meeting (held in public) - Bexley CCG body... · An initial GP engagement event took place in June...

DATE: 24 March 2016

Title

NHS Bexley CCG - Commissioning Intentions 2016+

This paper is for Decision

Recommended action for the Governing Body

That the Governing Body: Approve The CCG’s Commissioning Intentions for 2016+

Potential areas for Conflicts of interest

None known.

Executive summary

Over the past year the CCG has been developing its commissioning intentions for the next 2 year period (in detail) with stakeholders from across the health economy, fundamental to their development has been GP engagement and the significant input of our GP clinical leads. This will form the basis of our strategy for the coming years. The South East London 5 year strategy (Our Healthier South East London), which articulates the key themes where the 6 local commissioning organisations have agreed to work collaboratively, lies at the core of the document and is then supplemented by uniquely local requirements. This ensures that our plans dovetail smoothly with planning and delivery across South East London (our Strategic Transformation Plan STP level). An initial GP engagement event took place in June 2015, and the GP clinical leads then met across the summer of 2015 to arrive at the draft plans. An engagement event was organised by the CCG on 3 November 2015 with representatives from patients, local NHS, independent and third sector providers as well as key commissioning partners such as London Borough of Bexley. Participants were invited to comment on the draft Commissioning Intentions and take part in a break out session focusing on one of the priority areas for change. The draft plans were discussed and there was support for these.

ENCLOSURE: J Agenda Item: 33/16

Governing Body meeting (held in public)

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Since November 2015 CCG teams have continually updated the document to reflect emerging national and local changes. Bexley CCG has utilised bench marking tools provided by NHS England to ensure that all areas for service improvement are investigated and acted upon. The document has been updated to include new areas of opportunity identified in this way. The CCG received notice of financial allocations to cover the period to March 31st 2017 from NHS England and a process was undertaken to ensure alignment of the plans with the expected financial settlement. The Governing Body are asked to approve the Commissioning Intentions 2016+.

How does this paper support the CCGs objectives?

Patients:

The document reconfirms our Joint Health and Wellbeing Strategy priorities as well as embedding self-management for long term conditions. It has integrated and collaborative commissioning with the council and fellow CCGs, as well as NHS England as a key enabler of success. We can achieve more together than apart

People:

Organisation and Workforce Development is one of our six key commissioning “enablers”. Our own Organisational Development Plan guides the development of our own staff and we will work closely with the Academic Health Sciences Centre and Health Education England to maximise innovation and plan for the necessary changing workforce that will support the Community Based Care approach.

Pounds:

The document sets out three financial scenarios: upside, downside and base- case. The QIPP has been extensively modelled, tested and challenged through our Programme Office approach which is set out. Financial Sustainability is one of the four key “pillars”. The inclusive CCG-wide approach taken means that financial sustainability and quality/safety have been worked on in a balanced way, together.

Process: The document serves as the foundation for our Operating Plan. The document has a strong focus on quality and safety with a clear set of short term and strategic priorities which will be advanced both through strong contractual review working with neighbouring CCGs and by continuing the journey of cultural change set out by Francis and Berwick. Involvement of patients and the public, together with good clinical engagement will ensure that we triangulate hard and soft quality trends and build an open, enabling approach. The JSNA refresh is indicating that our priorities are the right

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ones still, but that we now need to gear them to the areas of greatest deprivation within Bexley by fine-tuning our interventions by ward, gender, deprivation, age and ethnicity.

What are the Organisational implications

Key risks

Equality

The need to gear existing programmes and show how we intend to impact on those in greatest need. This will need considerable Equality Impact Assessment work.

Financial

The risks are well known and the main elements that need careful negotiation are the split between CCG and NHS England (specialised commissioning) budgets and reaching agreement on the Transformation Fund.

Data

Legal issues

NHS constitution

We will integrate all actions to meet Constitution standards into our mainstream plans. The document has a separate chapter that transparently sets out our red areas and proposes action plans.

Engagement

There has been wide engagement in the development of our Commissioning Intentions and there will be continuing discussion and iteration of these plans with all our stakeholders, providers and partners.

Patient and public involvement is embedded throughout the individual programmes and projects that form our commissioning intentions. It is anticipated that engagement and consultation will be undertaken as appropriate for each specific area as it is developed.

Audit trail

Financial position and plans are regularly considered by the Finance Working Group. PCAG has been engaged and Executive Management Committee has received periodic updates. Draft versions of the plan have been shared with the Governing Body.

Comms plan

Once agreed by the governing body, the commissioning intentions document will be officially launched at the GP engagement event on 14th April 2016.

The documents will be published on a new page of the CCG’s public website and publicised via the CCG bulletin, locality briefings, staff briefings, stakeholder updates and Twitter.

Author: Lindsey Coeur-Belle, Deputy Director of

Clinical lead: Dr Nikita Kanani NHS Bexley CCG Chair

Executive sponsor: Sarah Valentine Director of Commissioning

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Commissioning

Date 10 March 2016

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Excellent healthcare – locally delivered

Commissioning Intentions our plans for 2016+ (Issue V1)

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Index

2

Ref Section

Page Ref Section Page

1 Introduction 3 16 QIPP overview 19

2 Chairman & Chief Officer’s message 4 17 Introduction to our Commissioning Strategy 20

3 Plan on a page 2016 5 18 Our Healthier South East London overall model 21-23

4 Our track record so far 6 19 Bexley’s primary care 24-25

5 Our vision, mission & values 7 20 Planned care services 26-27

6 Our Health South East London introduction 8 21 Urgent & emergency care services 28-29

7 The NHS 5 year forward view 9 22 Maternity care services 30-31

8 Bexley’s population 10 23 Children & young people’s services 32-33

9 Bexley’s population health & priorities 11 24 Cancer and End of Life Care services 34-35

10 Quality & safety 12 25 Queen Mary’s & Erith Hospitals 36

11 Performance & outcomes 13 26 Partnerships & working at scale 37

12 Patient participation & experience 14-15 27 Better Care Fund 38

13 The CCG’s membership 16 28 Procurement & contract management 39

14 Our finances – overview 17 29 Glossary 40

15 CCG spend and provider landscape 18

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1. Introduction

3

NHS Bexley Clinical Commissioning Group (CCG) plans (the CCG), purchases (or „commissions‟) and monitors

the majority of health services accessed by Bexley residents (with the exception of specialised services which are

commissioned by NHS England, and primary care services which it now co-commissions with NHS England).

In 2014 the CCG produced our Commissioning Intentions strategy document, that explained our high-level plans

and areas of focus this document updates the 2014 documents and sets out NHS Bexley CCG‟s strategic

direction of travel for 2016/17 onwards.

To establish what the commissioning intentions for 2016/17 are, the CCG considers the health needs of local

people, health challenges and ensures its plans align to other key strategic documents such as, the NHS Five

Year Forward View, the Joint Strategic Needs Assessment and the Our Healthier South East London strategy.

Engagement is also key to the development of commissioning intentions. The CCG has worked alongside the GP

practice community, its clinical leads, patients and patient/community groups, voluntary sector organisations,

providers, local authority partners and others to produce this document and will throughout the year, keep these

key groups updated on the progress being made against it.

To help articulate its plans, the CCG will develop (as it has in previous years) a Plan on a Page, which will

highlight the key focus areas for 2016/17 as well as the priority schemes of work and provides an aide memoire,

this is shown at page 5 of this document.

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2.Chairperson and Chief Officer‟s Introduction

4

We are pleased to share NHS Bexley Clinical Commissioning Group‟s (CCG) commissioning plans for healthcare in Bexley

for 2016 and beyond.

This is our third set of such plans since the CCG was established in 2013 as part of the wider health reforms that saw GPs,

and other clinicians, put in the driving seat of deciding how and where money is best spent.

Working alongside our colleagues and partners we have made great strides in improving healthcare services since our last

plan in 2014. We have delivered an ambitious programme of service development, transformation and improvement – for

example, making massive changes in how musculoskeletal services are provided and the enhancement of urgent care and

out-of-hours provision. Major transformations at Queen Marys and Erith hospitals are underway to develop vibrant centres

of healthcare in the borough.

Much of work over the next few years will be building locally on the Our Healthier South East London programme, which

brings together the six CCGs in south-east London, working alongside partners and patients, to focus on priority health

issues that are best addressed collectively.

Our plans will also be underpinned by the NHS Five year Forward View, which sets out what the NHS needs to do to

improve the population‟s health and the health services that they receive.

We will maintain our strong focus on quality and safety as well as ensuring that patients are at the centre of everything we do.

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5 3. Plan on a Page 2016

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4. Our track record so far

6

In 2014 we identified the key priorities for the CCG (within our Commissioning Intentions 2014) we set an

ambitious program of services development, transformation and improvement. We are pleased to report that the

CCG delivered against the majority of its priority areas in 2014/15, making it a milestone year for NHS Bexley

CCG and its patients. This was due work led by the CCG, our patients and clinicians, to redesign a number of

services to help join-up care across a number of different providers to ensure patients receive the right care, in

the right place, first time.

For example, the CCG‟s new joined-up musculoskeletal (MSK) service, is providing patients with a much more

rounded picture of care. Patients are initially triaged by a number of health professionals, who help to ensure

patients receive the right treatment first time. Patients receive a more holistic approach to their treatment and are

offered greater choice about where they would like to receive care. The new service has seen waiting times

reduce – from 22 weeks to four for physiotherapy appointments. Patient feedback has been extremely positive

through the CCG mystery shopper scheme. Our new integrated Cardiology services (community & acute

care) are providing better support for patients focusing on faster access, improved health, prevention and

avoiding exacerbations – avoiding admissions to hospitals.

Bexley‟s new urgent and unscheduled care service has helped to revitalise Erith hospital as a hub of activity

with a new urgent care centre (UCC), in operation from 8am to 10pm daily. The UCC at Queen Mary‟s hospital,

open 24 hours a day seven days a week, has remained a popular service with patients in Bexley and beyond.

The pathway also includes a new borough-based GP out-of-hours service. This new service has helped to reduce

the number of Bexley patients accessing accident and emergency departments and in turn, reducing pressure on

the overall health system.

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5. Our Vision, Mission and Values

Our Vision, or longer term goal, is for Bexley‟s residents to stay in better health for longer, with the support of good-quality integrated-care, available as close to home as possible – backed up by

accessible, safe and expert hospital services, when they are needed.

Our Mission, or “the job in hand” is Excellent Healthcare; Locally Delivered.

The vision and mission are supported by our Values, which guide how we work, the kind of culture we live by & how we ASPIRE to behave.

7

A We are accountable to our members, stakeholders, partners & ourselves

S We support our staff to be the best they can be, so we can deliver the best for our population

P We commission for quality to deliver improved outcomes for our patients

I We encourage new ideas & innovation

R We respect the diverse needs of our population & the expertise of our delivery partners

E We aim for excellence, working to high standards & increasing transparency

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6. Our Healthier South East London

Our Healthier South East London is a 5 year commissioning strategy which aims to

improve health and integrated care across south east London. It is the cornerstone NHS

Bexley CCGs Commissioning Strategy.

The programme is led by the six NHS Clinical Commissioning Groups in south east

London – Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark – with

commissioners from NHS England (London), working in close partnership with local

authorities; local people and patients; local providers of care and other partners.

Our Healthier South East London focuses on priority health issues which need

collective action to address successfully. Its goals are to improve health, reduce

health inequalities and to ensure the provision of health services that meet safety

and quality standards consistently and are sustainable in the longer term.

This is likely to mean that the way in which some health services are delivered will

change, with more care provided in community settings outside hospital and a

greater focus on helping people to stay well, making services more joined up and

making sure that everyone gets the care and outcomes they expect from their NHS.

Further details on OHSEL and work program are shown later in this document.

8

http://www.ourhealthiersel.nhs.uk/

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http://www.ourhealthiersel.nhs.uk/http://www.ourhealthiersel.nhs.uk/http://www.ourhealthiersel.nhs.uk/http://www.ourhealthiersel.nhs.uk/about-us/issues-paper.htm

7. The NHS 5 Year Forward View (5YFV)

9

The NHS 5 Year Forward View (5YFV) was published in October 2014 and sets out a

clear direction and vision for the NHS showing why change is needed and what it will

look like. It recognises that in the last 15 years the NHS has dramatically improved,

but we can still do more. The key points of the 5YFV are:

• There needs to be radical upgrade in prevention and public health. The NHS

needs to back hard hitting national action on obesity, smoking, alcohol and other

major health risks.

• When people do need health services, then patients need far greater control over

their own care.

• The NHS must take decisive steps to break down the barriers in how care is

provided. It recognises England is too diverse for a “one size fits all” care model,

but we need to support and develop new delivery options (not letting “a 1,000

flowers bloom”). There are opportunities for new integrated care models and

these will be tested and developed, some of these will be similar to Accountable

Care Organisations being used in other countries.

• The national leadership of the NHS needs to act coherently together, and provide

meaningful local flexibility. Growing demand could mean a resource gap of £30

billion a year by 2020/21, action therefore needs to be taken on the 3 fronts of

demand, efficiency & funding to help close the gap.

These Commissioning Intentions and the Our Healthier South East London Strategy

are built on the basis of the 5YFV.

http://www.england.nhs.uk/ourwork/futurenhs/

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http://www.england.nhs.uk/ourwork/futurenhs/http://www.england.nhs.uk/ourwork/futurenhs/http://www.england.nhs.uk/ourwork/futurenhs/http://www.england.nhs.uk/ourwork/futurenhs/

8. Bexley‟s Population Key Statistics

10

Bexley‟s population was 239,865 in 2014, an increase of 10% since the 2001

Census. There was a 6.7% increased in the under 5s, and a 16.6% increase in

aged 65 and over.

Between 2014 and 2021 the Bexley population is predicted to rise by 4.6%, to

250,900 people and to 266,600 by 2030 (an 11.5% increase). The most

significant growth is predicted amongst the 0-15 year age band and in those

aged 65+. Our growing population places pressure on all public services.

The fastest growing ethnic group in Bexley is Black/ African/ Caribbean/ Black

British, now making up 8.5% of the total population.

The Index of Multiple Deprivation (IMD) places Bexley in decile 4 (1 being least

deprived and 10 being most deprived). However, this overall average position

masks important areas of deprivation and higher need, most notably in the

north and the south east of the borough.

Life expectancy at birth for both males and females in Bexley is above the

national average.

Life expectancy at the age of 65 years in Bexley is also above the national

average for both males and females.

Population overview by broad age band (2012) %

Area 0–15 years 16–64 years 65+ years

Bexley 20.5 63.1 16.4

London 20.1 68.7 11.3

England 18.9 64.1 16.9

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9. Bexley‟s Population Health & Our Priorities

11

Our Joint Strategic Needs Assessment (June 2014) highlights the following

health priorities:

1. Our Health Priorities (section 1.2)

• Tackling childhood and adult obesity

• Diabetes

• Supporting people with addictions – including smoking, alcohol and

drugs

• Dementia

2. Our Transformation Priorities (section 1.2)

• Balancing the health economy to provide improved community based

integrated care

• Improving Services at Queen Mary‟s Hospital (Sidcup)

• Improving Primary Care

• Strengthening the role of ill health prevention and support

The references to sections in this document, show where we have initiatives designed to

directly respond to the above.

0

5

10

15

20

25

30

35

40

45

Childhood overweight and obesity

England YRPrevalence

Bexley YRPrevalence

England Y6Prevalence

Bexley Y6Prevalence

0

1

2

3

4

5

6

7

2007/08 2008/09 2009/10 2010/11 2011/12

Proportion of people diagnosed with Diabetes (Aged 17+)

England

London

Bexley

0

500

1000

1500

2000

2500

2010 2011 2012 2013 2014 2016 2018 2020

Bexley population projections for Dementia (aged 65+)

Bexley: Total malesaged 65 and overpredicted to havedementia

Bexley: Totalfemales aged 65and over predictedto have dementia

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10. Quality and Safety

12

NHS Bexley CCG puts quality and patient safety at the heart of commissioning and contracting,

and expects its providers to be able to demonstrate that they have robust clinical governance

arrangements in place to protect patients from harm.

Our Quality & Safety Priorities going forward are:

• To embed learning from incidents, complaints and patient feedback, thereby reducing the

potential for further incidents (e.g. wider use of Quality Alert portal).

• Safeguarding children & vulnerable adults.

• Supporting Quality improvement through greater collaboration between hospital and community

services.

• To improve the quality of information between secondary, primary and community care e.g.

referrals and discharge.

• A better understanding around the prevention of inequality for the vulnerable groups and their

access to treatment.

• A CQUIN strategy that focuses on better outcomes for our patients.

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11. Performance and outcomes

13

The CCG continues to work with our care providers to deliver significant improvements in

the quality and safety standards across secondary, community and primary care.

In particular:

• Performance and Quality of Care at A&E departments

• Cancer services

• Infection Prevention and Control

• District Nursing

• Implementation of the London Quality Standards (see also Our Healthier SE London)

• Quality of Maternity provision for the women of Bexley (see also Our Healthier SE London)

• End of Life Care (linking through Care Home Forum) (see also Our Healthier SE London)

• Better Outcomes through closer working with Care Homes

• Quality Small Contracts via Provider Assurance Monitoring System (PAMS)

The CCG will implement annual audit work plans to support the drive for better outcomes.

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12.1 Patient Participation and Experience

14

We are actively engaging with local residents, patients and their carers in the development of the services

we commission.

We are committed to putting patients at the heart of everything we do, with an equal commitment to

working with patients and the public as partners. Their insight into services provides a valuable “richness”

and perspective and is fundamental to our design, development and monitoring of services.

The CCG also works closely with LBB, BVSC and a range of community, voluntary and faith sector

groups who help us reach many seldom heard communities.

We utilise a number of engagement channels including a Patient Council, who is represented on the

Governing Body and whose membership includes representatives reflecting nine protected characteristics

identified in EDS as well as Patient Participation Group (PPG) representatives and Bexley Healthwatch

Chair.

In 2014 the CCG launched a mystery shopper scheme. The scheme gives patients the chance to be

actively involved in shaping local health services by providing „real time‟ feedback on their experience.

Encouraging health conversations with patients/public enables us to gather additional views and at the

same time empowers people to be more involved in shaping their local NHS.

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12.2 Patient Participation and Experience

15

The CCG has worked closely with patients/ public to develop and test, then redesign and monitor the

services we commission, some examples of this are:

• MSK Service redesign – developing a patient survey, hosting patient focus groups, recruiting

patients to sit on contract monitoring board

• Cardiology Service redesign – developing a patient survey, in-depth patient interviews, hosting

patient focus groups, engagement sessions with local service user groups

Patients and public representatives have been very involved in developing work around the Our Healthier

South East London strategy and leading a number of local engagement activities to raise awareness and

engage Bexley residents.

Our plans for patient engagement in the service redesigns for the next 2 years include:

• Ophthalmology services (establishment of a programme board with patients at the heart)

• Diabetes redesign

• Children & Young People‟s services

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13. The CCG‟s membership

16

The CCG‟s membership is made up of representatives from each of the borough‟s GP practices.

Although decision making has been devolved to the governing body, the CCG works alongside its

members to ensure the services that it commissions are clinically-led, relevant and appropriate.

Our membership is divided into localities (North Bexley, Clocktower and Frognal) and the CCG meets

monthly with those localities. The localities provide current feedback on the quality of services that

provides a clear perspective from the ground up level on how those services are performing or the

opportunity for change.

The CCG has engaged members in the development of 2016/17 development plans by:

• Using quarterly engagement sessions to explain how commissioning plans were met in 2014/15

• Holding workshops with clinical leads and practice managers to identify the priority areas for

2016/17

• Engage GPs via locality meetings

• Communicate updates through public meetings, the GP zone (a secure extranet) and the CCG‟s

fortnightly bulletin.

• Meeting monthly with the localities (with CCG Director level representatives) to receive updates

and provide feedback.

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14. Our Finances - Overview

17

The CCG has a Revenue Resource Limit (RRL) for 2016/17 of £299m including £5m for Running Cost

Allowance (RCA). The CCG intends to comply with all business rules for 2016/17, except for the 1% surplus

requirement (we intend to achieve a surplus of £151k). We will ensure that:

• 0.5% contingency is in place

• 1% non-recurrent transformation fund is in place

• A medium term financial strategy is in place to cover the next 5 years.

Our key priorities are to deliver breakeven, remain with running cost allowance and meet Better Payment

Practice Code (BPPC) (payment of 95% of invoices within 30 days).

Our key risks remain acute over performance, prescribing, continuing healthcare and identification of and

delivery of QIPP.

Our risk mitigations are the contingency available, discussions with GP practices on delegated prescribing

for 2nd year, ensuring robust monitoring of acute contracts, exploration of Right Care opportunities and

access to the south east London risk pool.

On the next page we look at how we spend our RRL.

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15. CCG Finances - Spend & Provider Landscape

18

The charts below show how we spend the income that is allocated to us – these are based on our income in

2016/17. Chart 1 shows the spend by a health care group (including running costs), Chart 2 then shows the

spend with our providers for any contract over £1m

Chart 1 – Analysis of spend Chart 2 – Spend by provider (contracts over £1m)

Provider

Estimated

value of

contract

% of

allocation

£k

Oxleas NHS Foundation Trust - MH contract 24,635 8.25

Dartford and Gravesham NHS Trust 32,315 10.83

Guys and St Thomas' NHS Foundation Trust 17,379 5.82

Lewisham and Greenwich NHS Trust 61,337 20.55

Moorfields NHS Foundation Trust 1,258 0.42

Kings Healthcare NHS Foundation Trust 23,172 7.76London Ambulance NHS Trust 7,949 2.66

Kings Healthcare NHS Foundation Trust - Prime Contractor MSK 13,655 4.57

Guys and St Thomas' NHS Foundation Trust - Prime Contractor Cardiology 8,100 2.71

Oxleas NHS Foundation Trust - Community Services contract 9,950 3.33

Oxleas NHS Foundation Trust - Specialist Children's contract 3,848 1.29

Oxleas NHS Foundation Trust - Neuro Rehab 1,724 0.58

Hurley Group 3,724 1.25

Oxleas NHS Foundation Trust - Integrated Care 2,797 0.94

Greenwich and Bexley Hospice 1,175 0.39

London Borough of Bexley - Better Care Fund 5,620 1.88

London Ambulance NHS Trust - NHS 111 1,200 0.40

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16. QIPP - Financial Overview

19

The QIPP planning requirement is for at least 2% of Revenue Resource Limit

which equates to £5.8m for the CCG. However, the CCG needs to deliver £8.6m

to achieve its statutory breakeven duty. The CCG has a strong track record of

delivering service quality improvements (transformation & innovation) that have

lead to it being successful in delivering its QIPP programs since 2013. We have

robust processes in place to monitor these schemes (via our PMO office). In

2016/17 onwards the cornerstones for our QIPP schemes will be our work on Our

Healthier South East London, together with the NHS 5 Year Forward View. Our

more localised QIPP schemes are:

• Year 1 of our new Integrated and Community Based Pathways for Children

and Young People

• Diabetes – new integrated care pathway (primary care lead)

• Improved “frailty” pathways including Comprehensive Geriatric Assessments

• Ophthalmology – our lead provider framework

• Our GP Referrals project

• Provider productivity (across all contracts)

• End of Life care scheme (linked directly to our Better Care Fund see later in

the document)

• MSK & cardiology – integrated care contracts continued refinement &

improvement

• Corporate Schemes

QIPP stands for Quality, Innovation, Productivity & Prevention. It is a national, regional and local level

programme designed to support clinical teams and NHS organisations to improve the quality of care they

deliver, while making efficiency savings that can be reinvested into the NHS.

The CCG is currently forecasting 80% achievement of its 2015/16 QIPP programme

Percentage Achieved

* Forecast96% 82% 80%* N/A

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17. Our Commissioning Strategy - Introduction

20

The following slides show the key components of our Commissioning Intentions (Strategy) – these are

based on two cornerstones – Our Healthier South East London (OHSEL) 5 year strategy and then the NHS

5 Year Forward View (see previous section).

We have sub divided this section into:

1. Overview of the integrated whole system model for Our Healthier South East London

2. Primary & community based care (including Local Care Networks)

3. Planned care services

4. Urgent & emergency care services

5. Maternity services

6. Children & Young People‟s services

7. Cancer services (including End of Life Care)

8. Queen Mary‟s & Erith Hospitals (continued development of our health hub & spoke)

In each of the sub sections we firstly look at the model (and its key features) that we are developing across

south east London, and then add to this the “Bexley centric” initiatives that are that we intend to deliver

over and above the initiatives within the Our Healthier South East London strategy.

The CCG and its members have already come along way in developing services since its formation in 2013

– we have developed new integrated service pathways, and our intention is to build on this sound platform

in the future.

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21

A partnership of Bexley, Bromley, Greenwich, Lambeth, Lewisham and Southwark Clinical Commissioning Groups and NHS England

Community Based

Care delivered

through Local

Care Networks

(lead by primary

care) is the

foundation of the

integrated whole

system model that

has been

developed for

south east

London.

This diagram

provides an

overview of the

whole system

model,

incorporating

initiatives from all

6 Clinical

Leadership

Groups (each of

these are

described on the

following pages).

Draft in progress |

18.1 Our Healthier SE London – Whole system model - overview

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Serving geographically coherent populations

between 50,000 – 150,000

18.2 Community Based Care/Local Care Networks –

Our Target Model

22

• Leadership team • All general practices working at

scale (federated with single IT system and leadership)

• All community pharmacy • Voluntary and community

sector • Community nursing for adults

and children • Social care • Community Mental Health

Teams • Community therapy • Community based diagnostics • Patient and carer engagement

groups

‘The Core’ (as a minimum all LCNs should encompass)

• Strong and confident communities

• Accessible HOT clinics and acute

oncology (urgent and emergency

and cancer care)

• Specialist opinion (not face to face)

and clear specialist service

pathways

• Pathways to MDTs

• Integrated 111, LAS and OOH

system (interface with UCCs co-

located with ED model)

• Housing, education and other

council services

• Community based midwifery

teams

• Private and voluntary sector e.g.

care homes and domiciliary care

• Cancer services

• Children’s integrated community

team and short stay units

• Rapid response services

• Carers

• And there will be others..

Working with…

• Supporting patients to manage their

own health (Asset Mapping, Social

Prescribing, education, community

champions etc

• Prevention – Obesity, Alcohol and

Smoking

• Improved Core general practice

access plus 8-8, 365

• Enhanced call and recall – improves

screening and early identification

and management of LTCs

• Reduction in gap between recorded

and expected prevalence in LTC

• Supporting vulnerable people in the

community including those in care

homes and domiciliary care

• Reduction in variation (level up)

primary care management of LTCs

• Reablement – Admissions avoidance

and effective discharge

• MDT configuration – main LTC

groups (incl. MH) and Frail elderly

• End of Life Care

Big hitters

Bexley

Bromley

Greenwich

Lewisham

Lambeth

Southwark

Integrated Pathways of care

Integrated Single System Leadership and Management

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18.3 Care is wrapped around the individual

Self care

• Health coaching

• Self management tool kits

• Social prescribing

• Optimising neighbourhood assets

Managed care • Anticipatory care planning • Active case management • Disease management • Public health programmes

Local Care Network

Population needs & budget

Specialist input shared between LCNs:

Pulled into care delivery from outside the network: Virtual clinics | Specialist nurses | Consultants | Geriatricians | End of Life expertise | Specialist rehab

Wider community infrastructure:

Police | fire service | schools | Housing

Affordable high quality outcomes

Strong confident communities

Community Mental health

Social care

Voluntary sector

Therapies

Pharmacy

GPs

HCA

Practice nurses

Carers

Diagnostics Care co-

ordination

Person

Urgent and emergency

Local Care Networks will operate beyond usual GP hours in order to reduce referrals to emergency care

Health visiting

Family health

Proactive, Accessible , co-ordinated, Continuous Care

23

Community Nursing

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Accessible Care (1)

Delivery of core and extended hours to Bexley

population Local Care

Networks (6) Development of Local Care

Networks within Bexley Improving quality & reducing

variation of primary care provision

Co-ordinated Care (2)

Providing patient centred

coordinated care for patients with long term conditions or

complex needs and GP patient continuity

Proactive Care (3) Co-commissioning with primary care services to support and improve the

health and wellbeing of the population, self-care, health

literacy and keeping people healthy

Co-commissioning (4)

Working collaboratively with NHSE to improve the quality

of GP services and utilise local commissioning

opportunities to deliver strategic outcomes

Infrastructure (5)

Ensuring that the workforce, estate and IT infrastructure is

fit for the future to ensure that high quality, accessible and convenient primary care

is available

3) Proactive Care: 1. Social prescribing services 2. Self management support 3. Community Health and Wellbeing

Champions 4. Active support of screening programmes 5. Improving services for the unregistered

population

1) Accessible Care: 1. All GP practices open during routine

hours 2. A locality/borough wide model

developed for extended hours 3. All practices have a hearing loop & every

practice has access to sign language interpretation

4. Option for all patients to book appointment 4 weeks in advance

5. Telephone triage system so all patients in Bexley have same day access to a Duty GP/Nurse

2) Co-ordinated Care: 1. Local Care Networks developed in line

with OHSEL strategy 2. Self-management support available for

patients with complex problems 3. Avoiding unplanned admissions

enhanced service 4. Utilisation of Community Geriatrician

resource for the most complex frail elderly

6) Local Care Networks (LCN): Development Board fully operational and GP networks engaged in line with OHSEL strategy

4) Co- commissioning: 1.Primary Care Strategy in place & operational 2.Deliver the Strategic Commissioning Framework 3.Review of PMS contracts (GP practices) 4.Joint review General Practice performance 5.Development of schemes for quality improvement 6.Implementation of Iplato FFT module 7.Implemented Activity Reporting Tool (PCART)

5) Infrastructure: 1.Estates base-lining (to understand available

estate) & develop an estates strategy. 2.Infrastructure fund bids 3.CEPN and workforce development 4.Bexley Linked Care project

GP Networks

19.1 Bexley‟s Primary Care – overview of intentions

Through our Primary Care development programme we are focusing on the development of our Local Care Networks – through this we aim

to provide quality & equality of services to the population, wrapped around the person as an individual. The diagram below shows the

initiatives and the key tenets of the work program:

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25

Through our Local Care Networks we intend to harness the power of primary care to provide more

localised services for our community (community based care), wherever possible these will be focused

around or in our 3 GP localities of Clocktower, Frognal and North Bexley.

In addition to the work shown on the previous page we will aim to:

1. Develop an improved, easily accessible & searchable Directory of Services (which includes

charitable, voluntary, health & social care services) providing a resource library of services for

patients and health & social care professionals.

2. Undertake a review of district and community nursing teams ensuring that they are focused on &

accountable to the Local Care Network and its patient‟s needs.

3. Long term conditions, undertake a review of education services (this will be linked to 1. above).

4. Via co-commissioning to assist practices with recruitment and retention.

5. Roll out of social prescribing pilot to all localities (if the pilot is successful).

6. Implementation and embedding of Health Champions in the GP practices.

19.2 Bexley‟s Primary Care – additional intentions

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26


20.1 Planned care services – Our Healthier SE London

Key Features of the model

1 Standardisation

Reducing variation across the planned care pathway from

referral practice to discharge through to co-development

of high level standards.

2 Diagnostics

• Enhance patient management by GPs

• Rapid access to diagnostics for GP‟s

• Evidence based standardised Clinical pathways

• Shared results across the system supported by

integrated IT systems

3 Elective Care Centres

Provider collaboration to create centres of excellence for

high volume specialities that drive up quality of service

provision and improve outcomes for patients

• Orthopaedic (hips and knees)

• Ophthalmology

4 Pathway Review

• Urology

• Neurosurgery

• Nephrology

• Gynaecology

• Dermatology

H

Elective

Care Centres

Diagnostics

2 3

Person

Within OHSEL it is

our intention that

patients that need

planned care

services across

South East London

will receive

consistent quality &

outcomes

regardless of the

setting.

The diagram and

the chart to the

right shows the key

features of our

planned care

model.

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20.2 Planned Care in Bexley

27

In addition to our work within OHSEL care model our intention is to also

implement the following:

Ref Initiative Planned Care 2016/17 2017/18

1 GP education events: The continued development of a structured, co-ordinated approach, that

employs technological solutions (web based, skype etc.) to maximise learning & development

opportunities

Yes Yes

2 Amber Alert System (QAMS) to simplify the feedback of alert status and outcome information to GP

practices

Yes

3 Bexley Linked Care (system): To implement the system across GPs, urgent care and provider

organisations (to facilitate integrated and co-ordinated care for patients) see also primary care section

including Connect Care with Lewisham & Greenwich Trust

Yes

4 GP advice routes from secondary care clinicians: To expand availability for consultant level advice to

GPs by telephone and electronic systems (to avoid hospital admissions or unnecessary attendances)

Yes Yes

5 Queen Mary‟s services expansion: Open the Cancer Centre (August 2016), expanded Kidney

Treatment Centre and the new theatre suite

Yes Yes

6 Joint commissioning: Review of the potential for expanded prevention services in obesity, smoking,

stroke, alcohol/ substance misuse with London Borough of Bexley and Public Health England

Yes

7 Dementia diagnosis: Ensure the continued emphasis on diagnosis of dementia patients, combined

with reviews of support services and enhancing community resilience schemes

Yes Yes

8 Learning Disabilities Mortality Reviews (LeDeR) Programme: Implementing local reviews of all deaths

of people with learning disabilities (& reporting) in line with the national initiative

Yes

9 Dermatology Services: Re-procure community consultant clinics (Any Qualified Provider) services with

the aim of introducing further choice of service providers.

Yes Yes

10 Diabetes Care: Delivery of a new integrated care pathway (focused on primary and community care)

for the care of our population (avoiding escalation and deterioration).

Yes Yes

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28



A Enhanced access to unscheduled care capacity and capability out

of hospital

1. Networked standalone Urgent Care Centre's

2. Community based rapid access teams including a homeward. GPs,

urgent care centres and emergency departments functioning in a

closely linked co-ordinated way; responsive community care,

including specialist response teams, will prevent un-necessary

hospital admissions with easy access to specialist advice for GPs as

an alternative to emergency department referral

B Specialist advice and referral

3. Access to specialist advice

4. Specialist response clinic

C Improved 111 capability and London Ambulance Service onward

referral

5. London Ambulance Service will be able to redirect to appropriate

services, such as the rapid access team, home ward or hospital

based specialist clinics and excel in navigating patients to the right

part of the system

6. 111 are able to give advice, provide internal triage and coordinate

onward referral to other parts of the system other than the

emergency department

D An enhanced single “front door” to the Emergency Department.

7. Bringing together urgent care centres and the emergency

department in a single governance structure and providing expert

streaming across all sites

E Emergency Department interface with Mental Health services

8. This will also allow for earlier identification of mental health cases

(including Dementia) reducing length of stay and enabling quicker

streaming to specialities for mental health patients by having

Psychiatric Liaison nurse and Triage joint assessments

9. Quicker interface with specialist services like drug and alcohol

10 Quicker interface with under 18 mental health liaison teams

28

H

Specialist Response

Clinic

Enhanced Front Door

Rapid response

“Home Ward”

A

D

C

E

B

Person

21.1 Urgent & emergency care – Our Healthier SE London

It is our intention

that patients that

need urgent &

emergency care

will receive the

treatment they

need in the right

place at the right

time and will

support patients

to return home &

move back to

local health &

care services.

The diagram & the

chart to the right

shows the key

features of our

planned care

model. It is our

intention that

through this

strategy we will

meet the London

Quality Standards

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21.2 Urgent and emergency care in Bexley

29



Re

f

Initiative Urgent & Emergency Care

2016/17 2017/18

1 111 Services: Completion of the procurement, integration for South East London including service

mobilisation, ensuring the service meets national standards

Yes

2 Urgent Care Services: The continued promotion of our Urgent Care Centres (UCCs) for urgent and suitable

conditions, and ensuring advice to the population on the appropriate use of all urgent care points.

Yes

3 Hospice Services: Review of our commissioned hospice services provision and services available Yes

4 Comprehensive Geriatric Assessments: Implementation of these for frail elderly patients across the whole

system (acute and community services). Review of the potential for commissioning new levels of urgent clinic

services (Hot Clinics) within the community for the frail elderly to avoid hospital admissions

Yes

5 End of Life Care – continued emphasis (please see section on Cancer and End of Life Care)

6 Integrated Care Services – continued emphasis and productivity improvement in the services designed to

avoid hospital admissions & to facilitate discharges from hospital

Yes Yes

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30



1 Primary prevention and targeted wellness programmes

within the Local Care Network

2 Assessment of pregnancy risk before 10 weeks to assign

the most appropriate midwife team from the outset:

1. Local Care Network community based midwife

teams for low risk

2. Specialist condition focused teams for high risk

3 Easy access to acute assessment clinic for unexpected

problems during pregnancy and assessment unit for

assessment of onset of labour

4 Culture of birthing units to encourage straightforward birth

and improve the experience for low risk women

5 Achieve the London Quality Standards

6 Better co-ordination through postnatal and neonatal phase

to improve mother and baby flows and experience

7 Smooth handover to Local Care Network with continuing

advice and support on healthy choices.

It is our intention that through this strategy we will meet the London

quality standards. The above interventions aim to address this.

6

3 5

H

4

Condition focused midwife cohorts for high

risk mothers

Geographic midwife

teams for low risk mothers

DAU & 24/7

Triage 2

Person

1

22.1 Maternity Services – Our Healthier SE London

It is our intention

that mums-to-be

will receive a

personalised

service,

continuity of care

& a range of

birthing options.

The diagram & the

chart to the right

shows the key

features of our

maternity model.

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31

22.2 Maternity Care in Bexley



Ref Initiative Maternity Services

2016/17 2017/18

1 Self Referral Services: Introduction of a standardised and unified process for self referral to services. This

will include publicising the new services to our population.

Yes Yes

2 Peri-natal Mental Health Services: See Children & Young People‟s section

3 Health Visitors: With the London Borough of Bexley to undertake a review of Health Visitor (and School

Nursing) services to ensure capacity and that services are built around the needs of our Local Care

Networks (GPs).

Yes

4 Communication to GPs: To ensure that the commissioned providers of ante natal care services improve

communications with GP surgeries regarding pregnant women and their health, to facilitate primary care

services.

Yes

5 Consider the opportunity for skype and email consultations Yes

6 Ensure that in all service provision specific groups are considered: BME, young parents, SE Asian

community, and that documents are translated

Yes

7 Ensure consistency of post natal care services in Bexley Yes

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32



1 Primary prevention and wellness:

• Within the local care network, focusing on the well child.

• In the context of the family setting, looking after the child or young

person‟s physical, social, emotional and mental well being.

2 Children‟s integrated community team delivering:

• A range of proactive services for children with long-term conditions

and care needs

• Early intervention for acute illness and supported early discharge

• Management of short-term conditions

• Signposting and navigation through the system and navigate

through the system

3 Extended GP hours

• For general practice from 8 to 8

• With closer links to short stay paediatric units and emergency

departments, to enable better co-ordination and to help prevent

unnecessary hospital admissions

• To be delivered via the Community Based Care model .

4 Short stay paediatric units

• Designed to ensure that children and young people are returned to

the community as quickly as possible and unnecessary hospital

stays are avoided

• With close links with the Children‟s integrated community team

5 Planned care pathways

• With referral advice and guidance tools

• Specialist advice and support back into the community

6 Supported transition to adult services

• As part of community based care, within the local care network

It is our intention that through this strategy we will meet the London

quality standards. The above interventions aim to address this.

Person

H

3

5

6

Children‟s Integrated Community

Team

ACUTE CYP

SS PAU

2

4

1

23.1 Children and Young People‟s Services – Our

Healthier SE London

It is our intention

that children &

young people will

be able to access

more specialised

services through

children‟s

integrated care

teams.

The diagram & the

chart to the right

shows the key

features of our

children & young

people‟s model.

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33

23.2 Children and Young People‟s Care in Bexley



Ref Initiative Children & Young People‟s Services

2016/17 2017/18

1 Children & Young People‟s Community Services: Implementation of a new integrated set of services in our

community for both planned and unplanned care for children (Hot and Cold community clinics) ensuring

congruity with the OHSEL strategy. This will include and embedding a simplified referral service for all

children and young people from GP practices (aim is a single point of access to all services). Consideration

will be given to alternative care services (e.g. social prescribing and alternative therapies) as well as

opportunities for voluntary and charitable services provision.

Yes

2 Mental Health Services Expansion:

1. Child & Adolescent Mental Health service implementation in line with the 5 Year Forward View (IAPT

and Tier 2 services)

2. Improve peri-natal mental health services

Yes

3 Health Visitors & School Nurses: With the London Borough of Bexley to undertake a review of Health Visitor

(and School Nursing) services to ensure adequate capacity and that services are built around the needs of

our population needs and our Local Care Networks (GPs). Link to Strategy 2018.

Yes Yes

4 Child Obesity & Weight Management: Continued offer to age 7 children of health checks via GP practices,

with services for over weight children commissioned with the London Borough of Bexley (Tier 2 and Tier 3)

Yes Yes

5 Education for primary care teams Yes Yes

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34


|


1 Primary prevention: Best delivered in the Local Care Network

Early detection

1. Increased screening rates to national benchmark through

targeted engagement

2. Diagnostics: Pilot project – serious but unspecified symptoms

pathway

3. Promotion of early diagnosis and equal access to treatment for

older people

4. Professional development for all staff within Primary Care

2 Treatment

Provider collaboration to create networked centres of excellence:

5. Non complex cancer treatments and support closer to home

6. Access to appropriate information and support for patients and

carers

7. Acute Oncology Services – networked and supported by

integrated IT

8. consistently meet the access time scales on our cancer services

9. Routine use of the recovery package

3 Living with and Beyond Cancer

10. Stratified follow-up

11. Support for people living with the adverse consequences of

cancer treatments

12. Comprehensive support for carers

13. Psychological support for people living with Cancer

14. Inclusion of Cancer as a criteria for referral to exercise/physical

activity on prescription schemes

15. Support to return to work, study or volunteering

16. Routine use of the recovery package

4 End of Life: Best Delivered in the Local Care Network

17. Ensure a dignified death irrespective of setting

18. Ensure consistent use of coordinate my care

19. Advance Care planning

H

Person

1 2

3 4

Early detection

Treatment

Living with & Beyond

Cancer End of Life

24.1 Cancer and EOLC Services – Our Healthier SE

London

It is our intention

that we will

improve patient

outcomes

through

prevention &

earlier detection &

diagnosis of

cancer.

We will provide

stronger support

for people living

with & beyond

cancer.

The diagram & the

chart to the right

shows the key

features of our

cancer model

(including End of

Life Care (EOLC)).

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24.2 Cancer and End of Life Care in Bexley



Ref Initiative Cancer & End of Life Care Services

2016/17 2017/18

1 Open Queen Mary‟s Cancer Centre – summer 2016 including well-being services e.g. Care navigator to

coordinate care and signpost for patients/carers

Yes

2 NHS Constitution standards for Cancer Services: Ensure that the waiting and treatment times are

consistently met by all providers of services

Yes Yes

3 End of Life Care Services (including Care Planning):

1. Co-ordinate My Care (CMC) – to work with other CCGs and the CMC team in London to simplify the

tool, and to integrate and link the tool into GP practice systems.

2. Continued promotion of the use of CMC with GP practices (and all service providers) continued

emphasis of improving the number of our appropriate residents that have a CMC plan at the end of their

life.

3. Continued expansion of our End of Life Care Services (especially for non cancer patients): Designed to

reduce unnecessary admissions in the last year of life and at the end of their life (community, and

hospice services). Continued improvement in the number of patients able to die in their Normal Place of

Residence (choice).

4. Better bereavement support is needed: Consider those aged 20-59 where a significant other had died.

Ensure visibility and accessibility of the services.

5. Care of the dying - review of personal care and support services. Domiciliary care - ensure they have

time to listen and staff have information on services and contacts (consider care co-ordinators)

Yes Yes

4 Cancer: To improve early detection by GP‟s through the implementation of NICE guidance for referrals (signs

and symptoms of 37 cancers) and continued delivery of GP education events.

Yes Yes

5 Cancer: Streamline the services and pathways to ensure clear responsibilities and transfer of care (with

patient records).

Yes Yes

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25. QMH and Erith Hospitals

36

To help implement new

commissioning

arrangements e.g. an

integrated MSK service,

cardiology service, urgent

and unscheduled care

service etc. the CCG has

been working with its

partners to develop and

transform both Erith and

Queen Mary‟s hospital

sites as „smaller viable

hospitals‟.

The CCG explains this

model as a multi-provider

health „hub‟ – at Queen

Mary‟s Hospital – and a

„spoke‟ – at Erith Hospital.

The diagram to the right

shows the services that

have been opened, plus

new expanded services

that will open in 2016

onwards.

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26. Partnerships and working at scale

37

The CCG is working with the other five SE London CCGs and their co-commissioners from NHS England, London

region, on a five-year commissioning strategy (Our Healthier South East London) that aims to improve health,

reduce health inequalities and ensure the provision of health services across south-east London that meets high

standards of safety and quality and are sustainable in the longer term. The strategy is commissioner-led and

clinically-driven and focuses on issues for people across south-east London, which need collective action to

address them successfully, or where there is clear added value from the commissioners working together. Details

of this strategy are shown earlier in this document.

The CCG will continue to work with London Borough of Bexley (LBB) to further develop integrated commissioning

arrangements, with the emphasis on development of Local Care Networks and integrated care based around GP

localities.

We are working with BVSC and other voluntary sector partners in line with the Building Healthy Partnerships

Programme to implement co-production around:

• Early help for vulnerable children

• Dementia pathways

• Joint commissioning cycle

• Voluntary sector enjoyment with primary care

In addition to the above Bexley CCG continues to work across London with other CCGs and other bodies to

commission at scale and design improved services for our populations (examples of these groups are; ambulance

services commissioning, the Mayor‟s London Transformation Board, various clinical networks etc.)

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27. Our Better Care Fund

38

In Bexley a key focus for our Better Care Fund is reducing End of Life admissions (& admissions in the last year of life) to deliver better

outcomes for our patients. Overall it is designed to: Reduce non-elective admissions (i.e. emergency); Reduce admissions to care

homes; Reduce falls; Reduce Delayed Transfers of Care (i.e. where patients are in hospital when they need not be); Increase re-

ablement (all of these are designed to maintain independence and out of hospital or institutional care settings). We will seek to

develop an enhanced culture of collaboration through development of Local Care Networks. We are working closely with the London

Borough of Bexley to promote early identification of carers and early intervention to prevent escalation of need. The Better Care Fund

is overseen by the Health & Well Being Board and the CCG‟s Governing Body. Regular reports on performance are received by both

groups.

Both nationally and locally the Better Care Fund (BCF) is facing a significant challenge in achieving reductions in non-elective

admissions and being the ability to accurately demonstrate the impact of the dedicated BCF schemes. In 2014 Bexley was in the top

decile of performers nationally for ambulatory care admissions to our hospitals (based on population) – this clearly showed the impact

of our admission avoidance and community schemes. However, during 2015 this has reduced to upper quartile performance –

although this still remains an excellent level of performance. The introduction of a new clinical decision unit at one of our providers,

and changes in reporting systems has complicated the reporting of performance in this area. The CCG agreed with LBB to release the

quarter 1 & 2 BCF „performance related payment‟ which reflects the value we place on the joint work with LBB to reduce avoidable

admissions. These difficulties have been highlighted to the national Better Care Fund team.

For 2015/16 this work will continue and we will seek to promote an enhanced culture of collaboration through the development of our

Local Care Networks. We have appointed a joint project manager between the CCG, LBB and Oxleas NHS FT to lead this work.

The Better Care Fund (BCF) was introduced by the Government in June 2013,

to ensure the transformation & integration of health & social care. It creates a

local single pooled budget to incentivise the NHS and Local Government to work

more closely together around people, placing their well-being as the focus of

health & care services.

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28. Procurement and Contract Management Plans

39

The chart to the right shows our current plan for

procurements from January 2016 onwards. This is

tentative and may be subject to change. We maintain

details of our procurements on our CCG website.

Our contracts aim to deliver on the NHS 5 year forward

view, always promoting prevention, effectiveness,

improved efficiency/ productivity and our drive for

continual improvement in patient outcomes. We will

continue to promote a paperless environment with our

providers. Our Governing Body (and other committees)

receive regular detailed reports on activity, finance and

performance in these contracts.

We have in-house contracting and procurement teams.

In addition we buy a range of Commissioning Support

services to supplement this and ensure that we get

economies of scale, and professional support services.

In 2015/16 we have started “testing the market” for these

services, using the nationally negotiated Lead Provider

Framework (LPF). The results of this market testing will be known in March 2016.

In this section we look at the current procurement plans for 2016 onwards (these

are draft at publication and may be subject to change, plus developments in our

management of contracts.

Advert date (est) or year

Description

Dec-15 Commissioning Support Services (SE London wide agreement)

Dec-15 AQP for community dermatology clinics

Jan-16 Vasectomy

Jan-16 OPwSI

Jan-16 Patient Transport

Jan-16 Ophthalmology Schemes

Jan-16 Diabetes Services with GPs

Apr-16 Social Prescribing

Sep-16 Andrology Services

Sep-16 Dietetics Service

Jan-17 Dermatology Community Clinic


Jan-17 Gynaecology Community Clinic

Jan-17 Urology Community Clinic




Jan-17 Minor Surgery Community Clinics

Feb-17 Pulmonary Rehab

Feb-17 Patient Transport

Apr-17 Enteral Feeds 2018/19 Cardiology integrated prime contractor services

2018/19 MSK integrated prime contractor services

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29. Glossary of terms used

40

Here we provide a glossary of the terms used in this document:

5YFV Five Year Forward View

CCG Clinical Commissioning Group

DH Department for Health

ED Emergency department

IAPT Improving Access to Psychological Treatment

LAS London Ambulance Service

LBB London Borough of Bexley

LTCs Long-term conditions

MDT Multi-disciplinary team

MSK Musculoskeletal

NHSE NHS England

NICE National Institute for Health and Clinical Excellence

OHSEL Our Healthier South East London

PMO Programme management office

PPG Patient participation group

QIPP Quality, Innovation, Productivity and Prevention

QMH Queen Mary’s Hospital

UCC Urgent care centre

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Enc J(i) FS GB Commissioning Intentions 2016+ Cover Sheet 11.3.16Enc J(ii) Commissioning Intentions NHS Bexley CCG issue v1

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