CCG Clinical Commissioning Forum

1. CCG Clinical Commissioning Forum Thursday 7th January 2016

3. UPDATE JANUARY 2016

4. PLANNING GUIDANCE • CCG allocations expected early January – will be 5 year allocation (3 years’ firm, 2 indicative) • Provider tariff announced in January – efficiency expectation of 2% • 4 elements to allocations – each with a new formula! • CCG spend • Primary care spend on GPs • Other primary care spend • Specialist spend • Each area gets an allocation for all 4 – these are added together and the total is how distance from target is calculated • Target is calculated in a new way – recognises age and sparsity not deprivation • DH is committed to increasing money for those under target rapidly • Under the old/current formula CH CCG is about 5.7% above target • CCG position now unclear – were ok over next 5 years but now??? • Position for Local Authorities is tough – also NHS providers • Good news is allowed access to centrally held surplus Collective perfect storm?

5. Growth in 16/17 is directed to Trusts to bring them back into financial balance • No details yet • Will be lots of strings attached to this • A&E, cancer, waiting times • Use of agency staff • Efficiency • Growth in 17/18 is dependent on an agreed 5 year Sustainability and Transformation plan (July) • This has to show improvements to • Health and wellbeing • Quality and safety • Finance • over 5 years • Plan must be developed and agreed by all local partners – commissioners and providers

6. WORKING TOGETHER What powers do we need? Would a different delivery arrangement work? Devo

7. WHERE WE ARE NOW • Devolution pilot approved • Now need to develop our plans and the devolution tests • Establishing a senior group across all organisations (providers and commissioners) to oversee and manage 5 year plan • Supported by workstreams on IT, estates, manpower, finance and commissioning, organisational design, communications • Start work on the specific plans (patient and clinical lead) and the financial outlook • Contracts for 16/17 will carry on as now

8. DEVOLUTION • Is an experiment – both locally and for London • Is to test out whether local decision making and/or a different delivery vehicle would make the money work better than leaving things as they are

9. Local decision making • So what things are decided outside Hackney where bringing it local might help us • More political powers around smoking/fast food • Should impact on preventable ill health • Should therefore impact on health spend • Test is – will we be able to do more and do it more quickly

10. Delivery vehicles Fewer contracts Fewer separate organisations – all in it together • Now • separate organisations, contracts aligned • Alliance model – mental health, One Hackney • Providers are tied together to achieve outcomes collectively • Lead provider model • contract with one organisation who then subcontracts (anticoag model) • One integrated organisation • NHS and social care • One budget to deliver outcomes (CCG commissioned?) • Accountable care organisation (ACO) • Has a budget for the population it serves

11. For GPs • At present big influence in commissioning via CCG – 8 Programme Boards with GP Chairs, 6 elected consortia reps, Governing Body – but less so in primary care due to conflicts • Provision is less well integrated – One Hackney and Mental Health are our main attempts to get providers to come together as teams.

12. END | NOTES

13. Integrated Care Programme Board Clinical Presentation to CCF January 2016

14. Key message re: event • Community nursing workshop • 20th January 12:30 onwards at the Tomlinson Centre

15. Current Performance • 1,247 >75s receive the frail home visiting service • There are 398 >75s who receive this service • Total = 1,645 (slightly less than 1,788 estimated)

16. Current performance

17. Evidence Base for FHV • November 15 NICE Guidance on Integrated Care and Frail Elders http://www.nice.org.uk/guidance/ng22 • Recommendations back-up Frail Home Visiting Approach and One Hackney and City • Care planning for frail patients key part of guidance • However evidence of health gain achieved via care planning and integrated care is very limited • Important for 16/17 to capture as much evidence as possible to back-up the impact that the FHV contract is having on improving patient experience and co-ordination of care

18. Frail Home Visiting Contract • Case finding • Undertaking visits for housebound patients • Care plans • MDTs • Quadrant meetings We propose keeping the same core elements

19. Key aspect – data collection • We need individual patient-level data to support on-going evaluation • The confederation are supporting CCG with an audit using c. 20 measures shown on next slide • How many of these 20 measures – if any – should we collect on an on-going basis? • Or should we collect this data via regular audits

20. Key aspect – data collection • Medication review • Medication Changes • Dementia assessment • Mental health assessment including depression/anxiety/low mood • End of Life review/issues recorded • Evidence of and assessment of substance misuse • Skin care assessment including pressure ulcers • Foot care assessment • Assessment for vision • Hearing assessment • Dental or feeding issues identified • Nutrition discussed and advice given • Mobility assessment • Housing and environment assessment • Assessment for social isolation and loneliness • Review of patients wishes and goals • Carers review • Onward referrals made and list of • Was a geriatrician involved in the care planning • Was the patient discussed at a practice MDT meeting • Was the patient discussed at a quadrant MDT meeting

21. Improving the City and Hackney care plan • Group of primary and secondary care clinicians will work on improving the care plan (CCG lead is Dr Nikhil Katiyar) • Positive feedback on new version of co-ordinate my care – this could be used for all frail home visiting patients, or just those at the end of life • GPs could also use a new updated version of the City and Hackney care plan • What works well in the current care plan? • What could be improved?

22. END | NOTES