Moving Forward Together Update to the Kingston HWB September 2019 - - PowerPoint PPT Presentation

Moving Forward Together Update to the Kingston HWB

September 2019

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

We have been working together as six CCGs for over a year and are committed to ensuring that we have successful place based local systems supported by “at scale” where necessary. As we move forward a number of things will impact on how we currently operate:

Introduction – there are a number of new developments which mean we need to review the way we work

• development of primary care networks
• strengthening of local health and care partnerships and the development of the six local health and

care plans

• development of system rather than commissioning/ provider split and focus on the person rather than
• rganisations
• the expectation in the NHS Long Term Plan that we will make a 20% reduction in management costs

and move to consider one CCG across SW London This gives us the opportunity to build on what we have already delivered. It is vitally important that we move forward together, with our GPs, our partners at borough level and across SW London in a planned way

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

We have created the “moving forward together” programme that:

• Is led by GP Clinical Chairs in partnership with the SWL Senior Management Team.
• Is supported by a programme structure with 5 clear work streams. Each work stream

has a clinical and managerial lead.

• Ensures place-based development is being led locally
• Builds on the engagement we have already undertaken on local health and care

plans, to effectively engage our partners as we move forward

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

DRAFT Case for Change

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

We believe there is a strong case for change:

• 1. Evolution not revolution
• 2. Investment in ‘Primary Care Networks’ of GP practices – the building blocks to improve services
• 3. Retain and enhance local teams to support practices through these changes and new responsibilities
• 4. NHS Long Term plan – collaboration rather than competition - end of purchaser/provider split – more

resource to invest in frontline services. Reduce red-tape at local level and free-up resource

• 5. At least 80% of care would be planned and delivered locally, with strong clinical leadership
• 6. Take control of our future

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 1. Evolution not revolution
• We have been working together as six CCGs over the past year, and we know that when we work

together, it’s better for the health and care outcomes of local people. We can also influence policy and secure more national funding for our local SW London services. Some of the many examples include:

• Successful bids for national funding as a SW London health and care partnership:
• £1.85million of children and young people’s mental health to create enhanced mental health support

teams

• £1.6 million to help new and expectant mums in south west London to have access to specialist mental

health teams

• £9.9million to able us to share patients’ health and care records between organisations across SW London

so we can give local people the best joined-up care

• Improving functions by consolidating - Where we have brought functions together we have improved

quality of service e.g. communications and engagement has individual CCG teams working in a matrix way across SWL with reduced management overheads but improved quality, resilience and professional accountability

• Improving care to patients – e.g. ECI aligned decision making

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 2. Investment in ‘Primary Care Networks’ of GP

practices: – the building blocks to improve services

• The NHS needs to free-up resource so we can deliver the NHS Long Term Plan with

investment in community and mental health services, and in new developments such as Primary Care Networks (PCNs).

• PCNs will bring together GP practices to provide a wider range of services for local people.

They will also be the footprint around which community-based health and social care professionals will deliver more joined-up care for our communities. We are planning to strengthen our primary care transformation function to support PCN development (please see later slides).

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 3. It is our priority to make sure that GPs receive

the same level of support or better

• We want to maintain and improve primary care and day-to-day support as well as strong

local relationships e.g. a single IT service for primary care to improve connectivity and reliability of IT systems, and the quality of IT services to practices

• It is our expectation that our GPs in each borough will retain their current local primary

care team, potentially with enhanced resource, to support them though these changes and new responsibilities.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 4. Cut red-tape and duplication to invest in frontline

services

• The NHS Long Term Plan is clear that NHS organisations should work more closely

together, rather than in competition: meaning the end of the ‘NHS internal market’ or the purchaser/provider split. NHS organisations will no longer have to administer complex negotiations, contract monitoring and payment regimes at local level: a single SW London CCG could re-direct this resource in bureaucracy back to frontline services for patients.

• A single CCG could better support NHS organisations to collaborate and learn from each
• ther across SW London. By moving to collaboration and away from competition, we can

better drive-up quality and reduce variation in standards, and deliver better health and care outcomes for the people in every one of our boroughs. It will be easier to engage with the ICS as it develops if we have a single, strong commissioning voice.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 4. Cut red-tape and duplication to invest in frontline

services continued…..

• A potential merger of our CCGs would also free-up resource for frontline services by reducing management costs and layers of

bureaucracy at a local level.

• We currently have 6 Governing Bodies, 18 associated statutory committees, 6 sets of annuals accounts and auditors, and 6 assurance

processes from NHS regulators: it takes considerable clinical and managerial time, money and focus to work in this way. For example, by just moving to one CCG Governing Body, we would save at least £1.6 million.

• We believe a merger would be better for our CCG staff – with more career progression and opportunities across a bigger
• rganisation, and with more opportunities for training and development.
• Working across more than one CCG would also be much easier and less time consuming – we could get more done, more quickly,

with no need for multiple governance committees and different assurance paperwork. This would strengthen our ability to retain our expert staff.

• We have committed to minimise wherever we can, any compulsory redundancies, and recognise that any potential changes are

unsettling for our staff and we will work hard to support our people through this period, and involve and engage them on our future together.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 5. At least 80% of care would be planned and

delivered locally, with strong clinical leadership

• Our vision for SW London is that each ‘place’ or borough will bring together health and

care leaders in a local system. We want to enhance clinical leadership, protect our ability to engage with, and consider the needs of local communities, and embed the freedom to transform and improve services with our partners, to deliver local priorities.

• Local health and care leaders from each borough would oversee the assessment of local

people’s health and care needs, the planning and provision of services, and ensure they supported the strong monitoring of quality to drive improvements in care. We want successful ‘place-based’ local systems to be supported by a single SW London CCG.

• It is our expectation that 80% of care would be planned and delivered locally in our

boroughs, and we are working with our local partners to consider options for financial delegation and local accountability.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

• 6. Take control of our future…
• If we were to merge, we would want to make sure we designed our own model for the

way we would work together: a way that works for our GPs, and our partners in each

• borough. We would like to progress quickly, to ensure that we can influence national

thinking and deliver our South West London model.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

In context with our local place

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Neighbourhood: Primary Care network

transformation Partners working together around general practice neighbourhood level to:

• Define and drive collaboration initiatives
• deliver proactive, integrated care for populations
• f 30-50k people
• work with community, mental health and

voluntary sector services

• strengthen primary care
• lead multidisciplinary services and teams around

the person

Complex systems:

Partners working across multiple boroughs to:

• Set priorities for

transformation of hospitals

• Redesign care pathways
• Define and drive

collaboration initiatives

A picture of integrated health and care in South West London

Place: Borough level transformation

Partners in each borough working together to:

• Define and drive collaboration initiatives
• set the “place” strategy
• plan and implement local transformation
• ensure that the right care is deliver in the right

place for local people

• ensure a strong focus on self care, health

promotion and prevention

• Lead engagement with the public
• tackle the social determinants of health and

reduce health inequalities

• integrate health, care and third sector services,

where it is right to do so

• support local systems to be financially and

clinically sustainable and ensure delivery of system control total SWL System: South West London wide transformation

Partners working together across South West London to:

• Define and drive collaboration initiatives
• set the overall SWLHCP strategy, SWL wide

transformation programmes and enabling strategies such as digital

• support transformation and delivery at

borough level

• secure maximum investment into SWL

boroughs e.g. through regional/national bidding

• maximise resources by working at scale

when it is right to do so e.g. Estates strategy

• Ensuring business intelligence, research

and best practice are used to improve care and services

• Collaborate at or beyond SWL where it is

right to do so e.g. specialist services

• Provide assurance to NHS regulators

regarding performance, finances and delivery across all levels in SWL

• Ensure delivery of “place” system control

total

Neighbourhood Place Complex system South West London

This diagram is a starter for 10: We recognise that things may issues/things may move across different parts of each area and will undoubtedly change as our system/s develop.

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

SWL CCG Kingston Health and Well-Being Board Kingston Place Committee

• Kingston Borough Committee
• Local Authority officers - DASS/DPH/DCS
• PCN Clinical Directors/Chambers
• CE Your Healthcare
• CE Kingston Hospital
• CE SWLSTG
• Voluntary Sector Representative
• Chair Kingston Healthwatch

Partner’s Boards and other Governance Arrangements

Kingston Place Arrangements

Kingston and Richmond Partnership Board

• Members from Kingston and Richmond Place Committees as agreed
• Allows for efficiently addressing issues impacting both Kingston and Richmond
• Provides a forum for dissemination of best practice

Kingston Clinical and Professional Leadership Committee Creating space for clinical / professional dialogue and innovation, shaping clinical strategy Including from across the system:

• GP Clinical Leaders
• Medical Directors
• Directors of Nursing
• Pharmacy Leads
• DPH
• GP Clinical Leaders

Programme Specific Boards & Working Groups

• Delivering the

benefits of clinicians and managerial leads working together

• Supported by the

local “place” team

• Includes

Kingston and Richmond wide groups - eg Communications and engagement and Finance and Performance Oversight Group Council of Members Chaired by Elected GP Representative

• Shaping Kingston commissioning
• Supported by the local Primary Care team

Primary Care Commissioning Committee

Primary Care Management Group

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Place Based committee in common

• Borough sub committee can

meet with partners in a committee in common

• Each individual organisational

committee retains statutory responsibility on behalf of their

• rganisation
• Place committee could have

independent chair or local arrangements agreed with partners

• TOR will need to be agreed

across the partnership including how to manage conflicts

• HWBB and SWL CCG will have an
• versight function for strategies

and plans

CCG Local Committee Provider delegated committee or people Local Authority delegated authority Other Partners Patient Voice- either at place or individual committee

We believe in an inclusive and innovative approach to care. www.swlondon.nhs.uk

Potential high level timeline: if we were to proceed

Moving Forward Together

Mar 2019 June 2019 Sept 2019 Oct / Nov April 2020