UNCONFIRMED STOCKPORT PRIMARY CARE TRUST Minutes of the Professional Executive Committee Meeting Held on Thursday 13th September 2007 Present: Phil Allan Ged Lucas Richard Popplewell Alison Tonge In Attendance: M Greenwood, R Roberts 1) Apologies: D Dawson, P Foster, A Hussain, R Gill, A Patel R Popplewell welcomed members to the first meeting of the new PEC. 2) Declaration of Interests There were no declarations of interest. 3) Identification of Chair R Popplewell proposed David Dawson as the Chair of the PEC. This was supported and agreed. 4) Identification of Vice Chair R Popplewell proposed S Parker as the Vice Chair of the PEC. This was supported and agreed. 5) (a) Minutes of the meeting held on 19th April 2007 The minutes of the meeting held on 19th April 2007 were received as a correct record with the following amendment to Item 8: It was suggested that PEC should be the accountable body that receives quarterly reports from PBC. 6) Actions arising from the minutes There were no actions arising from the minutes. 7) Improved Governance/ Terms of Reference R Popplewell presented the PCT paper on Proposals for Improved Governance which had been approved by the PCT Board. This included a description of the new structures and terms of reference. Members raised a number of issues: a. If PEC provides a scrutiny process for the PCT there should be some relationship shown with SMCC on the diagram. Agreed. b. ‘Quality monitoring’ should be changed to ‘Assurance’. Line should point both ways and say ‘Strategic Direction’. Tanya Claridge Susan Parker Donna Sager Steve Watkins 2 c. The terms of reference do not reflect the role that the Local Authority representatives have in PEC. d. Quality of services should be a high profile of PEC. A quality perspective/ representative should be present at every meeting. e. PEC should have an overseeing role on Choice. f. There is currently no forum for Market Management. Would want to see this heading on the agenda. g. There is a conflict of interest as there are some members common to SMCC and PEC. It was agreed that they will withdraw from the discussions where conflicts of interest may arise. h. A workplan needs to be developed on subjects that PEC needs to cover over the next 6 months. i. The PEC needs to be clear about the form that reports to PEC should take. j. The expertise of members needs to be used. k. Summaries of assurance should come to PEC. l. The minutes of PEC should continue to go to Board and this should be reflected in the terms of reference. R Popplewell agreed to reflect the comments and subsequent amendments in the paper and bring back to both PEC and Board. 8) PEC Reimbursement levels and processes Members received the claim form for reimbursement of their work for PEC. 9) Report of the Chair There was no report of the Chair. 10) Report of the Vice Chair There was no report of the Vice Chair. 11) Member report There was a query about overspending on prescribing and whether this is something that the PEC should monitor. It was clarified that this would be the remit of SMCC however, PEC would monitor NICE issues. 12) GP Access Plan R Roberts presented a paper updating PEC members of the development of the PCTs Improving Access action plan. Action plans are being produced by all PCTs following the results of the GP access patient survey. The Department of Health is keen for PCTs to move ahead and have asked for draft submissions to the SHA by 24 th September. Stockport PCT will present its plan to an SHA assessment panel on 25 th September. D Dawson will be part of this assessment panel for the SHA. PEC discussed the financial implications of the plan. R Roberts confirmed that this should not have any additional cost for the PCT as it will be funded from a DES budget. 3 D Sager informed PEC that the PCT and Local Authority are working together on a wider approach to demand management, including looking at the local housing market. G Lucas added that there are currently a number of proposals for retirement units that could have an impact on the balance. PEC noted and sponsored the work, and agreed that they would like to see the aims in terms of delivery at a future PEC meeting. 13) Stockport PEC views on the commissioning of upper GI cancer services for Stockport residences P Phillips briefed PEC on the history and current issues in Upper GI Cancer services for Stockport residents. Under the Harrison Plan it was advised that University Hospitals South Manchester (UHSM) be designated as one of the three associate cancer centres in Greater Manchester. Discussions over the relationship between Stockport Foundation Trust (SFT) and UHSM ‘broke down’ in January 2007. As an alternative SFT developed an ‘in reach surgeon’ model with Central Manchester & Manchester Children’s Hospital (CMMC) and work transferred in August. UHSM have raised concerns about the in reach model and there have been various letters from NHS Northwest to say that the Harrison plan should be implemented. However clinicians at CMMC and SFT are very confident about the safety of the in reach model. Stockport PCT in principle wants to commission services for Stockport residents in line with the Harrison Plan but currently finds the CMMC: SFT model more beneficial to Stockport residents. S Watkins commented that he supports the Harrison plan but the requirement for an in-reach model will prevail in light of relationship difficulties. Members discussed the need for some outside advice on the ‘in-reach’ model. Any advice obtained from the SHA would just point towards the Harrison plan. It was agreed that PEC needs to have sight of an opinion about the safety of the model. If this could be assured, PEC would support the in reach service. 14) Update on Specialised Commissioning R Popplewell provided a brief on specialised commissioning services. The North West Specialised Commissioning Team (NWSCT) act as the lead commissioner for all specialised services. For collaboratively commissioned services there is a designated lead commissioning PCT with core functions. The coordinating role is performed by Greater Manchester Commissioning Business Services (CBS). 4 Two of the services include Cancer and Cardiac. Investment in these services has been looked at in comparison to the outcomes that the population is receiving for that investment. Both services showed that Stockport PCT is spending significantly more without improved outcomes. The PCT is currently undertaking a formal service review of Cardiac Services. Members discussed the issue of cancer drugs that are recommended by NICE, and it was suggested that a single decision making process about the use of these drugs should be made by Christie. There was a query about what happens if the specialised commissioning budgets are not spent. R Popplewell explained that services typically overspend as they tend to be more problematic. 15) Joint commissioning of particular services – Progress on Modernisation of Services for Older People R Popplewell presented a paper informing PEC of plans and progress in establishing an Integrated Commissioning Unit between Stockport PCT and Stockport MBC. This builds on the premise that an individual’s care, or its design, should not be compromised because more than one organisation is responsible for its commissioning. D Sager suggested that it would be useful to plot where the integrated commissioning unit sat in the governance structures. PEC supported the progress towards the establishment of an Integrated Commissioning Unit in line with proposals in the paper. 16) Practice Based Commissioning performance report A Tonge presented the PBC report for period April 2007 to June 2007. The report will be provided quarterly and will include update on the delivery plan, money management and incentives. Currently there is a projected under spend of £2.5m. Members noted that 18 weeks was an area of concern. The original 18 week referral work up was set at £50 per patients for direct access and mini health screen and the take up for this has not been good. Members agreed that the report was a very helpful summary. In future the report will come to PEC first, then to Board. 17) Risk Committee Annual Report R Popplewell drew member’s attention to the Risk Committee annual report. This report has come to PEC as part of the assurance to Audit Committee that this has been through internal processes. Following queries about certain sections of the report, R Popplewell agreed to check whether SABS processes are on track. 5 There was a discussion about which part of the health economy the incident reports relate. It was considered that the number of deaths is high. It was explained that these incidents relate to the PCT area rather than the PCT responsibility. 18) PBC survey A Tonge presented a questionnaire and some results of a PBC survey undertaken in May 2007. Only 5 practices opted to take part in Stockport. This low response rate will be taken up at SMCC Board. It was noted that the SHA will be using this as monitoring PCTs effectiveness in developing PBC. Communication will need to be worked on as this will be undertaken on a quarterly basis. 19) Any other business. PEC noted that S Parker would be working on future agenda setting and present a paper to the next PEC.