Key Notes and Action Points from SLA Review meeting between WHHT & Hertfordshire PCTs held on Thursday 20th December 07 at 12 p.m. - Solutions House, Letchworth Garden City

In attendance:	Andrew Moore, WHHT Head of Business Development
			Nick Evans, WHHT Director of Service Development 	
			Beverley Flowers, PCT Director of Commissioning
			Alan Pond, PCT Director of Finance
Clare Jones, PCT Senior Contracts Manager
			Katrina Power, PBC Representative
			Ian Isaac
			Mo Girach, Chief Executive StACom.
			Jon Clegg

Apologies		None

Note/Action	Responsible Lead	
2.1	Orthotics Disaggregation 

Meeting with TS & PJ. TS picked up 2 issues. Information is available to the PBC groups – MG has contract. PJ may be opposed to making any changes to the contract. PJ to look into the legality of changing the contract. Sub-contract – national – did it jointly with E&NHT. Contract is for £600K across all com – most for own divisions. There is a small amount for true direct access. If PCTs want to enter into separate arrangements is this possible? St Albans is interested in going first – possibly as a pilot.

The specialist element of orthotics is provided by the North London Pan Thames consortium at the RNOH. This will be re-tendered in the next financial year. Due to space limitations this will impact on WHHT.

2.2	HIV/A&E hosting arrangements 08/09
Discussions with specialist commissioning over scope of work. AM agreed to provide break down of attendances by practice.	BF/CJ/AM	
2.3	Capacity & Waiting List.
KP is pulling together a meeting with Moira McGrath. B&CF are doing technical work through C&B – only seen by CAS teams. Direct access booking is OK as long as there is an agreed written policy that is auditable and meets all the reporting requirements. MG held meeting on 19th December with Colin Johnson re introduction of new service on the 01/04/08 Business plan will need to be submitted mid January.

18 weeks (Diagnostics) – want to include FUPs as part of CATs. There have been initial discussions between TS&JR. need to be very clear on what is covered and rationale for inclusion. CATs will be classed as first definite and is therefore covered by 18 week rules. Need to arrange a meeting with WHHT early January to discuss as part of the OP discussions.  
	KP	
3.1 Specialist Commissioning Disaggregation

Disaggregation exercise concentrating on London providers and designated centers. For EoE trusts only looking at Renal, Neonatal and HIV. Outstanding issue is whether L2 SCBU is covered in specialist services disaggregation. BF to confirm.	BF	
3.2   18 week plan
AM has provided the latest IP plan. Delivery of this is now of national concern and so the trust will be called into the recovery unit in the beginning of January. Following a meeting with the SHA BF reiterated some key points:
-	Milestones are not optional
-	Need to be really clear that where additional capacity has been identified reasons why the cost would be more than the tariff.
-	Sustainability – how will the trust ensure performance is met post March
-	Problem specialties – particularly orthopedic backs. Need to link into wider process possibly implementing a network approach.
-	Daily reporting regime. Need to ensure that patients are treated and accurately reported. If the number of unknown clock starts does not reduce trust will be required to do daily reporting.
CJ has requested a copy of the slot planner produced by DA for completion by the Trust. 

PCT has flagged to the SHA that backs maybe undeliverable. NE may have a solution – will be able to confirm tomorrow (21/12/07). Rest of orthopedic cases should be cleared.

Re sustainability the trust feels they won’t be able to sustain this position post March. NE stated that the trust may need to limit capacity. BF stated that there is a very clear message that trusts cannot close capacity unless this is a permanent closure of a service. Wider review taking place including Jane Halpin. Waiting list does include people who have been waiting a long time. From April there will be a change to the rules to allow people to stay on the waiting list provided the trust has plans in place to increase capacity. 

KP feels that communication between the local provider and CATs could help. If CATs teams know how much capacity is available at the trust they could hold an informed discussion with the patient which would help to manage demand. GPs also do not have a view on capacity and they could also influence referrals. Regular updates required from the trust. 

Independent sector included on extended choice – not covered by a contract this financial year. Aim to have contract in place 08/09. However, no invoices have been paid as they are not being validated. There are 4 invoices that have been with PBC since September KP to follow up.

Overall position of the trust is that all EL & OP slots are booked until March.

NE to provide list of consultants who have 18 week capacity issues.

KP raised the issue of allowing CATs to book directly onto W/L i.e. foregoing outpatient appointment. MG will agree process with AM and circulate paper. 
 	BF/NE	
3.3 RSU Meeting
BF offered the opportunity for PBCs to attend the meeting.

RSU will be interested in seeing:
-	Can trust demonstrate best practice
-	How are services booked
-	Are there unnecessary steps in the process?

AP feels that there are still things to be done on efficiencies although these will not deliver the big wins that the SHA expects. Need to be able to demonstrate by the meeting that the trust has plans in place to address issues. Also need to ensure SHA feeds back on actions they are taking.

Re Backs – looking at forming a consortium arrangement with other local providers.

Need to be more proactive with the SHA when tried everything they suggested. 

	BF/NE	
3.4 Audiology
Trust confirmed that the backlog has been cleared – fitting is now being done.

Audiology pathway work is continuing. CJ to contact KG to ask KP for a PBC representative to attend the local Audiology steering group. 

Issue remains with payment of Audiology activity. Various emails & discussions have occurred outside this meeting. Trust & PCT do not agree on payment and therefore needs to be referred to the Chief Execs meeting.  	AP/NE	
3.   High Cost Drugs
BF has asked Rasila Shah to provide detailed reports – will need to be split by practice/PBC group on the over performance.	RS	
4.   ITU
AM confirmed that ITU plan was set to last year’s activity plus 2.5% growth and is for all localities.	AM	
5.   Month 8/November Performance
The performance report was circulated and discussed.  It was noted that there still remained significant under performance. Several Areas were highlighted:
-	Elective – starting to claw back the underperformance
-	Clinical Haematology – seen big moves in blood transfusions and local chemotherapy
-	First attenders – struggling to achieve targets. Orthopaedics are much lower than last year. Some of the drop may be accounted for by the surgical thresholds being applied.
-	DNAs – running at 8-9%

	AM

	
18.   Commissioning Intentions 08/09
NE stated that need to agree the process & timescales for contracts. AM has produced the 1st draft of requirements to continue to meet 18wks.

BF stated that need to build everything up from the PBC groups (including the Red House). One option may be to invite the Red House to join St Albans.

Adrian Lambourne has been looking at the disaggregation of the trust plans. The PCT has produced the initial submission to the SHA. However, this didn’t reflect PBC plans or service reconfigurations. Version 1 of the ASR modelling will be submitted as the second cut to the SHA on the 4/1/08. This will be shared with the Trust and the PBC groups.
	BF/CJ/AM	
Any Other Business
		
28.  Date & time of next meeting
To be confirmed. 

Dates for the full year will be set and send out in advance.	BF/CJ