Council of Members 27 March 2014 Minutes of last meeting: 29 - - PowerPoint PPT Presentation

Council of Members

27 March 2014

Minutes of last meeting: 29 January 2014

• Dr. Richard Proctor, Council of Member Chair

Five Areas to Track

Bulletin: Quarter 3 2013/14

• Dr. Richard Proctor, Council of Member Chair

The Current Situation 1. The NHS Constitution sets a right for patients to be treated within 18 weeks of referral should they require admission. Trusts must ensure that a minimum of 90% of all patients referred are treated within this timeframe. 2. King’s has failed this target in all months in the financial year 2013/14. The trust has had a planned failure on RTT, designed to reduce a backlog of approximately 1,483 (December figure) patients who had waited more than 18 weeks for admitted treatment. In December 87.8 % of admitted patients were treated within 18 weeks of referral at King’s. 3. KCH currently have particularly long waiting times in trauma and orthopaedics and for the most recent period for which we have detailed data (December 2013), of the 531 patients starting their admitted treatment only 81% had waited 18 weeks or less for it to be completed. 4. The King’s RTT performance position was made known to commissioners ahead of 2013/14 and is attributable to the trust using theatre capacity to reduce the ‘backlog’ of patients waiting over 18 weeks; an increase in non-elective cases; and a lack of capacity for planned elective cases at the Denmark Hill site. Recent Actions Taken 1. Acquisition of the PRUH site and development of the centenary wing at Denmark Hill has provided further ‘ring-fenced’ elective capacity since October and November respectively. Additional capacity at the Orpington site includes 45 beds and 3 theatres both with phased

• penings which started from mid October 2013 with the last theatre opening in January 2014. Centenary wing development will provide a net

additional 16 beds (opened in end of November 2013) and 1 HpB theatre which opened in February. 2. King’s have a combination of increased internal capacity and outsourcing to private providers in place. 3. The CCG has advised local referrers of the long waiters at King’s trauma and orthopaedics service to transfer referral to GSTT. Outcome of Actions / Planned Outcome 1. The backlog has not returned to the levels expected in the agreed trajectories. As part of the 2014/15 contract, the CSU will be agreeing revised trajectories to achieve a sustainable position as early as possible in 2014/15. 2. 25 King’s T&O patients had been treated at GSTT by the end of December. All sides would like to see this number increase. The CSU hosted a meeting between both parties on 13 February, a new process was agreed that would aim for King’s to transfer 30 patients a month to GSTT, until end of Q2. 3. King’s consultants undertake regular clinical review of all patients waiting in excess of 18 weeks for treatment. 4. Andrew Bland wrote to King’s in February requesting assurance around the amount of over 52 week waiters currently at the trust and updated recovery plans covering how the trust would address this issue. 5. CCG will continue to monitor backlog clearance and admitted performance against agreed trajectories.

• 1. Hospital waiting times: 18 weeks for admitted patients

• 2. IAPT and practice-based counselling

The Current Situation 1. Southwark Psychological Therapies Service (SPTS) is provided by SLaM. Practice-based counselling also provide services in 43 practices . Both providers deliver talking therapies under the Improving Access to Psychological Therapies (IAPT) national programme. 2. The CCG has a predicted prevalence of 41,929 people in Southwark with depression/anxiety and a target that 12.5% of these people are seen by IAPT services each year and that 50% of patients ‘move to recovery’ following the intervention. The CCG is currently failing both national targets. 3. At present we know there aren’t enough people being seen by all IAPT services (SLaM and counsellors) and not enough of these patients are getting the outcomes they want. 4. We also know there is significant variation in the delivery of counselling services offered across practices in Southwark, which impacts on delivering NICE and IAPT compliant services. 5. The CSC reached a decision in December 2013 to re-commission the entire primary care psychological therapies service provision (SLaM, practice based Counselling, Waterloo Community Counselling and Southwark Carers – Bereavement service) and the decision was taken to the Governing Body in January 2014. Mental health commissioners are in the process of developing a procurement model and service specification, which will be subject to engagement. Recent Actions Taken 1. Update given to February 2014 CSC on progress made to date and plans for engagement and an outline of model to be commissioned i.e. commissioning one provider to deliver the service specification for Southwark residents. 2. Engagement with CCG membership and patients. Feedback collated from stakeholders, public and patients. 3. Discussions with commissioning colleagues and review of national service specification and other services to inform development of local specification, potential issues and risks in the procurement. Outcome of Actions / Planned Outcome 1. Planned engagement on service specification following feedback from, CSC, PPG and locality meetings. 2. Draft service specification developed. 3. Communication planned with GP practice providers around the HR issues to be considered for the procurement to mitigate risks associated with TUPE arrangements. 4. Project/procurement Board in development.

• 3. Community clinics and single point of referral

The Current Situation 1. Over the last two years Southwark CCG has been developing pathway specific single points of referral (SPR) and community clinics as part of the CCG’s Programme of Service Redesign. There is a commitment to further expand this community provision in order to shift care out of hospital (as per the aim included in the CCG strategic plans). 2. SPRs are currently operating for MSK (MCATS), Diabetes, Respiratory, and ENT. Community services/clinics exist for MSK, diabetes, dermatology, gynaecology and heart failure (as a step down from secondary care ) and a CVD service (AF/hypertension/lipid management). 3. In addition to the SPR & community clinic functions , a number of our community services provide ‘virtual clinics’ to support Primary Care in reviewing practices’ caseloads and providing advice on management. Recent Actions Taken

• 1. Southwark’s ENT referral & advice service has been delivering for over 5 months (data received from Sept- Jan), in this time the service

has received 820 referrals, of which 10% have been returned to Primary Care with Management Plans and 90% referred onto secondary

• care. As expected, there has been a slight increase in referrals to secondary care as a consequence of decommissioning the community

ENT treatment function, however initial financial analysis suggests overall cost of the new ENT pathway including the increase in secondary care activity has reduced. Requests for Advice & Guidance through this service remains low. A six month review will be conducted in March/April 14

• 2. The Community Dermatology Service, was launched as a single point of referral for all routine referrals on 1st October (data received for

Oct/Nov/Dec). There’s currently no significant change in the number of referrals into the service or the subsequent outcome of triage or appointments since the service was re-launched. Approximately 300 referrals per month (869 referrals in Q3) continue to be received in the Community Service with 75% subsequently seen in one of the clinics. Of the patients seen in the community clinics, half are discharged after their first appointment. Outcome of Actions / Planned Outcome 1. Both the ENT and Dermatology services offer a programme of training and support services to up skill primary care practitioners. The intention will be to improve capability and competency across Primary Care to reduce variation and deliver better care to patients . 2. The delivery and uptake of ENT & Dermatology SPRs by all Southwark practices is vital to reduce activity and deliver Southwark’s acute QIPP plans. 3. Community services will provide Southwark residents with services closer to home with reduced waiting times. 4. There is also an intention to review Southwark’s pathway specific SPRs in 2014/15 with a potential option of developing a universal model for SPR for all non-urgent referrals to secondary care.

• 4. Communication between district nursing and primary care

The Current Situation 1. During 2012/13 the CCG’s contract with Guy’s & St. Thomas’ Community Health Services (GSTCHS) included a CQuIN (contractual standard) focused on implementing monthly meetings between GP practices and local district nurses in Southwark and Lambeth. 2. GSTCHS failed the 75% target in quarter 4 last year (Jan-March 2013), however nearly 70% of GP practices were having regular monthly meetings by the end of the year across the 2 boroughs. In the main, performance was worst in the south of the borough. GSTCHS attributed this to poor recording. 3. 2013/14 performance reported for quarter 3 2013/14 (Oct - Dec) shows that 56.7% of meetings were taking place between GP practices and district nurses. (Q1 – 46.8%, Q2 – 50.4%). The equivalent figure in Lambeth was 86%. The service reports exceptions (e.g. cancel meetings ). 4. A related KPI illustrates 81% of patients referred to the district nursing service are contacted within 24 hours – a drop from 91% in Q2 following a continuous improvement over 2012/13 and 2013/14. Recent Actions Taken 1. A task action plan has been shared with commissioners and progress is monitored at fortnightly meetings between both Southwark & Lambeth CCGs and the head & deputy head of district nursing. Also reported at GST CQRG meeting in November with update in Feb 14 2. Service has reported difficulties in recruiting qualified District Nurses and will undertake a big national recruitment programme during Q4 3. Community matron service integrated with the district nursing team until 31 March 2014 to ensure core service delivery during winter pressures and with large number of vacancies. Outcome of Actions / Planned Outcome 1. Proposed 2014/15 District Nurse Service Improvement plan as part of 2014/15 GST integrated contract 2. CCG will continue to monitor recording of meetings and progress 3. To work with partners to design integrated nursing approach in line with neighbourhood working arrangements currently in development

• 5. Southwark & Lambeth Integrated Care (SLIC) programme

The Current Situation 1. The SLIC frail elderly pathway including primary care LES for health assessments and case management is being implemented . The pathway is supported by the Lambeth and Southwark admission avoidance programme. 2. The CMDTs are operational and cover all of Lambeth and Southwark. However, there is significant under-delivery of primary care elements of the pathway. 3. Other planned work includes work on the discharge pathway and work on nursing homes, falls and dementia. The SLIC approach to Long Term Conditions is in development, with a Business Case expected in April. Work on enablers including information sharing and workforce development is progressing, but at a relatively slow pace. 4. The CCG and Local Authority have agreed the use of the Better Care Fund, including support for the costs of admission avoidance and 7 day working. Recent Actions Taken 1. The roll out of @Home (Homeward) is underway , with referrals now accepted from all practices in Southwark, operating on a shared care basis with practices. The capacity of the services will build up to 100 beds across Southwark and Lambeth by June 2014, with two wards covering the Southwark borough. 2. Delivery of the elderly pathway in primary care will be in place across the borough from April as a result of the neighbourhood delivery of extended services. 3. SLIC programme is working on a number of business cases for the future of integration, including commissioning framework, financial incentives and the provider model for integration. 4. The CCG is in discussion with the Council about a programme for developing the Better Care Fund plans which compliments the SLIC programme. Outcome of Actions / Planned Outcome 1. Increased utilisation of @Home beds over January and February, taking more referrals of Southwark patients. 2. Development of a commissioning framework for integrated care, including a basket of outcome measures. Delivery of holistic health assessments and integrated case management.

CCG Financial Position Month 11

Malcolm Hines, Chief Financial Officer

CCG Programme Budget Summary 2013/14 (M11)

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Programme Budget Annual Budget (£k) Variance to Month 11 (£k) Predicted End of Year (£k) Acute 210,466

• 5,079
• 6,342

Client Group 69,944 1,215 1,321 Community Contract 30,238

• 609
• 640

Prescribing 31,617 633 702 Corporate Costs 5,610

• 37
• 50

Earmarked Budgets and Reserves 6,055 3,876 5,009 Planned Surplus 3,972 3,641 3,972 Total Programme Budget

357,902 3,641 3,972

Total Running Costs 7,220 187 210

Risks and Mitigations

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• Acute contracts. We expected to overspend by £6.34m this year. Winter

monies – which were made available to providers as part of recent national announcements – are now all played in to the financial position.

• Year-end. Agreements are in place to limit the CCG’s exposure with all three

main trusts: GSTT, KCH and SLaM.

• QIPP programme. The expectation is a small underperformance of

approximately £100k (1.1%) against a target to save £7,374k. So a £7,274k saving is expected to be achieved this year.

• Surplus target. We remain very confident of achieving our target surplus of

1%, equivalent to just under £4m for the year.

Sign-off of Annual Accounts and Annual Report

Malcolm Hines, Chief Financial Officer

Annual Report and Annual Accounts

The Council of Members is responsible for approving the CCG’s Annual Report and Annual Accounts. This is set out in the CCG Constitution.

• Pre-audit accounts to be submitted to the Department of Health on 23

April 2014.

• Final CCG accounts to be submitted 6 June 2014.
• Asking Council of Members to delegate the authority to the Chair and

Deputy Chair of the CCG Council of Members, working with the Chief Financial Officer, to sign-off these documents on behalf of member practices.

• The draft Annual Report including the pre-audited accounts will be

available to member practices in April.

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CCG Governing Body Selection/Election Update

Malcolm Hines, Chief Financial Officer

Election Update

• Tenures of four clinical leads finishes end of June 2014: Amr Zeineldine,

Simon Fradd, Roger Durston and Patrick Holden.

• Deadline for applications was Friday 14 March.
• Interviews were conducted during w/c 17 March (the ‘selection’ phase).
• Selection is to check applicants’ ability to meet competencies in the job
• description. Successful candidates will be put forward for election.
• Electoral Reform Services creating ballot papers of applicants successful

at interview.

• Ballot (‘Election’) opens 7 April and closes 28 April – paper and electronic.
• Result will be announced at 8 May Governing Body meeting.
• New clinical leads take up roles 1 July 2014.

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Delivering through the CCG and our membership

• Dr. Richard Proctor, Council of Members Chair &
• Dr. Jonty Heaversedge, CCG Clinical Lead

On the eve of the CCG’s first anniversary to provide an overview of:

• The CCG’s governance structure and how it operates
• Our planning processes and members’ engagement and roles
• CCG decision making and managing conflicts of interest.

Purpose

• The CCG is its membership and the member practices are the CCG with a

commissioning responsibility as the best advocates of their patients and the population of Southwark.

• Wide ranging responsibilities - decision making and delivering for patients must

be effectively delegated and devolved if local commissioning of services is to be effective.

• Conflict of interest arrangements are established to ‘enable’ rather than ‘restrict
• r replace’ clinically-led decision making.

A clinically led membership organisation

In 2014/15 the CCG will run multiple major programmes of work, plan for and secure more than 30 national or local standards for patients and will make and report against a significant number (hundreds) of decisions and actions over the year. We must be well organised to achieve this. The importance we have placed on population focused commissioning, reduced inequalities and the pivotal role of primary and community care – conflicts of interest must be recognised and managed in order that we realise our ambition in these areas.

Practice, GP and clinical roles

Member Practices – advocate for their practice population, and also have a range of roles whilst being members of the CCG:

• Deliver care
• Coordinate care
• Provide clinical expertise
• Gate-keep for the system
• Run a business

CCGs – advocate for the system, ensuring:

• Quality, safety &

improvement

• Value
• Equity
• Accountability
• Sustainability

The primary role of member practices in relation to the CCG is to ensure that the system delivers the care required to achieve the best possible health outcomes for their practice population – through their contribution to the work of the CCG and holding the Governing Body effectively to account.

Leadership and Delivery Locality Locality Locality Governance Membership Engagement Governing Body NHS England

The CCG is accountable to the Department of Health via NHS England for delivery of statutory and national requirements and

• ur locally agreed plans

The CCG’s Council of Members allows the membership to discharge four functions to: 1. Agree the CCG Constitution and any changes to it 2. Consider and agree CCG operating and strategic plans 3. Hold the Governing Body and members to account for delivery 4. Ensure the processes we have established are followed

The Governing Body receives a national (DoH) and local (CoM) mandate and is required to lead the development and delivery of commissioning plans. In receipt of that mandate it is required to engage the membership through localities and interaction and representation through clinical leads in securing high quality services from current commissioned services and to plan and enact agreed changes to future services

Localities provide forums for member practices to engage in and shape decision making, implementation and delivery in-year and for future years. That work is taken forward by the Governing Body on their behalf

Council of Members

Governance, Leadership & Engagement

Practice responsibilities

As commissioners – member practices are advocates of their patients in the commissioning process – ensuring their front line experience of knowledge of the local system shapes its future Practice Practice Practice Practice

Member practices have collective and individual responsibility for commissioning……. Practice Populations

Council of Members Governing Body Localities Member Practices GB Committees

Hold members and the Governing Body to account for delivery of plans Ensure the constitution is upheld

Engage members in the development of plans to implement the agreed strategy Lead the organisation responding to planned and unplanned commissioning activities , taking remedial action etc

Monitoring and providing frontline insight in to the performance of the system Engaging in the development and / or implementation of plans to deliver the strategy Taking decisions that achieve the strategy and adhere to the statutory responsibilities of the CCG as a public body

Consider and approve the Operational and Strategic plans of the CCG – recommended by the Governing Body in response to National and Local priorities

Consider and approve changes to the CCG Constitution Develop a framework for strategic and operational planning Produce and recommend operational and strategy plans for the future reflecting engagement with the membership upon local and national requirements Shape through engagement - plans that respond best to patient needs

‘Where’ and ‘Who’ In-year or ‘Today’ Next year or ‘Tomorrow’

Who, when and where

NHS Constitution NHS Mandate Local needs assessment Member engagement Patient engagement NICE / Evidence Regional Planning Financial Allocation Work in progress / pre- commitments

Membership and Patient Engagement

Five Year Strategy Plan (Local) Five Year Strategy Plan (SEL) Two Year Operating Plan

Aligned to Partner Plans (e.g. Health & Wellbeing Board)

Five Year Strategy Plan (Local) Five Year Strategy Plan (SEL) Two Year Operating Plan

Governing Body Recommendation Council of Members Approval

Five Year Strategy Plan (SEL) Two Year Operating Plan Five Year Strategy Plan (Local) The Inputs Draft Plans Implement Final Plans

Membership and Patient Engagement

Planning inputs–to–implementation

Provider engagement Public Health data

• All public bodies seek to understand and manage (rather than remove) their

conflicts of interest: publically available Registers of Interest and policies.

• As providers and commissioners of care, member practices and other

members of the CCG will often have a conflict of interest – either perceived

• r actual – in decisions made by the CCG.
• It is important that interests are managed – clinical leadership of decision

making is the keystone of our organisation and we must secure it.

• To do this the CCG:

– Maintains a Register of Interests – Has appointed a Conflict of Interest Guardian – Has established a Conflicts of Interest Panel

Conflicts of Interest

Where decisions are likely to involve a conflict they are reviewed by, or are referred to, the COI Guardian. Having identified that a conflict might or could be seen to influence a decision the guardian will either advise:

• That where a conflict in clear and relates to an individual they are asked to exclude themselves from the process
• That provided conflicts are known a recommendation can be discussed and made to the Governing Body once it

is reviewed by the COI panel (majority of cases)

• That because all clinical members are totally conflicted the issue should be considered by the Panel only.

In every case the COI panel never makes the final decision but makes its recommendation to the Governing Body for their approval or not. The Panel consists of non-conflicted members – the COI Guardian (a Lay member), the Director of Public Health, the Chief Officer and the Chief Financial Officer. The Panel can also co-opt experts including clinicians from outside of the area provided they have no material interest in the decision. The Panel itself would have to exclude one of its members should they have a relevant interest. Where the panel is considering a recommendation from clinical leads to the Governing Body for decision it:

• Checks that all interests have been declared and are recorded
• Reviews the recommendation to ensure it didn’t suffer a conflict – typically this will be a review against a number
• f criteria including whether there was an evidence base used, whether the decision will reduce or enhance

inequality of outcome for all residents, whether it will improve value for money

• Importantly they will seek to assure themselves that the recommendation was not unduly influenced by a known

interest of any individual party to the discussion. Should a decision be on an issue where everyone involved is conflicted then the panel would have to seek to make a recommendation itself to the Governing Body.

Conflicts of Interest Process and Panel

Proposal to the Strategy Committee Shaped by GB leads Discussed with members – Localities, PLTs and direct contact / email Re-shaped by GB leads taking account

• f member views

Strategy Committee recommendation Referral to COI Guardian Potential Conflict Total Conflict Yes No COI Panel makes recommendation to the Governing Body COI Panel concludes recommendation has NOT suffered a Conflict – Strategy Committee recommendation to the Governing Body COI Panel concludes recommendation has HAS suffered a Conflict – Recommendation is return to the Strategy Committee Governing Body accepts or rejects recommendation

Clinically led decision- making Conflict of Interest Panel Assurance The Governing Body has the ‘final say’

Decision-making and managing conflicts

CCG Operating Plan and Budget 2014/15 & 2015/16

Malcolm Hines, Chief Financial Officer

Reminder: what is an Operating Plan

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1. The Operating Plan is written as an assurance document. It details all of the requirements made of a CCG by NHS England and sets out our locally-defined response to these. 2. CCGs are required to declare their commitment to meet national requirements; state the extent of their ambition for the improvement of certain performance and outcome indicators; and provide a view of the programmes of work underway and planned to ensure these targeted improvements happen. 3. Requirements of CCGs to be addressed in an Operating Plan include: a. Ensuring commissioned providers meet NHS Constitution and national performance standards (e.g. 18 weeks; A&E; cancer waits; access to psychological therapies). b. Ensuring commissioned providers meet quality and safety standards (e.g. rates of c.difficile and MRSA infection; rates of dementia diagnosis) c. Ensuring commissioned providers and the CCG act to improve a number of mandated population-wide outcome indicators (e.g. potential years of life lost to causes amenable to healthcare; rate of emergency admissions; patient experience of GP services; % of patients with LTCs who feel supported to manage their health). d. Demonstrating the CCG has a clear forecast of anticipated levels of commissioned activity at all hospital providers accessed by our patients.

Reminder: what is an Operating Plan

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3. In the Operating Plan for 2014/15 and 2015/16, CCGs are asked to demonstrates their plans to use the jointly agreed Better Care Fund to support the delivery of national requirements and contribute to the integration of health and care services. 4. CCGs must show how they plan to meet the aforementioned requirements in a way that allows them to remain financially sustainable and deliver a 1% surplus at the end of each year. 5. CCG Operating Plans describes the first two years of a medium term 5 year

• strategy. In essence, the commissioning intentions included in the Operating Plan

should describe both how we are going to achieve the ‘musts dos’ over the next two years but also what the CCG plans to do to establish a foundation for the delivery of large scale transformational change across both Southwark and south east London.

Reminder: on engagement completed

February-to-May 2013 – Consultation on improving health services in Dulwich & the surrounding areas April 2013 – Stakeholder engagement event on Primary & Community Care Strategy (PCCS) May 2013 – Stakeholder engagement event on review of Urgent Care Centre July 2013 – Mental health stakeholder event Spring & summer 2013 – Locality meetings/ PPGs on Dulwich and Primary & Community Care Strategy September 2013 – Member practice engagement event on Primary & Community Care Strategy September 2013 – Patient engagement event on manual therapies Autumn 2013 – Locality meetings on commissioning intentions; CQuINS; PCCS October 2013 – Council of Members roundtable on commissioning intentions October 2013 – Call to Action stakeholder event looking at planning priorities for 2014/15 and beyond October 2013 – Governing Body workshop exploring key areas of service development. November 2013 – Member practice survey on review of Lister Walk in Centre. November 2013 – Commissioning intentions focus groups with CCG practices; partners & clinical leads November 2013 – Primary care engagement meetings on primary care counselling November 2013 – Urgent primary care access stakeholder engagement event November 2013 – Big Health Check Day for people with learning disabilities December 2013 – Planning briefing to Southwark Health & Wellbeing Board December 2013 – Joint Lambeth and Southwark practice event on Primary & Community Care Strategy December 2013 – Joint Lambeth & Southwark GB workshop on joint programmes of work January 2014 – Council of Members round table discussions on extended access January 2014 – Health outcomes stakeholder event in Lambeth and Southwark February 2014 – Extended primary care access stakeholder engagement event February 2014 – CCG Governing Body workshop on quality and commissioning intentions March 2014 – Clinical workshops on extended access

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Headline CCG Commissioning Intentions

Integrated Care

• Work with SLIC programme and Southwark Council to agree future

commissioning plans for integrated care, moving towards commissioning for

• utcomes.
• Develop a programme to support developing integrated neighbourhood services,

including primary care, community services, social care and housing.

• Oversee extension of ‘@home’ admission avoidance programme including full

roll-out of Homeward across Southwark and integration with supported discharge.

• Work with SLIC and other partners to deliver on key enablers of integration,

including information sharing across acute, primary care and social care.

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Headline CCG Commissioning Intentions

Integrated Care (continued)

• Implement a prevention strategy to support the HWB Strategy, including a focus on

secondary care brief intervention and commissioning more community based support for healthy living.

• Implement Joint Dementia Strategy to commission new community intervention

services for people with dementia including a medicines optimisation programme; and specialist services.

• Commission enhanced primary care support to Southwark care homes operating as

part of a specialist multi-disciplinary model of care for patients living in residential accommodation.

• Develop a primary care model of early diagnosis and integrated care for children with

autism.

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Headline CCG Commissioning Intentions

Primary Care and Community Care

• Implementation of the CCG primary and community care locality development

plan and broader CCG Primary and Community Care Strategy.

• Commission enhanced diagnostic capacity in primary and community care

settings, to support improved care management and better use of acute care.

• Design and deliver a comprehensive primary care workforce development

programme.

• Contribute to shaping Southwark Council’s approach to the commissioning of

enhanced community support services (home help and domiciliary services).

• Continued implementation of the service model for the Dulwich locality and

implementation of community hub model across the borough.

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Headline CCG Commissioning Intentions

Urgent Care

• Commission effective urgent care pathways including A&E front-end; UCCs and

WICs and develop a model of care to enhance access; the quality of services; and the percentage of patients that attend the most appropriate care setting.

• Commission extended access to primary care across the borough.
• Commission for services 7-days-a-week in collaboration with Southwark local

authority and NHS England commissioners to support admission avoidance and to improve discharge from hospital.

• Complete inner south east London procurement for provision of NHS 111 service.
• Commission London Ambulance Service to safely and effectively increase the

proportion of calls treated ‘on site’ to reduce A&E conveyance rates.

• With social care services, commission new services targeted at people ‘in-crisis’.

This will be initially focussed on people with mental health, alcohol misuse issues and on those who are homeless.

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Headline CCG Commissioning Intentions

Planned Care

• Review systems to support best practice referrals including use of referral

management systems, single points of referral and decision support tools.

• Commission pathways for patients referred with common health conditions (e.g.

diabetes; respiratory illness; gynaecology) to specialist services provided in community facilities in different locations of the borough.

• Review access policies including south east London Treatment Access Policy.

Consider implementation of clinical management protocols and pathways for people who smoke and require non-urgent elective admission.

• Re-procurement of psychological therapies pathway, to deliver effective and high

quality services that treat people holistically, taking account of their mental health, physical health and social needs.

• Work with providers to implement contractual requirements to support increased

productivity and efficiency. These will be based on shared priorities for transformation in secondary care.

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Financial allocations and position for 2014-15 onwards

• The CCG will receive an increase of 3.5%, just over £12m in 2014-15 and a further

2.7% in 2015-16.

• Against this the CCG faces significant acute contract cost pressures from increased

demand, population growth, and increased mental health pressures.

• Inflation is predicted to increase in the future and beyond 2015-16 it is likely that the

CCG will only receive an annual increase of less than 2% per year.

• Our local population is growing at 1.7% or more per year, which will increase the

demand for services across all services.

• CCG Governing Body members are considering proposals for investment to take

forward service redesign and improved quality and access. The CCG GB must also consider how to achieve the savings schemes required to ensure the CCG can make available investment resources without risking a balanced budget.

• Currently the overall QIPP savings target is approximately £13m for 2014-15.

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2014-15 Acute services 207,863 Mental Health services 58,987 Community services 32,581 Primary care prescribing 31,200 Re-ablement with Local Authority 1,844 Continuing care and Funded Nursing Care 10,413 Corporate costs and property costs 4,021 Total Budget envelopes 346,909 Reserves and Contingencies 15,597 Total Programme Budget excluding running costs, net of QIPP savings 362,506

Opening Budget Envelopes 2014-15 (£’000)

Responding to Challenges in the Year Ahead

• Dr. Richard Proctor, Council of Members Chair

What can practices do to help achieve the CCG’s objectives?

• 1. Quality & Safety
• What can we do to better identify issues about quality of care our

patients are receiving?

• 2. Unplanned Care
• What can we do to further reduce unnecessary A&E attendances?
• 3. Planned Care
• How can we better inform patients of the performance of local Trusts

to help them make more informed choice?

• 4. Patient Engagement
• How can we better engage with patients at practice level?

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What can practices do to help achieve the CCG’s objectives?

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Quality & Safety

• Continue to flag issues and concerns through the CCG Quality Alerts System
• Complete adult and child safeguarding audits and implement action plans

Unplanned Care

• Continue to work with the CCG team to support good patient access
• Work with the CCG team to review A&E activity
• Refer patients to alternatives to A&E wherever possible:
• a. Geriatrician Hot Line and TALK
• b. Hot clinics
• c. Enhanced Rapid Response
• d. @Home
• e. Admissions Avoidance information
• Case management of high risk patients and referral to Community MDTs

Planned Care

• Discuss waiting times at local trusts with your patients before referring to

long-wait specialities Patient Engagement

• Use the resources from the National Association of Patient Participation

(NAPP), support from CCG to run PPGs and support email and web-based interactions

• Co-design with CCG and patients an engagement celebration event to share

good practice as part of national PPG week

Discussion

Question and Answer Session

• f the CCG Governing Body

Any Other Business

CCG 360º Stakeholder Survey

• 1. NHS England is conducting the CCG 360º Stakeholder Survey on behalf of all

CCGs, allowing stakeholders to provide feedback on working relationships with CCGs.

• 2. Purpose is:
• 1. To feed into annual assurance between NHS England and CCGs
• 2. To provide CCGs with information to inform the development of their

relationships with stakeholders.

• 3. Stakeholders include:
• 1. GP member practices
• 2. Neighbouring CCGs
• 3. Health and Wellbeing Boards
• 4. Local Authority
• 5. Local Healthwatch and patient representatives
• 6. Provider Trusts – acute, mental health and community
• 4. Survey runs from 12 March – 4 April

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