Annual General Meeting - Southwark CCG · Agenda Time Title Presenter 14:00 Welcome and...
Transcript of Annual General Meeting - Southwark CCG · Agenda Time Title Presenter 14:00 Welcome and...
Annual General
Meeting
30 August 2018
#SwkCCGAGM18
Welcome
Dr Jonty Heaversedge, CCG Chair
Agenda
Time Title Presenter
14:00 Welcome and introductions Dr Jonty Heaversedge
14:15 Presentation of CCG Annual Report and Key Achievements
2017/18 Ross Graves
14:35 Presentation of CCG Annual Accounts 2017/18 Malcolm Hines
14.50 Questions and answers from members of the audience All
15:00
Community Based Care – improving care for patients:
• SEL Commissioning Alliance
• Introduction
• Community estates
• Digital development
• Clinical effectiveness
Andrew Bland
Ross Graves
Rebecca Scott
Dr Jonty Heaversedge
Dr Payam Torabi & Nick Harris
15:35 Questions and answers from members of the audience All
15.50 Closing comments and thanks Dr Jonty Heaversedge
16.00 Close
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CCG Annual Report and Key
Achievements 2017/18
Ross Graves, Managing Director
Annual Report 2017/18 and key achievements
Strong performance across CCG assurance and an overall rating of ‘outstanding’
• Overall rating of outstanding for 2017/18, an improvement from the previous two years where
the CCG received a good rating. One of only 20 CCGs nationally and three in London to receive
the top rating.
• High performance was maintained for dementia diagnosis rates, appropriate prescribing of
antibiotics, and low rates of maternal smoking.
• Improvements were seen in the proportion of cancers identified at an early stage and one-
year survival from all cancers.
• Other key achievements include outstanding ratings for the quality of CCG leadership and
patient and public engagement in commissioning health and care.
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Leading and supporting delivery across national NHS standards and key local programmes
• Delivery of key NHS standards for: seeing a cancer specialist within two weeks of referral,
reduction of inappropriate antibiotic prescribing for UTI in primary care, reduction in E coli blood
stream infections.
• Worked collaboratively to support the delivery of provider improvement plans where
performance against constitutional standards is challenged.
• Over 100% increase in the use of electronic referrals from GPs into hospital care – a key tool
for offering patients meaningful choice by having all relevant and up to date information available
to inform the discussion.
• Step change in assessment pathways for NHS Continuing Healthcare meaning that
assessments follow discharge from hospital, when a person’s long-term needs are clearer.
• Stage 2 business case for Dulwich Health Centre approved by the National Investment
Committee on 20 March. Construction on the site has now started.
• Worked alongside GP federations to guide and assist four practices to move from a CQC rating
of “requires improvement” to “good”
Annual Report 2017/18 and key achievements
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Providing leadership across the local health system
• Improved response rate to 88% in 360o stakeholder survey, and improved scores in the
confidence in CCG leadership, stakeholders being given opportunity to influence plans, and
involving the right individuals/organisations when commissioning/decommissioning services.
• Leading the transformation of primary care programme across London.
• CCG members and staff have key roles in South East London’s Sustainability and
Transformation Partnership, particularly its approach to community based care, estates, digital
and continuing healthcare.
• Lead roles for LAS commissioning across south east London and for King’s College Hospital
NHS Foundation Trust for London.
• Delegated responsibility for commissioning GP practice services.
• Further established the Partnership Commissioning Team with Southwark Council, working to
deliver population based commissioning for residents.
• Lead CCG for national Diabetes Treatment and Care Programme in South London, including
completing the procurement of a Diabetes Hub to improve the uptake of structured education
• Lead CCG for SE London heading the development of tier 3 weight management service pilot
Annual Report 2017/18 and key achievements
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Taking a common approach to improving quality and driving key projects across health services
across Southwark
• Duty of Candour training launched to help GPs understand their duty to inform patients and make
a formal apology if an error has occurred in an element of care.
• The CCG are assured that our hospital providers have a robust mechanism to learn and improve
where incidents do occur.
• Rollout of Optimise RX: helping prescribers to achieve safe and quality prescribing, reducing
unwarranted variation
• Medications Safety Officer was appointed for the CCG, as were clinical champions for HIV and
Antibiotic Stewardship
• Launch of Clinical Effectiveness Southwark, providing support and clinical leadership to localise
and implement guidance using templates, facilitation and feedback.
Annual Report 2017/18 and key achievements
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Transforming services through Southwark’s Five Year Forward View, addressing fragmented
arrangements of planning and funding health and social care
• Working through the CCG and council Partnership Commissioning Team, agreed how best to use
the £31million Better Care Fund to support people at risk in the community, reduce hospital and
care home admissions and help people to be transferred smoothly and safely from hospital.
• In January 2018, the CCG and Southwark Council finalised our new Joint Mental Health and
Wellbeing Strategy.
• Agreed to take forward Southwark Bridges to Health and Wellbeing as a shared approach to
commissioning across the CCG and Southwark Council. This means commissioning for
populations rather than separate organisations.
Annual Report 2017/18 and key achievements
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Bringing organisations and professionals together
• Developing our Local Care Networks (LCNs) to play an increasing role in designing,
implementing and managing services. Significant progress was made with the launch of the new
care coordination pathway, which is delivering coordinated and person-centred care to people
with three or more long-term conditions and addresses both physical and mental health needs.
• Working with Community Southwark and the local settlement organisations (Pembroke
House and Time and Talents) in Walworth and Rotherhithe to develop ways to help mobilise and
empower people to make better choices and have more control over their lives. LCNs are
exploring how to expand the learning with other areas.
Annual Report 2017/18 and key achievements
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Empowering residents and service users
• Continuing to support people living with three or more long term conditions to contribute to
the design of our approach to joining up care. We won an award for this work at the Patient
Experience Network National Awards (PENNA) in March 2018.
• Talking to local people about what they think would improve quality in primary care.
• Engaging local residents to develop the vision for transforming mental health and wellbeing for
local people, as part of our joint Southwark mental health and wellbeing strategy.
• Transforming education and self-management for patients with diabetes.
Annual Report 2017/18 and key achievements
CCG annual accounts
2017/18
Malcolm Hines,
Chief Financial Officer
Duty YTD Target YTD
Performance RAG
Expenditure not to exceed income £488,480k £486,900k
Capital resource does not exceed the
allowance £69k £50k
Revenue resource does not exceed the
allowance £467,415k £465,854k
Capital Resource use on specified matters
does not exceed the allowance N/A N/A
Revenue resource use on specified matters
does not exceed the allowance N/A N/A
Revenue administration resource use does
not exceed the allowance £6,500k £6,457k
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Key Financial Performance Duties
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2017/18 Annual Accounts
• Met all of the statutory financial performance duties in 2017/18.
• The CCG has demonstrated continued strong financial performance, achieving
a surplus of £11,074k against a plan of £9,743k. The main driver of the
increased surplus was the NHS England requirement not to commit the 0.5%
non-recurrent reserve which CCGs are required to establish in their planning.
• Included in the 2017/18 accounts was a non-recurrent cost of £1,277k relating
to No Cheaper Supply Obtainable (NCSO) drugs. There was also a non-
recurrent cost of £1.75m relating to the CCG’s share of a £10.5m South East
London liability with Lewisham & Greenwich NHS Trust due to the Trust Special
Administrator Agreement at South London Healthcare NHS Trust in 2013.
• In addition to the above, the CCG underspent by £43k on running costs.
• The CCG received £69k capital funding in 2017/18 and underspent by £19k
due to a late allocation of the same amount.
• CCG accounts were audited by KPMG LLP. The CCG received an unqualified
audit opinion.
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CCG Expenditure 2017/18
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Financial Forward View: opening allocations
Opening Allocations 2016/17 –
2020/21
2016-17
£’000s
2017-18
£’000s
2018-19
£’000s
2019-20
£’000s
2020-21
£’000s
Recurrent Allocation 393,667 403,334 413,881 425,807 441,391
Delegated Primary Care - 43,208 44,749 46,469 46,469
Non recurrent sums announced/
anticipated 1,355
Running Costs allocation 6,457 6,496 6,533 6,565 6,594
HRG4 adjustments 2,058 Made
recurrent
IR rules adjustments -5,241 Made
recurrent
Total Resources 402,124 449,855 466,518 478,841 494,454
Target surplus for the year with
drawdown 7,673 9,743 12,063 tba tba
% change over previous year’s
recurrent allocation 3.05% 2.45% 3.33% 2.55% 3.66%
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Financial Forward View: QIPP requirements
2016/17 – 2020/21 estimated net
QIPP programme requirements
2016-17
£’000s
2017-18
£’000s
2018-19
£’000s
2019-20
£’000s
2020-21
£’000s
Total QIPP programme- net of
investment 6,659 12,393 16,550 15,428 13,950
QIPP programme as a
percentage of allocation 1.7% 3.0% 3.60% 3.3% 3.15%
Questions and answers
South East London
Commissioning Alliance:
working together to improve care
Andrew Bland, Accountable Officer
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Why work as an ‘alliance’ of CCGs?
• Efficiencies from ‘doing things once’ where possible (and freeing up local CCG teams to focus on
things very local)
• Having an aligned approach to external discussions; e.g. our SEL ICDT (acute) team supported a
contracting round with no disputes
• Ability to respond effectively and efficiently to regulator ‘at scale’ requirements (e.g. a SEL wide
assurance approach is being developed as NHSE assures at that level now)
• Enhanced ability to attract funding/ negotiate effectively (SEL CCGs were able to secure funding
for QIPP delivery by applying ‘ at scale’ and negotiated a more significant CSU contract reduction
by doing this once for the alliance)
• Support for under-resourced/ over capacity teams by working collaboratively (QIPP leadership
and PMO being established across BGL; supported by QIPP resource funded by the Alliance)
The SEL Commissioning Alliance aims to be complementary both to the local work of CCGs
and the work of the full STP programme.
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The system in south east London
SLaM is the key MH provider for
Lambeth, Southwark and Lewisham
Community Based Care:
making a difference to Southwark
residents
Ross Graves, Managing Director
A key focus of our community based care programme is supporting
those with multiple long term conditions: Jacqueline’s story
A key focus of our community based care programme is supporting
those with multiple long term conditions: Lindsay’s story
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Our shared vision and ambition for Southwark
Making Southwark the best place to be born, live, and grow old
Keeping people healthy, preventing illness
& supporting people to manage their
condition
• Shifting towards proactive preventative
care and early action
• Delivering outcomes that matter for the
people of Southwark
• Person-centred care planning and self-
management support
We will
achieve
this by…
Activating support from family, friends,
carers and the community
• Supporting community and voluntary
sector services to come together
• Providing better links to activities and
support in the community
• Creating opportunities for people to
support one another in their community
Providing great quality whole person care close to home
• Strengthening our workforce and removing artificial boundaries between service providers
• Better use of innovation & technology
• Quick access to specialist expertise in the community
• Better transition across health and care services; particularly in and out of hospital
• Developing our approach to neighbourhood working to coordinate care for people with
complex needs
• Making primary care more resilient and sustainable
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The Southwark CBC Programme
Southwark Community based Care
(CBC) Programme
Local Care Networks
(LCNs)
Developing collaborative arrangements
Commissioning Development
Community estates
Interdependency
Today we are going to showcase three enabling projects that support this
programme
Quality improvement and clinical effectiveness
Digital
Supporting Community based
Care through our community
estates
Rebecca Scott, Estates Programme Director
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What do we mean by ‘community estates’
Buildings from which our GP and community health services are provided
• These fall into three main categories
• GP Practice premises across the borough
• Health centres
• Mental health centres.
• There is a big range in size and quality.
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Why is this an issue for us now?
More health
services being
provided in
community health
buildings
More people will be
living in the
borough
More ill health to
be prevented
through proactive
management of
long term
conditions
More health care
will be provided
remotely
Although some care will be taken away from community health facilities by the
advance of technology and proactive management, this is significantly outweighed by
the population increase we are anticipating.
The sort of space that we will need will be different
We will need more space for health professionals to provide care
Where are the hotspots we need to address?
Dulwich Locality
Peckham & Camberwell
Locality
Bermondsey & Rotherhithe
Locality Borough & Walworth
Locality
Blackfriars and
the Elephant
18,000
Canada Water 13,000
Aylesbury and
Mandela Way
10,000
Old Kent Road (SE)
32,000
Peckham and
Camberwell 5000
An estimated 78,000
additional people
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A network of health centres…
Dulwich Locality
Peckham & Camberwell
Locality
Bermondsey & Rotherhithe
Locality Borough & Walworth
Locality
Canada Water
Old Kent Road
Lister Health Centre
Aylesbury
Elephant and Castle
CH
CH
CSH
CSH
CSH
CSH
CH Dulwich
(under construction)
Surrey Docks Health Centre
…to meet needs of more people and allow us to offer more services
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What services should we be planning for?
The work we did on the ‘Developing health services in Dulwich and the
surrounding area’ project offers a useful prototype on which we can build.
A new facility
now being built
which will open
in 2020
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What did people tell us then?
The engagement and consultation we did in preparation told us that
…as this would
be easier for
access and help
the integration
of services
they would
prefer these to
be in a more
central and
accessible
health centre…
they wanted
wider services
provided in
community
settings
local people
really value high
quality GP
services
A community health hub is a building housing a wide range of health services
under one roof.
Health services at Dulwich
General Practice
Support for people with
long term conditions and
older people
Diagnostics including
blood tests
Out-patients - including
musculo-skeletal
physiotherapy
Children’s services
health visiting and
Speech therapy
Pharmacy
Refreshments,
health
information and
voluntary sector
space
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Social regeneration - developing our ambition
Other possible services that could be linked to Community Health & Wellbeing Hubs
General practice space
Pharmacy
Primary care children’s services
Voluntary sector presence
Diagnostics
Consultation space for multi-
disciplinary clinics
Shared support space (eg
meeting rooms)
VCS, Social Connectivity,
Physical activity programmes
Heathy eating support
Job Centre Plus
Accelerator hubs
CAB/benefits advice
Apprenticeships
LBS/RSL housing office
• wellbeing workers/navigators
• Community curated space
• Cultural and arts space
Digital access & support
Library
SIAS
Group rooms and exercise space
Wellbeing Services
Work/economic support
Housing support
Community Space
Access to council services
Information/advice
services
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How can we link these services?
• Through putting services close to each other – even in the same building
• Through having properly managed community space for community
activities
• Through changing pathways so that people can be referred into other
services by health and care professionals.
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Conclusion
• This is an exciting time for health services – the regeneration in the borough
is offering us the opportunity to make sure we have modern fit for
purpose health facilities.
• Our engagement work gives us a framework we can build on to make sure
that services fit our communities in Southwark
• The CCG is working closely with the council to make sure that where we can
we address the wider issues affecting people’s health and wellbeing.
Dr Jonty Heaversedge, Clinical Chair
Supporting Community based
Care through digital development
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Digital technologies are becoming ubiquitous
Source: ONS Statistical Bulletin 2018, NHS Digital 2017
94% of all UK households have internet access and
over 90% of adults in the UK are recent internet users
Over 80% of the population between the ages of 16
and 74 use a portable computer or handheld device
to access the internet away from home or work
In 2017 NHS Choices received over 525 million visits 525m
80%
94%
People in Southwark have told us…
Following the engagement on the CCG’s digital strategy, practices and patients
involved in the discussions identified four key opportunities for digital technology
in the local system:
1. To empower people to optimise their health and wellbeing
2. To improve access to support and services
3. To reduce workload for clinicians and administrative staff
4. To facilitate multi-disciplinary team working.
Digital enables many of our priorities
For example…
• All NHS providers and GP practices in Southwark are able to access a shared care record for patients
• By 31 March 2019 all practices will have implemented eConsult our online consultation tool. It is already live in 13 practice with approximately 350 visits per week do date.
• Southwark have increased our electronic referrals by 44% over the last 12 months and are on target for all electronic referrals by GPs from October 2018.
• VisualDX is supporting GPs with advice and guidance to make effective diagnoses and referrals
Better, more joined up
experience for patients
Better clinical
outcomes
Value for money
Empowered patients
Patient Benefits from online consultation
https://econsult.net/why-econsult/patient-benefits/
Samantha, 37, Elephant and
Castle
Ongoing back pain
Working professional with a
successful but demanding
career – does not want to take
time off from work to attend
doctor’s appointment
Technologically literate
Moira (internet savvy), 74,
Dulwich
Moira was discharged from
hospital with new medications
but does not fully know how
she should take them
Moira is weak and vulnerable
and therefore can’t easily leave
the house to attend a GP
appointment
To avoid readmission Moira
needs continuity of medication
without leaving home
Peter, 57, Bellenden Road
HIV positive and suffers from a
range of other long term
conditions. Some of these are
caused by historic and current
medications. This means that
Peter has many more
appointments and treatments
than most patients.
How Digital will support patients?
Apps to
manage
conditions
Online
information
and self-help
groups
To be able to
contact the
GP online
View patient
record
Book
appointments
online
Direct
booking to
other health
professionals
e.g. physio
GPs
supported
with advice
and guidance
Supporting Community based
Care through Clinical Effectiveness
Dr Payam Torabi and Nick Harris
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What is CES?
Clinical Effectiveness Southwark (CES) is a systematic approach designed
to tackle health inequalities.
We strive to ‘make the right thing to do, the easy thing to do’, for busy
general practice teams working in Southwark. This builds on an established
collaboration between the CCG working and General Practice to improve
outcomes (e.g. work by our Medicines Optimisation team to deliver a step
change in detection for anticoagulation and stroke).
CES is a partnership team including NHS Southwark Clinical Commissioning
Group and Southwark’s two GP federations; supported and part-funded by The
Health Foundation.
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Informed by good practice
CES is based on the successful Clinical Effectiveness Group (CEG) in east London.
As a multi-skilled partnership we connect and learn from other local quality
improvement initiatives, enabling us to localise our approach.
AF improvements in East London
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CES process
CES prioritise medical conditions that GPs see
and treat frequently in Southwark.
Produce local ‘GP friendly’ CES Guides.
These summarise national guidelines, highlighting
key messages relevant to our population and local
services.
‘Guides’ inform templates that GP teams use to
remind them of the important things to focus on.
These help practices record important clinical
information. Data analysis also helps inform health
planning.
CES attend practice meetings and deliver regular
training sessions to help GPs and nurses deliver
best-practice care.
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Where are we now and what next?
CES launched its first three guides: Atrial Fibrillation (AF), Type 2 Diabetes
and Hypertension in May 2018
The second tranche of CES guides will be launched in October:
• Breathlessness
• Heart failure
• Asthma
• Chronic Obstructive Pulmonary Disease (COPD)
Further engagement over the coming weeks includes;
• Patient workshop with Healthwatch Southwark in September to explore how
CES could refine and enhance its offer of support
• Increase engagement with practices to tailor support and shape the next
phase of work
• Finalise the evaluation criteria with our independent evaluation partner, Kings
College London (KCL)
Community Based Care:
Focus for 18/19 – 19/20
Ross Graves, Managing Director
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Our areas of focus for 18/19 – 19/20
Questions and answers
Closing comments
Dr Jonty Heaversedge, CCG Chair
Close