Agenda item

Presentation by Chris Edwards, Chief Officer, and Dr. Robin Carlisle, Deputy Chief Officer

Chris Edwards, Chief Officer, Robin Carlisle, Deputy Chief Officer, and Lydia George, Rotherham CCG, referred to the powerpoint presentation which had recently been given to SCE/GPs which covered:-

 

-          2014/15 commissioning plan was available on the intranet – www.rotherhamccg.nhs.uk/our-plan.htm

-          2015/16 Plan was a refresh rather than a complete re-write

-          CCG transformation capacity was finite so it was important that if new initiatives were prioritised some exiting initiatives were stopped

-          Strategic Clinical Executive

-          Clinical Referrals, Medicine Management and Mental Health

-          Medicines Management

-          Mental Health

 

2014/15 Progress and Issues

-          Clinical Referrals

Early 2014/15 data show referrals and electives rising after 2 flat years

Audit programme and feedback via PLT working well, TRFT starting medical directorate ‘PLT’

Follow-up audits failing to identify many opportunities to reduce follow-ups

 

-          Medicines Management

Cost growth currently on track

33 out of 36 practice plans agreed

Service redesign projects performing well but some risks regarding TRFT re-organisation

Waste

 

2015/16 Proposals

-          Clinical Referrals

Develop a “Plan B” for the increase in referrals

Monitor and address issues with “other referrals”

Closer involvement of CCG in the development of RFT medical pathways

Improve access to neurology and develop appropriate pathways

Bench marking for GPs to improve quality and consistency

Development of pathways to provide advice on access to blood tests and imaging

Explore opportunities for self-care and non face-to-face consultations

Explore the market for primary care based Dermatology and Diabetes Services

Develop the prevention agenda with Public Health England

 

-          Medicines Management

Same priorities plus realising the benefits of electronic prescribing (decreased waste)

Address the high admission tate for respiratory conditions and prescribing rates

Consider local and national risk of reducing waste

Address waste in term of general waste and in particular nursing home waste

Plan for the risk to special projects due to TRFT restructuring

 

-          Mental Health and Learning Disabilities

3 reviews carried out (Adults, CAMHS and Learning Disabilities)

Learning Disability – following consultation would implement the decision taken at 3^rd September Governing Body

Action plan for RDaSH Services due to be agreed in September/October, common messages agreed, included being minded to contract with RDaSH as main provider but investing QIPP in voluntary sector or general practice

Adult and Older Peoples Mental Health Liaison Services most urgent issue

Issues with partnership working

 

-          Adults and Older People

Implement action plan including improved data and pathways, Adult Mental Health liaison, primary care focussed model, improved IAPT, improved Dementia Services

Increase the number of mental health patients on the case management programme

Develop a dementia pathway with more focus on Primary Care and “one stop shops”

Involve the voluntary sector on the dementia pathway

Improve RDaSH communication with stakeholders and providers

Support RDaSH management of change

Obtain patient experience of instances of poor service in respect of long waiting times and poor communication

Parity of esteem and 7/7 working

Long term impact of Child Sexual Exploitation

Learn from CRMC referral pathway work

Address the acute management of the physical health of mental health patients

Address the variations in Mental Health care (IAPT/Dementia)

Extend Community Transformation to include IAPT and Dementia

Measurable outcomes

 

-          Mental Health CAMHS and Learning Disability

CAMHS

Ensure that 2014/15 improvements were maintained and that the extra consultant improved capacity

Impact of Child Sexual Exploitation

 

Learning Disability

Evaluate the impact of Governing Body approved ATU/community investment decision

 

-          Unscheduled Care and Transforming Community Services

Urgent Care redesign

Care Co-ordination Centre

Transforming Community Services – Locality Based Nursing

Increased use of Alternative Levels of Care to Hospital

 

-          Transforming Community Services

Priority 1: A better quality Community Nursing Service

Priority 2: Integration across Health and Social Care

Priority 3: An enhanced Care Co-ordination Centre

Priority 4: Utilisation of alternative levels of care

Priority 5: A Better governance framework

 

-          2014/15 Progress and Issues

New Service model agreed for Community Nursing

Locality Nursing Teams serving GP practice populations

Extended Care Co-ordination Centre hours to 24/7

Development of the supported discharge care pathway

Reconfiguration of the Community Unit to support frail elderly

Discharge to assess (D2A) Care Pathway for CHC patients

Commissioning of specialised nursing home beds for D2A and winter

New governance framework in place for Community Health Services

 

2015/16 Proposals

-          Development of locality based Health and Social Care Teams

-          Development of an Integrated Rapid Response Service

-          Integration of the Care Co-ordination Centre with Rothercare

-          Introduction of integrated telehealth and telecare packages

-          Extend use of Care Co-ordination Centre to support case management

-          Clarify arrangements for medical cover in alternative levels of care

-          Primary care engagement in performance management framework

 

2014/15 Progress and Issues Emergency Centre

-          Governance structure for project management in place

-          Service model designed and work underway to establish patient flow pathways

-          Capital development designed and planning permission approved.  Capital scheme proposed includes adaptions to the existing A&E department at a cost of £12M

-          External review from the Emergency Care Intensive Support Team

Service model was innovative, safe, provided a quality service to Rotherham residents and made the best use of resources

Review of workforce to staff the Service model undertaken for each of the scenarios which may prevail

-          Finance and contracting discussions ongoing

-          Draft IT service specification being firmed up

-          Business case for approval

TRFT Board – 31^st October, 2014

CCG Governing Body – 5^th November, 2014

 

2015/16 Proposals/Next Steps

-          Agree finance and contracting arrangements

-          Commence with capital development

-          Continue service model development – testing out pathways at simulation events and ratifying via CRMC and MH QUIPP group

-          Develop pathway back to GP practices and implement

-          Procure, develop and implement IT system

-          Implement workforce development strategy to move away from reliance on locum cover

-          Develop clear transition arrangements and monitor progress

-          Robust strategy on culture change to be developed and implemented

-          Establish regular clinician to clinician meetings

-          Implement communications strategy (a) public campaign (b) internal communications across organisations

 

Maximise Partnerships and Primary Care

-          Better Care Fund – incorporating GP Case Management and additional investment in care outside hospital

-          To effectively align secondary and primary care plans with NHS England (co-commissioning of Primary Care and specialised services)

-          To deliver ‘working together’ in collaboration with other CCGs

 

Better Care Fund (BCF)

2014/15 Progress

-          No new money

-          £23M total fund (13.5M Health/£9.5M Local Authority) to a single pooled budget for Health and Social Care Services to work more closely together supporting Adult Social Care Services

-          15 agreed schemes within the plan

-          BCG plan contributed to 4 of the strategic outcomes of the Health and Wellbeing Strategy

-          Rotherham recognised as 1 of the top 15 plans nationally

-          On track for the resubmission of plans by 19^th September

-          BCF now incorporated the schemes from the investment in care outside hospital

2014/15 Issues

-          Nationally expected to see a 3.5% decrease in non-elective admissions within the plan – Rotherham’s ambition was 0% as a result of the significant reduction (10%) over the last few years

-          Nationally expect ‘benefits’ to be attributable to BCF – but BCF was 1 part of the overall commissioning plan and needed to ensure the picture was not ‘skewed’

-          Capacity to deliver on the 15 agreed schemes and to meet ongoing reporting requirements

-          The second evaluation event for the additional investment in care outside hospital was arranged for 22^nd October.  As part of BCF, continuation of funding was a joint decision, the main criteria for evaluation was to demonstrate impact on hospital admissions

2015/16 Proposals

-          Implement the revised plan agreed and submitted on 19^th September

-          Continue to work in partnership with RMBC

-          Agree realistic timescales for the 15 schemes and ensure capacity to deliver

 

GP Case Management

2014/15 Progress

-          Currently 6,687 active care plans

-          35 out of 36 practices were signed up

-          Inclusion of 75 and over health check – 1,410 completed

2014/15 Issues

-          Range of uptake across Rotherham from 0.1% to 5%

-          Capacity of practices to deliver this

-          35 different methods of delivery – wide disparity in uptake of supporting services

-          Complexity of IT systems to support

2015/15 GP Case Management

-          Continued funding of the service for at least 5 years with possible amendments to how it was delivered

-          Annual evaluation

 

Align Secondary and Primary Care Plans with NHS England (co-commissioning of Primary Care and Specialised Services)

2014/15 Proposals

-          NHS England have asked CCGs to express interest in co-commissioning Primary Care

-          It was also expected that CCGs would be asked to take a greater role for the commissioning of some specialised services

2014/15 Issues

-          Should we move towards being a ‘one’ place commissioner

-          Finances would need to be delegated to CCGs from NHS England

-          CCG would need to review staffing structures and governance arrangement if it wished to proceed with co-commissioning

2015/16 Proposals

-          The CCG proposed to co-commission Primary Care as from 1st April, 2015

-          Further information regarding specialised co-commissioning was expected from NHS England in October, 2014

 

Deliver ‘Working Together’ in collaboration with other CCGs

2014/15 Progress

-          8 CCGs and the Area Team as commissioners of Primary Care and Specialised Services had initiated a programmed of work to collaborate on key priorities (smaller specialities, paediatrics, stroke)

-          SYCOM agreed a Project Initiation Document in February, 2014 and programme director recruited in April, 2014 to work with each commissioning partners

-          Project Initiation Documents had been agreed for 3 of the 4 clinical priorities

-          Good progress made to date with 3 of the 4 workstreams

-          Following agreement to take forward the Children’s workstream jointly with provider colleagues, a joint document had been produced which would be shared and discussed at the joint meeting on 5^th September

2014/15 Issues

-          Identify shared resources to deliver projects between CCGs

-          The Out of Hospital workstream had been placed on hold pending further details of Phase Two of the National Urgent Care Review

2015/16 Proposals

-          Over the next we months to continue to deliver the 4 agreed key priorities:

Acute Children Services

Acute Cardiology and Stroke Services

Smaller Specialities (Speciality Collaborative)

Out of Hospital (currently on hold)

 

Discussion ensued with the following issues raised/clarified:-

 

·           Regular updates would be presented to the Select Commission on the Urgent Care Centre which was currently anticipated to open in 2 years

·           It was the intention to enhance Community Services and keep/treat patients in the community as long as possible to prevent hospital admissions

·           The presentation was a refresh of the proposals presented last year, not new proposals, and comments could be fed in via the link in the presentation

·           2015/15 would see a continued emphasis on working together across South Yorkshire, Bassetlaw and North Derbyshire to deliver the 4 key agreed priorities i.e.  Acute Children’s Services, Acute Cardiology and Stroke Services, smaller Specialities and Out of Hospital (currently on hold due to the National Urgent Care Review). 

·           The provision would still be at Rotherham Hospital but would be a mix of clinicians from across the region.  It was the desire to maintain services in Rotherham wherever possible unless there was a clinical reason not to.  The provider had to make efficiencies but in a way that did not have a detrimental effect on the patients

·           Proposed event in December, 2014, at the New York Stadium where clinicians would give updates on the Working Together schemes – invitations to Members to follow

·           Business cases for the proposals were not complete as yet but any that involved major service change would be submitted to the Select Commission and Patient Groups for comment

·           One area being considered was the overnight rotas for on-call consultants as this was very costly

·           Business cases were being led by clinicians and would have patient care as an absolute priority

·           Smaller specialties were discussed with emergency eye trauma given as an example - low admissions in Rotherham averaging two per week. 

·           Concentrating experienced clinicians tended to lead to better outcomes.

·           The refresh took into account the Health and Wellbeing Strategy (underpinned by the Joint Strategic Needs Assessment), reflected the needs of the clinicians, the views of the public and mindful of national guidance and  mandate

·           The first draft of the 2015/16 refresh would be complete by December and a second draft in the New Year once the NHS financial guidance had been received.  It would be submitted to the Health and Wellbeing Board in February, 2015

·           Rotherham’s Social Prescribing had been highlighted by the NHS as best direction of travel

·           Further information would be submitted in due course regarding NHS England’s intention for CCGs to take on a greater role on the co-commissioning of some specialised services and primary care

·           The place based plan for GPs and primary care was important and should reflect the Access to GPs Scrutiny Review, building in the recommendations made

·           The existing 5 year plan did not contain great detail on specialised commissioning or on Primary Care commissioning as they currently sat with NHS England.  Discussions were ongoing as to whether those services were to be directed back to CCGs and if so would necessitate a change in the CCG’s constitution and greater involvement of lay members to avoid potential conflicts of interest. Resourcing would also be an issue

 

Chris, Robin and Lydia were thanked for their attendance.

 

Resolved:-  (1)  That the presentation be noted.

 

(2)  That the CCG’s commitment for further engagement with the Select Commission be noted.