Commissioning Intentions 2016-17 Jill Shattock Director of Commissioning
Mission Enab ablin ing th the people le of of Har arin ingey to o liv live lon long an and healt lth liv lives with ith ac access to o sa safe, well ll co-ordin inated an and hig igh quali ality se services Engagement Openness Values Efficiency Quality Innovation Inclusiveness High quality, valued and To promote wellbeing, reduce To improve the quality of life for responsive services, working in Aims health inequalities and improve people by commissioning partnership with the public to health outcomes for local integrated health and social care make the best use of available people delivered closer to home resources Objectives Explore and commission More partnership Build capacity for Re-define the alternative models of working and integration populations to enhance model for primary care their own health and care wellbeing • Working at scale • Value Based • Better Care Fund • Value Based Projects Commissioning • Federation • Development of a Commissioning • End of Life Care • Urgent Care development strategy for North • Workforce (CPEN) • Supported self • Vanguard Central London • Co-commissioning • Securing a future for management • End of life care • 7x7 8-8 working • Childhood • QIPP mental health services • Locality teams • London transformation obesity • Children’s Pathways • Development of HACI • Procurement of NHS 111 / GP out of hours service
One Year On…. • Lead provider for Diabetes (with Islington CCG) and Older People with Frailty (OPwF) • Better Care Fund (BCF) authorised and governance in place • New community services and pathways for gynaecology, urology, gastro-enterology, paediatric allergy, CAMHS in primary care. • End of life care pathway and lead provider model • Mental Health Framework agreed with partners • Federations established (Haringey Health Connected and Central4Haringey) • Bid for a CPEN successful • Working at scale and GP interoperability • Red areas in the next slide highlight the next phases 3
3. Build population’s 1. Explore and 2. More partnership 4. Re-define the model commission new working and integration ability to enhance health for primary care models of care and wellbeing Value Based Joint working with Local Supported self-management Co-Commissioning for Commissioning Authority training Primary Care • Diabetes • Joint budget for BCF • For patients with long term • Participating in NCL wide • Older People with Frailty • Integrated governance in conditions arrangements for co- • Psychosis and depression, • Diabetes programmes place commissioning • BCF will be extended – MSK , non stroke rehab? children, mental health ? Urgent Care Development of a strategy Joint commissioning on Access • Full review of short stay • Expanding 7 days a week for North Central London health life expectancy • Significant financial • Focus on case finding for pathways (paediatric and access to primary care and adult) challenge across health atrial fibrillation and working at scale • Ambulatory Care model at • Working with NHS England economy hypertension • Establishing how and where • Reviewing integrated NMUH being developed on premises • Alternative Conveyance CCGs work together at commissioning of all Pathways with LAS scale preventative services Facing the Future Together Procurement of NHS 111 Enablement model in mental Training and education • Programme of practice for Children and GP out of hours (OOH) health • Focus on reducing • Reviewing recovery houses services nurse training • Procurement of combined • Focus on CPEN to deliver unplanned admissions and re-tendering • Strong focus for 16/17 on • Developing models of 111/GP OOH model across training within primary care pathways and community 5 CCGs in north central shared-care to support nursing London enablement QIPP Programme Securing a future for mental Neighbourhood Connects Federations • Ophthalmology • Development of GP health services and Integrated Advice and • Medicines management • Federations – within Reviewing the future of Guidance Service • Musculo-skeletal pathway • Commissioned to build BEHMHT Collaborative areas and • Dermatology • PICU, autism, locked neighbourhood capacity across Haringey • Intermediate care • Single service providing rehab and ADHD pathway review advice and guidance • CRHT, memory clinic, inpatients
Continuing…Next Phase • Unscheduled Care: – Expanding ambulatory care, focus on improving short stay pathways – especially paediatrics – Pursuing NHS 111 and GP out of hours procurement across 5 CCGs – Working with London Ambulance Service • Community Services – Rapid response and 24/7 District Nursing service now recurrent – Investment in lymphedema – Focus on quality of community services – “Building” the locality teams to become multi-disciplinary units • Planned care – Maximise use of community schemes (ophthalmology, gynaecology, urology) • End of life care – 7 day service and development of bereavement service 5
Challenge Areas for Commissioning • Long term financial sustainability within the health economy • Improving healthy life expectancy • Commissioning responsibility for quality improvement and access to primary care • Integration of care for older people – making it happen, building community capacity and reducing unplanned admissions • Unscheduled care – developing a more consistent and coherent approach • Paediatrics – high rates of unplanned admissions, gaps particularly in community children’s nursing and in communication/education exchanges with primary care • Mental health – quality, access, GP training and education, awareness of services, quick and effective communication between primary care and the mental health trust • Planned care – high referral rates for gastro-enterology, urology, gynaecology and dermatology • Capacity to deliver 6
Focus Areas 2016-17 Integrated Care • Implementation of Locality Teams (multi-disciplinary teams (MDTs) based around practices); GP role in interacting with locality teams. Move to care navigation and co-ordination - NOT referral based and episodic • Focus on improved discharge process and on intermediate care: discharge to virtual wards or MDTs/hospital at home • 7 day therapy, pharmacy, phlebotomy at Trusts; establishment of an Integrated Discharge Team Paediatrics • Initiatives to support care out of hospital, email advice, reducing variation in primary care Improving healthy life expectancy • Case finding and management of hypertension and Atrial Fibrillation • Focus on pathways – CQUINs to support prevention • Improving early diagnosis of breast and colorectal cancer Planned care – MSK, dermatology, termination of pregnancy AQP, cardiac rehab. Primary Care • Focus on co-commissioning; education and training; premises review, extended access and quality Mental Health • Acting on review of acute psychiatric liaison service • Peri-natal mental health service • Equipping primary care management of people with mental health conditions • Enablement pathway development 7
Next steps • Contracting process – begins with letters to providers at end of September 2015. Expectations regarding productivity improvements, approach to local pricing, contract form, quality standards and CQUINs etc. • Engagement throughout – GPs, practices, engagement network, partners and stakeholders • Detail development • Results of reviews – CAMHS, intermediate care, mental health services (memory clinic, CRHT and inpatient services) • Collaboration with other CCGs – especially QIPP 8
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