Annual General Meeting 31 August 2017 Welcome Jonty Heaversedge, - - PowerPoint PPT Presentation

Annual General Meeting

31 August 2017

#SwkCCGAGM17

Welcome

Jonty Heaversedge, CCG Chair

Agenda

Time Title Presenter 15:00 Welcome and introductions Jonty Heaversedge 15:15 Presentation of CCG Annual Report and Key Achievements 2016/17 Andrew Bland 15:35 Presentation of CCG Annual Accounts 2016/17 Christine Caton 15.50 Questions and answers from members of the audience 16:00 Five Year Forward View: Next steps on segmentation Mark Kewley Rob Davidson Mike Wilson 16:35 Questions and answers from members of the audience 16.50 Closing comments and thanks Jonty Heaversedge 17.00 Close

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CCG Annual Report and Key Achievements 2016/17

Andrew Bland, CCG Chief Officer

Annual Report 2016/17 and key achievements

NHS England annual assurance rating

• Southwark is one of only three CCGs in south east London to receive the overall

rating of good for 2016/17. We are one of only two CCGs to receive this rating for the last two years.

• Improved our rating for dementia from ‘requires improvement’ to ‘outstanding’; and

for mental health from ‘greatest need for improvement’ to a rating of ‘good’.

• Our significant improvement in the rating for dementia reflects an increased

identification of people with dementia and the proportion of these people who have a recently reviewed care plan.

• The improvement in mental health reflects the progress made on the transformation
• f services for children and young people; crisis care; liaison mental health services;

and for people placed out of area for acute mental health inpatient care.

• The CCG’s rating for cancer services was confirmed as ‘requires improvement’. We

have a clear action plan in place with our partners to improve cancer care and this is a priority as part of the south east London Sustainability and Transformation Plan.

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Quality achievements

• Changing our quality approach to a rotation of system-wide learning, quality

improvement and quality assurance each quarter.

• ‘Reverse quality alerts’ in primary care – good engagement of GPs in the significant

event analysis process with identification of lessons learnt, which are shared.

• Development of the Quality Resource Tool for Primary Care in response to themes

from the CQC visits in primary care.

• Development of the quarterly GP Safeguarding Leads Forum, which is a thriving

forum attended by representatives from at least 30 practices.

• Promoting awareness and supporting work around Female Genital Mutilation led for

health by our Designated Nurse. This work was recognised in the recent Single Assessment Framework inspection.

• Medicines Optimisation Team work on antimicrobial stewardship and antibiotic

guardianship.

Annual Report 2016/17 and key achievements

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Transformation: developing sustainable general practice, and at scale-working

• Federations established in north and south Southwark involving all member practices

supported by embedded teams. Delivering services to patients such as 8am-8pm EPCS and Population Health Management contract supporting practice resilience.

• London’s biggest “Super Partnership” established in Southwark and working towards

transforming general practice by improving care quality and reducing variation.

• Establishment of new innovative roles including embedded teams within federations;

clinical pharmacists; population health fellows; clinical associates (for example HIV). Transformation: developing new models of collaborative working across our Local Care Networks and supporting new models of commissioning and contracting

• Continued development of Local Care Networks in the borough involving all main

health and social care organisations.

• Innovated to create much greater alignment between different contracts in the system

for people with 3+LTCs, so that it is easier for general practice, federations and the rest

• f the system to work together.

Annual Report 2016/17 and key achievements

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A high-performing organisation

• Delivery of NHS constitutional standards for: cancer 62 day pathways; IAPT access;

c.difficile infections; and significant improvement in diagnostic waiting times.

• Control of unscheduled care demand: lowest DToC rate, halved the numbers of

MFFDs, exemplars in admission avoidance.

• Extended Access: 18 months ahead of national targets, improved utilisation, trebled

re-direction from A&E.

• Achieved all financial statutory duties including a QIPP delivery of £6.6m.
• Accelerated contracting round completed ahead of schedule.
• CCG’s engagement work rated as ‘outstanding’ and achievement of patient

experience awards.

• First stage business case approval for the new Dulwich Health Centre and significant

progress on other estates projects (such as Aylesbury).

• A number of GP premises upgraded with assistance from Improvement Grant funds

and Wi-Fi set up in all GP and community premises for public, patient and staff use.

Annual Report 2016/17 and key achievements

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System leaders

• Achieved the highest 360 stakeholder survey response rates in London, with

excellent feedback received on a range of criteria.

• Leading the transformation of primary care programme across London.
• CCG and members of the leadership team have key roles as part of South East

London’s Sustainability and Transformation Partnership, particularly it’s approach to community based care, estates, digital and continuing healthcare.

• Led the successful bidding for more than £17m of transformation funding across

south east London (e.g. diabetes structured education and treatment).

• Lead roles for LAS commissioning across south east London and for King’s College

Hospital NHS Foundation Trust for London.

• Established a new Partnership Commissioning Team with the local authority, created

processes for joint planning and governance and jointly led the development of the Better Care Fund.

• Newly ‘delegated’ commissioning of primary care.

Annual Report 2016/17 and key achievements

Presentation of CCG annual accounts 2016/17

Christine Caton Acting Chief Financial Officer

Duty 2016/17 Target 2016/17 Performance RAG Achieve planned surplus (Expenditure not to exceed income) £7,673k £10,213k Capital resource does not exceed the allowance £350k £345k Revenue resource does not exceed the allowance £417,963k £407,750k Capital Resource use on specified matters does not exceed the allowance N/A N/A Revenue resource use on specified matters does not exceed the allowance N/A N/A Revenue administration resource use does not exceed the allowance £6,460k £6,372k

Key financial performance duties

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• Met all of the statutory financial performance duties in 2016/17
• The CCG has demonstrated continued strong financial performance, achieving a

surplus of £10,213k against a plan of £7,673k. The main driver of the increased surplus was the NHS England requirement not to commit the 1% non-recurrent reserve which CCGs are required to establish in their planning.

• Excluding the release of the 1% above, the CCG overspent on programme costs

by £1,484k. The main driver of this overpsend was £1,750k relating to the CCG’s share (1/6th) of a £10.5m South East London liability with Lewisham & Greenwich NHS Trust relating to the Trust Special Administrator Agreement at South London Healthcare NHS Trust in 2013

• In addition to the above, the CCG underspent by £87k on running costs.
• The CCG received capital funding for the first time in 2016/17 and underspent by

£5k on a budget of £350k

• CCG accounts were audited by Grant Thornton UK LLP. The CCG received an

unqualified audit opinion.

2016/17 Annual Accounts

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Acute Hospital Services £227m Mental Health Services £62m Continuing Care £13m Community & Primary Health Services £36m Prescribing £32m Better Care Fund £21m Corporate Costs £9m Transformation £2m Running Costs £6m

CCG expenditure 2016/17

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Opening Allocations 2016/17 – 2020/21 2016-17 £’000s 2017-18 £’000s 2018-19 £’000s 2019-20 £’000s 2020-21 £’000s Recurrent Allocation

393,667 403,334 414,410 424,994 440,548

Delegated Primary Care

• 43,208

44,749 46,469 46,469*

Running Costs allocation

6,457 6,496 6,533 6,565 6,594

Total Resources

402,124 453,039 465,692 478,028 493,611

Target surplus for the year with drawdown

7,673 9,743 9,743 9,743 9,743

% change over previous year’s allocation

3.05% 2.45% 2.51% 2.55% 3.66%

Financial forward view: opening allocations

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2016/17 – 2020/21 estimated net QIPP programme requirements 2016-17 £’000s 2017-18 £’000s 2018-19 £’000s 2019-20 £’000s 2020-21 £’000s Total QIPP programme- net of investment 6,659 15,241 13,971 14,640 13,950 QIPP programme as a percentage of allocation 1.7% 3.4% 3.0% 3.1% 2.83%

Financial forward view: QIPP requirements

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Questions and answers

Five Year Forward View: next steps on segmentation

Mark Kewley, Dr Rob Davidson & Mike Wilson

The Council and CCG’s shared Forward View sets out an ambition to develop population-centred and outcomes-focused contracts

• Our local ambition is to create a much stronger emphasis on

prevention and early action as well as deeper integration across health and social care, and wider council services (including education).

• To support this change we will increasingly join

commissioning budgets and contracting arrangements to incentivise system-wide improvement.

• We will focus on specific populations, including particularly

vulnerable groups. We will put ever greater emphasis on the

• utcomes achieved in addition to the quantity of activity

delivered.

• This means moving away from a system with lots of separate

contracts and instead moving towards inclusive contracts for defined segments of the population that cover all of the various physical health, mental health and social care needs

• f people within that group.

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What we are trying to do

A population-based, value-driven care system is an accountable care system (ACS); but to establish this we need to fix a variety of issues

The fragmented contracting arrangements can make it difficult to move resources to where they are needed to deliver what really matters to people The fragmented arrangement of

• rganisations and professions

(including training) can reinforce boundaries and can make it too difficult to work together and to work consistently The disempowerment of service users and carers can create confusion and risks making people passive recipients of care

Issues that make our existing system a less than accountable care system

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What we are trying to tackle

There is not yet a strong enabling/integrator partnership to support different agencies in the local system to share information, to align workforce strategies, or to coordinate purposeful developments within a shared transformation plan 4

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We need to simplify the way we contract so that local care teams can work together to keep people well, and to get people back to health

Ambulance

£

Surgery Post-op

£

Rehabilitation

£

Community activity

£

GP Care

£

Current State

Funding for proactive care which is well coordinated within a Local Care Network £

Future State

Fragmented contracting

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We need to help local care teams to proactively mange the health of the population rather than just react to the needs of individuals in crisis

Individual level Reactive Providing care Following pathways Population segments / groups Proactive & preventative Empowering wellbeing Supporting person-centred care

Fragmented contracting

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One size does not fit all – by segmenting the population we can commission care that is designed around people with similar needs

Source: Lynn et al, 2007. Using Population Segmentation to Provide Better Health Care for All: The “Bridges to Health” Model [Illustration adapted from OBH] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690331/

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Whole Population

Short period of decline before death (often cancer related) Limited reserve with serious exacerbations (often heart failure and lung disease) Long period of decline and frailty (often with dementia) Frailty and Dementia Declining Health with Significant Support Needs Long Term Conditions Stable with significant long term physical / learning or mental health needs Long Term Support Needs Healthy Maternity and Child Health Support to Stay Well

Episodes of acute illness with likely return to health

Fragmented contracting

1

Stable and resilient general practice, working efficiently and effectively Sustainable general practice, working collaboratively in the interests of their local population Transformed primary and community-based care, working with joint accountability to deliver better outcomes Responsive and supportive specialist/acute care working with primary care as part of ‘one system with one budget’

Integrated commissioning relies on providers being willing and able to work together – we’ve been supporting this to happen in different ways

We have been investing in our local health and care organisations to support this type of development

Local Care Networks are about partners in the system working together formally with shared accountability for the

• utcomes of a specified population

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Fragmented provision

2

The CCG has supported our GP federations to help local practices to learn new skills and to work together more effectively

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Fragmented provision

2

Stable and resilient general practice, working efficiently and effectively Sustainable general practice, working collaboratively in the interests of their local population Transformed primary and community-based care, working with joint accountability to deliver better outcomes Responsive and supportive specialist/acute care working with primary care as part of ‘one system with one budget’ We have been investing in our local health and care organisations to support this type of development

We are working within communities to ensure LCNs are more than medical, instead focused on getting the most out of people and places

Empowered people

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Questions and answers

Closing comments

Jonty Heaversedge

Close