NHS England Board meeting 4 July 2018 Highlights

NHS England Board meeting 4 July 2018

Agenda

• 1. Minutes of the Previous Meeting 
• 2. Chairman’s report 
• 3. Chief Executive’s Report 
• 4. Developing the NHS long term plan: reducing ineffective or wasteful clinical procedures 
• 5. Developing the NHS long term plan: primary care reform 
• 6. General Practice Services – programme update 
• 7. Second progress report from the Empowering People and Communities Taskforce 
• 8. NHS Performance and progress on implementation of next steps 
• 9. NHS Finance Report 
• 10. Reports from Board Committees 
• i. Commissioning Committee 
• ii. Investment Committee 
• iii. Specialised Services Commissioning Committee 
• iv Audit and Risk Assurance Committee 
• 12. AOB 

Highlights for CCGs and Arden GEM CSU below relating to 
4. Developing the NHS long term plan: evidence based interventions that should not be routinely commissioned.
5. Developing the NHS long term plan: primary care reform - GP contract reform including

• A review of the Quality and Outcomes Framework (QOF)
• GP payments in light of the growth of digital-first primary care

6. GP Services Programme Update
7. Second progress report from the Empowering People and Communities Taskforce

4. Developing the NHS long term plan: evidence based interventions

• NHS England will consult on the Evidence-Based Interventions programme, developed and jointly led by NHS England, NICE, NHS Improvement, the Academy of Medical Royal Colleges, and NHS Clinical Commissioners. 
• The focus of the programme is on surgical interventions commissioned by CCGs, where there was high variability in the application of clinical guidelines. 
• Priority was given to changes which could test the approach and implement relatively quickly on a large scale. 
• The consultation proposes that four interventions (Category 1) that should no longer be routinely commissioned by CCGs unless accompanied by a successful Individual Funding Request (IFR) and 13 interventions (Category 2) that should only be commissioned by CCGs or performed when specific evidence based clinical criteria are met. It is proposed that Category 1 interventions will be set at zero tariff in National Tariff without a successful IFR. 
• Category 1 
• Snoring Surgery (in the absence of OSA) 
• Dilatation and curettage (D&C) for heavy menstrual bleeding in women 
• Knee arthroscopy for patients with osteoarthritis 
• Injections for nonspecific low back pain without sciatica 
• Category 2 
• Breast reduction 
• Removal of benign skin lesions 
• Grommets for Glue Ear in Children 
• Tonsillectomy for Recurrent Tonsillitis 
• Haemorrhoid surgery 
• Hysterectomy for heavy menstrual bleeding 
• Chalazia removal 
• Arthroscopic shoulder decompression for subacromial shoulder pain. 
• Carpal tunnel syndrome release 
• Dupuytren’s contracture release 
• Ganglion excision 
• Trigger finger release 
• Varicose vein surgery 
• Proposals also suggest that changes in the NHS Standard Contract will require commissioners and providers to comply and enable commissioners to withhold payment. 
• The consultation paper includes evidence to support the proposals, and STP level and CCG level activity data for the 17 interventions. 
• Phase 2 will be launched in early 2019 and will consult on further interventions and will also include specialised services which are commissioned by NHS England 
• See the consultation document (paper 4b) for details. 
• Public consultation 4 July – 28 September 2018. 

5. Developing the NHS long term plan: primary care reform - GP contract reform

• There is consideration of significant changes to the GP contract as part of the forthcoming Long Term NHS Plan. 
• NHS England has taken over responsibility from NHS Employers for changes to the BMA GPC(E). Two aspects are presented: 
• A review of the Quality and Outcomes Framework (QOF) (see paper 5a(i)) proposes 5 main changes modification of indicators, update exception reporting, introduction of a Quality Improvement domain, retirement of some indicators, and trial of a network level QOF. 
• Updates to GP payments in light of the growth of digital-first primary care (see paper 5a(ii)) to ensure fair funding in light of long term evolving digital delivery in primary care. 
• [Triggered by early impact of the GP at Hand programme, Hammersmith & Fulham CCG).] 
• Suggestions to smooth out geographic disparities include changes to rurality index payment, amendment to the London adjustment and reduction in payment of patients who live outside catchment area. 
• Consideration of impact of patient characteristics will come later. 

6. GP Services Programme Update

• A summary of key progress against each of the five areas in the General Practice Forward View. 
• Primary Care Networks - NHS England is developing a Reference Guide to support regions, CCGs and practices with advice and guidance on the key areas they should consider in establishing networks, and establishing a Primary Care Network Programme Board and an External Reference Group. 

7. Second progress report from the Empowering People and Communities Taskforce

• The Public Participation Dashboard has been widened to include public participation by CCGs. 
• Indicator 4: CCG compliance with 14Z2 statutory guidance requirements (from CCG IAF Indicator 50) 
• Indicator 5: Perceptions of local system partners of CCGs, based on 360 stakeholder survey 
• Indicator 6: Sustainability and Transformation Partnerships (STPs) / Integrated Care Systems (ICS’) emerging practice 
• Dashboard is at Appendix 1.

Date of next NHS England Board meeting 27 September 2018
Date of next NHS England / NHS Improvement Board meeting in Common, 27 September 2018