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N O R C O M ...

    A

    YORKSHIRE AND THE HUMBER SPECIALISED

    COMMISSIONING GROUP (SOUTH)

    MINUTES OF THE COMMISSIONER ONLY MEETING

    Friday, 14 March 2008

    in the Willow Room, Cedar Court Hotel, Wakefield

Present:

     Ailsa Claire Chair Barnsley PCT

     Jayne Brown Doncaster PCT

     Andy Buck Rotherham PCT

     Louise Newcombe Bassetlaw PCT

     Nigel Parkes Rotherham PCT

     Steve Broughton Barnsley PCT

     Jan Sobieraj (from item 5b) Sheffield PCT

In Attendance:

     Cathy Edwards Director of Yorkshire & the Humber SCG

     Kim Cox Yorkshire & the Humber SCG

     Alan Browne Yorkshire & the Humber SCG

     Kevin Smith Medical Advisor, Yorkshire & the Humber SCG

     Peter Davies East Midlands SCG

     Kate Lawrence (item 2 only) Sheffield PCT

     Joanne Poole (item 2 only) Yorkshire & the Humber SCG

     Action 1 APOLOGIES:

    None

    2 CHILDREN’S SERVICES

    The meeting discussed the need for a review of children’s services

    across the patch. It was agreed that there were four main drivers for a

    review. These were:

     ? Sheffield Children Hospital’s concern over the physical capacity of

    the current estate

    ? The current reconfiguration of neonatal services and the potential

    knock on effects to paediatric secondary care services

    ? The paediatric and maternity elements of the Darzi review

    ? The view that the needs of many children can better be met through

    community care rather than hospital admission.

     The meeting agreed that there was a need to determine options for a

    C:\convert\temp\61488041.doc paediatric service model and to determine what the consequences to

    other services of these options would be.

     It was agreed that the primary aim of the review would be to determine

    how best to support children requiring acute and/or planned care in their

     Action

    normal lives. Kate Lawrence and Joanne Poole would produce a broad

    specification for the review; clarifying the geographic area to be covered

    and the timescale. The specification would be considered at the April

    SCG (South) meeting. The SCG would then seek an external partner to Kate Lawrence/

    undertake the work. Joanne Poole

     All acute providers would be informed that the review was being

    commissioned. There was also a need to ensure that Sheffield Children’s

    Trust were aware that commissioner support for any significant

    development of Sheffield Children’s Hospital would be dependent upon

    the outcome of the review. Jan Sobieraj

    3 MINUTES OF THE JOINT BOARD MEETING HELD ON 8 FEBRUARY

    2008

     The minutes were agreed as a correct record.

    4 MINUTES OF THE COMMISSIONER ONLY MEETING HELD ON 8

    FEBRUARY 2008

     The minutes were agreed as a correct record.

    5 MATTERS ARISING

     a) Morbid Obesity

    The meeting received feedback from the “supra PCT services for

    morbid obesity” event held on 5th March. Commissioners noted the

    common areas of work to achieve consistency and the other priority

    areas for action listed on the covering paper.

     Cathy Edwards reported that the stepped model of care had been

    well supported at the event and that a project group would now be Cathy Edwards/

    set up to undertake the actions agreed. Sarah White

     The level of surgical activity to be commissioned from Sheffield

    Teaching Hospitals in 2008/09 was still predicted to be too low to

    meet demand and the 18 week target. It was likely that an

    additional provider would be required. Following discussion it was

    agreed that Cathy Edwards and Sheenagh Powell would determine

    how additional activity might be procured from a second provider, in

    the context of the Operating Framework guidance on competition Cathy Edwards/

    and collaboration. Sheena Powell

     b) Age Related Macular Degeneration (ARMD)

    The meeting received a draft paper on the use of anti-VEGF drugs

    for ARMD. Yorkshire & the Humber SCG had approved a common

    policy for the treatment of ARMD in June 2007. The SCG had

    agreed in September 2007 that the policy would remain in effect

    pending the publication of final NICE Technological Appraisal

    Guidance.

     Some PCTs were now receiving significant numbers of requests for

    treatment for patients outside the current policy. The meeting

    discussed whether, in the light of these requests, the SCG should

    review the interim policy.

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     Action

     It was agreed that PCTs that considered it would be appropriate to

    review the policy should formally write to the Director of the SCG

    detailing the reasons for requesting a review. Such requests would thbe considered at the full SCG meeting on 28 March.

     c) Shared Care Protocols

    The meeting received a detailed proposal for the introduction of a

    process for developing shared care protocols. It was agreed that

    commissioners would fund for a year a project manager to set up

    the process and produce a number of shared care protocols for

    high priority areas. The project manager would be hosted by the

    SCG team. Cathy Edwards

     d) Natalizumab

    Following the publication of NICE Technological Appraisal

    Guidance no.127, work had been ongoing with clinicians to agree

    clear criteria for the commencement and cessation of natalizumab

    for rapidly evolving relapsing-remitting MS.

     The meeting agreed the proposed criteria and noted that the

    projected commissioning implications had been included in the

    LDP.

     The drug would be procured centrally by the SCG for PCTs in

    South Yorkshire, but not for Bassetlaw or Derbyshire County.

    Commissioners agreed that the drug costs would not be risk

    shared. The activity associated with delivering the drug would be

    procured through the consortium contract.

    6 CANCER SERVICES

     a) IOG Action Plans

     i) Children & Young People

    The meeting noted that work on the IOG Action Plan was

    progressing. The national deadline for submission of the

    Teenage and Young People plan had now been deferred to

    September 2008. Cathy Edwards

     ii) Sarcoma

    The Cancer Action Team had requested submission of the

    Sarcoma IOG Action Plan by March 2008. However, as there

    was a national delay in clarifying the patient numbers and the

    potential treatment centres, Yorkshire & the Humber would be

    unable to submit plans before the end of May. Cathy Edwards

     b) NICE Technology Appraisals

     i) Pemetrexed for Mesothelioma

    In January 2008, NICE issued Technological Appraisal

    Guidance (TAG) no.135 on the use of Pemetrexed for

    malignant pleural mesothelioma. The TAG gave clear

    indications as to which patients would be most likely to benefit

    from the treatment.

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     Action

     The Cancer Board had discussed the introduction of the

    guidance and recommended that it be introduced with

    immediate effect. Commissioners agreed the

    recommendation.

     ii) Rituximab for non-Hodgkins Lymphoma

    NICE Technological Appraisal Guidance (TAG) no. 137 on the

    use of Rituximab for non-Hodgkins lymphoma, was issued in

    January 2008. The Cancer Board had recommended that the

    TAG should be implemented with the usual 3 month timescale

    allowed by NICE.

     However, the Cancer Board had also discussed a small

    subset of patients meeting the eligibility criteria which, it was

    considered, should have the treatment made available to them

    with immediate effect. Commissioners agreed the Cancer

    Board’s recommendation.

     c) Funding Clinical Sessions

    The Cancer Board had discussed the time commitment included in

    the job plans of clinicians who chaired Network Site Specific

    Groups. The Board had recognised that there were times when

    additional clinician involvement was needed in order to deliver

    sustainable change management.

     It had therefore been proposed that the Cancer Network Office

    should hold a budget to support the additional payment of clinicians

    involved in Peer Review and/or IOG implementation. The funding

    would come from the 2008/09 service improvement allocation.

     Applications for payment, including start and finish dates, would be

    agreed between the Cancer Director, Lead Clinician, Clinician and

    local manager.

     SCG (South) supported a trial of this system for one year. A

    progress report would be made to the October 2008 Cancer Board Kim Fell/

    meeting. David Fell

    7 PERFORMANCE MONITORING YEAR END POSITION

     a) National Contracts

    The meeting received a schedule of national contract performance

    by health community as at month 10 (January 2008). The schedule

    showed that the forecast outturn, based on month 10, was in line

    with expectations. However, there were differences in individual

    PCT positions.

     Alan Browne explained that invoices and refunds to PCTs would be

    based on the projected year end position as at the end of month10.

    Any adjustments to actual performance would be made in 2008/09. Alan Browne

     b) Risk Shares

    A report on the financial position of the risk shares was deferred

    pending receipt of renal information from Doncaster & Bassetlaw

    and medium secure information from Rotherham, Doncaster and

    South Humber Healthcare. Alan Browne C:\convert\temp\61488041.doc 4

     Action

     c) Budget

    The meeting received a forecast outturn for the SCG (South) Alan Browne

    budget for 2007/08. Alan Browne confirmed that there would be a

    small underspend on the budget, which would be refunded to PCTs.

    8 LOCAL DELIVERY PLAN

     a) Revised Investment Schedules

     The meeting noted the revised investment schedules sent

    previously with the agenda. Alan Browne confirmed that the figures

    for the commissioning of coronary artery bypass grafts (CABG)

    from Hull had now been clarified. It was agreed that the costs in

    excess of national tariff for CABG commissioned from Hull would be

    risk shared. Alan Browne

     b) First Draft Funding Distribution

     The meeting received and approved the schedule for the release of

    funding.

    9 FERTILITY POLICY

    Commissioners were informed that the commissioning policy for In Vitro

    Fertilisation had been reviewed in January 2007 and extended to the end

    of March 2008. The policy had been reviewed again and arrangements Cathy Edwards/

    were being made to consult on a new policy. Sarah White

     In the meantime, it was agreed that the current policy should be extended

    for a further six months to the end of September 2008, pending the

    outcome of the consultation. John Radford

    10 PRIMARY CARE IS PROCUREMENT

     Cathy Edwards confirmed that the remainder of the funding for supporting

    primary care IS procurement projects would be carried forwards to

    2008/09. The funding had been included in the budget report discussed

    previously.

     Cathy explained that there was a small amount of spend predicted for

    2008/09 and that two proposals remained outstanding for consideration. Cathy Edwards

    11 CHLAMYDIA SCREENING THE WAY FORWARD 08/09

     Jayne Brown explained that currently the Terence Higgins Trust provided

    chlamydia screening for Doncaster, Rotherham, Barnsley and Bassetlaw

    PCTs. During 2007/08, Doncaster PCT had instigated a number of

    actions as part of the performance management of the screening

    contract. These had primarily been prompted by a projected under

    performance exceeding 75% of the contract target.

     Recent action had improved the performance of the Terence Higgins

    Trust. However, a significant year end shortfall in activity was still

    projected. Following discussion it was agreed to proceed with more

    stringent action to performance manage the contract and to explore other

    options to deliver the activity required.

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     Action 12 ANY OTHER BUSINESS

     (a) Review of Commissioning Policies - Cinacalcet

    The meeting noted that the SCG (South) commissioning policy for

    Cinacalcet in the treatment of secondary hyperparathyroidism in

    patients with chronic renal failure had been superseded by NICE

    Technological Appraisal Guidance no.117. As a result, a local

    policy was no longer required.

     The meeting agreed that the current policy would be discontinued

    in favour of TAG no.117. Kim Cox

     (b) Management Budget

    Cathy Edwards informed the meeting that a budget report for the

    full SCG was in preparation and would be presented to the SCG

    thmeeting on 28 March.

     A separate budget report would be prepared showing the

    management costs of clinical networks and the collaborative. Alan Browne

    11 DATE AND TIME OF NEXT MEETING

     Friday 11 April 2008 commencing at 1.00 pm, Room 4, RED Centre,

    Doncaster

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