Minutes Subject: Professional Executive Committee (PEC) Notes for the PCT Board The PEC approved the list of Low Priority Procedures for the commissioning framework for 2007/08. The PEC supported the development of a subcommittee (of the PEC) to support the governance required under the guidance “Implementing Practice Based Commissioning” November 2006.
Date: Thursday 7th December 2006 The Board Room, West Sussex PCT, New Park House, North Street, Horsham, RH12 1RL Chair: Dr Minuted By: Present:
Dr Andrew Foulkes Chairman of the PEC Dr Farhang Tahzib
Director of Public Health and Well Being
Dr Farhang Tahzib Director of Public Health & Well being Sara Weech
Director of Community & Primary Care
In Attendance Bridget Mguni
Interim Director Contracts & Performance
Apologies: Minutes of the last meeting
The minutes of the last meeting were agreed as a correct record.
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Matters Arising Terms of Reference
The revised Terms of Reference were agreed subject to the words ‘horizon AF
scanning’ being replaced (item 3, para 4). It was agreed that the change
would be subject to chairman’s action.
At the PCT Board meeting on 30th November 2006 it was agreed that two
members of the PEC should be invited to join the Board. The nurse
member has been agreed as Sue Dewar. Both Dr Amit Bhargava and Dr
Alison Smith have expressed interest in becoming the GP Board member. AF
It was agreed that the PEC chairman would meet with both GPs to agree a
Presentations and Discussion Fit for the Future (FFF) Update – John Wilderspin
The PCT held a public board meeting in Horsham on 30th November 2006
and a presentation was given on FFF. This covered background
information and progress to date. Options for a single MGH (Major General
Hospital) for West Sussex was the issue taken up by the press. Reports
recently published in the national press from Tsars, Robert Boyle and
George Alberti support the direction of FFF with the centralising of some
services. Local MPs have been involved in the FFF debate and have
enquired whether it is the intention of the PCT Board to declare their
preferred option for the future configuration of providers in West Sussex,
ahead of the public consultation process, which will commence early in the
new year. A response has been sent and will be shared with PEC
A clinical reference advisory group has been set up to support the FFF
process. Representation includes acute trusts, the ambulance service and
the PCT. The remit is to oversee the clinical validation, which will underpin
the proposed changes in service delivery. A number of sub groups have
been formed to focus on particular areas e.g. A&E, acute medical
emergencies, critical care, paediatrics and maternity. Discussions are
continuing between the PCT and the acute trusts and the acute trusts are
working on the costings, which will need to be validated.
A separate project has been set up with Brighton University Hospitals to
consider the future of Princess Royal Hospital. If the options include only
one MGH in West Sussex, then Princess Royal Hospital because of its
geographical location is the least preferred. It is important therefore, that
NHS organisations look at further options for Princess Royal Hospital.
Brighton & Hove PCT who are the host commissioners are involved in the
project but the onus is on Brighton University Hospitals to make the
Meetings have also been held with clinicians at the Royal West Sussex
Trust and Worthing and Southlands Trust and meetings are planned both
with Brighton University Hospital and Princess Royal Hospital. At this stage
there is not a consensus of views from clinicians on the future configuration
of acute providers. It is planned to hold a workshop in early January 2007
to focus on the changes that will impact on community and primary care.
The ambulance service is fully engaged in the FFF process and more
change will be needed – i.e. location of bases, training etc. A further strand
of work is reviewing community hospitals, to ensure cost effectiveness and
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It is widely accepted that no change is not an option. The PCT does not
have a preferred option and is open to options that meet the criteria of
patient safety, affordability and sustainability. It was agreed to hold a workshop in January 2007 for community staff and a series of other forums to focus on FFF and commissioning plans. Supporting Fit for the Future – Geoff Lowry
The central driver for change in Adult Services is self-directed care for
service users. This is underpinned by the shared health and social care
strategy originally developed by John Dixon and Steve Phoenix. Aims
include closer integration between health and social care, particularly
through joint commissioning and governance. Also, engagement with local
people, as well as increased choice and control for service users.
The ‘Transformation Blueprint’ outlines Adult Services’ development over
the next five years. One action is the delivery of Adult Services being linked
to the twelve County Local Committees from April 2007. The current five
areas and Area Manager posts will cease to be replaced by twelve Locality
West Sussex County Council is seeking to save £15m within this financial
year through its Fundamental Services Review. This involves over 60 Adult
Services posts being lost by March 2007. These include management and
home care posts. The loss of home care posts does not reflect a reduction
in that service. It is the result of in-house provision being expensive relative
In relation to working with Health, Adult Services will be looking for
opportunities to develop joint working. This could include aligning localities,
integrating commissioning arrangements and shared planning
John Wilderspin referred to the proposed county local committees
geographical areas that will be established from April 2007and confirmed
that as part of implementing a PCT management structure he had
discussed with practice based commissioning leads locality configurations.
The proposal is to have three locality areas and whilst the PBC leads held
no strong views, Arun District Council felt strongly that coterminosity was
important and that Arun should not be divided between the two area
localities in the South The proposed locality areas are: Western (South
East) which would include Arun; Adur and Worthing; and Horsham,
Chanctonbury, Mid Sussex and Crawley. This proposal changes the
position from that previously discussed at the last PEC meeting, which was
to keep West Arun with Western and East Arun with Adur and Worthing to
keep continuity during the FFF process. The size of the locality areas will
be reflected in the size of the area locality teams. It was agreed to review the management support arrangements in the different locality areas in twelve months.
A decision on the exact geographical split would be taken before Christmas. AF
Andrew Foulkes agreed to meet with Amit Bhargava and Alison Smith to
discuss the FFF lead roles in the light of the proposed locality area
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Practice Based Commissioning (PBC) – Sara Weech
Sara Weech confirmed that she had met with all the GP PBC locality leads.
Locality leads want a forum to develop PBC in order to share best practice
and to meet with the PCT. This forum’s remit will not include agreeing
The West Sussex Commissioning Forum has been established and its first
formal meeting was held on 14 December 2006. It was agreed that locality
business plans would be signed off by the PEC via a sub group. PBC
remains central to NHS reform and the new guidance provides a framework
for governance and accountability through the creation of a sub group of the
The implementation of PBC requires that PCTs agree local incentive
schemes, provide activity and finance information, provide support to
practices for commissioning and to report on indicators that monitor
progress. PBC plans will need to understand the needs of the local
population and contribute to national priorities by service redesign that will
enable resources to be released. In some areas a more collective approach
Two options taking account of governance arrangements were put forward
for the creation of a sub group of the PEC or area boards, which would have
the responsibility for considering business plans over a certain financial
amount, making recommendations to the PEC, who would subsequently
make recommendations to the Board. It is important that governance
arrangements are not over bureaucratic but take account of and manage
the potential conflict of interests of GPs as both providers and
The PEC supported the establishment of one sub group of the PEC over
three area boards to review commissioning and business plans and to make
recommendations to the PEC. Plans will be supported at area level to ensure they are consistent and demonstrate compliance with the PCT’s Local Delivery Plan and commissioning framework.
Discussions are continuing on how 5% of the acute commissioning spend
will be devolved to the localities for PBC.
Low Priority Procedures (LPPs)
Since 2001 the West Sussex PCTs have had a number of clinical policies
and LPPs, which were part of the contracts/service level agreements (SLAs)
with the local providers. In the majority of cases providers have not been
following the policies. In light of the local health economy financial position,
PCTs from April 2006 started to monitor more vigorously the implementation
of the restrictions on the procedures. It became apparent that there was no
awareness of the existence of LPP or restrictions in the clinical policies.
The list has now been updated and includes more detail. It also includes
suggestions from clinicians across West Sussex, both for the removal and
The SHA stated that from April 2007 there should be a list of LPP across the
whole SHA area. West Sussex Public Health has led the work to include
adding more detail to the old West Sussex list. This list has been shared
with the East Sussex PCTs and Brighton & Hove City PCT with the aim of
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The paper “Low Priority Procedures and Other Procedures with
Restrictions” was considered and endorsed by the West Sussex Joint
Forum for Service Improvement, Priorities and Clinical Effectiveness
The PEC approved the list of “Low Priority Procedures and Other Procedures with Restrictions”. The approval was on the basis that its
implementation, which is immediate, is subject to the provision of secondary
care. This is because the list raises a number of issues e.g. minor surgery
which is included in the additional services part of the GMS Contract and
the DES (Directly Enhanced Services) which is applicable to primary care.
It was agreed that a work stream was needed to look into quality assurance
issues that surround the provision of the DES in Primary Care. For dental
procedures, patients needed to be able to seek treatment and currently
some dentists were not able to undertake some procedures through lack of
experience/training. An additional service is being planned by the Oral
It was recognised that there were some unresolved issues e.g.
Vertebroplasty that would be subject to a more formal clinical review.
The LPP list will be forwarded to the SHA by 15th December 2006 at the
latest and will form part of the SLAs with the providers.
Financial Report
Since submission of the finance report the financial situation has
deteriorated. In month seven the deficit was reported as £10.1 million. It is
now in the region of £12 million. There are three main contributing factors: -
over performance on SLAs, a short fall in achieving recovery plan targets
and the impact of demand management plans not being fully realised.
Crawley hospital is being treated separately for reporting purposes.
The financial recovery plan (FRP) for Crawley has two aspects covering
manpower and physical assets. It has been necessary to appoint some
staff. The PCT is discussing with the SHA an overall financial control total,
The PCT’s FRP has three main strands: - workforce and prescribing which
are controllable and management of SLAs. Provider activity is more difficult
to manage given that providers are delivering the service. In this area the
PCT is working closely with SACS looking at coding classification, counting
of activity etc. The PCT is avoiding spend wherever possible as part of the
Given the seriousness of the financial position a more stringent FRP is
needed. This needs to encompass prescribing, demand management
(nationally referrals have reduced by 8%), SLA management, manpower
and PCT provider service efficiencies. The revised FRP will be an item for
discussion at the next PEC meeting on 4th January 2007.
Dr Alison Smith said that last year, GPs in AAW (Arun, Adur and Worthing)
had a £3 million surplus but with the impact of capitation changes, funding
being top sliced to support other health economies and the impact of
payment by results the position had changed to a £17 million debt.
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It was confirmed that the Board had requested more detailed financial
information in order to better understand the current financial position and to
support FFF options, in particular transition costs detailing a staged
approach to changes. More detailed information was also needed to
support service changes showing the shift in costs.
Policies for Approval: PR2006/04: Use of surgery to aid weight reduction in people with morbid obesity - eligibility criteria for bariatric surgery
Implementing the policy will require an additional investment of
approximately £700,000 across Surrey and Sussex per year. To utilise the
current full potential capacity and provide services for 0.5% of the eligible
population, would attract and additional investment of approximately £1.4 to
£1.6 million across Surrey and Sussex. Increasing capacity to treat 2% of
morbidly obese individuals with bariatric surgery would result in an
additional investment of approximately £13.5 million in Surrey and Sussex.
The Surrey and Sussex Policy Recommendation Committee’s policy on the use of surgery to aid weight reduction in people with morbid obesity - eligibility criteria for bariatric surgery was adopted by the PR2006/05: Rimonabant for the treatment of obese, or overweight patients with associated risk factors The Surrey and Sussex Policy Recommendation Committee’s policy on the use of Rimonabant for the treatment of obese, or overweight patients with associated risk factors was adopted by the PEC. Fit to Lead Update
It was confirmed that the NHS Alliance’s Fit to Lead ‘A review of the Primary
Care Trust Professional Executive Committee’ document had been ALL/AS
circulated to PEC members. The document poses several questions. PEC
members were invited to send their comments to Alison Smith who agreed
to provide a summary for discussion at the next PEC meeting. The PEC’s
comments will be submitted to the Board who intend to formally respond to
For Information Clinical Governance Minutes
Notes of the clinical governance committee meeting held on 17th November
2006 were received and noted for information. Much of the discussion at
the first Clinical Governance Committee meeting had focused on setting the
10.12/06 PCT Directorate Structures
It was confirmed that the initial structures had been circulated to the PEC
members for comment. A meeting was held on 4th December 2006 to
consider all the comments received. Revised structures will be circulated
enabling the appointment process to commence.
11/12.06 Any Other Business
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Medical Director Post
The original executive team structure had included a medical director, but
this post has not been appointed to in the first round. The role will
incorporate primary care development and include community services.
Whether accountability is to the Director of Community and Primary Care or
to the Chief Executive needs to be decided together with whether the role AF
should encompass accountability for clinical governance? It was agreed to
bring a proposal for discussion at the next PEC meeting. Andrew Foulkes
agreed to circulate some initial views in order to assist discussion. Alison
Smith said that she was keen to be involved in the debate.
Locality Leads
PBC and locality leads have requested a copy of PEC minutes. It was
advised that PEC minutes once confirmed would be available on the PCT’s
website and that the minutes will be circulated.
12/12.06 Dates, times and venues of next meetings
College Lane, Chichester, PO19 6FX Tel. 01243 770770
Distribution: Dr Andrew Foulkes
Director of Public Health & Well Being
Contact:
Jo.limmer@wsx-pct.nhs.uk tel 01243-534036
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