Our 2015/16 Commissioning Plan for Governing Body 27 May 2015 - - PowerPoint PPT Presentation

Our 2015/16 Commissioning Plan

for Governing Body 27 May 2015

Simon Hall Deputy Chief Officer/Director of Strategy and Performance

Our Commissioning Plan has Three Key Elements:

• Activity
• Finance
• Performance and Quality

Activity Baseline

• The CCG’s activity plan has been through

extensive scrutiny from NHS England.

• The focus this year has been to commission

enough activity to respond to a higher than expected out-turn position, to ensure our performance is secured against key targets and Constitution standards.

• Our activity plans align much more closely to
• ur contracted activity. This will enable better

performance monitoring this year.

Activity : Example of 3 year trend analysis

• Within the local Health Economy, NHS Greenwich has experienced a significant change in our acute provider following the

recommendations of the Trust Special Administrator. SLHT was dissolved on 1 October 2013 and the 3 individual hospitals were merged with other trusts. For Queen Elizabeth Hospital in Woolwich the merger was with University Hospital Lewisham and created the new Lewisham & Greenwich NHS Trust.

• Based upon our submission made on the 18 March 2015, our findings from this shows that there are a number of factors that impact

upon our historical trends.

• There is insufficient baseline activity over a sustained period to provide a robust baseline. However, this explains our position compared

to the methodology provided by NHS England on their growth assumptions.

• We have therefore used the first ten months of 2014/15 as our baseline, adjusted for BCF, QIPP, provider data changes, Clinical

Decision Unit and Referral To Treatment resilience. We have applied demographic and non-demographic growth to form the 2015/16 projection.

Activity Plan 2015/16

14/15 outturn run rate

• M10 by POD
• No adjustment for seasonality

Population growth assessment

• Based on ONS (1.7%)

Non-demographic uplift

• Based on local knowledge (1%)

Specific Issues

• RTT
• CDU

Acute QIPP (£2mil)

• Eltham Community Hospital
• Alliances

BCF (acute impact £2.3mil) 15/16 predicted activity

How we have contracted with our providers to secure activity

Lewisham & Greenwich Trust

• Cap and collar contract agreed
• Cap with no reduction of activity for

efficiency improvement

• Collar adjusted for reduction in activity by

834 NEL episodes of care i.e. £2.3m (revised down from original plan) Oxleas MH and Community blocked – agreement to find £880k QIPP in year to achieve lower run rate next year Guy’s & St Thomas’s/King’s – proposed block – more work to do on the final details but contract due to be signed by end of May. Dartford and Gravesham NHS Trust – we have agreed a full PBR activity contract.

• Could reduce admissions by more than

834 (estimated opportunity is 2,500) and also reduce LOS more but still pay block – our benefit would reduce our out-turn and therefore the cost of 2016-17 contract and bring us back into balance.

• MH strategy needed in-year to inform

next year to achieve standards and model future needs to include more integration between physical and mental health

• Community – separate out work into

Alliance, children etc. rebase 2016-17

• Baselines have been set on outturn plus

population adjustments. If we can divert work to community care there will be a financial QIPP saving

Financial overview of our Plan

• Planning 1% Surplus
• The Plan has followed NHS business

rules including meeting population growth, (0.7%), Non Demographic growth (1%), Continuing Care(2%), Prescribing (5%) and London Health Care(0.15%) and committed (1%) towards Our Healthier SEL.

• In addition, we have committed £12m

(3.4%) investment in the Better Care Fund (BCF) and have signed a Section 75 agreement with the Royal Borough of

• Greenwich. This is in addition to the £6m

allocation which we funded directly in 2014/15 and is over and above our 2015/16 commitment. Our BCF contains 14 transformation projects and is expected to realise a £2.3m QIPP in 2015/16.

• We are building our Local Care

Networks, building on our new GP Provider Networks that were set up in

• 2015. A key focus in the plan is investing

in transformation e.g. alliance, better primary care and maintaining financial balance but also quality, productivity and service improvement. Our Plan has dedicated chapters on our trajectories on key targets and how we going to improve services and the health of our local population.

QIPP (Quality, Improvement, Productivity & Prevention)

• Total figure by which we need to

have reduced spend by in 2015/16: £7.3m

• Anything not achieved in year needs

to be covered with non recurrent resources (using money loaned to

• thers in previous years, reducing

surplus etc.) – and these will not exist in the future.

• Additional £4m needed 2016/17 and

anything not saved this year rolls into next year i.e. worst case £4m + £7.3m = £11.3m

• Reduce avoidable admissions and

reduce LOS at LGT which reduces contract cost by £2.3m (this is in line with BCF programme of reducing unplanned admissions by 834).

• Medicine Management £1m (in

which we have confidence).

• Gap of £4.3m could be covered by
• ther savings in year (e.g. reduce

continuing care spend, reduce planned investments, service redesign as outlined in the Plan).

• If we reduce admissions and LOS

beyond our target level then this helps us invest in 2016/17.

How will we deliver?

2015/16 delivery:

Eltham Community Hospital beds used to admit more people directly and reduce hospital admissions BCF investment in enhanced care home support, nutritional support, CMC etc. 4 hour wait project plans:

• Rapid Assessment & Treatment in ED reduces

conversion rate by 3%

• LGT have plans to reduce simple LOS from 5 to

3 days which reduces tariff

• Improved discharge arrangements & reduced

LOS (marginal saving) and reduce admission rate when hospital is less full Other pathway improvements from the Alliance Developing a programme approach across all our commissioning areas in the Plan led by a new Transformation and QIPP Executive and a new Joint Commissioning Executive with the Council.

2016/17 delivery based on work in 2015/16:

GP Provider Network LTC contract & Year of Care implementation reduces hospital admissions Pioneer (Stage 3) roll out across Greenwich reduces admissions Frailty and alliance models reduce admission New urgent care pathway embedded Children’s urgent care pathway embedded Better Care Fund (BCF):

• Impact of Connect Care; reducing social

isolation, support to carers, making every contact count Building on our strategic programmes in the Plan, to refresh them and deliver QIPP via a new plan in 2016/17.

Our Must-Do’s for 2015/16

• Delivery against our contract agreements
• Eltham Community Hospital opens, running and busy
• Achievement of constitution targets
• A&E (Qtr 3)
• Cancer (Qtr 3)
• IAPT recovery (Qtr 1)
• Balanced budget that delivers at least £7.3m QIPP
• New urgent care pathway
• Implementation of new enhanced long term conditions contract
• Access improved to general practice
• Alliances up and running
• Co-commissioning /Joint commissioning of Primary Care
• Improved engagement of public and members
• Implementation of Connect Care
• Informed decision making based upon intelligence
• Response to in-year demands

• Copies of our Plan

are available on the CCG Website.