The Chair welcomed everyone to the meeting. 

Members are asked to declare any pecuniary, non-pecuniary or other pecuniary interests relating to items on the agenda. 

There were no declarations of interest. 

To receive a report and presentation, for consultation on the Enfield Clinical Commissioning Group 2016/17 Commissioning Intentions. 

The Board received a report and presentation slides from Graham MacDougall, Director of Strategy and Partnerships, Enfield Clinical Commissioning Group (ECCG), on the NHS Enfield Clinical Commissioning Group draft commissioning intentions 2016/17.

1.               Presentation of the Report

Graham MacDougall presented the report to the Board, highlighting the following: 

·       Commissioning intentions are produced every year, setting out the new services and changes to existing services, which the CCG would like to see.

·       The intentions are influenced by local imperatives and national directives. 

·       They are the opportunity to set the commissioning framework. 

·       This year there will be a focus on mental health, both in adults and children. Focusing on how services respond to crisis, the quality of treatment offered and how to prevent people falling into crisis. 

·       Action plans are being developed and will be bought to the board at a later date.

·       Local challenges include Enfield CCG’s financial position: finding £13m in savings will be challenging.

·       Urgent and Urgency Care are under the spotlight - particularly the 4 hour accident and emergency target.  The systems are fragile, a strategic approach to create greater resilience in the system required. 

·       Transformation plans are being worked on in 6 areas and there will be an opportunity for the Health and Wellbeing Board to look at them in greater detail later in the year.  

·       Other areas of priority include eating disorders, psychological therapies and perinatal health. 

·       A strategic alliance with the other North Central London CCGs is being developed. 

·       The CCG is beginning to explore new models of care, working out new ways to contract it and will be commissioning for outcomes. 

·       The corporate objectives are set out on page 8 of the agenda pack. 

2.               Questions/Comments

2.1           Paul Jenkins advised the board that the CCG was under a category of “directions” where its priorities were laid down for it.  They had a statutory obligation to balance the books.  Recovery would take several years as they currently had an overdraft of £33.4m out of a budget of £360m.  Further details could be provided if requested. 

2.2           The provision of integrated diabetes, respiratory and heart failure services by the emerging GP Provider Network, to practice registered pan-Enfield population, was welcomed but it was felt that this should be extended to public health as well. 

2.3           Concern was expressed about how those that were not registered with a GP would be able to access these services.  There were various opportunities to address this though urgent care, and using public health methods.  It was very difficult to determine the level of those not registered.  Various initiatives were under consideration.  The problem was specific to certain wards which could receive targeted interventions.  Guidance to practice managers on proof of address would be helpful.  Co-commissioning should enable the CCG to have more influence in this area. 

2.4           A patient engagement event had been held on the previous day.

2.5           By the end of September the ECCG Executive Committee would have agreed and published the commissioning intentions.  Contracts with  ...  view the full minutes text for item 3.

To receive a report on the re-procurement of the 111 Out of Hours Service. 

The Board received a report from Clare Kapoor, North Central London Urgent Care Programme Manager, on the proposed procurement of an integrated NHS 111/Out of Hours Service across the five North Central London boroughs. 

1.                Presentation of the Report

Clare Kapoor presented the report to the Board highlighting the following: 

·         The report provides an update on the procurement of one integrated service for both the 111 and Out of Hours services across the whole of North Central London. 

·         Barndoc had provided the Out of Hour’s service in Enfield for many years and were familiar to local residents.

·         The contracts for both Out of Hours and 111 services were coming to an end providing an opportunity to improve all services.

·         40% of 111 calls ended up requiring the Out of Hours services.

·         The benefit of integration would result in fewer hand overs, provide access to a greater range of clinicians and to a direct booking service, avoiding the need for call backs.

·         This will also be an opportunity to improve services for deaf users.

·         An extensive engagement programme has been carried out with both large and small groups and more events were planned.  A patient reference group including four members from Enfield had also been established. 

·         Although there had been a low response to the July engagement exercise, many people had accessed the engagement documents on line and 161 had responded to the on line survey.

·         In July NCL had received a letter from NHS England requesting a pause in the procurement process due to the development of new commissioning standards but this was in line with NCL’s original procurement plans. 

·         Procurement will begin in October 2015 and outcomes will be reviewed by each of the 5 CCGs.  The issues will also be considered by the Joint Health Overview and Scrutiny Committee. 

2.               Questions/Comments

2.1     The contract would last for 5 years.  The NHS was moving to longer term contracts which would enable contractors to commit more resources to improving services. 

2.2     Camden and Islington have carried out focussed engagement with learning and disability services but not Enfield.  Clare would also be attending some parents and deaf user group meetings. 

2.3     It was reported that there was concern about the high numbers of people referred by the 111 service to Out of Hours services and that the 111 service was not staffed by clinicians.  It was felt that people needed reassurance if the contract were to be taken away from the current providers.   There was also concern that smaller local providers would have difficulty bidding for such a large contract and that it would therefore inevitably be let to a big pharma-company.  Local GPs would not be able to compete.   Many local people would prefer locally based services provided by local GPs. 

2.4     There was the potential for larger companies to sub contract the work out at the local level.  A key consideration was the way that the specification would be put together and decisions on the balance between price, quality  ...  view the full minutes text for item 4.

To receive and agree the minutes of the meeting held on 14 July 2015. 

The minutes of the meeting held on 14 July 2015 were received and agreed as a correct record. 

To note the dates agreed for future meetings of the Health and Wellbeing Board:

·       Thursday 15 October 2015, 6.15pm

·       Thursday 10 December 2015, 6.15pm

·       Thursday 11 February 2016, 6.15pm

·       Thursday 21 April 2016, 6.15pm

To note the dates agreed for board development sessions

·       Wednesday 4 November 2015, 2pm

·       Wednesday 6 January 2016, 2pm

·       Wednesday 2 March 2016, 2pm

The dates agreed for future meetings were noted as follows: 

·       Thursday 15 October 2015, 6.15pm

·       Thursday 10 December 2015, 6.15pm

·       Thursday 11 February 2016, 6.15pm

·       Thursday 21 April 2016, 6.15pm

The dates agreed for board development sessions were noted as follows: 

·       Wednesday 4 November 2015, 2pm

·       Wednesday 6 January 2016, 2pm

·       Wednesday 2 March 2016, 2pm