Council of Members 15 May 2019 Welcome Dr Jonathan Love, Council - - PowerPoint PPT Presentation

Council of Members

15 May 2019

Welcome

Dr Jonathan Love, Council of Members Chair

Minutes of the previous meeting: 27 March 2019

Dr Jonathan Love, Council of Members Chair

Question and answer session

• f CCG Governing Body

Practice representatives

Final opening budget framework 2019/2020 2019/20

Malcolm Hines, Director of Finance

Financial settlement for 19-20 and later years (1 / 2)

• Since we met in March, contracts have been agreed across SEL with

provider Trusts, and other providers of care services.

• The settlement for 19-20, and later, is still a significant increase in

resources.

• Our core services- commissioning budget has increased by 5.98%.
• Our Delegated primary care budget has increased by 6.5%, but this has

now been reduced back to c. 3.5% by a deduction for the creation of the new Clinical Negligence scheme for GP’s nationally.

• Running costs remain static, but with a 12% saving from April 2020. We are

aiming to achieve a 10% saving in this year, leading to making the full 12% from April 2020.

• Overall this is higher than previously awarded, but has significantly

increased commitments attached to it.

• Overall the CCG is now seen as 1.75% above its target allocation, and will

receive c. 4% uplift in 2020-21.

Financial settlement for 19-20 and later years (2 / 2)

• The National pay awards are now funded through this uplift .
• The PBR tariff, has increased net by nearly 3% this year,

compared to 1% the year before.

• Mental Health budgets are expected to be increased through

investment in IAPT, CAMHS and other local schemes by 6.7%.

• Community services are also to be invested in by 6% extra this

year.

• The primary care uplift is to take account of the new contract

deal, and fund the new Clinical Negligence scheme that applies to Practices(CNSGP).

• There are many other commitments, as well as the need to

pump-prime to achieve some of our savings initiatives.

Allocation increases in SEL 2019-20

CCG Final core services allocation 19-20 % uplift in 19-20 Distance from target under latest formula

NHS Bexley CCG 327,611 5.98 0.79 NH Bromley CCG 466,885 5.98 2.17 NHS Greenwich CCG 402,379 6.33 3.44 NHS Lambeth CCG 500,202 5.72

• 3.47

NHS Lewisham CCG 451,617 6.16 2.77 NHS Southwark CCG 439,773 5.98 1.75 OHSEL total 2,588,467 6.01 1.08 London 5.78 1.37

Table 1 :Core Allocation increase for 2019-20 and distance from target

Resources available to Southwark 2019-20

• In 2018-19, we were required to make a surplus of £989k,

which will be carried forward on our balance sheet , for future investment, at such time as we are allowed to “drawdown” these funds by NHSE.

• For 2019-20, we are asked to achieve a break even position

for the year ( taken on its own).

• This is as part of a control total position for the whole of SEL,

where only Bexley has an agreed deficit position at present. All 6 CCG’s have submitted plans to meet their control total for the year- 5 CCG’s break even, and Bexley a £7.5M deficit target, which when achieved will allow them to get an equal amount of national CSF funding, to then reach break even.

• It is essential that we mitigate our savings plan, by obtaining

value for money, and procuring quality services from providers.

Final Opening Resources available to Southwark CCG in 19-20 and 20-21

2018-19 2019-20 2020-21 Recurrent core Allocation 413,881 439,773 459,236 Delegated Primary Care 44,749 47,696 49,830 Adjustment for CNSGP

• 1,373
• 1,373

Non recurrent sums announced 1,355 841 Running Costs allocation 6,533 6,537 5,766 Total Resources 466,518 493,474 513,459 Target surplus for the year 989,000 Break even tba % change over previous year’s Rec.allocation 3.33% 5.78% 4.01% 2018-19 2019-20 2020-21 NB 12% reduction in running costs on all CCG’s in 2020.

Budgets and Contracts 2019-20

• Nationally, there was a deadline of 21 March to achieve agreed contracts

with NHS providers. We have achieved Block contract agreements with all local Acute and community providers, and with SLAM, and Oxleas, that will deliver improvements, with the new investment monies.

• For community services, the discussions are still continuing about the

detailed areas to target investment for the new year.

• The primary care uplift, will be used to implement the new national contract

deal, with an adjustment to this funding , to fund the clinical negligence scheme as mentioned earlier.

• All CCGs are currently working to deliver running cost savings, and will

soon be considering where some functions can be delivered more effectively by working at scale across a number of CCG’s, or as a whole SEL approach.

QIPP Savings Programme 2019-20

• In 18-19, we set a programme of some £16,550k, after

investment to be achieved. We have delivered some £16.1M of this representing c. 95% of our plans. This is much higher than the London wide average 85% delivery.

• For 19-20, despite the high uplift, it has been demonstrated

that there are many cost pressures, and a high outturn in terms

• f increased hospital referrals and demand generally, meaning

that we need to find savings anew, to balance the overall budget to break even.

• The programme for 19-20, is £15,661k, and the CCG have

currently identified over 90% of this programme, with much being built into block contracts.

• This means the level of in year risk is significantly lower, both

around overperformance, and the need for reserves.

Managing risk in 19-20

• We have already stated that we have a number of block

contracts for the year, which will reduce in year risk to the CCG, and therefore we can consider what reserves we need to hold, taking account of other risks.

• We always have some risk on small contracts, Non –NHS

contracts, continuing healthcare, and Prescribing budgets.

• We have a national requirement- again- to hold a ½%

contingency, this is c £2.5m.

• In addition we will be holding another £2m, for local risks and

pressures, so in total c.£4.5m.

• This compares favourable with our 18-19 start position, where

we had £5.4m, but less block contracts in place.

Recommendation

Southwark CCG Council of Members are asked to:

• Approve the financial framework for 2019-20
• Note the Southwark CCG Control Total target of achieving

breakeven in year

• Note the ongoing work being done to achieve our financial

position

• Note the joint SEL work, to agree the achievement of the SEL

CCG’s control total for 2019-20.

Update on planning and priorities for 2019-20 & beyond

Ross Graves, Managing Director

2019-20 Planning Update

• Our 2019-20 CCG Operating Plan narrative will go to Locality Meetings

and our Integrated Governance and Performance Committee next week

• In 2019-20 for the first time we have carried out a joined up planning and

contracting approach across all of the six CCGs in SEL

• This will be a one-year transitional plan which will also form the first year
• f a five year place-based plan for Southwark, aligned to our NHS Long

Term Plan response.

CCG System Reform Update (1 / 2)

• At the end of 2018/19 - Our six Governing Bodies agreed that changes to

the structure of our CCGs in SEL would be required in order to progress our Integrated Care System (ICS) and best respond to the NHS Long Term Plan

• Over March and April 2019 - We have engaged in more than 30

conversations with our partners and members on our thinking to date. From this we have developed a case for change for merger and informed NHSE & NHSI that we would like to consider an application to merge in April 2020

• This is our current intention but the merger application will be based
• n further engagement and a final Governing Body decision.

CCG System Reform Update (2 / 2)

• In late April 2019 - national merger guidance was published. Should SEL

CCGs wish to merge we must have plans and an application submitted on 30 September 2019

• Throughout May - we will ask our six Governing Bodies to agree a process

for this work

• Going forwards - We will regularly communicate with our staff and our

membership throughout this programme and engage you in plans. At this stage we are gathering baseline data and information that compares our six separate CCG team structures that will allow us to begin design work for any change in late May 2019

• We are clear that we will need the right capacity at every level of our

system - very locally, at borough level, and at SEL level.

Partnership Southwark

Ross Graves, Managing Director

Over the next two to three years, health and care partners across Southwark will change the way services are commissioned and delivered in the borough. Within Partnership Southwark we want to do things differently, with and for, our local communities We will work with partners beyond health and care to tackle the causes

• f inequalities and prevent illness,

and improve our use of data and digital technology so we can be more proactive in our approach to delivering care and support.

Through Partnership Southwark we will:

• Make best use of the Southwark pound to deliver improvements in health and

wellbeing outcomes for local people.

• Be inclusive, and wider than health and care organisations so that we can tackle the

causes of health inequalities and prevent illness.

• Ensure every part of the health and care landscape is clearly focused on common

goals of supporting self-management, keeping everyone well, providing resilient high-quality services, meeting individual and population-level needs, and making it easier for people to access the information, advice, care and support they need.

• Support resilient and sustainable general practice, including enabling practices to

work together within Primary Care Networks, and with other local health and care providers, through our neighbourhood model.

• View health, social care, housing, VCS organisations, education and employment as

equal value/partners when working towards a healthier Southwark.

• Equip people to manage their own conditions, take part in activities that will help

keep them well and to support others in their community.

Our priorities for the next two years are:

• Accelerating the development of neighbourhoods supporting circa 30,000 –

50,000 people. These neighbourhoods will involve primary, community and social care, wider council (e.g. housing) and the VCS; and better join up care and support for people with complex health, care and wellbeing needs.

• Helping more people with long-term conditions/frailty to be supported in the

community and their own home, which will reduce unnecessary time spent in hospital.

• Providing focused support for residents of care homes and nursing homes to

ensure better outcomes and reduce avoidable hospital admissions.

• Supporting people with mental health issues in a primary and community care

setting, reducing the need for people with stable moderate to severe mental health to be seen unnecessarily in specialist mental health services.

• Increasing focus on prevention and self-management, supporting people to

live healthier for longer and working to prevent deterioration.

• Improve our population health analytics capability to better understand and

proactively respond to population need at a neighbourhood and place-based level by sharing and linking data.

• Supporting people to have greater control over their own health and

wellbeing, connecting them, to the community and reducing social isolation.

• Developing our approach for children and young people bringing together

work within the Children and Young People’s Health Partnership (CYPHP) and the development of population-level outcomes using Southwark Bridges to Health and Wellbeing.

Work with local people and frontline staff to co-design and develop Southwark’s neighbourhood model to better join up care and support within the community, and respond to the health and wellbeing needs of local populations. Formalise collaborative alliance arrangements enabling system partners (initially Southwark CCG, GSTT, SLAM, GP federations, and Adult Social Care) to deliver integrated primary and community-based health and care. Join-up strategic commissioning between the Council and CCG which, over time, will move towards a population-based approach to commissioning for outcomes using Bridges to Health and Wellbeing segmentation framework. This will build on work we have done to date; providing a foundation to go further faster in delivering tangible benefits for local people and reducing pressure on the system. See Appendix A for our Partnership Southwark implementation plan.

How we will begin to deliver on these priorities

Developing neighbourhoods

• Neighbourhood working will connect people to services as close to their home as

possible, to enable new ways of working for improved outcomes.

• We want to create neighbourhood teams with strong relationships that improve the

health, social wellbeing and lives of local people. The neighbourhood teams will make best use of the skills, resources and energies in our local communities.

• Neighbourhoods will be the natural way of working, focusing on the needs of local

people, understanding the impact of the wider determinants of health in the

• neighbourhood. They will not be constrained by organisational or professional

boundaries.

• We have been testing neighbourhood principles and ways of working through four

test and learn partnerships in Dulwich, Peckham, Rotherhithe and Walworth

• Triangle. Co-design with front-line staff, managers and people with lived experience

has contributed to an emerging neighbourhood model and the next phase of this work.

• Primary Care Networks will be the building blocks for neighbourhood working. They

will enable an enhanced primary care team to integrate in multidisciplinary way with

• ther health, care and voluntary and community services to deliver care and support

and improve outcomes for specified population groups.

Our emerging neighbourhood model

Formalising collaborative alliance arrangements

The benefits of the Partnership Southwark alliance include the ability to accelerate the delivery of our shared system priorities by:

✓ Working to an agreed, co-produced set of delivery

expectations.

✓ Embedding a shared governance and

accountability structure (in line with scope), minimising impact of competing priorities/incentives

✓ Having the ability to pool resources and funding,

and make shared decisions about how best to deploy it to drive more coordinated, integrated and sustainable services; as well as redirect funding towards more proactive preventative care

• A Southwark Strategic Partnership Board will be established from May

2019, with inclusive representation from all partners. This will provide strategic direction and oversight of the Partnership Southwark programme (see Appendix B).

• During 19/20, we will formalise Partnership Southwark through an

alliance initially made up of Southwark CCG, Southwark Council, GSTT, SLAM, IHL and QHS; working closely with wider partners including KCH, the VCS and other agencies involved in supporting Southwark residents.

• The scope and scale of partnership arrangements is intended to increase
• ver time, as we move to strengthen our approach to outcomes-based

commissioning and embed place-based models of care.

• The alliance will be underpinned by a Memorandum of Understanding

from 1 April 2019 with the intention of moving to a more formalised alliance agreement by the end of September, which will overlay existing contractual arrangements.

• A Partnership Southwark Leadership Team will lead the alliance and
• versee the delivery of workstreams against agreed priorities within

scope.

Moving to a population-based approach to commissioning for outcomes

The phase 1 priority segments for implementing Southwark Bridges to Health and Wellbeing are:

▪

Dementia, frailty and end of life

▪

Protecting vulnerable children (0-18 years) – keeping families strong; and maternity and children services (up to 5 years) including those with specialist or complex needs Shifting to a population-based approach to commissioning for outcomes will allow us to:

❖ Match care models to people’s holistic needs

rather than one size fits all.

❖ Understand people’s wants and needs holistically

not by setting.

❖ Give parity to mental, physical and social care. ❖ Align incentives to support providers to work better

together, focusing on outcomes that matter to people

❖ Ensure the best use of resources available across

Southwark by shifting the focus to prevention.

• Southwark Bridges to Health and Wellbeing is the framework

Southwark CCG and Southwark Council commissioners have agreed to develop their approach to population-based commissioning for

• utcomes.
• The first phase of this work will focus on priority population

segments to test our approach before scaling up across the whole population.

• We will co-produce outcomes with local people and providers;

including those beyond health and social care.

• The outcomes developed through this work will support service/

pathway redesign and the development of new models of care at a neighbourhood and borough level, a greater focus on prevention and early intervention, and the shift towards establishing integrated care arrangements to deliver these outcomes.

Some practical examples

• A care home resident receives care from a GP who they know and who is able to access advice and

support from community geriatricians and dementia services, and support with medicines regime from community pharmacists

• For a patient who suffers from ulcers and is not housebound, the Neighbourhood Nursing team will be

part of the wider team and will discuss with GP, pharmacists and social care how to better prevent and dress these ulcers through attention to their self-care, attendance at practice nurse appointments or community dressing clinic

• A frail elderly patient seen by GP, with carer spouse struggling to cope at home and is at risk of being

admitted into a care home. Under the Partnership Southwark model, the GP will be able to refer to housing who can organise for adaptation to the property; navigators signpost to other local voluntary and community services to better support the patient and their spouse. The home carer who attends

• n a daily basis is able to pick up on signs of deterioration and inform their co-ordinator who can

contact neighbourhood nursing directly or the GP for proactive response

• A woman with schizophrenia which is stable on medication plus diabetes/ hypertension will be cared for

by her GP but advice on antipsychotic medications and rapid help if relapsing will be available from the mental health colleagues working into the Neighbourhood team

• Parents of a child with asthma and frequent A&E attendance will be supported by community nurses

and school staff to become stable on treatment

• Decisions about how all of this will be done to achieve specified outcomes will be made as a group of

local commissioner and provider organisations – Partnership Southwark.

Discussion

Table discussions Share feedback

• Gathering reflections and any questions on the model and approach
• From a general practice and PCN perspective, what are the opportunities

from the Partnership Southwark model to provide better and more joined up community based care that meets the needs and priorities of our patients? Areas to consider:

• Adults and Older People
• Primary and Community Mental Health
• Children and Young People
• How do we achieve the right clinical conversations and clinical leadership in

these new arrangements?

Any other business

Suggestions for future Council of Members agenda items – portfolio presentations Dr Jonathan Love, Council of Members Chair

Date of next meeting:

25 September 2019

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