Annual General Meeting 2014/15 Dr Tim Spicer 14 July 2015 Welcome - - PowerPoint PPT Presentation

Annual General Meeting 2014/15

Dr Tim Spicer 14 July 2015

Welcome

This is our second Annual General Meeting 2014/15 was our second year as a fully authorised CCG The patient is at the centre of all we do We aim is to commission the highest quality care for the population We continue to work as part of an established Collaborative of CCGs in NWL

Introduction to the CCG

We commission hospital care, urgent care, community & mental health services We have 31 member practices and a population

• f around 200,000

Hospital care is changing, focussing more on specialist care We are aiming to invest more in mental health to achieve commitments of parity of esteem Primary care is changing, providing more services closer to patients

Agenda for today

Annual General Meeting 4.15 Arrival, tea and coffee 4.30 Introduction and scene setting Dr Tim Spicer 4.35 Some local achievements Patient and public engagement Trish Longdon Changing face of primary care Dr Tony Willis Changing mental health services Dr James Cavanagh 5.05 Working in collaboration across Clare Parker North West London 5.15 Quality and Safeguarding Jonathan Webster 5.25 Annual Accounts 2014/15 David Tomlinson and 2015/16 budget 5.35 2015/16 priorities Janet Cree 5.45 Questions Dr Tim Spicer 6.00 Close

Patient and public engagement

Trish Longdon Governing Body Lay Member

I worked with other patients and organisations across NWL to shape the future of wheelchair services I am now able to book and change my GP appointments online I can now choose the nurses and carers that help me everyday with my long term condition I am actively sharing the patient voice at CCG committees I shared my experiences as a new mother to help develop mental health services I shared my experience of inadequate changing facilities at the hospital for my child with complex needs, now they have Changing Places facilities

Sharing Success

I can now follow the CCG on Twitter

Patient Participation Groups at GPs Improving links with groups in the community People being prepared to share their experiences

What can the CCG improve on?

They couldn’t be any nicer and they take good care of you After they came it’s all

• changed. It’s a

big relief It’s incredibly good for one’s

• utlook on life

I know I’m going to get better now Now I’ve got confidence I can’t tell you what it meant to be back at home It’s the most wonderful, wonderful service

Quotes from CIS Video

Out of Hospital Services

Commissioning quality services closer to home

Dr Tony Willis 14th July 2015

Collaborative-wide Primary Care Contracts

Contracts with GP federation to deliver a range of services aimed at improving care

• Proactive
• Local
• Quality based
• Patient experience
• Evidence based

Out of hospital services (17 in total)

• Ambulatory BP monitoring
• Anticoagulation
• Care planning
• End of life care
• Diabetes
• ECG
• Homeless
• Mental health
• High risk medication
• Phlebotomy
• Ring pessary
• Spirometry
• Wound care

Focus on diabetes

3 contracts to improve diabetes care

• High risk of diabetes
• Level 1 (key care processes, care planning, reducing

hypoglycaemia risk)

• Injectable initiation

Local issues

• Wide variation in quality /

model of 1°care delivery

• Diabetes care in silos
• Low uptake and completion
• f structured education
• Little patient involvement in

decisions about own care

• No unified diabetes

guidance for clinicians

• Low levels of pre-diabetes

intervention

• High levels of prescribing

expenditure

Care planning

Information gathering Information sharing Agenda setting shared decision making Agenda and shared goals and actions (care plans) Goal follow up

1st visit Between visits 2nd visit

Invitation letter

Common elements

• Common GP clinical system (SystmOne)
• Network based contracts (min population 30k)
• No exception reporting
• Patient empowerment
• NHSE and Diabetes UK representation
• Named diabetes lead GP and nurse for each practice
• Diabetes education programme for clinicians
• Diabetes care dashboard
• Encouragement to focus on patient goals

Example of guideline page

Dashboard

• CCG, network, practice, patient
• Aim to reduce variation
• Peer review
• Discussion at MDGs
• Target learning
• Patient experience a factor

London Strategic Clinical Network – Models of care

Changing mental health services

James Cavanagh GP Governing Body Member and interim Vice Chair

Mental Health

• H&F CCG supports the national ambition of achieving parity
• f esteem between mental and physical health by 2020

through the following programmes:

• Shifting Settings of Care: people receiving their care closer

to their homes, and in a less-intensive environment.

• Urgent care: Developing a single point of access of all

referrals to secondary care.

• Memory services: delivering a service which is GP-led and

support people with dementia and their carers after their diagnosis.

• Perinatal: supporting mothers and fathers with mental

illness through their pregnancy and post natally.

• Delivering on national wait times eg IAPT, Early

Intervention Psychosis.

Back on Track- IAPT service

• A talking therapies service for those with common mental illness

(anxiety and depression).

• 16% of those with common mental illness have accessed this

service (15% nationally).

• 50% of those who enter treatment recover.
• Low wait times for treatment.
• Wide range of therapeutic modalities; groups; CBT: 1:1 and couple

counselling.

• Supporting and educating those with a long term condition on how

to manage their condition, eg diabetes. For 15/16:

• Digital solution for those who wish to access online support.
• Locating in job centre to support those getting back to work

Working in collaboration across NW London

Clare Parker Accountable Officer

Collaborative working with neighbouring North West London CCGs

• Collaborative with Central London, Hounslow, West London and

Ealing CCGs

• Shaping a Healthier Future with 7 CCGs in NW London

Our vision of care

Improved hospitals delivering better care 7 days a week, more services available closer to home Promoting Wellbeing and improving mental health for North West London Multi- disciplinary Care co-

• rdinated

around the patient, led by the GP Better out of hospital services, greater access to GPs at convenient times and locations 7 days a week People are empowered to manage their own wellbeing and health

Primary care transformation

• Network-based services
• Online services and convenient appointments
• Common IT network
• Out of hospital services
• Primary care joint co-commissioning

• 9 Early Adopters, unique models of care
• Co-produced Integrated Care Toolkit
• Information & Data Sharing
• Facilitating expert input and sharing best practice
• Next steps:

Launch & Sustain, Change Academy, Pooled budgets, Evaluate

Whole Systems

Mental health

• Mental Health & Wellbeing transformation
• NWL Crisis Concordat
• Acute psychiatric liaison services
• Primary Care Plus
• Dementia strategy and framework

• A&E from Hammersmith and Central Middlesex Hospitals
• NW London Urgent Care Centres 24/7
• Ealing Hospital maternity, neonatal & paediatric transition
• Implementation Business Case development
• 7 day services
• Engagement and communications

Acute reconfiguration

Quality and safeguarding

Mary Mullix Deputy Director of Quality, Nursing and Patient Safety

Safeguarding (Children & Adults)

• Core membership of the Local

Safeguarding Children

• Compliance with Care Act

Safeguarding Adult Boards Established

• Commissioning Framework

developed to support learning from serious cases

• MCA project with Bucks University

Medicines Management

• Reduction of medicines-related harm
• Better treatment pathways for

rheumatoid and psoriatic arthritis

• Help for people with diabetes to

increase effectiveness of blood glucose testing

• Reduction of unintended prescription

changes after people leave hospital

Quality Improvement

• Quality schedules streamlined and

embedded within provider contracts

• Standardised performance indicators

for maternity services

• Transformed the access to and the

delivery of ‘essential Skills’ training for nurses working In GP practices

• The Infection Clinical Network

detects trends in infections and works across providers and with national bodies to provide solutions

Patient Experience & Equalities

• Reviewed all patient and staff experience

data to help us understand what is working and what needs improving

• Worked with providers to improve the

quality of reporting on patient experience and equalities

• Delivered projects in partnership with local

providers and the local community to improve the way we capture experience from often excluded group e.g. My Health My Say

Strategy Development

• Patient Experience Strategy

embedded

• Quality and Safety Strategy nearing

completion

• Integration with clinical pathway and

service redesign

Quality Assurance

• Development of standardised quality

schedules enabling benchmarking across provider organisations

• Improvement in safety data for

assurance

• Increased number and spread of clinical

assurance visits to providers

• Quality role in the procurement process

e.g. Respiratory, Community Independence Services and Cardiology

• Revised Quality reporting to allow

greater scrutiny of all providers at local CCG level

• Greater scrutiny of trust systems for

infection prevention

Quality Achievements

Annual accounts

David Tomlinson Chief Financial Officer

Financial duties

• Most of our income comes straight from the Department of Health (DH)
• Called Revenue Resource allocation (or Capital Resource allocation for

capital spend)

• Can be recurrent - fixed and then subject to an annual uplift; or non

recurrent - usually small amounts for specific purposes

• The total of the allocations that we receive is called the Revenue

Resource Limit (RRL) (or Capital Resource Limit – CRL)

• We have a statutory duty not to exceed our RRL or our CRL – i.e. we

aren't allowed to spend more than we are given

• We receive a separate allowance to pay for our running costs – this is set

at £25 per head of population. Again we are not allowed to exceed this amount

• We are not allowed to borrow money or go overdrawn. We are also not

allowed to hold cash at year end.

Financial position 2014/15

The Clinical Commissioning Group met or surpassed its statutory

requirements in 2014/15

Duty Actual Expenditure must not exceed income Compliant Capital resource use does not exceed the amount specified in Directions £0.277m Revenue resource limit £260.17m Revenue resource use on specified matter(s) does not exceed the amount specified in Directions £242.842m Revenue administration resource use does not exceed the amount specified in Directions £4.157m

• CCG Surplus

£13.175m

2014/15 Summary of Net Expenditure

This chart shows how the CCG spent its money . The highest proportion

• f

spend goes on acute services, at 50% of total expenditure. 50% 9% 8% 13% 6% 2% 4% 1% 5% 2%

2014/15 CCG Expenditure, £m

Acute services, £133.8m

Community health services, £24.4m Prescribing, £20.2m Mental health services, £33.5m Continuing and free nursing care, £17.7m Primary care services, £6.6m (1) Programme admin and estates costs, £3.3m

Other services, £3.4m

Surplus, £13.2m Running costs, £4.2m (2)

Notes: (1) GP local enhanced services and out of hours care. NHS England holds the budget for GP contracts (2) In line with the £25 per head allocation that NHS England set for each CCG

Underlying position – forecast 2014/15

Historically Hammersmith & Fulham CCG has had a strong financial position: At 1 April 15: Brought forward surplus £13.2m, underlying (recurrent) surplus forecast to be £14.4m BUT: There is a national formula that sets out how much funding each CCG should receive based on its population’s characteristics and need – its capitation target This indicates our recurrent funding is more than we should be receiving. This is referred to as our ‘distance from target’ or DFT , and has moved from an opening 12.7% in 2014/15 to 11.3% in 2015/16 as the CCG received only the national minimum growth of 1.4%. CCGs that have funding levels below target have received a higher level of growth. We don’t yet know how quickly this could accelerate and move our funding away from the historic level towards the capitation target.

Financial strategy

Our high level financial strategy is therefore:

• Our 5 year planning assumes the 1.4% growth allocated in

2015/16 continues in 2016/17 and onwards.

• The CCG needs to generate sufficient QIPP savings to offset the

growth in demand for services year on year. Our current planning assumption is for a minimum 2% QIPP target in 2015/16 and 2.5% in 2016/17 onwards.

• The CCG needs to strengthen its underlying financial position, by
• nly committing reserves non recurrently where possible and using them

to pump prime new services that will lead to reduced costs (i.e. investing to save).

• Supporting the NWL Financial Strategy to enable the 8 CCGs across NW

London to invest in out of hospital and primary care services, to deliver the Shaping a Healthier Future programme.

2015/16 Budget

David Tomlinson Chief Financial Officer

2015/16 Budget

The planned surplus for 2015/16 is £9.2m. This is £4m less than 2014/15 as nationally CCGs have been allowed to ‘draw down’ surplus subject to business case approval from NHS England. H&F CCG have drawn down the following:

• 1% of allocation to contribute to the

NWL Strategy (£2.7m)

• Return of the planned increase in

14/15 surplus (£1.3m) The final operating plan was submitted to NHS England on 27 May 2015 and the 2015/16 budget shown below was approved at the CCG Governing Body meeting in June 2015. Agreed contracts are in place covering 99% of planned spend with acute, mental health and community providers.

£'000s Final 2015/16 budget Programme allocation 267,119 Running cost allowance 3,940 Total resource 271,059 Acute 125,031 Community 30,703 Continuing healthcare 16,884 Mental health 33,334 Primary care 5,639 Prescribing 20,782 Other programme 25,592 Running cost 3,940 Total spend 261,905

Surplus / (deficit) 9,154

Key financial risks

The key financial risks we are facing are: Short term

• Acute overperformance
• Delivery of QIPP
• Delivering a surplus greater than the plan – and losing the

money as a result Medium term

• Capitation target and the pace of change towards this
• Acute overperformance
• Delivery of the out of hospital agenda
• Better Care Fund

The challenge in 2015/16 will be to strengthen the underlying position, and key within this will be controlling the acute position, delivery of the QIPP programme, and the successful implementation of new initiatives: Out of Hospital Services and BCF implementation.

2015/16 Priorities

Janet Cree Interim Managing Director

"I know how to lead a healthy lifestyle and can manage my own care"

“I feel in control over my care because decisions are taken with me and consider my lifestyle and individual choices"

Personalised

"My care is now more convenient because the services closer to my home are more accessible"

"I know I will be provided with a wider range of high quality care within my community for all of my health and wellbeing needs”

Localised

"I'm not treated 'in parts', but as a whole person in a coordinated way" "Whoever I see, knows me and my preferences, and I no longer have to repeat my details each time"

Integrated

“I have a better experience in a great hospital environment which helps me feel confident in the quality of care provided to me"

“I am kept in hospital for as long as I need to be, and am able to receive effective care sooner rather than later”

Centralised