NORTH SOMERSET CLINICAL COMMISSIONING GROUP CLEAR AND CREDIBLE PLAN Version7 (final) 300413 Creating...

NORTH SOMERSET CLINICAL COMMISSIONING GROUP

CLEAR AND CREDIBLE PLAN Version7 (final) 300413

Creating the healthiest community together

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North Somerset- Creating the healthiest community together

Contents National Priorities Health Inequalities/Joint Strategic Needs

Assessment Performance on Outcomes CCG Vision, Local Priorities and

Commissioning Plans Quality, Innovation, Productivity and

Prevention (QIPP) Financial Plan Timeline and Milestones


National Priorities


NHS Mandate Reaffirms the Government’s commitment to an NHS that

remains comprehensive and universal – available to all, based on clinical need and not ability to pay – and that is able to meet patients’ needs and expectations now and in the future.

Improvements expected in following areas: preventing people from dying prematurely enhancing quality of life for people with long-term conditions helping people to recover from episodes of ill health or following

injury ensuring that people have a positive experience of care treating and caring for people in a safe environment and

protecting them from avoidable harm. Through the Mandate, the NHS will be measured, for the

first time, by how well it achieves the things that really matter to people. http://mandate.dh.gov.uk/b

http://mandate.dh.gov.uk/b


Everyone counts: planning for patients for 2013/14 Sets out the principles behind the NHS

Commissioning Boards vision for a modern, patient centred NHS with improvements driven by clinically-led, local commissioning from April 2013.

Success in the future will be judged on: Delivery of the NHS Constitution rights Quality of outcomes as set out in the NHS Outcomes

Framework. Physical and mental health given equal weight http://www.commissioningboard.nhs.uk/everyonec

ounts/ http://www.dh.gov.uk/health/category/policy-areas

/nhs/constitution/ https://www.wp.dh.gov.uk/publications/files/2012/

11/121109-NHS-Outcomes-Framework-2013-14.pdf

http://www.commissioningboard.nhs.uk/everyonecounts/

http://www.commissioningboard.nhs.uk/everyonecounts/

http://www.dh.gov.uk/health/category/policy-areas/nhs/constitution/

http://www.dh.gov.uk/health/category/policy-areas/nhs/constitution/

https://www.wp.dh.gov.uk/publications/files/2012/11/121109-NHS-Outcomes-Framework-2013-14.pdf




NHS Constitution Establishes the principles and values of the

NHS in England. Sets out rights to which patients, public and

staff are entitled, and pledges which the NHS is committed to achieve, together with responsibilities which the public, patients and staff owe to one another to ensure that the NHS operates fairly and effectively.

All NHS bodies and private and third sector providers supplying NHS services are required by law to take account of this Constitution in their decisions and actions.


NHS Constitution Rights

To receive NHS services free of charge, apart from certain limited exceptions sanctioned by Parliament.

To access NHS services. Patients will not be refused access on unreasonable grounds.

To expect your local NHS to assess the health requirements of the local community and to commission and put in place the services to meet those needs as considered necessary.

In certain circumstances, to go to other European Economic Area countries or Switzerland for treatment which would be available to you through your NHS commissioner.

Not to be unlawfully discriminated against in the provision of NHS services including on grounds of gender, race, religion or belief, sexual orientation, disability (including learning disability or mental illness) or age.1

To access services within maximum waiting times, or for the NHS to take all reasonable steps to offer you a range of alternative providers if this is not possible.


NHS Outcomes Framework Five domains - help shape what we are

striving to achieve for the patients and populations of North Somerset. Preventing people from dying prematurely Enhancing quality of life for people with long-term

conditions Helping people to recover from episodes of ill

health or following injury Ensuring people have a positive experience of

care Treating and caring for people in a safe

environment and protecting them from avoidable harm


CCG Outcomes Indicators


Helping people have a positive experience of care Early Warning Dashboard / Patient Safety

Thermometer key focus of CCG Governing Body

Robust commissioning / contracting of providers to ensure high quality safe services are in place

Action plans agreed / monitored to support continuing improvement cycle

Systematic review of serious incidents & clinical incident trends through Quality Assurance Group

Active engagement in safeguarding boards and serious case reviews


Helping people have a positive experience of care Triangulation of data to identify experience of

patients across care pathways within clinical outcome framework

Measuring how patients feel about services provided, including ‘Friends and Family Test’

Accessible feedback opportunities for patients through PAL’s, working with Health Watch and offering carer / public engagement events

Participation and support to peer review of providers e.g. dementia care

Working with partners to maximise commissioning of integrated care


Health Inequalities/Joint Strategic Needs Assessment


Demographics We have a fast growing population, especially

among older people; Higher proportion of people over the age of 50

compared with the rest of the SW or England - (35% in Clevedon);

Many live in rural communities – making access to services and amenities difficult.

Increasingly diverse population – rise in number of people from black and minority ethnic groups (approx 5%);

High number of Looked After Children (approx 240);


Deprivation (IMD) Some areas in North Somerset are now in top

1% most deprived in the country; Weston’s South and Central Wards are among

the most deprived areas in England; North Somerset has the 7th largest range of

inequality of all the 326 districts in England.


Levels of deprivation


Life Expectancy Life expectancy is higher than the England

and South West average Life expectancy men 80 years

(England 79 yrs) Life expectancy women 84 years

(England 83 yrs) 22 year gap in life expectancy between our

most deprived areas (Weston Central) and least deprived (Clevedon Yeo)


Trends in male life expectancy

Male Life Expectancy at Birth North Somerset PCT

70

72

74

76

78

80

82

84

86

1997-99

1998-00

1999-01

2000-02

2001-03

2002-04

2003-05

2004-06

2005-07

2006-08

2007-09

No

. Ye

ars

Least deprived quintile Most deprived quintile

Least deprived: life expectancy has increased by 4.3 years Most deprived: life expectancy has increased by 1.0 year


Trends in female life expectancy

Female Life Expectancy at Birth North Somerset PCT

70

72

74

76

78

80

82

84

86

88

1997-99

1998-00

1999-01

2000-02

2001-03

2002-04

2003-05

2004-06

2005-07

2006-08

2007-09

No

. Ye

ars

Least deprived quintile Most deprived quintile

Least deprived: life expectancy has increased by 3.5 years Most deprived: life expectancy has increased by 0.7 year


Causes of death which account for the inequality gap


Trends in deaths from circulatory diseases

0

20

40

60

80

100

120

140

160

180

200

2001-03 2002-04 2003-05 2004-06 2005-07 2006-08 2007-09

Year

Sta

nd

ard

ise

d r

ate

s p

er

10

0,0

00

IMD most deprived income quintile

IMD least deprived income quintile

Coronary Heart Disease mortality rates over time by quintile, all ages

Source: ONS mortality file

Both groups fallen but mortality in deprived areas still 1.8x higher.


Lifestyle factors

Smoking 16% of adults smoke in North Somerset

(21% in England) 40% of adults smoking in WSM South

compared to 10% in Clevedon Walton Alcohol

- Rates of alcohol–related hospital admissions are higher in wards in Weston-super Mare

http://www.google.co.uk/imgres?imgurl=http://www.zawaj.com/askbilqis/wp-content/uploads/2010/04/smoking-and-drinking.jpg&imgrefurl=http://www.zawaj.com/askbilqis/i-want-him-to-change/&usg=__MHJR0TzJOyCIKKZoVN4RFFYQ5tg=&h=276&w=460&sz=103&hl=en&start=4&zoom=1&tbnid=swuc5osWv7AaSM:&tbnh=77&tbnw=128&prev=/images?q=smoking+and+drinking&hl=en&safe=vss&sa=G&gbv=2&tbs=isch:1&itbs=1


Binge drinking in North Somerset


Reducing health inequalities

We have significant health inequalities in North Somerset;

These result from a range of underlying factors (health, social, economic);

Benefits of reducing inequalities are huge and far reaching (economic, social and equality of opportunity);

We need action across all determinants of health by range of partners;

Clear role for PPGs - empowering local communities.


North Somerset CCG Performance on Outcomes


NS CCG performs well on….. Non-elective admission rates Non-elective admissions growth. GP Referral Rates GP referral growth Elective admission growth Prescribing spend rates (biggest programmes) in

primary care Prescribing spend growth (biggest programmes) in

primary care Elective admission rate (although only at national

level) Emergency admissions for alcohol related liver

disease


NS CCG performs less well on... Under 75 mortality rate from cancer – we are worse

than both the national and ONS median range. Work on the JSNA shows this relates to poor outcomes in relation to lung cancer

Patient Reported Outcome Measure (PROM) for elective surgery on groin hernias – below national and ONS median - under review

Healthcare acquired MRSA and C-dif – slightly lower than national and ONS median

Health related quality of life for people with long-term conditions – above the national median but lower than the ONS median

Under 75 mortality rate from cardiovascular disease – above national median but lower than ONS median


North Somerset CCG Vision, Local Priorities and Delivery Plans


Our Vision - Moving from this…..

Local

Communities and

Third Sector

999, 111, OOH

Patients and Carers

Primary Care

Social Services

Secondary Care

Community Services


Through this….. Coming together around the patient

Local Communities and

Third S

Sector

Secondary Care

Social Services

999, 111,

OOH Primary CarePatient

s and CarersCommunity

Services


To this…. Seamless service provision around the patient

Patients &

Carers

Patients and Carers

Community Services

999, 111, OOH

Secondary Care

Primary Care

Local Communitie

s & Third Sector

Social Services

Always the right care, in the right place by the right person The right thing is the easy thingNo decision about me without me


Long-term ambitions until 2017 Work with partners to develop a patient-centred

integrated system across all health and social care that minimizes duplication and provides a coordinated service across North Somerset.

Continual improvement of the quality and safety of services

Patients know how to access services appropriately and are better able to manage their own care

Ensuring that carers are supported More patients supported with end of life care at

home or another place of their choice Reduced hospital beds and increased care and

support in our community


Solving our key challenges Needs of Frail Older People – coordinating the

services, greater integration across health, social care and acute services

Quality and Safety of all commissioned services – learning from Winterbourne View and Mid Staffs

Weston General Hospital– reshaping the hospital for the future

Clevedon Community Hospital – securing services for the future

Reputational Integrity – given all of the above and some difficult decisions ahead


7 ‘planks’ underpinning our commissioning plans Integrate Care Reduce hospital beds More care closer to home High Quality and Safe services Active Patient Involvement Reshape Provision Financial sustainability


Clinically Led Delivery Plans

Planned Care Urgent Care Community Care Long-term

Conditions End-of-Life Care Children’s and

Young People

Mental Health Learning

Disabilities Primary Care

Quality Medicines

Management


Local Commissioning Priorities for 2013/14 Reduce under 75s mortality rate from

cancer Reduce under 75s mortality rate for

cardiovascular disease Improve health related quality of life

for people with long term conditions Reduce emergency admissions for

alcohol related liver disease


Quality Premium and commissioning for quality and innovation


CCG Quality PremiumNational Measures – 75% of Quality Premium

Domain 1 Reducing potential years lost through amenable mortality

12.5%

Domain 2 & 3 Reducing emergency admissions 25%

Domain 4 Ensuring roll out of Friends and Family Test 12.5%

Domain 5 Preventing healthcare associated infections 12.5%

Local Measures – 3 to be selected

Domain 1 & 2 & 3

Brief Intervention for Alcohol Use 12.5%

Domain 1 & 2 & 3

Enhanced Access to Stop Smoking Services 12.5%

Domain 1 & 2 & 3

Enhanced Uptake of Health Checks Programme

12.5%


National Mandatory Indicators 0.5%

High Impact Innovations Indicators 0.5%

System Change Indicators 0.5%

Locally determined Indicators (aligned with local CCG priorities)

1.0%

Total Value of 2013/14 CQUINs Scheme 2.5%

2013/14 CQUIN Framework for allocation of the 2.5% across the various measures:


Providers need to satisfy at least 50% of the pre-qualification criteria:

Area of innovation

Criteria headlines Provider types

3 million lives Set a trajectory for 2013-14 for increasing planned use of telehealth / telecare technologies

Acute – yesCommunity – yesAmbulance – n/aMental health/Learning Disability – yes

Intra-operative fluid management

Demonstrate to commissioners that 2013-14 trajectories for the technology are in place which are consistent with the National Technology Assessment Centre (NTAC) Guidance

Acute – yesCommunity – n/aAmbulance – n/aMental health/Learning Disability – n/a

Child in a chair in a day

Review the provision of wheelchair services to ensure outcomes similar to those achieved by the best performing providers of mobility services for children

Acute – yes (where applicable)Community – yesAmbulance – n/aMental health/Learning Disability – n/a

International and commercial activity

Demonstrate that clear plans are in place to exploit the value of commercial intellectual property – either standalone or in collaboration with Academic Health Science Network

Acute – yesCommunity – yesAmbulance – yesMental health/Learning Disability – yes

Digital first Establish a 2012-13 baseline and trajectory for improvement to reduce inappropriate face to face contact

Acute – yesCommunity – yesAmbulance – yesMental health/Learning Disability – yes

Carers for people with dementia

Demonstrate that plans have been put in place to ensure that for every person who is admitted to hospital where there is a diagnosis of dementia, their carer is sign-posted to relevant advice and receives relevant information to help and support them

Acute – yesCommunity – n/a Ambulance – n/aMental health/Learning Disability – yes


CQUIN Gateways Delivery of the 2012/13 high impact change

CQUINs will be a nationally required gateway for achieving CQUINs.


National CQUIN’s - 0.5%0.5 per cent of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to national CQUIN goals (where applicable). There are 4 national CQUIN goals for 2013/14

Friends and Family Test – where commissioners will be empowered to incentivise high performing Trusts;

Improvement against the NHS Safety Thermometer (excluding VTE), particularly pressure sores;

Improving dementia care, including sustained improvement in Finding people with dementia, Assessing and Investigating their symptoms and Referring for support (FAIR); and

Venous thromboembolism (VTE) – 95 per cent of patients being risk assessed and achievement of a locally agreed goal for the number of VTE admissions that are reviewed through root cause analysis.


System CQUIN’s – 0.5%0.5 per cent of the value for all healthcare services commissioned through the NHS Standard Contract is to be linked to system CQUIN goals (where applicable). BNSSG Commissioners intend to agree system level CQUINs for acute and community based providers.

GOAL: Reduce volume of occupied bed days in acute hospitals for patients staying over 2 weeks.

Reduce volume of patients staying over 14 days in acute hospitals Manage 95% of patients in 23 midnights

GOAL: Improving End of life Care Achievement of the following:

People dying from a long term condition who have a preferred place of care recorded and communicated and die in their preferred place of care

Production and implementation of project plans and reports. Production and implementation of a single unified referral proforma.


Local CQUIN’s – up to 1.5%At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for WAHT:

Clinical treatment of pneumonia Alcohol Brief Interventions / Stop Smoking North Somerset ‘Amber’ Patients Management Frail Older Peoples Pathway Improvement Improvement in PROM’s for hernia repair


CQUIN Example ExplanationImplementation of the pneumonia pathway measures

Oxygenation assessment: to ensure that the oxygen levels in your blood are assessed when you arrive in hospital. This will help the medical teams to assess the severity of your pneumonia and whether or not you need treatment with oxygen. Blood cultures performed in A&E prior to initial antibiotic received in hospital: to ensure that blood cultures are taken before antibiotics are prescribed to the patient, so as to ensure the sample is not affected by the antibiotic. Blood cultures are taken to try and identify the bacteria which are causing the pneumonia and to help ensure that the most appropriate antibiotic is given.Initial antibiotic selection for Pneumonia in immunocompetent patients: to ensure that the antibiotic you are given is the most appropriate antibiotic for the patient’s specific condition & circumstances.Initial antibiotic received within six hours of hospital arrival: the timing of antibiotics is very important and it has been shown that in patients who have pneumonia, the antibiotic is most effective if started in the first six hours of you arriving at hospital.Adult smoking cessation advice/counselling: if you are a smoker, stopping smoking is the most important step you can take to improve your health. While you are in hospital you will be asked whether you are a smoker or if you have smoked within the last 12 months. If so, you will be advised to stop smoking and support and advice will be offered.


Local CQUIN’s – up to 1.5%At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for NSPT:

Complex Adults Pathway Improvement Enhancing Integrated Working Embedding enhanced management of

pressure ulcer prevention and training Alcohol Brief Interventions / Stop Smoking Seven Day Community Working


Local CQUIN’s – up to 1.5%At least 2% of a providers total contract outturn will be available for local CQUIN schemes Including System level and High Impact innovation indicators). Ideas being considered for AWP:

National Early Warning Score (NEWS) to include; adult physical health screening, stop smoking & alcohol

Mencap Charter Suicide Prevention tool kit


Financial Planning for 2013/14


Planning Context

Everyone Counts: Planning for 2013/14

Re-allocation of the NHS budget to new organisations

2012/13 Performance

2012/13 Prior Commitments

QIPP Potential


Financial Planning and Business Rules

2.3% Increase in CCG allocation for commissioning0.3% increase in CCG allocation for transfer to LA£25 per head allocation for running costs

4% provider efficiency requirement 2.7% provider inflation0.2% CNST premium1.1%-1.3% reduction in provider price tariff30% marginal tariff for emergency admissions above 2008/09 levels

Income

Efficiency

2% headroom 1% operating surplus 0.5% contingencyRisk Pooling with other CCGs

Risk Management

2.5% CQUIN payable to providersQuality premium payable to CCGs

Rewarding Quality


Reallocation of PCT Budget to CCG

EXPENDITURE Recurrent Budget 2012/13

Budget Transfers

Reallocation of Headroom

Recurent Budget 2012/13

£m £m £m £mAcute 176.7 (45.0) 131.6Mental Health 23.2 (0.4) 22.8Community 29.2 (0.5) 28.7Primary Care 47.2 (43.6) 3.6Public Health 5.1 (5.1) 0.0Running Costs CCG/Cluster 8.3 (7.5) 0.8CHC 12.8 12.8Prescribing 31.6 31.6Managed Programmes 1.4 1.4Headroom 0.0 0.0Total CCG Budget 335.4 (102.1) 0.0 233.4INCOME Recurrent Allocation 334.1 (102.2) 231.9Social Care Transfer 2.5 2.5Redistribution of headroom (1.8) (1.8)Total 336.6 (102.2) (1.8) 232.6

Surplus(-)/Deficit(+) (1.1) 0.1 1.8 0.8


2012/13 Commitment into 2013/14

£m Acute Contracts 2.5NICE 0.4Community 0.3Mental Health/LD 0.5Prescribing (1.5)2012/13 Budgets 2.2NBT PFI 1.5111 Implementation 0.4Other 0.1Social Care Transfer to LA 2.5Commitments entered into in 2012/13 4.3

Impact of reallocation of headroom funding 1.9

Total commitment from 2012/13 into 2013/14 8.5


Commissioning Intentions Overview Focus on strengthening

quality/performance and managing financial risk;

Continue work to harness resources of whole system;

Live CQUIN including gateways with high impact innovation, system level CQUINs and appropriate local CQUINs;

System wide initiatives to improve quality, performance and reduce hospital bed days

Underpinning workstreams securing a credible infrastructure and capacity


Commissioning intentions - CQUIN Important Lever for quality and system change Process ensuring system engagement and

involvement Gateways: Intention to use mandatory and local Strong focus on High Impact Innovations Local CQUINs within identified priority areas System CQUIN developing through Urgent Care

Programme Board focusing on >14day LOS Early senior review Direct admission of expected patients 7/7 Acute psychiatric liaison GPSU: Consider in-year variation to specification


Commissioning Plan 2013/14

* Schemes commenced in operation in 2012/13

INITIATIVES

Integrate Care

Reduce

Hospital

Beds

Care Closer to

home

Quality and safety

Active

Patient

Role

Reshape

Provision

QIPP £

Urgent Care /Long Term Conditions

Heart Failure Service* ü ü ü ü ü ü ü

Pulmonary Rehab Service* ü ü ü ü ü

Roll out Integrated Care Teams*

ü ü

ü

Community Geriatrician Support

ü ü ü ü

ü

Support to Carers* ü

Risk Stratification ü ü ü ü

Urgent Care Model* ü ü ü ü ü ü

Ambulatory Emergency Care*

ü

ü

Expand Community Ward "Beds"*

ü ü ü ü

ü ü

DVT Pathway* ü ü ü ü ü

Community Reablement* ü ü ü ü ü ü ü

Community Rehabilitation ü ü ü ü


Commissioning Plan 2013/14

* Schemes commenced in operation in 2012/13

INITIATIVES

Integrate Care

Reduce

Hospital Beds

Care Closer to

home

Quality and safety

Active Patie

nt Role

Reshape

Provision

QIPP £

Planned Care

Teledermatology* ü ü ü

“Optimise “- Referral Management*

ü ü

ü

Advice & Guidance ü ü ü ü

Threshold management ü ü

Mental Health

Dementia Suppport Workers

ü ü ü

Court Diversion ü ü ü

Positive Steps ü ü

Medicines management ü ü

Reshaping Provision

Weston Transition ü ü

Clevedon Transition ü ü

National Policy TBC

Demographic Growth

Maximise Contract Levers ü


2013/14 Financial Outlook

£238.8m - Funding Available

£234.8m - Prior year commitments

£0.9m - Cost inflation

£4.6m - Demand

£8.1m - National Policy

£10.6m - Savings Target

2013/14 Financial Outlook (as at February 2013)£m

2012/13 CCG Allocation 229,796 2012/13 Social Care Transfer Funding ( via LAT) - 2013/14 CCG Growth (2.3%) 5,293 2013/14 Social Care Funding (0.3%) via LAT - Anticipated Capital to Revenue Transfer 2,910 Surplus b/f 2012/13 751 Total Funding Available 238,750

2012/13 Funded Commissioning Budget 230,589 2012/13 Unfunded costs carrried into 2013/14 2,278 2012/13 Pre Commitments 1,914 2012/13 Social Care Funding Transfer 9via LAT)

Tariff deflation (-1.3%) (1,904)Other inflation (2%) 393 Prescribing (5.5%) 1,659 Tariff Impact 800

Demographic Growth 2,150 NICE /Quality Improvements 2,450 Cost of QIPP 901

National Policy - Carers/Mental Health 794 2013/14 Social Care Funding Transfer Increase to LAReinstate CQUIN (2.5%) 298 Headroom (2%) 4,702 Operating Surplus (0.5%) 1,176 Contingency (0.5%) 1,176

QIPP Savings Target (10,626)

Total Expenditure 238,750


QIPP 2013/14 Key Areas Process Financial and Activity challenges in acute sector quantified for

13/14 Growth to be met plus additional challenge specific to each CCG Credible plans coming from

Focus on High Impact Innovations Healthy Futures e. urgent care and Frail Older People Review of QIPP best practice reviews CCG plans emerging from local intelligence

Draft short form business case templates completed Further work reviewing impact/viability and ensuring

deliverability of plan overall during Dec CCG meetings

Highlights Frail older people assessment tool being championed across

local health community Unscheduled care developments being led through Healthy

Futures programme.


QIPP Programme 2013/14

Programme Ambition Status £000sLong Term ConditionsCommunity Wards Contain demographic growth in elderly emergency admissions Action 2013/14 500 Reablement - Nursing Home Placements Reduce nursing home placements for self funders Live 80 Maximise Clevedon Rehabilitation Beds Transfer patients from Weston/NBT to Clevedon - 2 beds Live 144 Community Heart Failure Reduce readmissions for heart failure Live 20 COPD Pulmonary Rehabilitation 10% reduction in emergency respiratory admissions Live 70 Urgent Care Weston Front Door - A&E Contain 2012/13 overperformance, demographic growth plus

benefit from extended primary care hours - see business case (5%)Action 2013/14 216

Weston Front Door - AEC Attendances Reduced pressure on A&E and extended hrs will reduce no of 0-1 LOS admissions

Action 2013/15 293 GP Prescribing Contain 2% demographic growth Action 3013/14 900 Planned Care Teledermatology 25% of patients referred into teledermatology Live 68 Contract Levers 1% of planned care budget Action 2013/14 350 RSS(PTS)/Optimise Reduce inapppropriate referrals/Improve quality of referrals Action 2013/14 - 2013/14 QIPP Programme 2,641


QIPP Pipeline 2013/14

Programme Rationale Status £000sUrgent Care CCT reconfiguration - Community Inreach to Weston Better links with community services will avoid more admissions Business Case TBCAmbulatory Emergency Pathways Local Trusts maximise use of 39 ambulatory care pathways Business Case TBCEarly Senior Review Evidence indicates potential 12% reduction in admissions Business Case TBCUrgent Care in Primary Care Scope ot improve urgent care response in primary care Business Case TBCAcute Mental Health Liason - Extend Cover Evidence of potential reduction in LOS and readmissions Business Case TBCDVT Pathway New pathway reduces no of outpatient attendances Business Case TBCLong Term ConditionsResidential care home admission to hospital Intervention to reduce the high number of hospital admissions Business Case TBCRisk stratification Early intervention to reduce downstream hospital costs Business Case TBCSelf Care Enabling Improved outcomes where patients actively manage care Business Case TBCCommunity Rehabilitation Improved quality of care provided in community Business Case TBCCommunity Geriatrician Evidence of improved outcomes Business Case TBCUnbundle stroke tariff Unbundle rehabilitation tariff to fund community service Business Case TBCPlanned Care Advice and guidance Reduce secondary care referrals Business Case TBCINNF Maximise clinical benefit Business Case TBCIncreased Use of decision aids Evidence of reduction in treatments where patients are informed Business Case TBC2013/14 Pipeline Schemes TBC


Closing the Funding Gap - £10.6m

£mFunding the Financial Gap 10.6

QIPP 2.6 Prior year flexibility 1.0 Non recurrent windfall gain 1.0 Applied headroom 4.7 Unidentified 1.3

Total Mitigation 10.6


Key Risks


Key Risk Areas Maturity of system and new organisations Transition management Capacity gaps especially during transition Financial challenge and risk Provider performance System and organisational focus Wider system pressures e.g. Local Authority Addressing health inequalities gap Community services keeping pace with shift

from hospital Provider reconfiguration

NORTH SOMERSET CLINICAL COMMISSIONING GROUP CLEAR AND CREDIBLE PLAN Version7 (final) 300413 Creating...

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