Annual General Meeting 2014

NHS North Norfolk CCG One Year On

North Norfolk CCG is:

• A clinically led membership organisation comprising 20 GP Practices, situated across North Norfolk and parts of rural Broadland.

• Licenced from 1 April 2013 under provisions enacted in the Health and Social Care Act 2012.

• Patient focused approach to

commissioning healthcare for residents who largely live in rural areas and at some distance from the major acute hospitals.

• Demographic and socio-economic profile comprising the oldest population of any CCG in England.

• Local GPs with long and deeply embedded roots in our practices and communities will ultimately judge the success of the CCG simply by what is achieved for patients.

The CCG is accountable for exercising the statutory functions of the Group, but has granted authority to act on its behalf to:

Audit CommitteeClinical Quality and Patient

Safety CommitteeConflict of Interest

Governance CommitteeRemuneration and Terms of

Service Committee

This is demonstrated in the following Scheme of Reservation and Delegation:

• Any of its members • The Governing Body • Its Executive Team

• Senior Management Team• Its Committee and/or Sub-

Committees

Council of Members

Governing Body

• The Council of Members meets on a monthly basis. Attendance at meetings is very good, with member practice representation delegated to a Practice Manager if required.

• The Governing Body meets on a monthly basis. Meetings are held in the presence of the general public on a bi-monthly basis.

Key Issues / Successes

• 111 Service - addressed significant issues with performance through a close working relationship with EEAST and weekly clinically led performance reviews.

• Ambulance Response Times – highlighted serious shortcomings in EEAST’s ability to meet acceptable response times, resulting in an increase in capacity and remodelling of resources across North Norfolk.

• Mental Health Services – on-going quality reviews and engagement of clinicians to highlight concerns with waiting times and the impact of the Trust’s strategy to reshape services in Norfolk.

• Significant progress in the development of fully integrated primary, community and care teams across North Norfolk.

• Urgent Care Performance, impact on A+E waits and winter pressure 2013/14

• Re-commissioning of Referral Management Service and Non-emergency Patient Transport Services to secure value for money , and services which meet the needs of patients in a rural location.

• Commissioning of ‘closer to home’ Audiology services under the Any Qualified Provider scheme.

Engagement

Patients and carers are central to planning health and care services and their insight as service users informed the CCG’s thinking. The following variety of mechanisms have been used to consult and engage with patients and stakeholders throughout 2013/14:

• Annual Stakeholder Events which reviewed North Norfolk’s health priorities, discussed how the CCG should support local voluntary and third sector organisation and gathered insight to inform a new volunteer service;

• Biannual Patient Conferences, attended by local Patient Participation Groups (PPGs), which focused on dementia support and community services in 2013/14;

• Patient Surveys conducted by the Referral Management Service to gather patients’ views on the referral process and the service they received in relation to audiology and Lower Urinary Tract Symptoms (LUTS) service;

• Online consultations via ‘Your Voice’, recruiting people across the county with an interest in informing how services our are shaped in the local area;

• Patient Stories presented at each public meeting of the Governing Body, which gives local people the opportunity to tell their story ; and

• Partnership News, launched in the summer of 2013 and issued on a quarterly basis, with the aim of keeping patients and stakeholders appraised of the work of the CCG.

Collaborative Commissioning Arrangements

The CCG has entered into the following formal joint arrangements with other CCGs in Norfolk and Waveney;

• Acute Care;• Integrated Services (community, out

of hours and 111);• Mental Health Services (including

elements of Learning Difficulties); and

• Children’s Services

In addition the Acute Commissioning Board established an ‘Urgent Care Board’ to specifically manage aspects of the unplanned and acute emergency care system.

• The CCG’s Chair, is a member of the joint Health and Wellbeing Board (HWB) in conjunction with Norfolk County Council and other strategic partners. The Board leads the development of the Joint Health and Wellbeing Strategy.

• The HWB has linked with a Safeguarding Adults Board, including membership from the police, social services, the NHS and local charitable organisations. The CCG’s Nurse Member of the Governing Body is a member of this Board, which is de to become statutory in 2014/15.

2013/14 Annual Accounts -Context

• Financial Envelope• Programme and Running Costs• Planned Surplus• Financial Challenges in 2013/14• Mitigations• Final Reported Position• Impact on 2014/15

How do we spend your money?

2013/14 Annual Accounts• Statutory Financial Duties - To not overspend against allocated resources - To ensure value for money - Audit opinion

• Primary Financial Statements

- Statement of Comprehensive Net Expenditure - Statement of Financial Position - Statement of Changes in Taxpayers’ Equity - Statement of Cash Flows

Statement of Comprehensive Net Expenditure for the Year Ended 31st March 2014

2013-14Note £000

CommissioningGross employee benefits 4 1,049Other costs 5 210,926Other operating revenue 2 (1,053)Net Operating Costs before Financing 210,922

Other operating revenue - Other (gains)/losses - Finance costs - Net Operating Costs for the Financial Year 210,922

Net (gain)/loss on transfers by absorption - Retained Net Operating Costs for the Financial Year 210,922

Other comprehensive net expenditure - Total Comprehensive Net Expenditure for the Financial Year 210,922

Statement of Financial Position as at 31st March 2014

31 March 2014

Note £000Non-current assets:Property, plant and equipment 13 176Total non-current assets 176

Current assets:Trade and other receivables 17 1,787Cash and cash equivalents 20 73Total current assets 1,860Total assets 2,036

Current liabilitiesTrade and other payables 23 (14,710)Provisions 30 (1,200)Total current liabilities (15,910)

Total Assets less Current Liabilities (13,874)

Non-current liabilitiesTotal non-current liabilities -

Total Assets Employed (13,874)

Financed by Taxpayers’ EquityGeneral fund (13,874)Revaluation reserve - Other reserves - Total taxpayers' equity: (13,874)

Statement of Changes in Taxpayers’ Equity for the Year Ended 31st March 2014

2013-14 2013-14General Fund Total Reserves

Note £000 £000Changes in taxpayers’ equity for 2013-14Balance at 1 April 2013 - - Transfer of assets and liabilities from closed NHS Bodies as a result of the 1 April 2013 transition

13 197 197

Adjusted CCG balance at 1 April 2013 197 197

Changes in CCG taxpayers’ equity for 2013-14Net operating costs for the financial year SoCNE (210,922) (210,922)

Total revaluations against revaluation reserve - -

Net Recognised CCG Expenditure for the Financial Year (210,725) (210,725)Net funding SoCF 196,851 196,851Balance at 31 March 2014 (13,874) (13,874)

Statement of Cash Flows for the Year Ended 31st March 2014

2013-14Note £000

Cash Flows from Operating ActivitiesNet operating costs for the financial year SoCNE (210,922)Depreciation and amortisation 13 21(Increase)/decrease in trade & other receivables 17 (1,787)Increase/(decrease) in trade & other payables 23 14,710Increase/(decrease) in provisions 30 1,200Net Cash Inflow (Outflow) from Operating Activities (196,778)

Cash Flows from Financing ActivitiesNet funding received a 196,851Net Cash Inflow (Outflow) from Financing Activities 196,851

Net Increase/(Decrease) in Cash & Cash Equivalents 20 73

Cash & Cash Equivalents (including bank overdrafts) at the End of the Financial Year 73

NNCCG will look to build on its successes throughout 2013/14 by adopting the ‘Commissioning for Prevention’ approach to:

• Build on the capacity and skills of the Integrated Care Teams, to identify people with complex and long term care needs and design proactive services which will reduce incidences of acute crises;

• Implement a fully integrated service between 111, out of hours primary care and 999, available 7 days a week;

• Develop a robust and locally sensitive Directory of Service to enable 111 call handlers to direct people to the right care, at the right time;

• Ensure people in North Norfolk are supported by a high quality 999 emergency ambulance service, that delivers the best possible response times in a dispersed population;

• Deliver responsive Mental Health assessments and services, with better stratification between low level conditions and more complex mental health disorders.

Any Questions?

Patient’s viewCase Study: Mary and John Tuck