City and Hackney Clinical Commissioning Group Annual General Meeting

Wednesday 16th July 2014

Geffrye Museum

WelcomeOur first AGM as a CCGHousekeeping• No planned fire test tonight• Toilets through the doors to the right• Light refreshments

Agenda• Presentation of our performance last year• Questions and Answers• Informal discussion with Programme Boards

IntroductionWe are a very successful health economy

Why?

• Our GP members • High quality practices• Very engaged in commissioning

• Homerton• Excellent local hospital• Provides secondary and community services

• Active voluntary sector• Competent borough and

corporation

Mental HealthChildren and young people

• Lowest waiting times in east London for treatment

• Carers and parents reporting increased levels of support

• Very high recovery rates:

CORC – Children's outcomes research consortium

Homerton

• £1m investment in Homerton Psychological Medicine to support patients with mental health problems in the Homerton and presenting at A&E

• Keep people out of hospital – fewer admissions

• Reduce unnecessary time spent in hospital

Primary care

• Our services have improved for people with mental health and emotional problems

• Up-skilling primary care: improved training and services

• 500 patients seen by Enhanced Primary Care service

• Feedback from patients:

the primary care service is better

than before

I no longer need to be seen by the Community Mental Health Team and now I can go to my GP practice to see

my mental health nurse or the GP without the other patients knowing

my reason for being there

I spend more time talking to

my nurse and GP than before

People with dementia

• All memory clinic feedback sessions have an Alzheimer Society Dementia Advisor to support people in their local communities

• Lowest anti-psychosis drug prescribing in east London

• 10% increase in dementia diagnosis since 2012/13 meaning more people have access to early support for their illness:

People with short-term problems

• Over 5,000 people with depression and anxiety supported (15% of all people with depression/anxiety) – highest number and % in London:

Mental Health

People with complex needs

• Tavistock and Portman awarded Royal College Psychiatry award for adult mental health with over 600 people with complex mental health needs receiving care in their local GP surgery

• 75% of users report a recovery from using this service

PrescribingInnovation

Joint (between CCG and Homerton Hospital), first of its type, electronic formulary to facilitate safe and cost effective prescribing. Being repeated in East London Mental Health Foundation Trust in 2014/15

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C&H Ranking – of 32 London CCGs 2 1 8 10 9 10 5 29 3* 8 8

Reducing waste

Approximately £1M worth of medicines issued in C&H is wasted annually

Patient campaign raising awareness of the costs of medicines waste

Quality of Prescribing

City & Hackney is in the Top 10 London CCGs for 10 out of 11 prescribing quality indicators:

*CCGs without a centralised dressings service

Children’s

Expansion of out-of-hours Children’s Community Nursing team

Highly skilled nursing care for children in the community

• Now available at the weekends

• Treated 103 children who would otherwise have attended hospital

Children and Families Act 2014

Working with our partners toimplement these changes fromSeptember 2014

Thresholds are not changing – but personalised Education Health and Social Care Plan. We will work closely with young people and families.

Vulnerable Children’s Contract with GPs• Focus on asthma, epilepsy and diabetes• Mental Health• Improving care for vulnerable children and families• 16th birthday health check

MaternityMaternity Service Liaison Committee (MSLC)

The committee of approximately 15 includes local health professionals and parents to help ensure our woman’s voices are reflected in the commissioning of maternity services

Priorities for the coming year include:

MSLC 14-15 Work Plan priorities Actions

A. Parents voice and experience Walking the patch – postnatal Observing maternity/labour reception area

B. Vulnerable women’s pathway Focus groups with target populations Local VCS and parent reps to collect views and feedback

C. Tongue tie service Continue to monitor need, and support pilot bid for non-recurrent funding pilot project.

D. Breastfeeding Review breastfeeding services Support campaign for Homerton to attain Baby Friendly status

Community Midwifery

Midwifery led clinics are being set up in GP practices andChildren’s Centres across the area to provide care closer tohome for pregnant women

MaternitySocially vulnerable women

Long Term ConditionsContract with GP practices

Tackles:

• our high premature cardiovascular disease mortality rate

• our high respiratory disease mortality rate

• helps people feel supported to manage their long term condition

Key outputs and outcomes in 2013/14

Care plans and annual reviews:

Long Term ConditionsLong Term Condition management

Additional patients treated

Hypertension and blood pressure controlled to ≤150/90

1621

Coronary Heart Disease and cholesterol controlled to ≤5

144

Coronary Heart Disease and blood pressurecontrolled to ≤150/90

202

Coronary Heart Disease – annual review 57

Diabetes – annual review 583

Diabetes and blood pressure controlled ≤145/85 1104

Diabetes and blood sugar controlled to ≤59 1090

Diabetes and blood sugar controlled to ≤86 590

Diabetes – retinal screening 669

Diabetes cholesterol controlled to <5mmols 370

Diabetes – microalbuminuria checked 584

Chronic Kidney Disease and blood pressurecontrolled to ≤140/90

293

High risk of heart disease – proxy review127

Increase in % of people with diabetes in City and Hackney recently screened for retinopathy (now highest in London)

Primary Care Quality

• Support practices to reflect on their own practice and commission services

• Working to promote the appropriate use of computer systems to augment good patient care

• Supporting an extensive programme of education and training to promote development of the primary care workforce

• With so much good care being delivered in primary care: one of the outcomes of this is that City and Hackney has one of the lowest outpatient referral rates in the country

Planned Care

Diagnostics

Commissioning direct access diagnostic contracts for MRI scans and Dexa scans including increasing access for colonoscopy in line with best practice recommendations for cancer pathways

Early detection of cancer

Working in partnership with Cancer Research UK to secure a dedicated worker to improve early detection and diagnosis of cancer in primary care. We would hope that by detecting cancer earlier we would improve survival and reduce premature cancer mortality:

Total knee replacement

• New pathway, including increased use of decision aids for patients

• Increase in average health gain reported by patients of 20%

• Patient feedback:

Felt very involved in decision-making

process. Very happy with the clinic

Not keen for surgery currently, this was openly discussed and respected. Felt involved in decision-making

Urgent Care Our priorities• Capacity across all services• Helping patients access the right service• A high quality out of hours service • Urgent Care Board to plan services

Improvement in performance of Homerton A&E - Additional hospital registrar and GP posts within A&E- 4hr waiting time target met 42 out of 52 weeks

(average 81%)- Mean performance (on % of patients seen within 4

hours) improving over 2013/14:

17/03/201314/04/201312/05/201309/06/201307/07/201304/08/201301/09/201329/09/201327/10/201324/11/201322/12/201319/01/201416/02/201416/03/201413/04/2014

90% 93% 95% 98% 100%

National 4 hour target

Initiatives

• A&E capacity planning• Work with frequent attenders of A&E• Patient navigators within A&E – helping patients to

register with GPs and use healthcare most appropriately

• Building up capacity of Out Of Hours services • Rapid Response & Paradoc • Primary Care Capacity

Urgent CareOut of hours GP service

• New local provider commenced service since Dec 2013

• More telephone advice by GP

• More visits to the Centre

• Increased quality of telephone advice

• Less visits to A&E or ambulance service

• Service to include nursing capacity from August

Increasing Primary Care Capacity

• Extended Hours – Evening and weekend appointments across four bases in City and Hackney

• Enhanced Duty Doctor− Free GPs to work with Paradoc and enhanced rapid response

services− Free named GPs to attend to urgent care needs of High Risk

Patients

Joint Paramedic and GP Clinical Response service – A&E and Admission Avoidance

• Urgent primary care cases

• Referrals from ambulance clinicians both on site and in control room

• First Two Months: 251 Patients

• Reduction in unnecessary taking patients to A&E

Extended Hours Rapid Response

• Multi-disciplinary team including nursing and therapists

• Extended to midnight everyday and across whole weekend

Integrated CareVision

• To focus on improving the experience of patients and service users

• To improve the health and quality of life for patients and carers

• To help people avoid emergency admission to hospital and to stay at home rather than move to residential care

• To ensure care is co-ordinated and easy to find

Approach

• Focus on frail elderly people

• Prepare a care plan for and with each patient

• Ensure each patient’s care is co-ordinated at the GP practice with all the professional staff (the integrated care team)

• Help patients find the right care for their needs

• Expand services available to people at home

• Partner with voluntary and community services

Patient and Public Involvement• Established a well-attended and representative Patient and Public Involvement Committee, ensuring that the

patient voice is at the centre of our commissioning activities

• Launched an Innovation Fund in response to the issues raised by the public at our consultation event in November 2013 – bid for small projects suggested and run by Community and Voluntary organisations

• Jointly commissioned the Fund for Health with Healthwatch Hackney to understand the barriers to accessing healthcare and to understand what patients mean by patient centred services.

Finance highlights 2013-14• Delivered a £27m surplus for the year which will provide a buffer against future funding and cost pressures

• Manoeuvred successfully through the uncertainty of new system changes and commissioning responsibilities

• Financial risks managed and mitigated with a prudent view taken by the Board in deferring investment whilst funding uncertainties were resolved

• Robust governance process embedded within the organisation with key commissioning risks managed through Programme Boards

• Unqualified audit opinion issued on the accounts – clean bill of health from external auditors and a good platform into 2014-15

• 2014-15 Plans approved by the Board including £21m non-recurrent investment and £5.4m saving plans for the Health Economy

What the CCG spent in 2013-14

Questions & Answers

Jaime Bishop – CCG Board Member (Patient and Public Involvement and Conflict of Interest lead) to lead questions to:

• Dr Clare Highton – CCG Chair

• Paul Haigh – Chief Officer

• Philippa Lowe – Chief Financial Officer