WELCOME TO SUTTON CCG Annual General Meeting 2016/17 Dr Jeff - - PowerPoint PPT Presentation

WELCOME TO SUTTON CCG Annual General Meeting 2016/17

Dr Jeff Croucher M.B.B.S. F.R.C.G.P Clinical Chair

ANNUAL REPORT 2016/17

Dr Chris Elliott F.R.C.G.P. Chief Clinical Officer

Who we are and what we do

• Clinically-led membership organisation
• 25 GP practices
• Responsible for the local NHS budget (over £270 million)
• Our role is to:

– make sure that the budget is spent on the right services to meet the health needs of people living in Sutton – commission hospital, community, mental health and primary care services – monitor the quality of local health services

@NHSSuttonCCG www.suttonccg.nhs.uk

Sutton focus 2016/17

• Our priorities are built from:

– Sutton’s Health and Wellbeing Board Strategy – emerging joint health and social care strategy – developing South West London Sustainability and Transformation Plan – our priorities outlined on our Plan on a Page including:

• Out of hospital care
• Long term conditions management and end of life care
• Mental health
• Hospital care
• Integration

@NHSSuttonCCG www.suttonccg.nhs.uk

Local partners

• Local NHS providers:

– Epsom and St. Helier University Hospital NHS Trust – Royal Marsden NHS Foundation Trust – Community Health Services – St. George’s Healthcare NHS Trust – South West London and St. George’s Mental Health Trust – Sutton GP services

• Health and Wellbeing Board
• London Borough of Sutton

– Public Health

• South West London Sustainability and Transformation Partnership

Programme Office

• Healthwatch Sutton
• Voluntary sector organisations

@NHSSuttonCCG www.suttonccg.nhs.uk

Working with patients

• Healthwatch Sutton

− Patient Participation Groups and annual forum

• Patient Reference Group
• Voluntary sector groups
• Patient education sessions

− monthly sessions to run for a year − first session delivered in March 2016 − average 100 patients per session − Nominated for Patient Experience Awards in 2017

• Help yourself to health

− six week courses for Polish, Urdu and Tamil communities − delivered by Hounslow and Richmond NHS Trust − Nominated for Patient Experience Awards in 2017

@NHSSuttonCCG www.suttonccg.nhs.uk

Achievements in 2016/17

• Delivering the Primary Care Extended Access Service

(appointments from 8am to 8pm, seven days a week)

• Successful NHS England bid (1st stage) for funding to

create Central Sutton Health Centre - a significant development on the existing health centre site and adjacent land at Robin Hood Lane in Sutton town centre

@NHSSuttonCCG www.suttonccg.nhs.uk

Achievements in 2016/17

• Taking on responsibility for Primary Care

Commissioning in April 2016, with all Sutton GP practices rated as “Good”

• The Sutton Integrated Digital Care Record allows

patient records to be shared, with the patient’s permission, across organisations within Sutton

@NHSSuttonCCG www.suttonccg.nhs.uk

Sutton Homes of Care

• The streamlined, integrated care through the hospital

transfer pathway (known as the ‘red bag’ pathway) has reduced residents’ length of stay in hospital by four days

• The Care Home pharmacist carried out 367 medication

reviews and 614 medication alterations at twelve nursing homes

@NHSSuttonCCG www.suttonccg.nhs.uk

Our performance

Five NHS performance domains:

• 1. Preventing people from dying prematurely
• 2. Enhancing quality of life for people with long term

conditions

• 3. Helping people to recover from ill health
• 4. Positive experience of care
• 5. Caring for people in a safe environment

@NHSSuttonCCG www.suttonccg.nhs.uk

Our performance

NHS England, the CCG’s regulator, set seven priority areas for 2015/16:

@NHSSuttonCCG www.suttonccg.nhs.uk

Priority area Sutton CCG performance

A&E access Annual performance was 94.85% (95% standard). The standard was met in March with performance at 95.5%. Performance for Epsom and St Helier for the year was above the 95% standard Waiting time - consultant-led treatment Meeting standards Diagnostic waiting times Meeting standards Cancer waiting times Meeting most standards except 62 day wait from GP referral to treatment Improving access to psychotherapy services Reaching targets by March 2016 for accessing the IAPT service, with 94% of patients referred to the IAPT service entering treatment within 6 weeks of referral and 100% within 18 weeks, meeting the national targets of 75% and 95% respectively. The 50% recovery rate standard was only met in two months Improving dementia diagnosis The standard (66.7%) was achieved in the second half of the year, with performance of 68.3% in March Transforming care for people with learning disabilities Meeting standards

Sutton CCG Review of financial year 2016/17

Geoff Price Chief Finance Officer

Finance

• The CCG met all its financial targets for 2016/17.

Specifically:

• The CCG achieved its target surplus.
• The CCG operated within its running cost limit.
• The CCG met its cash targets.
• The CCG operated within its capital limits.
• The CCG met the requirement to pay suppliers (of

health and non health services) promptly.

@NHSSuttonCCG www.suttonccg.nhs.uk

Where the money was spent in 2016/17

• NHS Sutton CCG spent £270.5 million in 2016/17. Of

this £266.4 million was spent on commissioned health services and £4.1m (or 1.5% of total resources) on running costs

• From 1st April 2016, the CCG became responsible for

commissioning primary care (GP) services

@NHSSuttonCCG www.suttonccg.nhs.uk

How much do we spend on?

Service Expenditure

Hospital services £144.0m Community services £37.0m Primary care £29.0m Mental health & learning disability services £25.8m Prescribing £24.0m Other programme expenditure £6.6m Running costs £4.1m TOTAL EXPENDITURE 2016/17 £270.5 m

@NHSSuttonCCG www.suttonccg.nhs.uk

2017/18 & beyond

• The NHS faces very significant financial challenges and

this applies to NHS Sutton CCG.

• Overall NHS Sutton CCG’s Governing Body is

committed to keeping the CCG on a firm financial footing so that it is able to commission the best available affordable services on a sustainable basis.

@NHSSuttonCCG www.suttonccg.nhs.uk

South West London Sustainability and Transformation Partnership

26 September 2017

Start well, live well, age well

About our five year forward plan

• SW London STP plan – November 2016

Following publication the NHS Five Year Forward View by NHS England in 2014, all regions of the NHS in England were required to produce five year Sustainability and Transformation Plans (STP). A draft plan was submitted to NHS England in November 2016.

• Refresh and a local approach

After talking to local communities, we believe a local approach, rather than a SW London-wide approach, works best. We have set up four local health and care partnerships in Croydon, Sutton, Merton/Wandsworth and Kingston/Richmond. The revised plan is expected to be published in November 2017.

• Bottom-up planning with councils at borough level, based on local people’s needs

These local health and care partnerhips (LA and NHS) are are looking at what services should be provided in the community and what their local hospitals should provide. They are working together to provide more joined-up health and social care services, and how to make these local systems clincally and financially sustainable

Summary of current STP thinking

• A local approach works best for planning health and care
• The best bed is your own bed – lets keep people well and
• ut of hospital
• Care is better when it is centred around a person, not an
• rganisation. Clinicians and care workers tell us this.
• Likely to mean changes to services locally - we are not

proposing to close any hospitals, evolution not revolution

• We need to show people how it works better with local

examples

• Involving people at local level will remain critical.

Working up real examples where we have delivered:

Sutton - Red Bag hospital transfer pathway

• When a care home resident is unwell and needs admitting to hospital for treatment

they are taken by ambulance with a “red bag” which contains important information about their health and social care needs, medicines they are taking and any personal belongings – such as glasses and hearing aids.

• The introduction of the “red bag” has improved:
• patient care because of better access to up to date information on patients helps reduce

delays in treatment (for example if a patient is taking medicine to thin their blood).

• communication about the patient/resident’s between the hospital and the care home –

staff now know who best to talk to.

• Care home staff now visit their residents in hospital within 48 hours supporting

their care and working with hospital staff to improve the discharge process when patients leave hospital.

• Following introduction of the “red bag” the time that residents stay in hospital has

reduced by an average of four days.

20

Start well, live well, age well

Keeping touch with local communities

• There have been local events this year for people to discuss the STP with clinicians,

managers and local authorities in our six boroughs

• We have written to over 1,000 local voluntary and community organisations at every key

stage of STP development: May 2016, September 2016 and March 2017 – setting out our emerging ideas, inviting feedback and offering to attend local meetings to discuss the issues raised. Grass roots engagement

• Working with local Healthwatch organisations, we have run an extensive grassroots

engagement programme, which was shortlisted for a national award. This has led to representatives from the local NHS discussing the challenges and emerging ideas with groups and individuals the NHS does not always reach, at 88 separate events in 2017/17. The evaluation report from these events is available on our website and we have agreed to run the programme for a further year. Patient and Public Engagement Steering Group

• Our Patient and Public Engagement Steering Group advises us on all communications

and engagement activity.

21

Involving local people

Start well, live well, age well

Sutton Health and Care

What is Sutton Health and Care?

• Integrated care around a population with complex needs
• Developing along two workstreams:

– Preventative and Proactive care. Spectrum of services from social prescribing to Locality Teams – Reactive care. Admission avoidance and accelerated discharge for the frail, older population

• Aim to bring together into one model of care for the population
• f Sutton
• A proposal for a joint venture across four main providers –

Epsom and St Helier, RMH Community Services, LBS (social care) and Sutton GP Services

• Potential for development into an ‘accountable care’ system

Barbara and Bob

• Barbara and Bob are both 80 years old and live independently in their own home in Sutton
• Barbara and Bob have one child, who lives nearby, and very supportive neighbours
• They both have chronic physical health problems (including diabetes and Parkinson’s); Bob is

getting increasingly confused and Barbara has had several emergency admissions to hospital in the last year. After each admission she seems to be more dependent than before.

• Barbara and Bob regularly see their GP, community nurses, hospital specialists, social care

reablement team, dementia services and voluntary sector agencies.

• They think the GP is wonderful but really don’t want to bother her; it takes so long to get an

appointment, she must be very busy

• They don’t mind seeing so many other different people but it doesn’t help with Bob’s confusion

and they are frustrated by repeating so much

• Most of all they are concerned about how they will manage the next stage of their lives

How do we want to work together to support Bob and Barbara?

Currently

• Complicated
• Gaps
• Inefficient
• Reactive
• ‘hands off’
• Fragmented
• Disruptive
• Isolating

What we want

• Joined up
• Efficient
• Proactive
• Giving control and choice
• Navigated
• Integrated
• Continuity of care
• Connected

Sutton Health and Care

• Social Prescribing
• Self Management
• Patient Education
• START social care
• Hospital discharge teams
• Community admission

avoidance and discharge teams

• GP clinical co-ordinator
• End of Life Care
• Care Homes Vanguard
• Step Closer to Home

Ward

• Intermediate Care beds
• Mental Health Services

Preventative Reactive Proactive

• Risk stratification
• Case Management
• Multi-disciplinary Locality

teams

Developing Preventative and Proactive Care Models

Preventative Proactive Reactive Social Prescribing

GPs supporting patients to access non medical support to patients to improve their well being

Approach Care Model Description Outcomes

Improved self management Reduced GP attendance Improved wellbeing

Locality Teams

Care to patients who would benefit from an MDT approach and care navigation

Reduced hospital admissions Reduced GP attendance

Sutton H&C

MDT support to discharge patients from hospital and support rehabilitation

Reduced length of stay Reduced hospital readmissions

Model of Care Development

28

Agree high level descriptions of how new model of care will work

• What the activities

described will deliver in agreed terminology

• How it relates to current

teams and ways of working Define key elements of the future team/s and activities

• Purpose / primary goal
• Target cohort / eligibility
• Skills requirements
• Entry and exit points
• Key interfaces /

handovers Define pathways and patient journeys 1 2 3 Identify integrated ways

• f working and

behaviours 4

The plan to develop the model of care involves answering key questions for the future design: Front line staff and patients will be involved in co-designing the model

• f integrated working

Key Workstreams

• Memorandum of Understanding between partners
• Scoping the services within “Sutton Health and Care”
• Phasing integration of services within “Sutton Health and

Care”

• Co-design of the model of care with front line staff
• Development and sign off of a shared business case
• Determining partnership and contractual model
• Communications and engagement – staff, patients, the

public – within and outside of “Sutton Health and Care”

• Implementation plan for first phase by April 1st 2018

Sutton Local Transformation Board Governance

Sutton Local Transformation Board

A&E Delivery Board Planned Care Delivery Board

SWL STP Programme Board

Organisational Boards (CCG, Providers)

Key – LHE governance Key – individual governance Key – SWL STP governance

Sutton HWB

Sutton Health and Care Programme Exec

Joint QIPP/CIP

group

Reactive Model (acute led business case) Proactive Model (primary care led, in development)

Key – Sutton only stakeholders

Finance and Activity Modelling Group

Intermediate care, EoLC, Care Homes TBC

Quarterly reporting of other STP workstreams and impact on Sutton health and care economy

New Extended Access Primary Care Service Opens in Sutton

Lou Naidu – Primary Care Transformation Programme Manager Dr Farhan Rabbani – Local GP, Director of Sutton GP Services

31

Introduction and context

• Strategic Commissioning Framework for Primary Care Transformation in

London - Nov ‘14

• Specification for General Practice that sets out the three aspects of care

that matter most to patients; – Proactive Care – Accessible Care – Coordinated Care

• Within Accessible Care, the specification relating to extended hours in

general practice is the focus of this document: “Patients can access a GP or other primary care health professional 7 days a week 12 hours a day (8 am – 8 pm) in their local area for pre- bookable appointments”

• NHS England has mandated the CCG to deliver an extended access

service for pre-bookable GP appointments

• A key work stream to deliver transformation of Primary Care

32

What is extended access?

• An extension of core primary care services
• GP and nursing appointments
• For patients registered with one of Sutton’s 25 GP

practices

• Pre-bookable via patient’s own GP practice
• 15 minute appointments
• Weekdays 6:30pm - 8pm
• Weekends 8am - 8pm
• Bank Holiday provision
• 2 year contract commencing April 2017

33

Where are services being delivered?

Hub 2 Opened 17/07/17 Old Court House Surgery Central Sutton Hub 1 Opened 19/04/17 Wrythe Green Surgery Carshalton

34

Who is providing the service?

• The service is provided by Sutton GP Services Limited (SGPS)
• SGPS is a collaboration of 24 practices in Sutton set up to provide quality

healthcare for all Sutton patients

• The services provided are commissioned by Sutton Clinical Commissioning

Group, and so are available to all patients registered with a GP practice in Sutton

• SGPS was formed in response to the growing need for change and

collaborative working within General Practice

• SGPS’s key aim is to deliver patient centred care in an efficient way, out of

hospital, locally, in line with patient needs and the South West London Five Year Forward View Plan

35

How do patients access the service?

Patient contacts

• wn practice for

an appointment Appointment

• ffered at own

practice Patient offered an appointment at HUB Patient seen at HUB of their choice at a time convenient to them HUB clinician reports consultation back to ‘home’ Practice If follow up required

36

37

GP and nurse available appointments April - August

241 208 523 474 500 462 736 702 596 590

100 200 300 400 500 600 700 800

GPs Nurses GPs Nurses GPs Nurses GPs Nurses GPs Nurses April May June July August

38

GP and nurse booked appointments April - August

150 97 447 396 446 395 561 537 501 477

100 200 300 400 500 600

GPs Nurses GPs Nurses GPs Nurses GPs Nurses GPs Nurses April May June July August

Patient records

• Full visibility of patient GP records by clinicians working

in the service

• Notes captured during the consultation are immediately

written back to the GP record

• Consent taken from patient at the time of booking an

appointment

• Data sharing agreements in place
• Less risk, improved safety
• Reduces medical indemnity costs to the service

39

GP caseload

• 250 appointments offered

per week

• Sessions mainly covered

by local Sutton GPs

• No problems getting

shifts covered

• Enjoyable work!

Top reasons for patient attendance:

• Convenience for the

patient, particularly younger working patients

• Minor illness
• Long term conditions
• Children’s illnesses
• Mental health

40

Nursing caseload

• 220 appointments offered

per week

• GP always available for

support

• Regular nursing team
• Mixed pool – regular

locums and local nurses Services offered:

• Wound care
• Contraception
• BP checks
• Ear irrigation
• Minor illness
• Cervical smears

41

Collaborative working with GP Practices

The hubs can:

• Refer for on-going treatment (with practice approval)
• Order routine investigations
• Generate prescriptions
• Send tasks to ‘home’ practice for on-going care and

management

• On-going feedback to and from local practices to inform

service development and resolve queries

42

What do patients say?

“Convenience” “Very useful as I would find it difficult to go anywhere else for a dressing change on a weekend. Nurse was brilliant” “Dr was very prompt, checked all

• ptions, explained well”

“Longer opening hours help those who commute to London” “Nurse was far more experienced and sorted my ears, she is a wonder woman”

43

Challenges

• 1 GP Practice (Vision site) unable to fully utilise service
• Utilisation rates dropped in July due to increased

capacity

• Significant number of Did Not Attends (DNAs)
• Utilisation impacted by summer holidays
• Patients arriving at wrong location
• Working together to make improvements

44

Next steps

• Solution for Vision practice
• Direct booking for patients
• Working across South West London to achieve ‘direct’

bookings from NHS 111

• Working with practices to reduce DNAs
• Working with communications team to actively promote

the service within the community

• Possible ‘online booking’ into hubs in the future
• Expand scope of services e.g. child immunisations
• Preventative work e.g. health checks

45

Sutton CCG Looking Forward – Our plans for 2017/8

Lucie Waters Managing Director

Looking forward

• In 2017/18 our strategic direction aligns with:

– Five Year Forward View (national policy) – South West London Sustainability and Transformation Plan (STP)

• We will continue to develop local priorities with our membership and
• ther stakeholders, aligned to the developing Sustainability and

Transformation Plan

• Implementation of our Plan on a Page
• Headlines of what we are aiming to achieve in 2017/18 …..

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Community services and out of hospital care

We are:

• continuing to work with Royal Marsden NHS Foundation Trust as
• ur community service provider to develop innovative, out of

hospital services such as:

• A Musculoskeletal service that triages and treats patients before

a decision is made for patients to be referred to a hospital for an

• peration
• More multidisciplinary teams that are part of the Sutton Health &

Care model of care to wrap services around individuals and reduce gaps in services

• Continuing to integrate our IUC services in the form of 111 and

OOHs linking to GP appointments and giving the ability to use the 111 service online.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Respiratory and diabetes

We are:

• Launching new guidelines, COPD, asthma and Sutton’s integrated diabetes

guidelines working with community services, secondary care, primary care, medicine management and patients.

• Supporting care being provided in the right place by the most appropriate

clinician to meet the patients assessed needs.

• Focusing on - Diabetes inpatient Specialist Nursing, Multi-disciplinary foot care

Teams and Structured Education following NHS England diabetes transformation funding success.

• Still referring pre-diabetic patients to Healthier You: NHS diabetes prevention

programme.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Long term conditions

We are:

• Developing pathways within Gynaecology to support the management
• f appropriate patients within primary care / community care.
• Developing pathways within cardiology that will help to improve the

management of patients with cardiac conditions such as Heart Failure.

• Working with our local acute trust to help make the pathway smoother

for gastroenterology patients requiring a diagnostic endoscopy.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Mental health

We are:

• Continuing our new model of care for dementia,

working with GPs and our hospital providers to identify patients within this cohort who need support.

• Continuing to work with Sutton Uplift to increase

performance against targets, particularly with regard to access and recovery and looking at innovative ways to engage with the wider older population.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Hospital care

We will be:

• building on the successful system resilience schemes of 2016/17

to bring together services that support hospital discharge and admissions avoidance working across all partner agencies.

• Continuing to develop GP advice and guidance systems such as

Kinesis, that directly links GPs to hospital specialists for rapid access to expert advice on referral questions.

• Working to support our providers so they continue to meet

national and local expectations on waiting times for treatment.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Hospital care

We will be:

• supporting providers to deliver timely access to key cancer

services, with a dedicated cancer team that is also tackling the challenges around early detection.

• developing closer collaborative working with partners across

south west London to develop firm proposals to put our local hospital providers on a firm footing to deliver sustainable services, both clinically and financially, for the future.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Integration

We are:

• Continuing to develop digital enablers to health such as the

Sutton Integrated Digital Care Record to enable health and social care professionals to share details to support better care for patients.

• working with social care colleagues to implement the Better Care

Fund and maximise opportunities for integration.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Children’s services

We are:

• Reviewing our CAMHS (Child and Adolescent Mental Health

Service) transformation plan with all Sutton partners to ensure that children and young people can access the best possible local service.

• Reviewing our CAMHS ASD/ADHD pathways to ensure it meets

the requirements of children and young people in Sutton.

• Reviewing all elements of our children's services to ensure that

they are robust and meet the requirements of children and young people moving forwards.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Primary care

• Primary care will continue to improve collaborative working with
• ther health and care organisations, becoming increasingly

proactive to keep patients well and improve communication between

• rganisations to give patients a better experience and remove

duplication of effort.

• Improving quality of service provision is a key priority for the CCG,

and the Primary Care team will be delivering a series of training sessions for practices to ensure that they are prepared for the Care Quality Commission’s new inspection regime.

• Exploring opportunities for expanding the skill mix in general

practice, for example, working with Sutton’s GP federation to increase the number of clinical pharmacists working in practices, to improve the quality and safety of prescribing.

@NHSSuttonCCG www.suttonccg.nhs.uk

Looking forward

Primary care

• Significant investment to improve the digital infrastructure in

practices to support the delivery of improved use of technology in general practice. Patients will benefit from Wi-Fi throughout all practices, and increased use of reminder messages, along with

• nline booking and access to medical records. GP practices will

also be provided with devices to access patients records away from the surgery, for example, when visiting patients at home or in care homes.

• Work will continue to explore opportunities to develop and improve

primary care premises in Sutton.

@NHSSuttonCCG www.suttonccg.nhs.uk

Your questions and comments

?

@NHSSuttonCCG www.suttonccg.nhs.uk