North Kirklees Clinical Commissioning Group Annual General Meeting - - PowerPoint PPT Presentation

North Kirklees Clinical Commissioning Group Annual General Meeting

Thursday 11th September 2014

Who are we?

• Established by the Health and Social Care Act (2012)
• Statutory body since 1 April 2013
• Clinically-led ‘membership’ organisation
• All 30 local GP practices are members

For longer, healthier, happier lives

What We Do

• Plan and buy healthcare services
• Serve a population of 190,000
• Have a budget in the region of £221 million
• Work closely with Kirklees Council and neighbouring CCGs

For longer, healthier, happier lives

Services We Purchase

These include:

• Emergency and urgent health care
• Community health services
• Maternity services
• Hospital care eg inpatient and outpatient services
• Rehabilitation
• Mental health and learning disabilities
• Medicines management

For longer, healthier, happier lives

Our Vision And Values

Enabling the population of North Kirklees to live longer, healthier and happier lives.

Patient First Strive for excellence Value each other Lead from every seat Engage, involve and include

For longer, healthier, happier lives

Key Challenges

• Growing population
• Increasing number of elderly people with multiple and long-

term conditions

• Areas of considerable deprivation
• Health inequalities
• Financial constraints

For longer, healthier, happier lives

Health Issues

• Infant mortality
• Asthma
• Obesity
• Smoking
• Alcohol consumption
• Cardio-vascular disease
• Depression and anxiety

For longer, healthier, happier lives

Our Priorities

• Care Closer to Home
• Transforming primary care
• Improving hospital services
• Urgent and emergency care
• Children and young people
• Maternity
• Mental health
• Prescribed medicines

For longer, healthier, happier lives

Highlights April 2013 – April 2014

Achieved a number of our national targets in relation to:

• Reduction in health care associated infections and treatment of

patients suffering from stroke, diabetes, cancer and mental health conditions. We know we have further work to do in relation to:

• MRSA,
• 18 week referral to treatment
• A&E 4 hour wait
• 62 day cancer treatment

For longer, healthier, happier lives

Highlights April 2013 – April 2014 CONT…..

• Meeting the challenge consultation and implementation of first element of

plan to improve hospital services.

• Increased range of services available in local GP practices including heart

and blood tests.

• Extended access to end of life/palliative care support through a 24 hour

helpline and

• seven day access to specialist palliative care beds.
• Admissions avoidance team working at A&E to provide on-going care to

patients where necessary and reduce the need for hospital stays.

• Clarity programme is helping patients to reduce or quit use of sleeping

tablets.

For longer, healthier, happier lives

Highlights April 2013 – April 2014 CONT…..

• Developed a robust primary care strategy with a focus on

improving access, reducing variation and improving quality.

• Prescription of antibiotics linked to health care associated

infections has reduced.

• Published 5 year strategic plan which was co-produced with

Greater Huddersfield CCG and Kirklees Council

• CCG moved offices to Dewsbury town centre.

For longer, healthier, happier lives

Highlights April 2013 – April 2014 CONT…..

• Consulted widely with patients and the public about range of

issues including our five year plan and commissioning intentions, care closer to home, NHS call to action, wheelchair services, urgent care services.

• Established patient reference group network.

For longer, healthier, happier lives

Challenges This Year…

• Scale and speed of change
• Public support and engagement
• Resource constraints
• Geographical and organisational boundaries – working across a wide

and complex ‘footprint’

• Working with our members

For longer, healthier, happier lives

Looking Forward…

• Improving hospital services and ensuring we retain a vibrant

hospital in Dewsbury (implementation and investment)

• Developing community-based services and achieving greater

integration across health and social care

• Meeting our financial obligations
• Building on strong foundations

For longer, healthier, happier lives

THANK YOU

For longer, healthier, happier lives

Annual Accounts – Overview 2013/2014

• Programme allocation of £221 million which we use to

commission health care services

• Running costs allocation of £4.6 million which we use to employ

staff and purchase support services we need to commission these services.

For longer, healthier, happier lives

Financial Performance

• Achieved surplus agreed with NHS England - £3.8m
• Managed within running costs allocation - £11k under spend
• Paid 96% of non-NHS invoices within target
• Achieved efficiency programme of £5.6m
• Approved £2m investments in additional out of hospital services

For longer, healthier, happier lives

Where the Money Goes

For longer, healthier, happier lives

9% 56% 16% 8% 7% 4% Mental Health Care Acute Care Primary Care Continuing Care Community Health Services Other

For longer, healthier, happier lives

Kirklees 5 Year Strategic Plan - Rachel Albutt

For longer, healthier, happier lives

4th April 2014: 1st Draft of strategic plan, Final draft of Better Care Fund Plan a Final draft of Financial Plan Final draft of 2 year operational plan 20th June 2014: Final Version

Key Dates

The strategy has been signed off by:

• Kirklees Health and Wellbeing Board
• North Kirklees CCG Governing Body
• Greater Huddersfield Governing Body

Mandatory Requirements…

For longer, healthier, happier lives

Unit of Planning…

The 5 Year Strategic Plan co produced on a Health & Wellbeing Board Footprint. Greater Huddersfield CCG, North Kirklees CCG and Kirklees Council have worked together to produce 1 plan The plan links to the Joint Strategic Needs Assessment and refreshed Joint Health and Well-being Strategy We are also working on a West Yorkshire footprint for key work areas.

For longer, healthier, happier lives

Planning Footprint…

CCTs H ? LCD Primary care

HUB

Hospice/EOL Social care Voluntary/ Third Sector HAT/ESD Specialist e.g. Consultant, nurse Therapy Rapid Response Community Bed Base

Frailty Model Paediatric Assessment Liaison Psychiatry Emergency Care Ambulatory Care PGH admission

Key  In scope for procurement  Out of scope for procurement, but key dependency

• The vision for transforming primary care focuses on strengthening primary care

services and up skilling the primary care workforce to ensure that patients receive better quality outcomes and are able to access more proactive and preventative care.

• NKCCG Primary Care Strategy outlines what interventions will be undertaken to

achieve this

• We are in discussion with NHS England regarding co-commissioning of primary

care services in the future

For longer, healthier, happier lives

Transformation of Primary Care…

• Improving access to a broader range of primary care services, including enhancing the

range of diagnostics in primary care

• Reducing dependency on hospital services and shifting the balance of care from

unplanned to planned. This will be particularly valuable for vulnerable patients with long term conditions and complex needs.

• Responding to the urgent care agenda with aspirations for 24/7 primary care provision

through extended hours and demand and capacity analysis

• Reducing variation in services and improving quality
• Enhancing the services offered to patients by optimising the use of NHS resources,

including the use of technology and referral management systems

• The central role of general practice and community based teams in the management
• f patients with long term conditions and those with complex needs
• Practices working collaboratively to deliver services at scale
• Supporting patients and carers to manage their own health and care
• A sustainable workforce to secure future provision
• Working at scale – federation of 30 practices

For longer, healthier, happier lives

The Principles For Transforming Primary Care Are…

• Implementation of the ‘Meeting the Challenge’ Mid Yorkshire

Clinical Services Strategy Full Business Case (FBC).

• This programme of work aligns closely with the integrated

service model which will support the reconfiguration.

For longer, healthier, happier lives

Reconfiguration/Transformation of Acute Services ‘Mid-Yorkshire Clinical Services Strategy’

The changes outlined in the Clinical Services Strategy include;

• The re-profiling of A&E services provided from the three hospital sites;
• An integrated approach between acute, primary care and community services;
• Delivering services 7 days per week
• Centralising some services to improve quality and safety
• Greater reliance on delivery of urgent services outside of hospital and providing

elective services, outpatient, day case and inpatient surgery, at the closest hospital to where a patient lives.

• Implementation of ambulatory care
• Children's Assessment Unit
• Midwifery Led Unit at Dewsbury District Hospital

For longer, healthier, happier lives

Reconfiguration/Transformation of Acute Services ‘Mid-Yorkshire Clinical Services Strategy’

• The programme will drive change through more effective integration of services

between community, social and primary care.

• This is a shared vision across Kirklees and through our integrated ways of working we

have agreed one approach to integrated care across Kirklees. It is recognised that there may be elements of the model which are specific to each CCGs population, however the overarching principles will be consistent across Kirklees. There will also be a number of generic functions.

• We are working to develop the governance to support this
• Principle which is fundamental to all our transformation programmes (children and

young people, planned care, maternity)

For longer, healthier, happier lives

Development of Integrated Services in the Community ‘Care Closer to Home’

• Information, advice and tools to encourage individuals self-care and self-management of long

term conditions;

• Improved primary and community care, available 7 days per week, providing the right care in the

right place, at the right time, first time;

• Integrated high-quality services operating 7 days per week to meet the needs of the individual;
• A reduction in reactive, unscheduled care - doing more planned care earlier;
• Care is co-ordinated across providers as one coherent package, with a focus on individuals;

helping them to get better and get on with their lives;

• We will build on what works well, redesign were we need to and by our single approach to

commissioning ensure services deliver integrated and seamless health and social care to our patients and clients; and

• Elements of this are already in place e.g. HAT, ESD, admissions avoidance

For longer, healthier, happier lives

Key characteristics of this new model of care are:

• Maintain a relentless focus on embedding and improving quality
• Patient/public participation
• Working with our partners to develop the market
• Integrated commissioning
• Ensuring we are sustainable commissioning organisations

For longer, healthier, happier lives

Other Key Elements to the Strategy…

For longer, healthier, happier lives

Integrated Commissioning Structure…

Pooled budget (existing funding streams) 2014/15 - £ 8 million across Kirklees 2015/16 - £ 28 million across Kirklees Links closely to our plans for acute services reconfiguration and care closer to home

• Plans for better care fund plus
• Requirement to reduce non-elective admissions by 3.5% across Kirklees
• Triangulation of the better care fund metrics across the system

For longer, healthier, happier lives

Better Care Fund…

Royal Voluntary Service delivering a partnership with commissioners that results in real and sustained change for older people in Kirklees

What do we do exactly… 3,000,000 interactions with older people

– a chat, a laugh or moral support

2,000,000 healthy, delicious meals on wheels 134,000 books read, imaginations fed 90,000 journeys with people to the shops,

appointments or to visit friends

500 cafes, shops, trolley services in hospitals 450 community centres and lunch clubs 67 community hubs across the country 1,000 years of volunteer time shared last year

What is happening out there?

Less Money – state funding is forecast to contract further Less Resources Pressure on hospital beds and admissions is increasing People are discharged sooner Increased use of residential/nursing home that is expensive and unsustainable Ageing population….we are living longer!

Why us? Why now?

• Our army of volunteers don’t need to measure our support to older

people in minutes – 40,000+ nationally. Over 130 locally in Kirklees

• We have over 75 years of experience in delivery and are a trusted

brand

• The state can’t provide anymore at the same rate, we want to help
• Our volunteer numbers are increasing daily
• We are getting ready for growth – local structures are our platform

for development. National perspective, local delivery “Consistency is better than rare moments of greatness”

Our Values….

Staying Connected/Reducing Isolation Promoting independence/ Choice & Control Enjoy & Achieve Making a positive contribution Being healthy & safe

• Positive
• Practical
• Professional
• Personal

Royal Voluntary Service in Kirklees

Our local community services being funded by LA/CCG

• Kirklees Good Neighbours
• Kirklees Home from Hospital

Which help us to also deliver:

• Lunch and social clubs
• Meals with Care reintroduced

Kirklees Good Neighbours

• Over 130 local volunteers trained and inducted already,

continuous growth in volunteer numbers

• Over 70 older people receive weekly befriending visits right now

– practical support from companionship to transport and shopping.

• Over 45 people receive telephone befriending weekly
• Ad/hoc transport, shopping etc. for those that want support

when they want it!

• Activity sessions – MMO, cook 2 eats etc.
• Working with local partners – KNH, extra care schemes,

Huddersfield university, Kirklees college, Al-Hikmah, Locala etc.

• Outcomes are around reducing isolation, promoting

independence, improving and avoiding deterioration of wellbeing and a service user led service.

Kirklees Home from Hospital

• This is a shorter term intervention (up to 12 weeks) –

ideal for older people that have been discharged from hospital and may not need a care package but require extra support to aid recovery and prevent re-admittance

• The focus of this service is more around assisting with

follow up appointments, safe & well checks, transport, food shopping, collecting prescriptions, building confidence etc. and preventing a re-admittance

• Over 20 HfH volunteers and another 15 that are willing to

work across services

• Outcomes are hospital avoidance, reduced need for health
• r social services, reducing isolation and staying

connected and people feel healthier as a result of our intervention.

The triumph of our services….

Mary Socha is one of the service users that has benefitted from our Good Neighbours befriending service. She was finding difficult to go out by her self and her confidence was very low when we first met Mary. Volunteer Sofia Malik now visits Mary weekly to provide company and transport. The perfect pair went to Dewsbury town centre recently for a coffee, had a stroll round the market place and a general fun day out – this was a massive achievement for Mary, who states, “The KGN service has made such a difference to my life and I now have somebody who cares and has time to spend with me…it has made such a difference to my life.”

The triumph of our services….

We received a home from hospital referral for a lady who had no next of kin, lived in sheltered accommodation, had multiple long term health conditions and was very isolated as she had no family and friends. We matched her with a wonderful volunteer named Ann who supported and visited Mrs X for some weeks, at one visit Ann noticed Mrs X was not responding normally and her RVS training meant that Ann quickly spotted that this may be a stroke and she promptly followed procedure – this not

• nly prevented a crisis, saved the NHS lots of money but also displayed the

high calibre of our volunteers and service delivery. Mrs X upon discharge from HfH was then referred to our befriending service from which she benefitted greatly, she sadly passed away but it was one of

• ur volunteers that held her hand when she died and made sure that no
• lder person is left alone when they need it the most!

The triumph of our services, what our beneficiaries say….

“…when I came out from hospital, I really didn’t think I would cope but that little extra support from Qadeer the RVS volunteer made such a wonderful difference. The diversity it bought to my life and the fact that the volunteer made me feel valued gave me the confidence I needed to feel better.” Mr Nolan, Dewsbury “….I live in Scotland and although my mum lives in a care home and has the early onset of dementia I always worried about her not receiving a regular visit from someone that wants to be there just for her….I no longer have to worry. Your volunteer is making such a difference and although my mum doesn’t always remember her name, when she sees her, her face lights up and I know she is happy to see her.” Daughter of Mrs X, Liversedge “…It is really nice that a volunteer phones me every week to ask how I am, in a world where people have so little time the fact that someone cares enough to phone and ask gives me hope and something to look forward to.” Service user benefitting from telephone befriending. “….the RVS volunteer comes every fortnight and we have done ukuleles, arts & crafts etc. She always asks us what we would like to do and so we have something to look forward to instead of being stuck in the flat!” Service user at KNH activity session

Outcomes being achieved?

• Customer Support Volunteer visit for all service users at point of

entry and a review visit at exit or after 6 months (whichever is earlier). This helps to monitor progress, ensure compliance and take remedial action if needed.

• Service support plan at entry helps us to identify needs and

deliver a personalised service

• Monthly calls to all service users from admin volunteers to

ensure service delivery is effective – using volunteers helps to keep an element of transparency and ensures that services are fit for purpose

• Local steering committee to act a sounding board, help us

develop and challenge when needed.

• Developing story boards to showcase service achievements

Questions

What is clinical commissioning ? And what does it mean for local people ?

Dr David Kelly - GP Clinical Chair

Clinical Commissioning Groups - What Are They ?

• Set up following Health and social care act 2012
• Organize and plan the delivery of NHS services locally
• Manage 2/3rds of NHS funding
• Replaced PCTs April 2013 - 211 nationally
• Clinically led groups formed from Membership organization of local GP groups
• Give clinicians power to influence commissioning decisions for their patients locally
• Overseen by NHS England and have a range of statutory responsibilities
• Constitution, governing body and governance/committee structure
• Co terminus with local authority
• Teams that feel and act differently

For longer, healthier, happier lives

What do CCGs do and not do ?

• Commission or buy healthcare services eg hospital services,

urgent care, community services, children's services, mental health and maternity services

• Plan and design local services based on needs of population
• Monitor performance, quality and safety of local providers
• Work in partnership/collaboration with others e.g. neighboring

CCGs, local authorities, Public health and NHS England

• Don't commission - primary care, dental services, ophthalmic

services, public health services

For longer, healthier, happier lives

Who are the CCG ?

• 29 local practices - members
• Board - 6 local GPs, 1 practice nurse, 1 practice manager, 1

consultant, 1 registered nurse.

• Senior managers - many with clinical background - CO and CFO
• Lay members x3 - audit, finance, governance, patient

involvement

• Public health and local authority representatives

For longer, healthier, happier lives

What does it mean for local people ?

• Strong engagement with patients
• Partnership with local communities and local authorities
• Local knowledge of healthcare services
• Clinically led priorities and champions
• Holistic view of healthcare
• Focus on quality of services for patients
• Focus on outcomes and evidence based care
• Innovation and improvement
• Local focus and commitment

For longer, healthier, happier lives

• What does care closer to home mean?
• What is already happening in North Kirklees
• The future?

For longer, healthier, happier lives

Care Closer to Home – Dr Jabbar

The Greenway Medical Practice 7800 patients New way of accessing GP's: Dr First Demand increasing: 75% increase from 1995 to 2008, 171 million to 300 million nationally More than 15,000 patients in North Kirklees waited 7 days or longer to see their GP over the last year.

For longer, healthier, happier lives

Dr First - Dr Cameron

• April 2013, introduced Dr First
• All requests to see a GP, spoken to first by a GP
• Assessed, advised, treated, referred, or given an

appointment.

For longer, healthier, happier lives

What Did We Do?

• Quick
• Day and time of choice
• Better planning
• Better continuity
• Efficient
• Patients happier
• ?decreased A&E

For longer, healthier, happier lives

Positives…

• Doesn't suit everyone: patients and doctors
• Increased demand
• Annual leave
• No break
• Phones

For longer, healthier, happier lives

Negatives…

Telephone consultations, 6243 Telephone consultations, 7761 Face to Face appointments, 4894 Face to Face appointments, 4439 1000 2000 3000 4000 5000 6000 7000 8000 9000 May - July 2013 May - July 2014

Telephone Consultations -v- Face to Face Appointments

Telephone consultations Face to Face appointments

(Y1308) Appointment For Nurse 2% (Y2620) Other outcome 3% (X904q) Prescription 20% (9NF2.) Home visit planned by doctor 2% (XaBIc) Sickness certificates 3% (X71Ez) Advice 34% (Y1307) Appointment For Doctor 36% (Xa1qK) Admission to hospital 0%

For us:

• Phones
• encourage self-care

For colleagues:

• Come and have a look
• Consider alternatives to face-to-face consultation

For patients:

• Consider alternatives before contacting the practice
• Do I need to talk to a GP?
• Do I need to physically see a GP?

For longer, healthier, happier lives

Next Steps…

• A patient with a long term health condition such as Diabetes,

Heart Disease or a breathing problem might see a Health Care professional for a couple of hours a year.

• For 364 days and 22 hours the patient is in charge of their

health and condition

• It is VITAL that the patient knows how to manage it to prevent

deterioration, deal effectively with problems or emergencies and to work towards improvements

Self Care – Kathryn Greaves

• 15.4 M people in England have at least one LTC
• Uses 70% of the NHS budget
• Numbers rising dramatically due to ageing population and

unhealthy lifestyles

• UNSUSTAINABLE and OVERWHELMING
• The healthcare equivalent to climate change

The Costs…

• Our aim is to never be PRESCRIPTIVE - we don't tell our patients

what to do

• CARE PLANNING - discuss, involve, motivate, plan, set

achievable goals for improvement, self management tools

• Aim to give every patient an AGREED WRITTEN CARE PLAN

For longer, healthier, happier lives

The North Kirklees Approach

• National studies - potential for Care Planning approach - 30

fewer emergency admissions /1000 patients, £290,000 efficiency savings, visits to GP could decrease by up to 40%

• Local - we are working together with Public Health to collect

and formalise local evidence.

• Many of the self care courses and tools are developed by PH

and the LA, a good example of joint working

For longer, healthier, happier lives

Results and Evidence

Mr S - diagnosed with Type II Diabetes Raised blood sugar, raised cholesterol, overweight, smoker Motivational interviewing, target setting, Care Planning Over time, Mr S chose to access a DESMOND course, PALS, take up cycling, smoking cessation course Outcome - blood sugar under perfect control, cholesterol level is good, has lost weight and no longer smokes, feels in control of his health, feels well All this now maintained on one tablet a day costing 2p and requires very little input. Has not needed to see a GP. Very cost effective approach.

For longer, healthier, happier lives

Case Study

Work together with providers to roll out this approach in

• ther organisations, putting the patients in the driving seat

Fits perfectly with our mantra 'Helping the people of North Kirklees to live longer, healthier and happier lives'

For longer, healthier, happier lives

Next Steps

Care Closer to Home

Aim: to provide the right care in the right place, at the right time, first time. By offering integrated high‐quality services at times required to meet the needs of the community we wish to reduce reactive, unscheduled care and do more planned care earlier.

Improved Quality Timely Care Better Co-

• rdination

Improved Access Integrated across Health and Social Care Outcomes Focused Longer Term Planning Care at Home Reduce Hospital Admissions Better Access to Records Continuity of Care Early Supported Discharge

The Case for Change

What will the future look like?

Meet Mrs Doris Clark This is Doris’ story….

www.thisisourstreet.com

The Future Model of Care

Primary, community and social care services will be brought together and provided under

• ne Integrated Care model using staff and resources flexibly. This could be provided at a

variety of levels such as:

• Practice Cluster Care Teams: promoting the independence and wellbeing of

individuals, provided around locally defined populations involving for example nursing, case management, care co-ordination and additional clinical support for care homes.

• Wider Integrated Team: wrapped around the practice cluster teams, with access to a

range of specialist clinical skills, therapy and rehabilitation and community bed provision.

• “Hub” provision: provision of a single point of contact, clinical triage, referral and sign

posting to other services. This will significantly contribute to supporting “crisis intervention” and early supported discharge

Progress to date….

Needs Analysis Strategic Case for Change Service Model Developed Estates Clarified Patient/ Stakeholder Engagement Working Together Initial Scope Developed High level Finance/ Budget Info Member Practice Support

Ongoing Engagement Care Closer to Home: Integrated Service Model

Ongoing engagement to build from the “Meeting the Challenge” consultation process

• Events held with the public, voluntary sector and GP membership e.g. stakeholder

event with over 50 people in January 2014

• NKCCG GP Forum
• Engagement with Area Committees
• Urgent and Integrated Care Symposium
• Further stakeholder event on 8th May 2014
• On going engagement with the local Patient Reference Group
• Market Sounding event held in August 2014

Feedback received at these events has shaped our model and proposals.

What do people say/want?

Themes emerging from users and carers

I want good information and sign-posting to help me plan my care I want my care/ support to be responsive, in my community when I want it How I can do more about my lifestyle and my own care My carers voice is heard and supported appropriately My GP knows what services are out there to help me I want to feel safe and trust my provider I want my care to be seamless across social care and health I want to use technology to help manage my care & access helpful information

• Agree future commissioning options and take

through our internal governance process

• To implement the joint governance structure across

Kirklees working with Greater Huddersfield CCG and Kirklees Council

• Work with the Health and Wellbeing Board
• New service model in place for October 2015

Next Steps

Thinking about what you have heard….

• What are your thoughts about our approach

to care closer to home and the integrated service model?

• Are there any further suggestions about our

approach to improve it?

• Have we missed anything?

Discussion….