Conditions. The document is still in draft and is due to go to the July PCT Board. The document sets out the commissioning intentions for Long Term Conditions over the next 3-5 years. It is a “live” document and therefore subject to change. The work is divided up into main disease areas and includes a snapshot of current services and an outline vision for commissioning in the future. The paper acknowledges that the PCT has inherited different services from predecessor organisations and that therefore future commissioning must address some inequities in provision. It is also fair to say that we are further ahead in some disease areas than others: for example, considerable work has gone on around the diabetes agenda and less has happened in relation to neurological conditions (though Clare Lewis and Sarah are working on this currently). The commissioning intentions also seek to correct this balance of activity. In general the document describes a shift of services from secondary to primary care and from tertiary to secondary care, bringing services closer to patients. There is also a shift of focus to earlier in the disease pathway, pro-actively screening patients who are “at risk”, making diagnosis earlier in the disease pathway and working with public health in preventative strategies. There are development groups around each disease area and some of these also have a locality focus where appropriate. These groups have benefited from patient representation and engagement. Some of the work is around service redesign and some requires new investment. The work on this agenda has benefited from clinical engagement at PEC level and from clinical leadership from Practice Based Commissioning Consortia. This work will be linked to the “Map of Medicine “ whenever possible and work will commence soon to develop a localised map for diabetes. There was some discussion about improving clinical engagement at both PEC and PBC level and this was welcomed by Sarah. A concern was raised by Paul Rees that Hypertension was not mentioned as a disease entity in its own right and he felt that it should be emphasised more in terms of case finding. Sean McKay enquired about resistance to moving services into the community from existing service providers. Mark Spencer explained that in some disease areas secondary care was embracing the opportunities to work more closely with primary care or to perhaps change their focus to more community work. Where possible this shift of focus would be facilitated in partnership with secondary care providers. However, if there was real resistance to this then as commissioners we could look for alternative providers to work with. The PEC agreed to support the Long Term Conditions commissioning intentions. CHAIRMAN’S ITEMS Annual Review Clinical Members individual Annual Reviews with Jim Gardner to be arranged in the near future by Gail Carey.




10.5 11. 11.1


Map of Medicine Launch – 8 July 2008 There was a good turnout for the Map of Medicine Launch (North East end) on the 8 July 2008. Approximately 90 people attended. The date for the South end of the patch is on 9 September and will be held at the Conference Centre, Pontins, Blackpool.


DATE & TIME OF NEXT MEETING There will be no meeting in August. The next meeting will be on Wednesday 10 September at 10am followed by a half day away day commencing at 1pm. Apologies were noted from Paul Rees, Jennifer Aldridge and Claire Lewis.

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