Group Annual General Meeting Wednesday 16 th July 2014 Geffrye - - PowerPoint PPT Presentation

City and Hackney Clinical Commissioning Group Annual General Meeting

Wednesday 16th July 2014 Geffrye Museum

Welcome

Our first AGM as a CCG Housekeeping

• No planned fire test tonight
• Toilets through the doors to the right
• Light refreshments

Agenda

• Presentation of our performance last year
• Questions and Answers
• Informal discussion with Programme Boards

Introduction

We are a very successful health economy Why?

• Our GP members
• High quality practices
• Very engaged in commissioning
• Homerton
• Excellent local hospital
• Provides secondary and community services
• Active voluntary sector
• Competent borough and

corporation

Mental Health

Children and young people

• Lowest waiting times in east London for treatment
• Carers and parents reporting increased levels of support
• Very high recovery rates:

CORC – Children's outcomes research consortium

Homerton

• £1m investment in Homerton Psychological Medicine to support

patients with mental health problems in the Homerton and presenting at A&E

• Keep people out of hospital – fewer admissions
• Reduce unnecessary time spent in hospital

Primary care

• Our services have improved for people with mental health

and emotional problems

• Up-skilling primary care: improved training and services
• 500 patients seen by Enhanced Primary Care service
• Feedback from patients:

the primary care service is better than before I no longer need to be seen by the Community Mental Health Team and now I can go to my GP practice to see my mental health nurse or the GP without the other patients knowing my reason for being there I spend more time talking to my nurse and GP than before

People with dementia

• All memory clinic feedback sessions have an Alzheimer

Society Dementia Advisor to support people in their local communities

• Lowest anti-psychosis drug prescribing in east London
• 10% increase in dementia diagnosis since 2012/13 meaning

more people have access to early support for their illness:

People with short-term problems

• Over 5,000 people with depression and anxiety supported (15% of

all people with depression/anxiety) – highest number and % in London:

Mental Health

People with complex needs

• Tavistock and Portman awarded Royal College Psychiatry award for

adult mental health with over 600 people with complex mental health needs receiving care in their local GP surgery

• 75% of users report a recovery from using this service

Prescribing

Innovation Joint (between CCG and Homerton Hospital), first of its type, electronic formulary to facilitate safe and cost effective prescribing. Being repeated in East London Mental Health Foundation Trust in 2014/15

Indicator Ezetimibe Rosuvastatin Metformin & sulphonylureas Non analogue insulins Blood Glucose strips Specials (Total Cost) Specials (Cost/1000pts) Specials Cost/Item Silver dressing s Cost per 1000 ASTRO-PU Omega 3 C&H Ranking – of 32 London CCGs 2 1 8 10 9 10 5 29 3* 8 8

Reducing waste Approximately £1M worth of medicines issued in C&H is wasted annually Patient campaign raising awareness of the costs of medicines waste Quality of Prescribing City & Hackney is in the Top 10 London CCGs for 10 out of 11 prescribing quality indicators:

*CCGs without a centralised dressings service

Children’s

Expansion of out-of-hours Children’s Community Nursing team Highly skilled nursing care for children in the community

• Now available at the

weekends

• Treated 103 children

who would otherwise have attended hospital Children and Families Act 2014 Working with

• ur

partners to implement these changes from September 2014 Thresholds are not changing – but personalised Education Health and Social Care Plan. We will work closely with young people and families. Vulnerable Children’s Contract with GPs

• Focus on asthma, epilepsy and diabetes
• Mental Health
• Improving care for vulnerable children and families
• 16th birthday health check

Maternity

Maternity Service Liaison Committee (MSLC)

The committee of approximately 15 includes local health professionals and parents to help ensure our woman’s voices are reflected in the commissioning of maternity services Priorities for the coming year include:

MSLC 14-15 Work Plan priorities Actions

• A. Parents voice and experience

Walking the patch – postnatal Observing maternity/labour reception area

• B. Vulnerable women’s pathway

Focus groups with target populations Local VCS and parent reps to collect views and feedback

• C. Tongue tie service

Continue to monitor need, and support pilot bid for non- recurrent funding pilot project.

• D. Breastfeeding

Review breastfeeding services Support campaign for Homerton to attain Baby Friendly status

Community Midwifery

Midwifery led clinics are being set up in GP practices and Children’s Centres across the area to provide care closer to home for pregnant women

Maternity

Socially vulnerable women

Long Term Conditions

Contract with GP practices

Tackles:

• ur high premature cardiovascular disease mortality rate
• ur high respiratory disease mortality rate
• helps people feel supported to manage their long term condition

Key outputs and outcomes in 2013/14

Care plans and annual reviews:

Long Term Conditions

Long Term Condition management Additional patients treated Hypertension and blood pressure controlled to ≤150/90 1621 Coronary Heart Disease and cholesterol controlled to ≤5 144 Coronary Heart Disease and blood pressure controlled to ≤150/90 202 Coronary Heart Disease – annual review 57 Diabetes – annual review 583 Diabetes and blood pressure controlled ≤145/85 1104 Diabetes and blood sugar controlled to ≤59 1090 Diabetes and blood sugar controlled to ≤86 590 Diabetes – retinal screening 669 Diabetes cholesterol controlled to <5mmols 370 Diabetes – microalbuminuria checked 584 Chronic Kidney Disease and blood pressure controlled to ≤140/90 293 High risk of heart disease – proxy review 127

Increase in % of people with diabetes in City and Hackney recently screened for retinopathy (now highest in London)

Primary Care Quality

• Support practices to reflect on their own practice and commission services
• Working to promote the appropriate use of computer systems to augment good patient care
• Supporting an extensive programme of education and training to promote development of the primary care

workforce

• With so much good care being delivered in primary care: one of the outcomes of this is that City and Hackney

has one of the lowest outpatient referral rates in the country

Planned Care

Diagnostics Commissioning direct access diagnostic contracts for MRI scans and Dexa scans including increasing access for colonoscopy in line with best practice recommendations for cancer pathways Early detection of cancer Working in partnership with Cancer Research UK to secure a dedicated worker to improve early detection and diagnosis of cancer in primary care. We would hope that by detecting cancer earlier we would improve survival and reduce premature cancer mortality: Total knee replacement

• New pathway, including increased use of decision

aids for patients

• Increase in average health gain reported by patients
• f 20%
• Patient feedback:

Felt very involved in decision-making

• process. Very happy

with the clinic Not keen for surgery currently, this was openly discussed and respected. Felt involved in decision- making

Urgent Care

Our priorities

• Capacity across all services
• Helping patients access the right service
• A high quality out of hours service
• Urgent Care Board to plan services

Improvement in performance of Homerton A&E

• Additional hospital registrar and GP posts within A&E
• 4hr waiting time target met 42 out of 52 weeks

(average 81%)

• Mean performance (on % of patients seen within 4

hours) improving over 2013/14:

17/03/2013 14/04/2013 12/05/2013 09/06/2013 07/07/2013 04/08/2013 01/09/2013 29/09/2013 27/10/2013 24/11/2013 22/12/2013 19/01/2014 16/02/2014 16/03/2014 13/04/2014 90% 93% 95% 98% 100%

National 4 hour target

Initiatives

• A&E capacity planning
• Work with frequent attenders of A&E
• Patient navigators within A&E – helping patients to

register with GPs and use healthcare most appropriately

• Building up capacity of Out Of Hours services
• Rapid Response & Paradoc
• Primary Care Capacity

Urgent Care

Out of hours GP service

• New local provider commenced service since Dec 2013
• More telephone advice by GP
• More visits to the Centre
• Increased quality of telephone advice
• Less visits to A&E or ambulance service
• Service to include nursing capacity from August

Increasing Primary Care Capacity

• Extended Hours – Evening and weekend appointments across four

bases in City and Hackney

• Enhanced Duty Doctor

− Free GPs to work with Paradoc and enhanced rapid response

services

− Free named GPs to attend to urgent care needs of High Risk

Patients Joint Paramedic and GP Clinical Response service – A&E and Admission Avoidance

• Urgent primary care cases
• Referrals from ambulance clinicians both on site and in control room
• First Two Months: 251 Patients
• Reduction in unnecessary taking patients to A&E

Extended Hours Rapid Response

• Multi-disciplinary team

including nursing and therapists

• Extended to midnight everyday

and across whole weekend

Integrated Care

Vision

• To focus on improving the experience of

patients and service users

• To improve the health and quality of life for

patients and carers

• To help people avoid emergency admission to

hospital and to stay at home rather than move to residential care

• To ensure care is co-ordinated and easy to find

Approach

• Focus on frail elderly people
• Prepare a care plan for and with each patient
• Ensure each patient’s care is co-ordinated at the GP

practice with all the professional staff (the integrated care team)

• Help patients find the right care for their needs
• Expand services available to people at home
• Partner with voluntary and community services

Patient and Public Involvement

• Established a well-attended and representative Patient and Public Involvement Committee, ensuring that the

patient voice is at the centre of our commissioning activities

• Launched an Innovation Fund in response to the issues raised by the public at our consultation event in

November 2013 – bid for small projects suggested and run by Community and Voluntary organisations

• Jointly commissioned the Fund for Health with Healthwatch Hackney to understand the barriers to accessing

healthcare and to understand what patients mean by patient centred services.

Finance highlights 2013-14

• Delivered a £27m surplus for the year which will provide a buffer against future funding and cost pressures
• Manoeuvred successfully through the uncertainty of new system changes and commissioning

responsibilities

• Financial risks managed and mitigated with a prudent view taken by the Board in deferring investment

whilst funding uncertainties were resolved

• Robust governance process embedded within the organisation with key commissioning risks managed

through Programme Boards

• Unqualified audit opinion issued on the accounts – clean bill of health from external auditors and a good

platform into 2014-15

• 2014-15 Plans approved by the Board including £21m non-recurrent investment and £5.4m saving plans for

the Health Economy

What the CCG spent in 2013-14

Questions & Answers

Jaime Bishop – CCG Board Member (Patient and Public Involvement and Conflict of Interest lead) to lead questions to:

• Dr Clare Highton – CCG Chair
• Paul Haigh – Chief Officer
• Philippa Lowe – Chief Financial Officer