Key Notes and Action Points from SPRG meeting between WHHT & Commissioners held on the 17th July 2008 at 2 p.m. – The Library, Parkbury Surgery, St Albans

In attendance: 	Nick Evans, WHHT Director of Partnerships
Andrew Moore, WHHT Head of Business Development
			Julie Cowie, PCT Deputy Director of Commissioning
			Clare Jones, PCT Senior Contracts Manager
Alan Pond, PCT Director of Finance
			Katrina Power, PBC Representative
			Ian Isaac
Mo Girach
Stella Wilkie, Hillingdon PCT

Apologies		Phil Bradley, WHHT Deputy Director of Finance 
Jane Rice, PCT Finance Lead
			John Clegg
Sarah Germin, Harrow PCT
			Karen Malone, Luton PCT
			Nikki Barnes, Bedford PCT

Note/Action	Responsible Lead	
1.   Notification of AOB

DONM

	JC	
2. Notes and Matters arising from previous meeting held on 19th June 2008

Minutes from meeting on the 19th June agreed.

Ambulance turnaround times – WHHT are doing some snapshot analysis as they do not agree with the Ambulance trust figures. WHHT show that the majority of handovers are around 20-35 minutes whereas the Ambulance trust show majority at 30-40 minutes. This would suggest recording differences. Trust figures show that 93% of ambulances are turned around in 15 minutes. AP stated that additional funding had been agreed to support the additional time for crews to get to Watford – is this happening already?

KP has had discussions held with APa around organising a meeting between PBC/PCT/WHHT to discuss next year’s plans. APa was due to discuss with BF – KP to confirm whether this has happened. 

NE

KP	
3. Contract 2007/08 – Outstanding Issues

PB and JR will be meeting next week to finalise year end position. Including additional staff support for 18 weeks and out-turn 
	JR/PB	
4. Contract 2008/09 

Outpatient Referrals
The PCT has done an analysis of OP Referrals which was presented to the PEC on the 16th July. This is across both PCTs looking at referrals into WHHT, E&NHT and neighbouring trusts where data is available. This was also discussed at the PBC leads meeting immediately prior to the SLA meeting. Analysis shows that referrals are significantly above plan and if this trend continues then will undermine DQHH assumptions and put the 18 week delivery at risk. KP states that she has a lot of soft information on why this may be happening. Suggest 5/6 practices are looked at in detail to identify causes. KP & MG to co-ordinate work and feedback to PEC in September.

Performance
AM presented the latest performance report – attached with minutes. 

MG raised a question on the increase in A&E activity – need to understand by practice. Dee Boardman is looking at a piece of work around this. JC to invite her to next meeting. II feels that there is evidence that some of the activity can be explained by ethnicity – e.g. eastern Europeans have higher expectations that they will be seen in a hospital. JC to circulate DB’s work.  CJ stated that HIDAS has the functionality to show frequent attenders by practice.

AM has no information to quantify how much of the overperformance is attributable to 18 weeks activity.

The trust is planning to clear independent sector orthopaedic work in Q1 – not large numbers.

Validation
SW raised concerns over validation queries. These have been discussed with Simon McGrath but not yet resolved. Hillingdon PCT would like a clinical team to review patient notes to determine the level of inappropriate HRGs. AM will discuss with SM and feed back.

KP has reviewed the trust responses to PBC queries and cannot identify amount to be credited. AP has spoken to DH about this. Any validation queries changed on PAS will be reflected on SUS and HIDAS. The only way to identify changes is to re-run the SUS extract and compare with the previous version. However, HIDAS does show when changes have been made and so practices should be able to identify changes themselves.

18 weeks
The NODDY has been run on the backlog of patients and this stopped clocks for 15,000 patients. This left 7000 requiring manual checks at the end of June which has further reduced to 5k at the end of last week. 3 students are working through the list and should complete mid August. The trust is reviewing processes to ensure that another backlog doesn’t build up again. Form completion in outpatient clinics is improving. Have kicked off an exercise to monitor form completion and have started a name and shame campaign which may form part of a performance review.

The SHA have produced a name and shame list of trusts not completing clock start info when making tertiary referrals. WHHT are not on the list. JC stated that it has been a pleasure working with the trust on this process and they should be congratulated for all their hard work. 

SUIs
No new incidents in June.

The 3 remaining cases from the MV tissue sampler have all closed. The concluding report has been produced.

KP/MG

AM

JC

AM	
5.  PBC Update

Watcom
Commission plans signed off. Focus will be on mental health and provider services. Mental health is a massive growth area – pilot work completed and watcom will included in the next tranche. On the provider side, now appointing more staff than loosing. Therefore are beginning to restart work programmes. Capital – there will be no Darzi centre in Watford however GPs may still wish to centralised some services.

Stahcom
Working on mental health with the Joint commissioning team. Have set up working groups looking at falls, obesity and sexual health. MG and Roger Sage will be holding monthly meetings with the Chief Exec of St Albans council. Attended an away day yesterday. Provider – similar comment to Watcom.

Dacorum
No report

Hertsmere
No Report

Red House
No report

II

MG	
6. Trust Issues

Cancer Reporting - 2 week referrals  
WHHT previously performed well against this target. The rules changed at the end of last year for reporting. New target is the totality of referrals received from decision to treat not those received within 24hrs. majority of referrals are OK however there is a proportion that arrive upto 10-12 days after the decision to refer has been made. There have been some discussions with individual practices to change the dates on the form but this is not a full solution. Group would like to see the names of the practices/GP that are working this way. NE agreed to provide and work with the PBC leads to resolve. 

Disaggregation
Discussions taking place.

Contract Variations
Meeting held last week between WHHT/HUC & PCT to discuss the contract variation needed to cover the period from October to March. AP queried the cost of double – need to quickly agree what these additional costs over the A&E tariff would be. The PCT will need to take a decision on how to proceed with the UCC, given the almost 6-month transition period.  This would depend among other things on the additional costs versus benefits. AM suggested that the double-running costs were associated with employing GPs ahead of reducing Trust employed doctors.  AP suggested that the PCT looks at whether the UCC would be operated 24/7 for the whole time that A&E was still on site and therefore whether there should be immediate recruitment to the full number of planned GP sessions. AM stated that the additional GP costs were £500k a year and the offsetting saving that would be made on Trust employed doctors was equivalent to £100k a year.  This gave net additional costs of £400k for a full year or about £33k a month. AM was thanked for this information and it was agreed that the project implementation team would continue to take forward planning for the UCC and AP would discuss further with APa.

Outpatient FUP work
Limited response from the PBC groups to nominate volunteers. MG to take forward. Suggest that PCT draft a letter in support of this piece of work.

Consultant to Consultant Referrals
Pick up outside the meeting and provide update for next meeting in August.

NE

AP/APa

MG/CJ

JC	
7. AOB

DONM – suggest that this meeting is moved for the remainder of the year to follow the PBC leads meeting.
 	CJ	
8.  Date & time of next meeting
22nd August, 3pm The Library, Parkbury Surgery, St Albans. 		

Dates of Future Meetings	
3.00 – 5.30 Commissioners and Trusts	
18th September – the library, Parkbury Surgery