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Holbrook House
Cockfosters Road
Barnet, Herts
EN4 0DR
Web: www.enfield.nhs.uk
Intranet: nww.enfield.nhs.uk
MINUTES
Tel: 020 8272 5500
Fax: 020 8272 5700
Minutes of a Meeting of Enfield Primary Care Trust Board held in
public on Wednesday 7th September 2005 at 2.00 p.m. at
Holbrook House, Cockfosters
Contact: Jo Powell Tel No: 8272 5578
Present: Carolyn Berkeley (CB) Chairman
Sally Johnson (SJ) Chief Executive
Rex Bourne (RB) Non Executive Director
Yasemin Brett (YB) Non Executive Director
Elliot Finer (EF) Non Executive Director
Dorothy Kousoulou (DK) Non Executive Director
Bernice Stronach (BS) Non Executive Director
Lesley Walls (LWa) Non Executive Director
Peter Barnes (PB) PEC Chairman
Ashfaq Khan (AK) PEC Member
Marion Andrews (MA) Nurse Board/PEC Member
Richard Martin (RM) Director Finance & Performance
Ugo Okoli (UO) Director Public Health
Kristy Leach (KL) Director of Nursing
Harry Plumb (HB) Deputy Chair, EPCT Patient‟s Forum
In Attendance: Jo Ohlson (JO) Director Primary Care
Liz Wise (LWi) Director Planning & Commissioning
Anita Grabarz (AG) Director Comms. & Corporate Affairs
Julia Brown (JB) Director Patient Services
Don Fairley (DF) Director Organisation Development
Jay Bevington
Jo Powell (JP mins) Minute Taker
1.0 Welcome: The Chairman welcomed members, staff and public to the
meeting. The Chairman made Excellence Award presentations for the last
quarter.
Chair: Carolyn Berkeley
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Team Award : Marion Andrews, Abigail Toghanro, Janis Jones, Ben Phelps
and Tracy Kidd were congratulated by the Chairman for their work across the
Trust in implementing Agenda for Change.
2.0 Apologies: John Lynch (but Harry Plumb attended in lieu) David Conway Donald
Graham and Ray James
The following comments were raised before the start of point 3.0
2.1 CB drew the Board‟s attention to the new meeting schedule for 2006.
EF raised the issue on the size of the papers. “…comparable to the size of a text
book…” He queried whether there was enough time given to adequately read and
retain the information due to the sheer volume. In particular the Local Improvement
Financial Trust (LIFT) documents and the Regulatory Framework.
SJ – Accepted the point and would try and limit the number of pages per report,
where appropriate. She went on to explain that the Regulatory Framework was a
requirement of the Audit Committee and that it had been some time since the Board
had looked at the full document.
ACTION
3.0 Minutes of Meeting held on 6th July 2005
The Board AGREED that the Minutes were a true record.
4.0 Matters arising not elsewhere on the Agenda
There were no matters arising.
5.0 2004/05 Financial Position
The Board considered a report from the Director of Finance and Performance. The
report described the financial performance of the Trust for the period April 2004 to
July 2005. The key issues highlighted were as follows:
Enfield Primary Care Trust (EPCT) is over budget by £1.0m at this stage.
Numerous saving targets are in place as part of our recovery plan. This
includes savings from modernisation and unscheduled care.
Commissioning activity is up. Over performance is recurring, but the reserve
will cover it.
Arbitration decisions resulted in EPCT being asked to pay £357k in
Accident and Emergency attendances for North Middlesex. EPCT also had
to give Barnet Enfield Haringey Mental Health Trust (BEHMHT) £619k non-
recurrent support, plus an incentive payment of £1.50k
Cash position –£2.8m deduction has been made from EPCT cash limit, in
line with national requirements. Consequently the shortfall is now £5.6m.
Health Authority will keep this under review to minimise possible cash
shortfall.
Financial plan – there are now 59 targets associated with the recovery.
The remaining part of the financial year is to achieve the best case
scenarios whilst continuing to identify any further opportunities.
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Capital programme – although not in breach of the Capital Reserve Limit
(CRL) there exists some risks with certain schemes, but this is being closely
monitored to minimise risk.
Comments
CB asked whether capital receipts from realisation could be kept? RM replied that
the cash planning exercise assumes retention, although SHA approval should be
sought.
Further debate continued on the question of assets.
National cash shortfall is only allocated at this stage to PCTs. SJ asked if there was
any share being met directly by the SHA. RM replied that he was not aware of a
share being borne by the SHA.
The Board AGREED the following recommendations to:
note the contents of the report, particularly the extent of the forecast risk and
the range of potential outturns. Note the projected cash shortfall and
expected recovery actions in the identified capital programme. Support the
Chief Executive in identifying the necessary recovery action and
management measures in order to achieve financial close.
ACTION
6.0. Performance Report
RM introduced the Performance Report. Essentially the report outlined EPCT‟s
performance against each of the 24 Core Standards of the new Health Care
Programme Assessment.
RM mentioned the key points:
Progress on the declaration has been sent to HA to add their comments. It will then
be returned to the Board for review as a final draft in October. Action plans have
been implemented for those standards, which we are at risk of not achieving.
Comments
CB – enquired why there were 3 reds relating to Sexual Health Service on page 6 of
the report. UO – replied that these were 2008 targets. Access to termination of
pregnancies is 48% at 10 weeks at present, but target is 70% at 10 weeks. Targets
for contraception is not clear. Family Planning is providing contraceptives and
access to emergency hormonal contraception. Access to GUM clinics a challenge.
Only 15% of the calls are seen.
PB informed the Board that the recent British Medical Journal‟s assessment of
access to contraception particularly over the counter has not shown a reduction in
teenage pregnancies.
SJ said that although it may not be yet apparent in statistical data, the number of
teenage pregnancies is slowing down.
AK reported he was still being asked for contraceptives (morning after pill) over the
counter.
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The Board AGREED to:
note progress and current status and actions required before the publication
of the final declaration in March 2006. This will be an ongoing item on our
Board papers.
ACTION
7.0. Acute Service Commissioning 2004/05 Performance
This report focuses on Acute and Mental Health Service agreements with the most
significant financial risks to EPCT, using the available performance data supplied by
provider trusts.
LWi highlighted the following:
Submissions were late due to the change from Nationwide Clearing Service
(NWCS) to the new information system Secondary User System (SUS)
being implemented. Caused difficulties in reconciling through lack
of detailed information. Until these validations are completed, this
information should be offered as best estimate for quarterly performance
risk.
Service Agreements - still outstanding as negotiations are ongoing. Base
lines have been agreed, but clarification on deficit support sought for North
Middlesex and Barnet and Chase Farm Hospitals (BCFH).
Inpatient and Outpatient targets are problematic. Fortnightly meetings re
planning and activity are underway. Issues have already been taken up, in
writing, with the Directors.
Comments
CB asked how much activity is being utilised at the SurgiCentre.
LWi replied not full in August, due to early difficulties, but working with BCFH to
rectify.
SJ –concerned about managing demand and rising activity.
PB queried reporting on page 10 of the graph re elected medical admissions and
length of stay, and asked for clarification.
LWi – explained this included investigations and cancer treatments, but would
clarify for next meeting. She also added that work was in progress with Haringey
and Barnet re developing Mental Health Trust performance bonds.
The Chairman said that the good work being carried out in collaboration with
University College London Hospital (UCLH) should be highlighted, and welcomed
the smoother working partnership that had developed.
The Board AGREED the recommendations to:
note the contents of the report and financial risk associated with the actions
being taken and to be taken. Graphs need clarification for the next meeting.
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8.0. HR Report
DF introduced the report, circulating revised graphs.
Agenda for Change (AfC)
Enfield has made good progress against national targets.
EPCT has assimilated a total of 83% - a testament to the job matchers and
work carried out. September – saw an improvement at 95% by month end.
On line to achieve 93% by end of September, just below national target of
95%. October, on track to achieve 100%.
Original estimate of cost has been reduced by half a million to £1million with
provision for appeals built in.
Improving Working Lives (IWL)
The external Validation Team inspection took place 25-29 July 2005, and
EPCT now awaiting outcome. Draft response has been submitted to HA
and an outcome should be with EPCT by end of September.
Audrey Anderson Commemorative Award highlighted
To commemorate the excellent contribution and service of Audrey
Anderson, the Trust is starting an achievement award in memory of her
name.
This has been approved and agreed by her spouse.
January Board presentations anticipated.
The Board endorsed the Annual Audrey Anderson Commemorative Award and felt
that there should be encouragement by managers to persuade their staff to
nominate their colleagues.
ACTION
9.0 Crime & Disorder Act
UO wished to raise awareness by explaining how on 30th April 2004 PCTs became
„responsible authorities‟ under the Crime and Disorder Act 1998. Our participation
should be viewed as an opportunity to be able to shape local action in collaborating
with other responsible authorities: police, fire and local authorities and cooperating
bodies from the voluntary and community sector. She drew our attention to page 5
of the report illustrating how we were contributing to this strategy. Attention was
also given to appendices.
Comments
CB – asked if the drug budget extended to providing treatment for alcohol problems,
given that there seemed to be only money available for drugs related treatment.
UO replied that they used money from the drugs budget to carry out a needs
assessment for alcohol services in Enfield. Subsequently an alcohol board has
been set up.
SJ – mentioned that the impact of alcohol abuse is a major problem. However,
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work carried out at St Mary‟s has shown a reduction in alcohol abuse where advice
had been given within the first 24 hours visit to A&E.
UO – informed the Board that Enfield had exceeded targets, which meant greater
numbers of patients were now accessing and completing the drugs treatment
programme.
PB – drew the Board‟s attention to page 6 of the report saying there was a need to
correlate the drugs problems with the theft issue.
DK – congratulated the EPCT on activity relating to decreasing domestic violence.
She then enquired whether there were gender specific drug services, for women in
particular.
LW –replied that some community groups/organisations have benefited from recent
grants, including gender specific.
UO drew our attention to page 7 of the report highlighting the funds for community
drugs projects.
To Board AGREED to
note and approve the strategic direction of the PCT involvement in the crime
and Drugs agenda in Enfield.
10.0 Board Assurance & Corporate Risk Register
AG introduced the Assurance Framework and Corporate Risk Register, detailing
known risks scoring 15 or above.
Comments
EF – claimed this was a huge improvement and that AG and colleagues should be
congratulated. However, clarity and wording needed to be improved. EF also
pointed out shortcomings and inconsistencies of scoring on the corporate risk
register.
SJ – felt the scoring would get better with training and over time.
EF – asked what is being done re flu epidemic? The action was not clear. UO UO
agreed to amend.
YB enquired why the risk management training score was only 15.
KL – replied for clinical staff this is mandatory and training is in place and will
happen hence the low score. General training is ongoing and attendance is under
review.
CB – queried that in addition to bringing the corporate risk register twice a year to
the Board that the Assurance Framework must include the top 5 risks.
AG/EF to
AG- (requested by EF) to look at introducing a risk chart to highlight changes. liaise
The Chairman noted the report and commented on how useful and easy it is to use.
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ACTION
11.0 Adoption of Annual Accounts 2004/05
The Director of Finance and Performance introduced the report confirming that
there were no fundamental changes to previous reports and the Board now needed
at this stage to formally adopt the annual accounts 2004/05.
The Board AGREED to adopt the Trust‟s audited accounts for the year 31 March
2005 subsequent to the July meeting.
ACTION
12.0. Regulatory Framework
RM introduced this report following the Audit Committee meeting held on 30 June
2005. The draft revised documents considered were Standing Orders, Standing
Financial instructions and Scheme of Delegation.
The Scheme of Delegation was cause for debate ie the requirement on the number
of non-executive directors (re authorisation of power). It was accepted to reduce
the number to one non-executive director.
The Chairman agreed that an email amendment should be circulated to reflect the RM
changes in „power‟.
Members of the Board also raised concerns over the size of the Regulatory
Framework and suggested there was a risk managers would not be aware of
relevant guidance should it remain in its current format. In response, managers RM
were reminded of the Standards of Conduct (8-page business document). One
suggestion put forward to enable the document more accessible was to introduce
indexes.
ACTION
The Board AGREED the recommendation to:
subject to voiced amendments re email amendments identified and note this
is to be read in conjunction with the Standards of Conduct and review how
the report could be more user friendly.
13.0 Moorfield Road
Charles Everard joined the meeting.
JO introduced this report, an update on Moorfield Road Primary Care Centre
(MRPC).
JO began with an overview of the report highlighting key points:
Financial impact – May 2005 the affordability gap for MIRC was £600k
„Commissioning a Patient-led NHS‟ - Over the coming years, decisions will be
made as to who provides services which will have an impact on the need for
premises for these services
Practice based commissioning – with the rolling out of practice based
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commissioning by end of 2006, could argue that Moorfield Road would be a
crucial opportunity to provide PCTs provision of care close to patients‟
homes. The practices based at Moorfield will contribute to a group who will
commission local services
JO then drew the Board‟s attention to page 5 of the report re Conditions of current
premises. In particular two practices would have to move, as the premises did not
meet the health and safety and DDA requirements.
Lastly, the Board Members were then offered the opportunity to raise questions with
the Director of Finance and Performance on the merits and best case scenarios on
the 6 options of development presented in the document. In conclusion options 5 &
6 were considered the most attractive.
The Chairman recommended the Board to support development and notes aim to
achieve financial close 2006/7.
The Board AGREED the recommendation, subject to any adjustment arising from
the audit, to:
support the development of a full Business Case in preparation for approval
by the SHA..
ACTION
14.0 Practice based Commissioning
The Chairman proposed this report be for information only.
The Board AGREED the recommendation to:
note the contents of the report and that work is continuing and monitored by
the Audit Committee.
15.0 The Chairman introduced Gary Birks (GB) and Jerry O‟Riordan (JO‟R) of the Health
Informatics Service.
15.1 HIS Business Case
The Barnet, Enfield & Haringey Health Informatics Service (HIS) provides
Information Communication Technology (ICT) related services to three Stakeholder
Trusts – Enfield Primary Care Trust (EPCT), Haringey Teaching Primary Care Trust
(HTPCT) and Barnet, Enfield & Haringey Mental Health Trusts (BEHMHT).
GB introduced this Business Case, highlighting key issues:
Background
Over the past 4 years, HIS has been supporting and maintaining the ICT
needs of over 3500 users sharing 2000 desktops and laptops across a
complex network infrastructure;
During that time, the demands on the infrastructure has grown considerably,
as the departments have expanded notably in Finance, HR, Payroll and
PIMS, to the extent a gap analysis exercise was undertaken.
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Funding requirements
£1.3 million over a two year period will need to be invested to support current
ICT demands of all three Trusts and the deployment of future applications.
Added Advantages
With an exclusive contract with BT the new network N3 will be noticeably
quicker
Savings would be made in technical support
Will integrate data and phone services in one cabling
In the event of relocation, BT would only need to change a switch on the N3
Comments
The report generated a lot of comment and questions:
SJ asked if the upgrade could be approached in stages as opposed to undertaking
the whole package.
JOR replied that it was essential to maintain the integrity of the core. GB reiterated
that investment in the upgrade was minimal.
RM pointed out that EPCT is the only stakeholder that has money available at this
point. Cannot afford Enfield to upgrade on behalf of the other two organisations.
Board Members agreed.
CB –we must be clear on how we apportion costs amongst users of shared services.
The Board AGREED the recommendation to:
support operation requirements and approve financial requirements for the
upgrade works of the HIS managed infrastructure, subject to the financial
contribution from partners.
Policies for Approval
16.0 Pan London Protocol for Working with Sexually Active Young People Under
the Age of 18 years
This Protocol has been developed by the London Child Protection Committee in the
wake of the Bichard Report. It requires health professionals to automatically refer to
the police any young person under the age of 13 years who reports sexual activity.
All young people 13-16 years should undergo a risk assessment using the Police
Risk Assessment Framework lead by the police to establish whether the young
person should be referred for formal child protection.
The Board had been asked to ratify the Pan-London Child Protection Committee
Protocol and also to take a view as to the advice that should be given to professional
staff following that ratification.
Comments
KL informed the Board on how the ethical and professional issues were raised. After
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having discussed the matter at length, the BMA and RCN and Royal Colleges then
raised the question of ratification with the Secretary of State. Subsequently, the
Protocol was then superseded, as it was felt counter productive for these vulnerable
young people. However, the most recent letter (dated 7 September) advised that
this had been superseded, urging for the Protocol to be ratified.
PB had informed the Board that serious concerns had been expressed by
professional bodies on these recommendations, in particular, it offered “no latitude”
in matters of confidentiality. He suggested this could be better worded. The matter
was then taken up with the Ethical and Standards Committee, in turn, generating a
huge response. (See summary of report). PB concluded that the Board should ratify
this protocol in conjunction with well-published guidance on interpretation.
YB - from a cultural perspective, felt a shorter version of page 3 2.3 (power
imbalances) of the report should be made available reflecting different cultural
scenarios. CB thanked her for that input.
EF felt children under 16‟s would be discouraged from disclosing information if they
felt the police would get involved.
It was very clear to the Board there were serious ethical issues, with the dilemma of
wanting to provide support and advice for the children versus the need to protect
them from harm. The Board certainly did not want this very vulnerable group of
children being put off approaching health and social care services when they most
need it.
AK confirmed he still had children purchasing contraceptives at the chemists.
However, wanted to discourage potential rumours should the children hear
pharmacists would be alerting police.
SJ – felt strongly its taking away professional judgment in terms of developing
competence. We should write to Julie Dent with our concerns to the London Children
Protection Committee with our intentions.
The Board AGREED to:
endorse protocol but working party to produce guidance and continue
training plan for health care professionals, police and pharmacists likely to be
involved in this.
Items for Information
17.0 Chairman’s Report
The Chairman had nothing to report.
18.0 Chief Executive’s Report
Hoped all Board Members would pay attention to the first part of this report ie
priorities rather than the future look on organisation.
LW raised concerns on TB Jabs. She felt that certain communities would be
vulnerable in contracting TB since these jabs were no longer mandatory. Fearing it
could see a return of TB with the next generation. UO replied that before any travel,
the persons concerned should consult their GP.
19.0 Use of Seal
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The Board endorsed the use of the Seal.
20.0 Annual Report 2004/5
AG introduced a near final copy. However, further minor changes were planned.
The theme of the report was the new healthcare standards. Corrections from the
Board Members should be notified by Wednesday 14 September.
The Chairman recognised that a lot of work gone in to it and AG and her team
should be congratulated.
21.0 Complaints, PALS and Incident Report - Quarter 1
See below
22.0 Annual Report Complaints, PALS and Incidents 2004/5
AG discussed both reports drawing the Board‟s attention to missing data (SafeCode
not being available). More sophisticated report will be possible as data grows on the
new Datix system.
TB queried the problem with the telephone system in Sexual Health Services Town
Clinic. JB explained the new telephone system enabled calls to be progressed
faster and kept callers holding rather than cutting them off!
23.0 Professional Executive Committee Report – Key messages – May 2005
Chair took as read
24.0 Quality Improvement & Risk Committee Minutes and amended Terms of
Reference – May 2005
Chair took as read
ACTION
25.0 Joint Staff Committee Meeting Minutes – May 2005
Chair took as read
26.0 Any other Business
(i)HP pointed out that the Commission for Patient Forum and Public Involvement
would not be abolished until 2007. He commented that the changes were still
demotivating for the volunteers.
AG – thanked HP for updating the Board and informed Members that the Patient
and Public Involvement Board of EPCT were keeping the situation under review.
The Chair of Enfield PCT Patient Forum is a member of this group.
(ii) AG reminded the Board of the following corporate events: – 6th October Staff
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Event. 12 October Modernisation Event. Details would be going out in Friday
envelopes and should be diarised.
(iii) SJ – Date of next meeting is 2nd November, 2005. There was a possibility this
would need to be given up for Development Board or Board Business.
Comments
LW pointed out that the volume of meetings in early October. This was noted.
It was also confirmed that Board Meetings would be moved to the last Wednesday
of the month. SJ would issue new dates but this would be happening from January
2006.
27.0 Date of Next Meeting – 2nd November, 2005
If a public meeting was needed in October as well then it would be the first
Wednesday in October.
28 The Board resolved that representatives of the Press and other members of the public be excluded
from the remainder of the meeting having regard to the confidential nature of the business to be
transacted, publicity on which would be prejudicial to the public interest (Section 1 (2) Public Bodies
(Admission to Meetings) Act 1960).
The Chairman thanked the Board then closed the meeting.
Signed............................................Chairman
Date.....................................................
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