City and Hackney Clinical Commissioning Group Annual General Meeting Wednesday 16 th 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 Primary care • Lowest waiting times in east London for treatment • Our services have improved for people with mental health and emotional problems • Carers and parents reporting increased levels of support • Up-skilling primary care: improved training and services • Very high recovery rates: • 500 patients seen by Enhanced Primary Care service • Feedback from patients: I spend more time talking to the primary care my nurse and GP service is better than before than before CORC – Children's outcomes research consortium I no longer need to be seen by the Homerton Community Mental Health Team and • now I can go to my GP practice to see £1m investment in Homerton Psychological Medicine to support patients with mental health problems in the Homerton and my mental health nurse or the GP presenting at A&E without the other patients knowing my reason for being there • Keep people out of hospital – fewer admissions • Reduce unnecessary time spent in hospital
Mental Health People with dementia People with short-term problems • All memory clinic feedback sessions have an Alzheimer • Over 5,000 people with depression and anxiety supported (15% of Society Dementia Advisor to support people in their local all people with depression/anxiety) – highest number and % in communities London: • 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 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 Reducing waste Joint (between CCG and Homerton Hospital), first of Approximately £1M worth of medicines issued in C&H is its type, electronic formulary to facilitate safe and wasted annually cost effective prescribing. Being repeated in East Patient campaign raising awareness of the costs of London Mental Health Foundation Trust in 2014/15 medicines waste * CCGs without a centralised dressings service Quality of Prescribing City & Hackney is in the Top 10 London CCGs for 10 out of 11 prescribing quality indicators: Indicator Specials Cost/Item Silver dressing s sulphonylureas Blood Glucose Non analogue (Cost/1000pts) Cost per 1000 Rosuvastatin Metformin & (Total Cost) ASTRO-PU Ezetimibe Specials Specials Omega 3 insulins strips C&H Ranking – of 32 London CCGs 2 1 8 10 9 10 5 29 3* 8 8
Children’s Vulnerable Children’s Contract with GPs • Focus on asthma, epilepsy and diabetes Expansion of out-of-hours • Mental Health Children’s Community • Improving care for vulnerable children and families Nursing team 16 th birthday health check • Highly skilled nursing care for children in the Children and Families Act 2014 community • Now available at the Working with our partners to weekends implement these changes from September 2014 • Treated 103 children who would otherwise Thresholds are not changing – but have attended hospital personalised Education Health and Social Care Plan. We will work closely with young people and families.
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: Community Midwifery MSLC 14-15 Work Plan priorities Actions Midwifery led clinics are being set up in GP practices and A. Parents voice and experience Walking the patch – postnatal Children’s Centres across the area to provide care closer to Observing maternity/labour reception area home for pregnant women 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
Maternity Socially vulnerable women
Long Term Conditions Contract with GP practices Tackles: • our high premature cardiovascular disease mortality rate • our 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 Additional Long Term Condition management patients treated Increase in % of people with diabetes in City and Hackney recently Hypertension and blood pressure controlled to screened for retinopathy (now highest in London) 1621 ≤150/90 Coronary Heart Disease and cholesterol controlled 144 to ≤5 Coronary Heart Disease and blood pressure 202 controlled to ≤150/90 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 293 controlled to ≤140/90 High risk of heart disease – proxy review 127
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 Early detection of cancer Total knee replacement Working in partnership with Cancer Research UK to • New pathway, including increased use of decision secure a dedicated worker to improve early detection aids for patients and diagnosis of cancer in primary care. We would hope • Increase in average health gain reported by patients that by detecting cancer earlier we would improve of 20% survival and reduce premature cancer mortality: Not keen for surgery • Patient feedback: currently, this was openly Felt very involved in discussed and respected. decision-making Felt involved in decision- process. Very happy making with the clinic 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
Urgent Care Improvement in performance of Homerton A&E Our priorities • Capacity across all services - Additional hospital registrar and GP posts within A&E • Helping patients access the right service - 4hr waiting time target met 42 out of 52 weeks • A high quality out of hours service (average 81%) - Mean performance (on % of patients seen within 4 • Urgent Care Board to plan services hours) improving over 2013/14: Initiatives 90% 93% 95% 98% 100% 17/03/2013 14/04/2013 • A&E capacity planning 12/05/2013 • Work with frequent attenders of A&E 09/06/2013 • Patient navigators within A&E – helping patients to 07/07/2013 04/08/2013 register with GPs and use healthcare most 01/09/2013 appropriately 29/09/2013 • Building up capacity of Out Of Hours services 27/10/2013 24/11/2013 • Rapid Response & Paradoc 22/12/2013 • Primary Care Capacity 19/01/2014 16/02/2014 16/03/2014 13/04/2014 National 4 hour target
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