hartlepool and stockton-on-tees clinical commissioning group
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Hartlepool and Stockton-on-Tees Clinical Commissioning Group. Dr Boleslaw Posmyk, Clinical Chair Dr Paul Williams, Stockton-on-Tees Locality Lead. What we aim to do in our presentation. Describe to you: Our journey so far The people we work with and on behalf of - PowerPoint PPT PresentationTRANSCRIPT
Hartlepool and Stockton-on-Tees Clinical Commissioning Group
Dr Boleslaw Posmyk, Clinical ChairDr Paul Williams, Stockton-on-Tees
Locality Lead
What we aim to do in our presentation
Describe to you:• Our journey so far• The people we work with and on behalf of• Our challenges, opportunities and risks• Our plans for improvement• How we do things around here:
Our decision making and our leadership
Meet our Team • We are a membership organisation of 40 general
practices with devolved decision making to our Governing Body
• Our team has a strong clinical focus, bringing together a broad range of skills and experience together with a passion for improving the health outcomes of our communities
Our JourneyTwo pathfinder groups – Hartlepool and North Tees
Merged into one CCG (40 General practices) April 2012, with first Shadow Governing Body meeting as a sub-committee of NHS Tees
Rationale for coming together:• Shared vision and values• Similar health needs, levels of deprivation, challenges• Share acute, community and mental health providers• Avoids duplication• More financially robust• Increased pool of clinicians willing to take on lead roles• Small enough to maintain effective practice engagement through strong
locality focus and co-terminosity with LAs• Offered potential for synergy and sharing of good practice• Still able to work effectively with neighbouring CCGs especially South Tees
Hartlepool & Stockton-on-Tees CCGPopulation c285,00040 General Practices
Hartlepool & Stockton-on-Tees CCGPopulation c285,00040 General Practices
Meaningful Engagement - Our Stakeholders How we are working “together”
Hartlepool and Stockton-on-
TeesCCG
Stockton-on-Tees Borough Council
Local Safeguarding
Children's Boards
Safeguarding Adults Boards / LD partnership
Community Groups
Clinical Networks
Other CCG’s/Northern
CCG Forum
Professional Clinical
Leadership
Voluntary Sector
NHS Commissioning
Board/LAT
LINks/Healthwatch
Patient participation
groups
Public Health
Providers
40 Member practices
Health and Wellbeing Boards
Hartlepool Borough Council
Meaningful Engagement – our communities
Communication & Engagement strategyLocal EventsPPGs
LiNKs/HealthwatchScrutiny Forums
Our Health ChallengesRank distribution of electoral wards in various deprivation groups
Hartlepool and Stockton compared with EnglandIndex of Multiple Deprivation (IMD) 2010
Electoralwardrank
position
StocktonA population of ‘two
halves’
HartlepoolA population with
little relative affluence
1
1587
793
2380
5553
4760
6346
7139
3967
3173
7934
Most deprived wardsin England
Most affluent wardsin England
Park (6412)
Dyke House (44)(17) Town Centre
(7567) Ingleby Barwick East
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
England Stockton Hartlepool
51 to 100%
11 to 50%
0 to 10%
The starkness of inequalities in health
InglebyBarwick
Parkfield& Oxbridge
StocktonCentre
697478
747882
Lifeexpectancy Men
Women
Life expectancy reduces sharplywithin
very shortdistances
from periphery to centre
9 years for men
8 years for women
One of the consequences
of differences in riskare differencesin outcomes…
Levels of health worse than
Average
Health inequalities
Smoking related deaths higher than
average
Healthy eating, smoking & obesity
worse than England average
Hospital stays for alcohol admissions
higher than England average
Mortality from suicide & undetermined injury; Cancer;
circulatory disease; Gastrointestinal disease; and
Respiratory disease worse than England mean
Life expectancy lower than
average
High levels of child poverty
High levels of deprivation
Our Health Challenges
Our Vision
Reduced inequalities / Improved wellbeing
Our Aims
Our Values
Our Work streams
Our Priorities
commission high quality, sustainable and evidence
based services that respond to local need,
bring care closer to home and are cost effective
work in partnership to reduce health
inequalities and improve the health and wellbeing
of the population
Look for opportunities to innovate, involving
users, carers, staff providers and the public in transforming services
Engagement &
Patient focus
Quality & safety
Value, efficiency
and affordability
Integrity and
honesty
CourageAccountability
Health & Wellbeing
Out of hospital care
Acute in hospital care
Mental Health, LD &
Dementia
Medicines Management
• Address health inequalities
• Improve lifestyles
• Focus on particular groups i.e. carers and children
• Transform community care (TAPs)
• Bring care closer to home
• Care home management & quality
• Improve productivity
• Choice & quality
• Streamline care pathways
• Reduce urgent care attendances
• Develop MH/LD
• Improve equity
• Improve Dementia care
• PHBs
• Safe, rational and cost effective use of medicines
• Reduce variation
STRATEGIC
OUTCOMES
J S N A
H&WB
STRATEGIES
Our Plan at a glance
Income ShiftsTechnical Efficiency
ProgrammesUnderlying Cost Pressures Investments
Managing Financially Sustainable Position up to 2016
Change in Recurrent In-
come
Additional Costs from In-
flation
Expected CQUIN
Payments
Efficiencies from Tariff
Efficiencies from Non Tar-iff Contracts
and Prescrib-ing
Demographic & Demand
National Local-20000
-10000
0
10000
20000
30000
40000
50000
60000
70000
Future planning assumptions are:- Lower Growth - Increase in inflation - Lower Tariff Efficiencies - Increase in demographic demand
£’00
0s
Our QIPP Challenge• Benchmarking Tools Utilised to identify outliers
• NHS Comparators – emergency admissions, A&E attendances, outpatients per 1000 population
• PBMA – identify high spending poor outcomes• PBR Benchmarking – identifies provider performance issues ie new to review ratios• Prescribing EPaCT• Variation in spend on specialities across Tees• Variation across practices
• What it told us – increasing activity in acute sector, prescribing above national average, local FTs where not performing to top quartile in some areas, significant variation in referrals, admissions and resource use across GP practices
• What we did –• Looked for evidence of effective improvement methods (Kings Fund, National QIPP
programme, Institute of Innovation programmes, VMPS/NETs) • Engaged our practices and providers• Developed our QIPP programme around what the benchmarks told us and grouped these
against our workstreams, developed our Delivery Plan• Developed our monitoring arrangments
Improving Quality and Safeguarding
Improving quality is at the heart of what we do
• Safe and tested governance with our systems and processes
• Implementation and monitoring of Quality Dashboards
• Robust provider Clinical Quality Review Groups
• Development of a Quality Assurance Framework for all commissioned services
• Embraced Legacy Document – now preparing to receive Quality Handover Document
• Committed to driving up quality in primary care - GVISQ
Recognising our statutory responsibilities for safeguarding
• Working with our Local Authority partners• Executive Governing Body appointment
(Nurse)• Supporting our Local Safeguarding
Children’s Boards and Adult Protection Committee’s
Preparing for the future
Sir Robert Francis
Council of members
GoverningBody
Remuneration Audit QPF Governance &Risk
Fundingpanel
Locality groups x 2
Delivery team
Workstreams
HartlepoolH&WB
StocktonH&WB
Partnership / QIPP delivery
board
Quality & SafetyGroup
SafeguardingBoards
CQRG
NEC
SConstitutional & Governance arrangements
Capacity and Capability
Local NECS Team &Collaborativecommissioning
Chair
Chief Officer Designate /Accountable Officer
Chief Finance officer
Corporate Governance and
Risk Officer
Commissioning development /
Deliver Manager
Executive Nurse
GP GB members &
locality leads
Clinical Workstream
Leads
Assistant Finance Managers
Head of Quality and Safeguarding
(designated Adults safeguarding)
Designated Nurse
Children’s Safeguarding
Designated Doctor and
LAC lead
Partnership & Innovations
Manager
Partnership Project Officer
Corporate Office Administrator
Admin Support
Risks and Mitigations• Clinical Engagement
• Improving quality & safety
• Economic environment and financial challenge
• Hospital Reconfiguration/ Momentum
• Developed different opportunities at all levels of the organisation
• Strong relationships, strong governance, high awareness
The biggest task is alignment………..
• Evidence based Clinical mandate, strong relationships with OSC, good public engagement
• Robust QIPP plans & track record of delivery, preparation, contingency, good governance
The difference we are making• Highly effective GP, public and other stakeholder engagement • Winner of HSJ National award for Efficiency, Medicines Optimisation• Safer Care NE; Adult safeguarding award• Finalists for Commissioning Organisation of the Year (HSJ); Vision Award –
use of data, NE lean Academy; spread of innovation, • Reduced variation in primary care - improved clinical quality• Transformed community services – commissioning for clinical outcomes• Progressing Momentum Pathways to healthcare; redesigning 46 clinical
pathways, improving patient experience, reduced length of stay, increasing productivity
• QIPP delivery – securing financial sustainability