NORCOM North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium

Transcription

1 NORCOM North Derbyshire, South Yorkshire and Bassetlaw Commissioning Consortium MINUTES OF THE NORCOM (Joint Meeting) held on Friday, 7 September 2012 in Rooms G04/G05, NHS Rotherham Present: Andy Buck NHS South Yorkshire and Bassetlaw Cluster (Chair) Steve Broughton NHS Barnsley Phil Mettam NHS Bassetlaw Chris Edwards NHS Rotherham Ian Atkinson NHS Sheffield Martha Mayhew NHS Doncaster David Peverelle Barnsley NHS FT Mike Pinkerton Doncaster and Bassetlaw Hospital NHS FT Sue Wallace Sheffield Teaching Hospitals NHS FT Jim Butler Sheffield Children s Hospital NHS FT Nikki Tucker Chesterfield Royal Hospital NHS FT Richard Cullen Rotherham CCG In Attendance: Cathy Edwards North of England Specialised Commissioning Group (Yorkshire and the Humber Office) Kim Fell North Trent Cancer Network Clare Hillitt North Trent Cardiac Network/Stroke Strategy Project Jacky Mason Commissioning Manager (Screening) Fiona Jorden Consultant in Public Health (Screening) 1 Apologies Action Apologies were received from Kirsten Major; Philip Foster; Steve Wainwright; Chris Stainforth; Steve Hackett 2 Minutes of the meeting held on 6 July 2012 The minutes of the meeting held on 6 July 2012 were approved as a correct record. 3 Matters Arising Head and Neck Cancer Services Review Kim Fell confirmed that since the last NORCOM meeting a commissioning statement regarding the position on Head and Neck Cancer, as agreed at the July NORCOM meeting, had been issued. 4 Transition Update Andy Buck confirmed that in relation to the NHSCB Operations Directorate a significant number of senior management and leadership posts at regional office and LAT levels had now either been appointed to or were in the process of being filled. Details of resourcing and structures for the Operations Directorate were expected

2 imminently and at that point the fit of workforce proposals and current workforce numbers would become clear. It was noted that there was critically still no formal guidance regarding senates and networks. Timescales were now significant with much still to do between now and 31 March CCG s were all working through the authorisation process between now and December. In South Yorkshire and Bassetlaw all Chief Accountable Officers had been appointed with good progress being made on Chief Finance Officers and other key appointments. The Commissioning Support Unit (CSU) Managing Director had now taken up post. It was confirmed that the Y&H specialised commissioning function would be hosted by the SY&B Local Area Team (LAT). Cathy Edwards confirmed that a publication by the National Clinical Advisory Group on the definition of specialised services for 2013/14 was expected in the next couple of weeks. It was noted that the prolonged uncertainty regarding this and other transitional issues was a cause for concern. 5 Cancer Services Service Changes (i) Radiotherapy In February 2012 the Specialised Commissioning Operational Group (SCOG) had agreed that a group be set up to take forward a set of actions to determine the optimum configuration of radiotherapy services to meet the expected demand by It was noted that the Y&H Radiotherapy Development Group had developed a process for this work and that a set of recommendations on the optimum location of additional sites (where needed) would be presented to specialised commissioners in January Cathy Edwards confirmed that radiotherapy services would be commissioned by the NHSCB rather than CCG s. The importance of the engagement of CCG s in the planning and development of the strategy was noted and Andy Buck indicated that this was one of a number of issues that would be considered in relation to the design arrangements needed for the new system in relation to defining responsibilities and partnerships/relationships. Cancer Drugs (i) Abiraterone in the treatment of prostate cancer In June 2012 NICE issued Technology Appraisal 259 regarding the use of Abiraterone for castration-resistant metastatic prostate cancer, previously treated with a docetaxel containing regimen. As a result of further negotiations with the manufacturer concerning the rebate arrangements, it had been agreed that the drug would continue to be funded by the Cancer Drug Fund in Yorkshire and the Humber with the aim that PCT funding would commence on 1 October 2012.

3 NORCOM noted the recommendation made by the Cancer Board and the approval of SCOG at its July meeting. (ii) Lapatinib and Trastuzumab in the treatment of breast cancer In June 2012 NICE issued Technology Appraisal 257 regarding the use of Lapatinib and Trastuzumab in combination with an aromatase inhibitor) for the first line treatment of metastatic hormone-receptorpositive breast cancer that over expresses HER2. Lapatinib in combination with an aromatase inhibitor was not recommended for first-line treatment in postmenopausal women with metastatic hormone-receptor-positive breast cancer that overexpresses human epidermal growth factor receptor 2 (HER2). Trastuzumab in combination with an aromatase inhibitor was not recommended for first-line treatment in postmenopausal women with metastatic hormone-receptor-positive breast cancer that overexpresses HER2. This guidance had been anticipated and the part year effect of 1.58m which had been included in the Cancer Local Operational Plan (LOP) had now been removed. NORCOM noted the recommendations made by the Cancer Board. (iii) Erlotinib in the treatment of non-small cell, EGFR-TK mutation positive lung cancer In June 2012 NICE issued Technology Appraisal 258 regarding the use of Erotinib for the first line treatment of locally advanced or metastatic EGFR-TK mutation-positive non-small cell lung cancer. NICE recommended Erlotinib as an option for the first-line treatment of people with locally advanced or metastatic non-small cell lung cancer (NSCLC) under two sets of circumstances. This guidance had been expected and it had been anticipated that this change would be cost neutral and therefore zero additional funding had been identified within the Cancer LOP. NORCOM noted the recommendations made by the Cancer Board. (iv) Bevacizumab in combination with Capecitabine in the treatment for the first line treatment of metastatic breast cancer In August 2012 NICE issued Technology Appraisal Guidance 263 regarding the use of Bevacizumab with Capecitabine for the first line treatment of metastatic breast cancer. Bevacizumab in combination with capecitabine was not recommended within its marketing authorisation for the first line treatment of metastatic breast cancer. This guidance had been anticipated and part-year funding had now been removed from the LOP. The first line treatment of breast cancer with Bevacizumab currently funded by the Cancer Drugs

4 Fund was confined to those patients with triple negative disease, rapidly progressing metastatic disease or patients with other poor prognostic features. NORCOM noted the recommendations made by the Cancer Board. (v) General In conclusion it was agreed that an update of the LOP funding for cancer drugs be produced for the October meeting. (c) Progress in delivering Improving Outcomes: A Strategy for Cancer Four Year Review This report had been discussed in detail at the Cancer Board and was highly commended. Any comments to be passed to Kim Fell, with the final report to be widely circulated. It was noted that this provided an excellent source/legacy document and was to be shared with Mike Richards before the network simulation event at the end of September. (d) PIP Silicon Gel Implants Kim Fell reported that a meeting between the Cluster Medical Director, the breast surgeons and the plastic surgeons had taken place and a further meeting to develop a consistent approach to patient management particularly in relation to follow up appointments was to be arranged. National reporting had now moved from weekly to monthly. The next report to NORCOM would be in October. 6 Cardiac Services Update on Cardiac Work Programme Progress & Risks The Cardiac Work Programme was received. Challenges and risks in terms of delivery were acknowledged but the importance of retaining focus on these important issues was recognised and supported. Review of Cardiology Commissioning Standards Ian Atkinson reported that the first meeting of the Cardiology Commissioning Standards Review Group had been held on 25 July Terms of reference had been agreed and all providers were represented along with members of the Network Board. Activities for the Clinical Group had been agreed and they were due to have their second meeting on 14 September The next Cardiology Commissioning Standards Review Group was due to take place in early November. Ian would be briefing CCGCOM regarding process as it was important to ensure engagement with GP colleagues on progress. Ian confirmed that clinical relationships which had come under pressure were now more resilient and the importance of the role of the Clinical Director at STHFT was recognised.

5 7 Stroke Services Outputs from the November meeting would go to the Network Cardiac Board in December and then on to NORCOM. Update on stroke work programme progress & risks The Stroke Work Programme was received. Challenges and risks in terms of delivery were acknowledged but the importance of retaining focus on these important issues was recognised and supported. Clare confirmed that North Trent was the first of the 3 networks to have delivered a 24/7 hyperacute stroke, including thrombolysis service. This achievement had been recognised and praised by the National Stroke Clinical Lead and NHS Improvement Stroke Director. A clinical notes audit was currently underway and initial indications were highlighting issues around the timeliness of nurse/doctor assessment and delays in patients receiving CT scans. It was noted that pathways may require revision and particularly in light of a likely change in Royal College of Physicians (RCP) recommendations in scanning times from one hour to 30 minutes. It was noted that this was being delivered already in some Trusts where patients went straight from the ambulance to CT scan. Cathy Edwards highlighted the issue of inequity across North Trent in relation to access to carotid endarterectomy (CEA). It was noted that within the national vascular service specification, Trusts would be required to achieve 100% of all cases from referral to surgery in 14 days. Finally, it was noted that recommendations regarding the future of the SHA Stroke peer review process were currently under discussion and recommendations would be made to NORCOM before Christmas. 8 Children s Services Neonatal Surgery Cathy reported that the recommendation of NORCOM had been considered at the July Yorkshire & Humber SCOG meeting and the decision had been made that neonatal surgery should remain at SCH. It was noted that the level of neonatologist input to this service required further work which was being taken forward by Joanne Poole with SCH and STH. Andy Buck stressed that now a decision had been reached it was important for both Trusts to move forward noting that there were important capacity and cultural issues to overcome. Neonatal Services Cathy reported that a significant report had been taken to SCOG in July regarding progress on the move to the 27 week gestational period and staffing thresholds. Good progress had been made within North Trent but significant work remained to be undertaken in the Yorkshire Neonatal Network. The other major issue for most Trusts was the achievement of increased staffing ratios and the implementation of the national Neonatal Toolkit workforce standards.

6 (c) Paediatric Neurosurgery Y&H SCOG had recently considered proposals for the future configuration of children s neurosciences networks and specifically the optimum configuration of paediatric neurosurgery and provider partnerships for the Yorkshire and Humber area. There was a need to submit network configuration information back to the national team, as part of the national Review of Paediatric Neurosurgery by 21 September The SCH preferred option was a provider network relationship with Nottingham and Birmingham (South) but commissioners recognised the importance of considering a network relationship with the North (Leeds and Newcastle). After due consideration and discussion by the Y&H SCOG the proposal to establish network links between Sheffield, Leeds and Newcastle would be taken to the North of England SCG on 14 September This decision had been shared with SCH managers and clinicians. There remained a number of concerns and reservations from SCH and a number of issues would be discussed further with the national team especially around sub-specialisation. Kim Fell asked whether patients from North Derbyshire would be included in this arrangement for very rare tumours. Andy Buck confirmed that Chesterfield Royal had raised a number of issues around network relationships which needed to be resolved. Richard Cullen stressed the importance of the advice offered by networks to GP s in terms of the assurance about services and in particular clinical outcomes regardless of where the service was provided. 9 Vascular Services Andy Buck reported that he had chaired a very helpful meeting with key Directors from STH and DBH FT s. This had provided a forum for a number of difficulties and anxieties to be discussed and acknowledged relating to the future planned provider partnership for vascular services. A series of next steps had been agreed with actions to be reported on by 24 August Mike Pinkerton gave verbal feedback on a number of issues and indicated that a formal response, which had been delayed by annual leave arrangements, would be available on 11 September Andy indicated that it was hoped that this meeting would lead to a positive resolution of a number of issues and felt that a clear commitment had been given by commissioners and providers to make progress. 10 SARC Andy Buck reported that Margaret Kitching had been asked to lead a meeting on 10 September 2012 to resolve the many issues that had been raised in relation to SARC. 11 Major Trauma It was noted that major trauma services would be commissioned in the future by the

7 NHSCB rather than CCG s. The Specialised Commissioning Operational Group (SCOG) had now signed off the commissioning framework and principles for phase 2 of implementation. Further discussions would be taking place through the Major Trauma Executive Group to inform commissioners of progress. The next meeting of the Major Trauma Executive Group was due to take place on 24 October Andy Buck confirmed that the major trauma services were working well in North Trent and Ian Atkinson confirmed that clinical education sessions were due to take place on 14 September Activity figures still remained very low. 12 Screening Services Update The update report on screening services was noted. Performance Report (c) Future Risk Assessment Fiona Jordan confirmed that this document sought to identify future arrangements and risks to delivery of the screening programmes over the next 6 months. Andy Buck indicated that early initial information was that LAT s would be responsible for the commissioning of screening services. The publication of this guidance was imminent and once this was confirmed, further discussions would take place to consider the details. (d) Risk & Incident Register The issue of the difference in the diabetic retinopathy screening performance for Rotherham and Barnsley was raised as the service was from a single provider. Fiona Jordan confirmed that it had been suggested that this was as a result of different invitation rates caused by a software problem. As the software provider was a national provider this issue had been raised as a serious untoward incident (SUI). Steve Broughton confirmed that NHS Barnsley was investigating the SUI through their governance processes. It was noted that COSSAC were concerned about the lack of assurance in the system particularly as the risk of litigation could be high. Andy Buck indicated that the Cluster Board should be sighted on this issue and should follow up these concerns. 13 Clinical Network Updates Cancer Critical Care

8 It was noted that a stock-take had been undertaken against the service specification standards, ICNARC and workforce levels. The results would be discussed at the Critical Care Board during w/c 10 September 2012 and a profile would be developed for each Trust. Kim and Jeremy Groves would then discuss the outcome with each Trust and agree action plans. Phil Mettam reported that Catherine Rao would be leaving the Network. NORCOM recorded their thanks to Catherine for her service to the Network. Cathy Edwards asked NORCOM to note that plans to mitigate the supply issues in relation to the equipment for Continuous veno venous haemafiltration (CVVH) were in place within each provider Trust. (c) Cardiac (d) Neonatology (e) Stroke 14 Date and time of next meeting Friday, 5 October 2012 in the Redmires/Howden Rooms, Don Valley House, Sheffield