Agenda, decisions and minutes

The Chair opened the meeting and announced that Dr Stephen Lynch had been appointed as the Partnership’s Clinical Director after a robust recruitment process and congratulated Dr Lynch on his appointment. The Chair also submitted his apologies for the IJB’s next meeting on 28 March 2017 and noted that this would be Councillor Ironside’s last IJB meeting before his retirement from public life and advised that he wanted to place on record his personal thanks for the support and inspiration provided by Councillor Ironside to him and the Board during the integration of health and social care in Aberdeen City. Thereafter this sentiment was endorsed by all Board members.

The Board resolved:-

(i)            to congratulate Dr Stephen Lynch on his appointment as the Partnership’s Clinical Director;

(ii)          to thank Councillor Ironside for his service and leadership during the integration of health and social care in Aberdeen City; and

(iii)         otherwise note the information provided.

Members were requested to intimate any declarations of interest.

The Board resolved:-

To note that no declarations of interest were intimated at this time.

The Chair moved that no items on today’s agenda be considered as exempt business.

The Board resolved:-

To agree that all items on today’s agenda be open to the press and public.

The Board had before it a report by Alex Stephen (Chief Finance Officer, ACHSCP) which updated the Board on the funding delegated by Aberdeen City Council and NHS Grampian for health and social care activities in 2017-18 and advised on budget pressure facing the IJB in 2017-18 and budget savings identified by officers to close the funding gap. The report highlighted the position with regard to the Board’s reserves and future year budget projections along with budget risks and assumptions underpinning the budget and sought approval of a budget protocol to be used in future financial years for the creation and approval of the IJB budget.

The report recommended:-

That the Board –

(a)       Agree the budget savings identified in Appendix A of this report;

(b)       Agree the use of integration and change funds amounting to £2,241,000 to close the budget gap;

(c)       Agree the Bon Accord contract level for 2017-18 of £26,289,000 and budget assumptions noted in section 2.7;

(d)       Agree the 2017-18 provisional IJB budget in Appendix B;

(e)       Agree the earmarking of £2.5million of 2016-17 underspend into a risk provision and £500,000 for replacement of essential equipment;

(f)        Agree the Budget Protocol in Appendix E;

(g)       Agree the directions to Aberdeen City Council and NHS Grampian contained in Appendices F and G; and

(h)       Request that a report be brought back to the IJB on 28 March 2017 with a proposal to distribute additional funding for the Living Wage and sleepovers.

The Board had before it a report by Judith Proctor (Chief Officer, ACHSCP) and David Pfleger (Director of Pharmacy and Medicines Management, NHS Grampian) which provided information in relation to actions being taken, or planned by the Executive Team to address the identified risks.

The report recommended:-

that the Board –

(a)       Note the IJB would be following an assertive approach in pursuing medicines efficiencies including maximising the use of generic medication;

(b)       Note the level of financial risk associated with the assumptions of achieving the maximal savings used in the budget assessment, especially relating to Pregabalin for the 2017-18 financial year which presented the biggest savings opportunity and therefore risk to the Aberdeen City IJB prescribing budget; and

(c)       Endorse the approach set out in relation to local measures being put in place to maximise efficiency and local control on the prescribing budget.

David Pfleger spoke to the report and highlighted the issues that would impact on the prescribing budget such as the volume and cost of drugs; and the level of transactions. Mr Pfleger set out the complexity of prescribing which was influenced by a range of factors such as population demographics; compliance with GP contracts and clinical guidance; in addition to legal issues associated with prescribing branded and generic medicines. Further to this, he outlined the controls available to the Board to manage prescribing costs as well as risks linked to these options and oversight arrangements NHS Grampian had put in place to monitor prescribing throughout Aberdeen City.

The Chair advised that he attended an IJB Chairs meeting on 6 March 2017 in which members had discussed local and national issues that impacted on prescribing budgets. He noted that today’s budget agreement was a strong statement of intent on how the Aberdeen City IJB would approach the challenges associated with prescribing. The Chair asked if the IJB would be required to make any adjustments to the level of savings related to generic medicines, particularly Pregabalin. Alex Stephen explained that it was unclear at this point how the balance of risk between Pregabalin and generic medicines would fall and highlighted that the IJB’s reserves fund was in place as a contingency.

Thereafter there were questions on workload challenges for GPs who would have additional responsibilities to achieve cost efficiencies and how Community Pharmacists could support GPs in this regard; and what measures the Partnership had adopted at both locality and Pan-Grampian level to engage the public in order to increase efficiencies related to prescribing.

The Board resolved:-

(i)           to note the IJB would be following an assertive approach in pursuing medicines efficiencies including maximising the use of generic medication;

(ii)          to note the level of financial risk associated with the assumptions of achieving the maximal savings used in the budget assessment, especially relating to Pregabalin for the 2017-18 financial year which presented the biggest savings opportunity and therefore risk to the Aberdeen City IJB prescribing budget; and

(iii)         to endorse the approach set out in relation to  ...  view the full minutes text for item 5.