Welcome Aylesbury Vale CCG Chiltern CCG Governing Bodies meeting in common in public Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Clinical Directors Presentation – 8 June 2017 Unplanned Acute Care Dr Dal Sahota Clinical Commissioning Director, Unplanned and Urgent Care Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Snapshot - Buckinghamshire 5 community 51 GP hospitals practices 547,084 1 acute 1 MIIU BOB STP Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Adding value by working at scale Clinical Chair Chiltern CCG : Dr Raj Bajwa
Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Finances • 2016-17 - 91.5 Million spent to plan • 2017-18 - £27 Million budget reflects increases in tariff charges for activity Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
The Pinch points • BHT- non elective • Frimley- Non elective, vascular, immunology, excess bed days • OUH – haematology, transplants • MK- excess bed days, cardiology Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
CCG Urgent Care Team Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
What have we done? • A lot! • Business as usual • Re-purposed Community beds • Primary care streaming • PTS Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Community Beds Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Primary care streaming Front door direction to:- • GP primary care, Ambulatory emergency care, Minor injuries, or A&E • 2 GPs & nurse and separate reception • 8am – 11pm • Refurb of current clinical space – 3 rooms • New building – 6 clinical rooms Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Achievements to date Support PDU expansion The Single Checking completed services environment of Medications Staffing skill mix Middle Grade appointed to support Consultant Workloads Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Discharges and Transfers April 2017 • Patient Transport services for A&E discharge – Buckinghamshire Healthcare NHS Trust 36.3% pre-planned (at least day before). • This compares to 21.6% Berkshire and Oxfordshire 33.7% for the month of April. • This is a considerable local improvement. Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
National Delivery Plan for Urgent and Emergency Care Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
National Delivery Plan for Urgent and Emergency Care Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Ambulance image Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
SCAS Thames Valley Contract Performance for April 2017: • Red 1 - (life threatening calls) 8 minute response – Target 75% was achieved at TV contract level (77.1%), however Bucks CCGs achieved 64.7% • Red 2 - (potential to be life threatening) 8 minute response – Target 75% was achieved at 75.5%, with Bucks CCGs achieving 68.8% • Red 19 - (requirement to have conveying vehicle to patient within 19 minutes) Target 95% achieved at 96.1%, with Bucks CCGs achieving 94.3% Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
SCAS • Emergency Care Improvement Programme (ECIP) collaborative working • Significant reduction in Ambulance handover delays- March 2017 (see table below) 65 hours, 35% improvement on March 2016 2:02:05 HORTON GENERAL HOSPITAL 13:34:47 79:53:44 JOHN RADCLIFFE HOSPITAL 50:43:37 117:43:55 MILTON KEYNES GENERAL HOSPITAL 51:09:23 42:52:56 ROYAL BERKSHIRE HOSPITAL 39:13:37 65:05:17 STOKE MANDEVILLE HOSPITAL 27:33:55 105:26:21 WEXHAM PARK HOSPITAL 35:04:43 Days 0.0 1.0 2.0 3.0 4.0 5.0 6.0 Excess Handover Excess Clear Up Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Call answering performance was reported at 89.10% in April, against 111 - SCAS a target of 95%. The target has not been reached since November. Warm transfer data continues to suggest poor performance at 25.10%. Monitoring of this is ongoing through the contract review meetings and SCAS are working to an action plan and trajectory. The continued drop in performance is due to increased and fluctuating demand, along with staff sickness rates There are no formal contract notices, however SCAS are working to remedial actions plans for call answer performance as well as warm transfer performance. These continued to be monitored through CRMs. 7.5% of 111 calls were transferred to the 999 service, against a KPI of <10% therefore this target has been met. Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Year-End Performance 2016/17 Bucks Bucks OPERATIONAL AV CCG C CCG INDICATOR CCG's CCG's Movement STANDARD 16/17 16/17 15/16 16/17 Dementia Diagnosis rate Dementia Diagnosis rate 66.7% 69.3% 64.5% 61.6% 66.2% Dementia Diagnosis rate A&E - 4 Hour Wait A&E waits Buckinghamshire Healthcare Trust 93.1% 90.5% Milton Keynes University Hospital 93.9% 92.1% 95% Frimley Health 94.7% 91.6% Oxford University Hospital 89.1% 86.1% Category A Ambulance Calls (SCAS) SCAS Category A calls emergency response arriving within 8 minutes (Red 1) 75% 63.67% 65.86% 64.12% 65.00% Category A calls emergency response arriving within 8 minutes (Red 2) 75% 67.08% 64.18% 65.17% 65.24% Category A calls ambulance arriving at the scene within 19 minutes 95% 91.12% 92.47% 90.74% 91.97% Mixed Sex Accommodation MSA Breaches of Same Sex Accommodation 0 0 3 2 3 Healthcare Associated Infection Healthcare Associated Infection Incidence of healthcare associated infection - MRSA Yearly Target 0 1 0 3 1 (Yearly Incidence of healthcare associated infection - C difficile 39 (49) 63 (61) 120 (110) 102 (110) Objective) Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Acute trusts-BHT • Establish a Frailty Assessment Unit • Establish 7 day ambulatory emergency care • Roll out of SAFER across all wards • Front Door primary care streaming • Discharge to Assess models - Home First model • Trusted Assessors Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Acute Trusts- Wexham Park Hospital • Director level conference calls to oversee an urgent care improvement plan • Natalie Fox attends A+E delivery board • Medically Fit for Discharge (MFFD) data discrepancy • Part funded GP for discharges • Weekly system call to unblock delays Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Looking at the last 5 months we can see that system performance improved from Jan – March 17, and we have sustained an average of 90% since then. In May our best performance was in the first week, and while we had a drop in performance in the weeks following our monthly average was slightly better then April . Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
Thames Valley 111 Integrated Urgent Care (IUC) • On track for September 2017 go live • Aylesbury Vale and Chiltern CCG governing bodies have previously signed off the contract award • Core principles reflect the national ambition for 111 Accountable Officer : Lou Patten Clinical Chair Aylesbury Vale CCG : Dr Graham Jackson Clinical Chair Chiltern CCG : Dr Raj Bajwa
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