Minutes Finance and Information Group 13 th March 2017, Meeting Room 1, Civic Centre, Arnot Hill Park, Arnold, NG5 6LU

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1 Minutes Finance and Information Group 13 th March 2017, Meeting Room 1, Civic Centre, Arnot Hill Park, Arnold, NG5 6LU Present: Terry Allen (TA) Jonathan Bemrose (JB) Maxine Bunn (MB) Sharon Pickett (SPi) Ian Livsey (IL) Sam Walters (SW) Dr James Hopkinson (JH) Sergio Pappalettera (SPa) In attendance: Andy Hall (AH) Louisa Hall (LH) Lay Member Financial Management & Audit (Chair) Chief Finance Officer Director of Contracting South CCGs Deputy Chief Officer Deputy Chief Finance Officer South CCGs Chief Officer Clinical Lead Contracts & Information Manager Director of Outcomes & Information Rushcliffe CCG Corporate Admin Officer (Minute taker) Apologies: Debbie Stiles-Powell (DSP) Senior Finance Manager QIPP/BCF Hazel Buchanan (HB) Director of Operations Purpose of Group As per the Terms of Reference of the Finance & Information Group (FIG), this Group has delegated authority from the Governing Body to monitor budgets and activity and ensure their delivery against plan, reporting all deviations and respective corrective action to the Governing Body. The FIG will also oversee the financial planning process, agreeing the financial plan assumptions and principles. Item Action FI 17/021 Welcome and Apologies TA welcomed the group to the meeting. Apologies were noted as above. Quoracy was confirmed. FI 17/022 Declarations of Interest No declarations of interest were made. FI 17/023 Minutes and Actions of the previous meeting The minutes of the meeting held on 14 th February 2017 were approved as a true and accurate record with the following actions acknowledged:

2 Update on Item FI 17/004- Ian Livsey (IL) updated the group on this ongoing item. IL confirmed the global accrual amount from the previous month is not available; however, this has been raised with the Finance Team. IL confirmed that the month in question was acknowledged as high due to staffing pressures and new coding issues. IL confirmed this has now reduced: data for Month 10 for the entire consortia was down to 100,000. James Hopkinson (JH) questioned if month 9 and 10 had all now been coded. IL confirmed this. FI 17/015- Hazel Buchanan (HB) to update on the sudden drop in Category M prescribing savings on the Highlight Report. As Apologies were noted from HB, Terry Allen (TA) informed the group that it was suggested this could be linked with revision of the baselines between 2015/ /17 and has requested HB to re-look at this and to provide an update to the group. HB FI 17/024 FI 17/017- High drug costs: TA informed the group that further communications have been exchanged on this item. Arrangements to be looked at putting in place contracting support to the Pharmacy teams (where appropriate) in negotiations with the providers. FI 17/018- Specialist Interface & Governance Pharmacist: TA informed the group that the vacancy was provisionally agreed providing confirmation from HB regarding employment grade savings. HB to update the group at the next meeting. Finance Update Jonathan Bemrose (JB) provided an update on Month 11 financial position and the positive impact on the year-end FOT. Key points included: Now forecasting to achieve the 1% planned surplus at the year-end (but see NUH below). Previous year to date and annual forecasts have shown delivery as high risk. Month 11: o Acute increased overall by 560,000 which is lower than usual; NUH only 20,000 and Circle 120,000. Pressures on Ramsay, Sherwood Forest and other smaller contracts saw an increase. o Mental Health added around 90,000. o CHC increased by 115,000 but this represented an improvement overall on the previous increasing trend. o Prescribing in line with previous month. o Co-Commissioning reserves remain uncommitted. o Management and Administration underspend increased. HB

3 Agreement with NUH regarding the year-end forecast is not yet finalised. Assumed delivery of the plan is based on a fair rather than best/worst case settlement, which appears reasonable. Members acknowledged the hard work of member practices and CCG staff in their positive attempts to contain expenditure during the year. FI 17/025 Financial Turnaround: Andy Hall (AH) provided an update on the current financial turnaround position. Key points raised: NHSE has commissioned support to assist with delivering the 2017/18 QIPP plan for certain challenged organisations. 48 days of support is available from PwC to the South Notts County CCGs although this will by default include Nottingham City due to the joint turnaround arrangements. AH informed the group that initial discussions had taken place to ensure the offer of support is used as effectively as possible on delivery of the identified opportunities. It was highlighted that negotiations would continue to re-model the level of support offered across the CCGs as schemes progressed. The planned elements with a focus on Elective care are currently with accountable officers to review. It was important that the focus be on a smaller number of high impact schemes to yield best benefit from the limited resources available. Accountable officers and PMO staff are continuously appraising opportunities to progress pieces of work. AH informed the group that Programme Director leads have been identified to work across the participating organisations and have started work on refining schemes. QIPP Plan: AH updated the group on the following items within the 17/18 QIPP plan: Urgent care schemes originally totalling 8.5m have been reduced to 4.3m reflecting more likely in-year delivery. As an indication of the 17/18 challenge, during 16/17 65/70% of QIPP has been delivered with further mitigation needed to deliver the required target surplus. NNE has been de-escalated following delivery of a revised plan however it is crucial to ensure the early months of activity plans are delivered for 17/18 financial year. List of financial schemes have been stratified for feasibility, savings and deliverability in order of priority. AH informed the group that these fed into the Programme Director Leads. Schemes are categorised into 3 main types: Traditional QIPP schemes

4 Transformation Decommissioning The group discussed the need to serve notice periods on local providers. JH queried if it was possible for the CCG to transact changes any quicker. AH suggested this could be a possibility if the provider is in agreement or with any service not secured under a standard national contract. FI 17/026 Activity Report Month-10 Sergio Pappalettera (SPa) gave an update to the group on Activity for Month 10. Key points included: April and July saw an increase in GP referrals, however since November; activity has reduced and continues to do so each month. Day case activity has increased: mainly driven by specialities such as Oncology, Pain Management, Repeat injections. Elective care reductions due to a shift from elective to day cases, T&O, spinal and paediatrics. Emergency admissions increased spells between Nov-Jan 2017 with increased numbers of patients 75yrs and over, due to complex needs. The group discussed the lower rates for GP referrals. JH informed the group that the table of individual practice rates provided a valid comparison and confirmed a change for around 1/3 of practices. Practices with high financial spend had previously been targeted for peer visits but the group agreed that this be extended to high referral rates and comparison tables to be sent to individual practices. Sergio Pappalettera to distribute via . SPa The group discussed Optimise RX and that this is being used by all. Sip feeds are being raised at every visit. AH queried the data findings for advice and guidance compared with first outpatient referrals and whether any conclusions could be drawn about the effectiveness of the service from the data. SPa added there had been a reduction in GP First Outpatient attendances but an increase for Non-GP attendances. FI 17/027 Nottinghamshire 2 Year Extension Meeting & Letter (Arriva Contract) Sam Walters (SW) updated the group on the Arriva contract. SW emphasised that it was no longer possible to deliver a viable service within the existing contract envelope. It was also identified that moving to a procurement process would almost certainly be at a significantly higher cost therefore it was proposed that the contract be

5 extended with Arriva. The letter confirmed Arriva have identified a number of initiatives to help mitigate those costs and improve service delivery, some of which would need the support of CCGs and providers to implement. SW informed the group that this will be included on the QIPP plan as a cost containment exercise. The group supported the proposed contract extension and agreed that a dedicated staff member will need to be identified to manage the project. It was agreed to take back to PMO and Chief Officer s meeting with a mandate from FIG group to appoint a Lead on this promptly. SW FI 17/028 Finance Risk Register It was agreed by the group to reduce Item SDFR1 from Red to Amber based on earlier discussions regarding the improved year-end position. IL to send an updated risk register to attendees. IL *AOB: SW gave an update on meetings with NHS England that clinicians are now required to attend. AH updated the group on the revision to the Activity Plan necessary to support the revised presentation of the 2017/18 Financial Plan. JB shared with the group that a meeting with NHS Property services had recently taken place. He informed the group that there could be a potential cost associated with the portacabins at Colwick and a claim for dilapidation charges at Byron Court. It was agreed that the HQ costs should remain unchanged. Date, Time and Venue of Next Meeting 11 th April :00-13:00, Committee Room, Civic Centre, Arnot Hill Park

Minutes Audit Committee Meeting 27 th January 2016, 13:00pm Civic Centre, Arnold

Minutes Audit Committee Meeting 27 th January 2016, 13:00pm Civic Centre, Arnold Present Terry Allen (TA) Janet Champion (JC) In Attendance Jonathan Bemrose (JB) Hazel Buchanan (HB) Tony Crawley (TC) Richard