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									                  MINUTES OF THE MEETING OF THE
               HELD ON WEDNESDAY 21 OCTOBER 2009
                      IN THE CHAIRMAN’S ROOM
                          BASSETTS HOUSE

Present:           Elizabeth Butler          Chair
                   Meredith Collins          Interim Director of Commissioning
                   David Fletcher            Non Executive Director
                   Jim Gunner                Non Executive Director
                   Harvey Guntrip            Non Executive Director
                   Jacqui Scott              Deputy Finance Director
                   Clive Uren                Chief Operating Officer

In Attendance:     Betty Copland             Corporate Office Business Manager


      Apologies were received from Dr Angela Bhan, Bee-Lean Chew, Sarah
      Dowling, Marie Farrell, Keith Fowler, Dr Nada Lemic and Steve Roberts.


      The minutes of the meeting held on Thursday 24 September 2009 were
      amended as follows: Page 2, line 9 – should read “…the PRUH was
      developing as one of the eight Hyper Acute Stroke Units…” not “four”. The
      minutes were then agreed to be a correct record and were signed by the


      09/054 – IFRS Implementation - there were no questions raised from
      members on the IFRS implementation paper presented to the Committee
      meeting on 24 September 2009.


      There was none.


      The Report was presented to the Committee by Meredith Collins.

National Targets
RAG ratings for all the key national targets were green or amber and the
Committee noted an improvement in the 6-week diagnostic wait target and
that there was now confidence that the Smoking Quitters target would be hit
this year.

Care Quality Commission (CQC)
The CQC performance ratings for all NHS organisations for 2008-09 had
been published on their website.

Bromley PCT had been rated „Fair‟ overall on the Quality of Commissioning
assessment. This included being „fully met‟ on core standards, „almost met‟
on existing commitments, and „fair‟ with regard to national priorities. Finance
had been assessed as „good‟ and Jim Gunner noted that no PCT had
achieved „excellent‟ for finance.

With regard to the national priorities, the Committee noted that the PCT had
failed against breastfeeding initiatives, teenage conception rates and access
to primary dental services. These issues were being addressed for 2009/10.
Meredith Collins confirmed that the budget for dentistry was ring fenced. The
Committee discussed the issue of NHS dental capacity within Bromley
following the move to private dental care for adult patients by a number of
Bromley dentists, whilst maintaining NHS dental care for children. It was felt
that there was more capacity for NHS dentistry within the Bromley and it was
agreed to invite Adam Wickings and/or Jill Webb to the next meeting to
provide an update report.

Acute Activity
The Committee noted continuing over performance at the Princess Royal
University Hospital with regard to elective spells, outpatient first attendances
and bed days.

Jim Gunner felt that the Referral Management Centre (RMC) would give
Bromley PCT the edge over other PCTs in future. Meredith Collins
considered that RMCs would create teams of GPs who would monitor and
review their own activity. It was anticipated that this would begin to make a
significant difference next year.

Jim Gunner enquired about the process for follow-up attendances. Meredith
Collins confirmed that clarification was required. It had been suggested that
some consultants were misusing the system by sending patients back to the
GP for a follow up appointment. These were then recorded as „first‟ referrals
and cost the PCT more. Clive Uren confirmed that he had already had
discussions with the PRUH on this issue.

Mental Health
Clive Uren said that the PCT now had far more information than previously,
although Meredith Collins still considered that it was difficult to predict
patterns because of limited information in the Oxleas block contract.
However, the PCT received full details of individual high cost patients which

     enabled accurate and timely forecasting / projections for the areas of greatest
     risk both in Oxleas and the South London and Maudsley Trust.
     Work was underway to develop a mental health tariff at national level, but it
     was likely that this would be based on episodes of care as an admission
     based tariff and encourage admissions rather than keep patients out of

     Harvey Guntrip asked what national bench marking was available. It was
     suggested that Paul Atkins should be invited along to the next meeting of the
     Committee to discuss.

     The Committee received and noted the Report.


     Jacqui Scott presented the Month 6 Financial Report (ending 30 September
     2009) to the Committee.

     She said that additional High Cost Area Contributions for both the PCT and
     South London Healthcare Trust (SLHT) were the most significant adjustments
     made in Period 6.

     Commissioning budgets were forecast to be over spent by £8.3m at year end.
     A slight improvement on the SLHT overspend was reported since the
     previous month. Market Force Factor (MFF) had had an impact on the
     financial position with MFF now funded via PCT baselines rather than paid
     directly by the Department of Health to the Trust.

     In 2008/09 the PCT had a £3m deduction late in the year in respect of MFF
     adjustments from the Department of Health. With effect from 1 April 2009
     MFF had been funded from PCT baselines and therefore had to be managed
     like any other budget. The level of overperformance in 2009/10 meant that
     the MFF budget was spent in full. The merger of the SLHT resulted in a lower
     MFF for the new Trust than for the former Bromley Hospitals NHS Trust.
     However, Bexley PCT had an additional pressure which they had requested
     the PCT to fund. Although the PCT would in principle want to support Bexley
     as a „one off‟ non recurrent measure, the current financial position and the
     fact that MFF was now on the PCT baseline meant that we could not agree to
     fund until the financial outturn became clearer.

     Meredith Collins confirmed that the PCT was monitoring but needed to know
     what was being fed into the system before being in a position to control.

     The Committee discussed how savings could be achieved. Meredith Collins
     agreed that this year would require a balancing act, and that demand would
     need to be managed in a better way, at the same time as maintaining quality.

     Primary Care Commissioning
     As previously reported, the forecast for prescribing was seen as volatile at
     this stage in the year and therefore the Finance Department was looking at
     trends and factoring these into the figures.

     The recent announcement of the availability of the Flu jab was discussed. It
     was confirmed that both the Flu vaccine and the associated GP activity would
     not constitute an additional cost to the PCT as both would be centrally

     CSP Initiatives
     Prevention and Health Improvement - there was a reported under spend of
     £40k at the end of month 6, and a forecast year end under spend of £100k.

     Slippage due to the delayed timescales on other CSP Initiatives. (GP Led
     Health Centres, Referral Management / Urgent Care Centres and End of Life
     Care): had been released into the position.

     Central Budgets
     There was an under spend to date of £107k, mainly due to vacancies in
     central management services. Flexibilities not required in year had been
     identified and reflected in the year end position.

     Working Capital
     Jacqui Scott outlined accounting treatment for bringing Beckenham Beacon
     onto the „Statement of Financial Position‟

     In response to a question from Jim Gunner, Jacqui Scott advised that it was
     the responsibility of SLHT to determine their accounting treatment with their

     Harvey Guntrip asked if the private sector could be utilised in any way.

     The Committee received and noted the Report.


     In Angela Bhan‟s absence, the Committee received and noted the Quality
     Report. The improvement in C Diff numbers and the dramatic fall in
     Caesarean Sections for August were acknowledged. It was understood that a
     review was being carried out regarding Caesarean Section data and the level
     of activity.


     World Class Commissioning (WCC)
     Meredith Collins informed the Committee of the work to be done. He
     confirmed that the PCT was continuing to assess and absorb the scope of
     work to be completed. The submission process had changed considerably
     from last year with guidelines still being received. It was felt that the PCT was
     well placed to complete the necessary tasks by the December deadline.
     Clive Uren said that input would be made by Ernst and Young on both the
     CSP and other key documents including the competencies.

     Phoenix Centre
     Elizabeth Butler said that the Phoenix Centre was a good example of
     partnership and co-operative working. She acknowledged that Staff had
     worked hard preparing for the Mayor‟s visit on 20 October. It was agreed that
     a NED/Executive visit to the Phoenix Centre should be organised as soon as

     BBG Alliance
     The BBG Away Time meeting in Greenwich on 9 November was seen as an
     opportunity to discuss how BBG will work in the future.

     Meredith Collins had been asked to prepare an assessment /report on the
     impact of CSL, APoH, the Hub and Sectors.


     11.00 am on Thursday 26 November in the Chair‟s Office, Bassetts House.

                                                          ………………… CHAIR


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