#glosSTP

Showcase on Gloucestershire’s Sustainability &

Transformation Plan

Ellen Rule, Director of Transformation & Service Redesign & STP Programme Director

#glosSTP

Top Line Messages:

http://www.gloucestershireccg.nhs.uk/gloucestershire-stp/

We will: • Invest in keeping people healthier for longer by enabling

communities to support each other, and support self care and prevention

• Reduce unwarranted variation, cut waste, and fund interventions that can deliver the greatest health benefit for our population

• Ensure that care is delivered efficiently and effectively, as close to home as possible

• Deliver integrated care with community services to support physical and mental health needs through 16 GP Clusters

• Have a clear integrated approach to urgent care provision, so that people will know when and where to access urgent care

• Introduce urgent care centres and streamline assessment services and reduce waiting times for our population

• Have a ‘one county’ approach to IT, Estates, and other system enablers

• Introduce countywide leadership, training, education and learning opportunities

#glosSTP

The scale of our challenge:

During 2016/17, public health developed a health needs assessment to inform the plan

#glosSTP

Enabling Active Communities Update: • Shortlisted for Sport England’s Active Ageing Fund • Daily Mile - 10,000 pupils from 43 primary schools (including 2 special schools) • 40 businesses having signed up to the Workplace Wellbeing Charter • Rolling out National Diabetes Prevention Programme (NDPP) • 7 Double Decker buses of weight has been lost so far via Slimming World • Social Prescribing Programme across all 81 practices and community teams,

including innovative cultural commissioning approach • Self Care & Prevention Board allocating £1.9m Prevention Fund: e.g.

– Remodelled Self-Management / Expert Patient Programme – £120k – Early Identification of Domestic Abuse - £160k – Postpartum contraception £200k (Inc. £100k contribution from GCC) – Breastfeeding social marketing project - £50k

#glosSTP

Clinical Programme Approach: • Cancer Programme:

– Macmillan investment of over £4m, Delivery of a successful early diagnosis programme & Community Based ‘living with and beyond’ Cancer

– Holistic Needs Assessments being undertaken in all 3 cancer site clinics − Top 20 CCG’s to improve one-year cancer survival rates (APPGC).

• Eye Health: – Delivery of a new community eye care service in 2016/17 with a staged roll

out of community pathways, Cataract pre-operative assessments -1,342 patients seen to date, Minor Eye Conditions (MECs) - 422 new appointments and 28 follow ups, Children's School Vision Screening uptake increased from 66.3% to 90%, audit shows significant sight loss prevented in 50 children

• Circulatory Programme: – Troponin-T pilot for chest pain increased rate of

patients home from ED from 32% to over 50% – 468 devices moved to remote monitoring – 51 practices completed the Don’t Wait to

Anticoagulate project substantial stroke reduction

#glosSTP

Clinical Programme Approach: • MSK CPG

– Orthopaedic elective procedures reduced by around 4% per year for the last two years , pathways published on G-Care to support delivery

– 8.4% reduction in falls related admissions compared to 15/16, new falls team and working with fire service doing home safety checks to spot falls hazards

• Mental Health CPG – Improved access to services for Children & Young People (CYP) by 5%, (419

students seen by Primary Mental Health Workers in school (January – June 2016), of which 271 (65%) needed no onward referral )

– The Cavern crisis café opened in July 2016, last month 529 visits were made to the service resulting in a significant impact on A&E admissions

0

50

100

150

200

250

300

350

400

Apr

May Jun Jul

Aug

Sep

Oct

Nov De

c

Jan

Feb

Mar

Falls Comparison 15/16 to 16/17

2015/16 2016/17

#glosSTP

Reducing Clinical Variation: • Ongoing medicines optimisation programme is focussed on reducing waste and

prescribing the most cost effective medicines with savings of £3.5m in 16/17. • De-commissioning of Gluten Free food on NHS prescription and reduced Sip

Feeds prescribing (83% reduction in gluten free prescribing to date) • Reduction of variation in follow-ups and roll-out of new models of follow up

care including negotiated and telephone follow ups. Early pilots included work in Rheumatology where open follow up model reduced follow ups by around 80%

• Living Well With Pain Programme is developing a new model of MDT care using cultural commissioning. A new Joint Formulary is being rolled out to support prescribers and patients to make the best choices of medicines for pain.

#glosSTP

One Place – New Models of Care

8

Locality led New Models of Care – 81 independent GP practices have come together as 16 GP Clusters, supporting populations of circa. 30,000-50,000 population developing new models of care based upon the needs of local population focussed on ‘Place’.

GPFYFV Building resilience and introducing extended access in primary care.

#glosSTP

One Place: Urgent & Emergency Care Significant delivery issues: • Access standards consistently not met • Confusing for users and staff • Fragmentation with lots of “hand offs” • Poor access to urgent diagnostics in the community • No easy access to an urgent specialist • Ineffective streaming Model with all people potentially requiring admission channelled

through A&E departments, A&E departments too small and struggling to respond to surges , risk that treatment for really sick patients is delayed

Early Impacts: • Reduce demand - There has been a significant reduction in 999 demand by 4.7%

YTD, Ambulance conveyance levels have stabilised throughout this year at 44.9% • Avoidable emergency admissions across our system are showing signs of reducing -

to end Nov admissions reduced below levels seen last year (data issues) Next Steps: • Performance Recovery / Review of Acute Service models for urgent care • Comprehensive planning for Urgent Care Centres completed in partnership with

clinical representation from localities, model covers urban and rural centres

#glosSTP

System Enablers: • The Workforce & OD Strategy is focusing on: Capacity, Capability & Culture with an

Information Sharing Gateway in development • IT Strategy group have worked extensively on JUYI and Local Digital Roadmap.

The Estates and Technology Transformation Fund (ETTF) • The Estates Strategy group have developed the ‘One Gloucestershire’ Strategic

Asset and Delivery Plan (SADP) which was submitted in December 2016. • The Improvement Academy has agreed a joined up approach and has delivered a

programme of QSIR courses to over 140 staff members to date

• Our Primary Care Strategy has been developed with a revised GP Five Year Forward View Plan. Innovative Primary Care Offer in place across county

• A cross-organisational virtual STP PMO approach has been agreed and the Programme Development Group have worked extensively on STP Solutions and ensuring alignment to contract agreements. A Strategic Networking Away Day was successfully held on 2nd February 2017 for Programme Areas with a further Clinical Away Day arranged for 13th June 2017

#glosSTP

Focus on Pain Programme: • Prevalence of persistent pain

– 13% UK adults – Up to 80 000 patients registered with GPs in Glos

• Effects of pain – Mood, sleep, mobility, social role, vocational role – Impact on family/carers – 20% UK healthcare budget spent on back pain

• Challenges in treatment – Few highly successful interventions – Gabapentin / Pregabalin 12 million prescriptions, £344

million annually – Opioids, 24 million prescriptions, £292 million annually

#glosSTP

Costs of Analgesic Prescribing in Gloucestershire

Drug(s) Cost (£ Opioids 2,644,470 Paracetamol 724,463 Gabapentin 266,031 Pregabalin 2,680,826 Co-codamol 745,545 Co-drydamol 80,236 Co-proxamol 105,008 Total £7,246,583 * ePact data – Mar 2016 – Feb 2017

457 reviews: 226 not on treatments for chronic pain n=231, 46 reviews of medicines In General • Medicines: lack of evidence • Injections: lack of evidence • Psychological interventions:

lack of long term evidence • Exercise interventions: some

evidence

#glosSTP

Living Well With Pain Programme: Objectives

Education

Services for complex patients

Deliver Savings & Reprioritisation

Service Redesign

Masterclasses / Locality Meetings Pain Formulary / Podcasts Joint Management of Complex Patients Collaboration with Cochrane G-Care / Patient Information

Outreach pilot complex patients Designing therapeutic spaces Improved pathway and confidence in managing pain Specialists to focus on complexity Pain Patient Reference Group

Use of Prescribing data Referrers / patients information Complexity outreach pilot Developing assessment tools Review of healthcare utilisation Non Medical innovations De-prescribing support

Costs of prescribing Rate of GP consultations Referrals to secondary care for pain management support Assessments and interventions in secondary care Re-prioritise to holistic support

#glosSTP

Some Case Studies:

• Cultural Commissioning pilot for Chronic pain, film is: https://vimeo.com/183982408 (Password: GlCCGfinal)

• Cultural Commissioning Project for young people with diabetes, in partnership with G Dance: https://www.youtube.com/watch?v=7VV3fP1iF94

• More information about Artlift – one of our main providers of Arts in Health in Gloucestershire http://www.artlift.org/