Commissioning Plan and Intentions April 2016 March 2017 Working - - PowerPoint PPT Presentation

April 2016 – March 2017

Commissioning Plan and Intentions

Working with the people of Camden to achieve the best health for all

Working with the people of Camden to achieve the best health for all

Introduction

This document sets out the Strategic Commissioning Plan and Commissioning Intentions

• f Camden Clinical Commissioning Group (CCG) for the period April 2016 – March 2017.

Aimed primarily at current and prospective providers, it describes how the CCG will use its commissioning budget to deliver the CCG’s strategic vision. Publication of this document forms part of the CCG’s strategic planning process. This involves working with partners, patients and the public in Camden, within North Central London, the wider NHS and the Local Authority. The commissioning plan and intentions are aligned to the CCG’s Business Plan, the Health and Wellbeing Strategy and the Joint Strategic Needs Assessment for Camden. This year the CCG’s intentions are also formed from the strategic commissioning review undertaken by the five CGGs (Barnet, Camden, Enfield, Haringey and Islington) in north central London (NCL).

Working with the people of Camden to achieve the best health for all

Commissioning Context

It is recognised by all partners that the scale of the financial challenge within the local health and social care system is significant and that we have to commission effectively in order to prioritise the improvement of health outcomes. Demand for services is predicted to rise and it is clear that without further wide-scale transformation the current system is not sustainable. Nationally, the recently published NHS England Five Year Forward View recognises the financial challenges facing the NHS over the coming years and indicates a drive towards closer integration of services and a strengthening of joint commissioning arrangements between health and social care services, the development of different models of provision and the transformation of primary care services. The plan also describes a stronger role for the voluntary sector with more emphasis on putting patients in control of their own care. There is also a strong importance on the use of technology and the role of public health in securing better outcomes for communities. Within this context, the CCG published its Business Plan earlier this year to guide planning and delivery. Work is continuing with NCL partner organisations and the London Borough of Camden Council to commission both strategically and operationally, to ensure improved outcomes for the Camden population.

Camden Story – Why Action is Needed

Needs

• Life expectancy gap

11.6 years in men (CVD/Cancer)

• 2nd  prevalence of SMI in

England

• High proportion 19-40s 

access to urgent care

• Poor outcomes in under 5s
• By 2017 over 85s  35%

Utilisation

• Demand increasing greater than population

growth

• e.g. in excess of 87,000 A&E attendances per

year for Camden Registered patients Outcomes National Outcomes Framework:

• Above-average results related to

preventing people dying prematurely

• Below-average for helping people

recover and live with illness Value

• 2nd highest spend per weighted

population of London CCGs with variable outcomes

• Spend on acute highest in

London

• Primary care spend among

lowest in London but good

• utcomes
• Mental health spend highest in

London

• Community care spend average

Camden CCG’s Strategic Vision

Working with the people of Camden to achieve the best health for all

• 1. Population level
• Predictably poor health outcomes
• Lack of focus on prevention
• Lack of personal responsibility for health
• Too little supported self-management
• 2. Systems level
• Reactive, poorly co-ordinated services, little

integration

• Focused on organisations’ needs not

patients’

• Fragmented, duplicative and inefficient
• Reliance on unplanned care
• Payments and incentives that do not support

integration

The challenges

• 3. Individual
• Complex patients mirror complex

system

• Primary care needs support to manage
• Health and social care not integrated
• IT systems need developing

Working with the people of Camden to achieve the best health for all 1. The emphasis of the NHS will have shifted

• Developing a systematic approach to

prevention

• Earlier diagnosis of disease
• Reducing inequalities in health outcomes

targeting vulnerable groups

• Encouraging individuals to take greater

responsibility for their health

• Supporting self-management of illness
• 2. All patients will experience
• Compassionate, high quality, effective and

efficient care pathways shaped by them

• Care that is integrated and focussed around

delivery of outcomes defined by them

• Easy access to services delivered in ways

and places convenient to them

• 3. For integration of care to be driven by
• Shared digital record for clinical records,

data sharing, measurement and evaluation

• Services to be commissioned and

contracted in ways that drive partnership and integration 4. Long-term financial sustainability will be achieved by

• Clinically-driven focus on the quality of

services

• Delivery of effective (evidence-based) and

efficient (right first time care) with savings achieved through cutting the ‘cost of chaos’

Camden CCG’s Strategic Vision

Working with the people of Camden to achieve the best health for all

The vision

Working with the people of Camden to achieve the best health for all

High quality services Identification

Good care in the right place at the right time Health and social care built around people’s needs …of people at high risk of illness or complications

• Clearly defined pathways
• Sufficient capacity and skills
• Quality of care information

measures & feedback

• Creating an environment that

promotes collaboration between existing services

• Investing in services/roles that

promote integrated care

• Contractually incentivising an

integrated care approach

• Adequately resourced services

responsible for identifying people at high risk

• Training
• Maximum use of IT capability

Improved Outcomes

Prevention where possible - Early diagnosis - Consistent quality - Patient consultation - Review and reconfigure if necessary

Integrated Care

Key Strands

Working with the people of Camden to achieve the best health for all

Future State

Upscale 1. Extend approach to focus on prevention, self supported care, out of hospital services and in hospital services 2. Wider geographical coverage 3. New structures/contracts to deliver new models Key messages 1. Integration of the whole system to deliver improved outcomes to populations and individuals 2. Measurement and evaluation drives quality and adoption 3. The clinical case for change can happen at pace

Working with the people of Camden to achieve the best health for all

The Organisation Has Aligned on Eight Objectives

Commission the delivery of NHS constitutional rights and pledges

A

Improve the quality and safety of commissioned services

B

Improve health outcomes, address inequalities and achieve parity of esteem

C

Integrate and enable local services to deliver the right care in the right setting at the right time

D

Work jointly with the people and patients of Camden to shape the services we commission

E

Involve member practices and commissioning partners in key commissioning decisions

F

Maintain financial stability and ensure sustainability through robust planning and commissioning of value for money services

G

Build a high performing organisation that attracts, develops and retains a skilled and motivated workforce

H Enablers Population segment addressed Children Adults Older people

Objectives agreed by the Governing Body:

Working with the people of Camden to achieve the best health for all

Commissioning Drivers – Business Plan Objectives

Working with the people of Camden to achieve the best health for all

Commission the delivery of NHS constitutional rights and pledges A Improve the quality and safety of commissioned services B Improve health outcomes, address inequalities and achieve parity of esteem C Integrate and enable local services to deliver the right care in the right setting D The CCG utilises the Business Plan to shape each commissioning intention to achieve individual objectives which in turn contribute to the achievement of our

• verall vision through the strategic planning process. For the purposes of

publishing our commissioning intentions plan, the first four business plan objectives below are used as the main drivers, segmented by our population groups.

Working with the people of Camden to achieve the best health for all

Business Plan Objective A – Specific Intentions

Working with the people of Camden to achieve the best health for all

Commission the delivery of NHS constitutional rights and pledges A Agree a framework of financial penalties and non-financial incentives for contract performance with all acute providers. Review diagnostic services at UCLH to ensure standard waiting times are achieved, commissioning additional services where required. Commission to ensure that there is sufficient capacity in the system to treat patients in a timely manner, working on the three most challenged specialties in 2016/17, with further added during the year. Improve management of drugs excluded from tariff through advanced notification procedures.

Working with the people of Camden to achieve the best health for all

Business Plan Objective B – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve the quality and safety of commissioned services B Review of early pregnancy service with commissioning to improve and increase access to early scanning out of hours. Implement the London Wide Maternity services review recommendations to improve services in Camden Using the Commissioning Intentions and Business Plan, Quality, Innovation, Productivity & Prevention Schemes (QIPP) will be scoped and developed and notified during the contracting round Implement contractual metrics for Acute Hospitals to improve and maintain performance levels – e.g. first to follow-up ratios Decrease variation, supporting evidence based safe prescribing practice in Primary Care Prescribing

Working with the people of Camden to achieve the best health for all

Business Plan Objective C – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve health outcomes, address inequalities and achieve parity of esteem C Commission a community hypertension intermediate service Deliver chronic obstructive pulmonary disease (COPD) service integration Deliver GP education for cancer including population awareness in high prevalence groups Commission an integrated heart failure service including atrial fibrillation specialist advice service Expand the locally commissioned service for patients with long-term conditions Improve quality of services to people with epilepsy and increase GP skills in managing complex patients Implement anti-coagulation locally commissioned services with the addition of virtual clinics

Working with the people of Camden to achieve the best health for all

Business Plan Objective C – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve health outcomes, address inequalities and achieve parity of esteem C Develop a single health and care reablement service Implement integrated vision/eye health strategy Implement Last Year’s of Life Plan Review of learning disability beds at Dunkley Ward to ensure they are delivering the desired outcomes for patients Transforming Care Programme – Review of all complex learning disability patients in long-term placements Implement autism strategy with social work and wellbeing support across Camden and Islington

Working with the people of Camden to achieve the best health for all

Business Plan Objective C – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve health outcomes, address inequalities and achieve parity of esteem C Implement first 1,001 days programme – working with Camden Council to maximise co-ordinated in-put into early years Commission All Together Better Integrated Child Health Projects – focusing on asthma, GP paediatrician clinics in primary care and health education programme for parents Expand oral health promotion programme Procure child obesity prevention and treatment services Community drug treatment services – streamline of existing services (Public Health services)

Working with the people of Camden to achieve the best health for all

Business Plan Objective C – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve health outcomes, address inequalities and achieve parity of esteem C Plan and commission a multi CCG model for dermatology to deliver community & acute services Complete work on Royal Free London pathways redesign to improve services in a group of specialities Extend audiology AQP contract to enable a full engagement and procurement exercise across NCL CCGs Continue funding of memory service Improve provision of IAPT services for people with long-term conditions and cancer Increase provision of early intervention psychosis service Redesign musculoskeletal service to deliver an outcomes based, integrated service

Working with the people of Camden to achieve the best health for all

Business Plan Objective D – Specific Intentions

Working with the people of Camden to achieve the best health for all

Improve health outcomes, address inequalities and achieve parity of esteem C Make the neurodevelopmental disorders pathways sustainable Redesign contract for supporting people with mental ill health to gain employment Expand personal health budgets to patients with a diagnosis of post-traumatic stress disorder (PTSD) Commission psychiatric liaison service across NCL and implement findings of Camden’s crisis review Commission the Recovery College for a further year with including an in-year evidence based review Re-commission sleeping tablet and minor tranquiliser service Work with Islington CCG to review and fund local provision of female psychiatric intensive care unit (ICU) beds

Working with the people of Camden to achieve the best health for all

Business Plan Objective D – Specific Intentions

Working with the people of Camden to achieve the best health for all

Integrate and enable local services to deliver the right care in the right setting D Strategically commission out of hospital services to include new models of care Review adult social care integrated care pilot Review Whittington adult community services, re-commissioning if necessary, and district nursing services to improve services and

• utcomes

Implement Telehealth development according to Camden Assisted Technology Strategy Develop integrated practice unit – include care navigators, multiple providers, social workers in GP practice and MDT teams Implement locally commissioned services for frail elderly patients including the rapid response GP service, over 75s home visiting services pilot

Working with the people of Camden to achieve the best health for all

Business Plan Objective D – Specific Intentions

Working with the people of Camden to achieve the best health for all

Integrate and enable local services to deliver the right care in the right setting D Complete joint re-commissioning of a 111 and OOH service with NCL including extending current contracts to meet revised procurement timeline Implement an integrated practice unit for people living with psychosis (subject to Governing Body approval September 2015) Implement the Emergency and Urgent Care Networks to shape the delivery of services across NCL

Working with the people of Camden to achieve the best health for all

Strategic Commissioning Process – Next Steps

Timetable The CCG’s work on Commissioning Intentions will be completed by end of September so that six month notice letters can be sent to all providers. These give formal notification to providers of changes to contracts, as well as setting out the CCG’s direction of travel. Engagement The CCG has engaged internal and external stakeholders in the creation of these

• intentions. This includes all member practices, including through forthcoming Locality
• meetings. In addition, the intentions will be considered by the Health and Wellbeing board

and Health Scrutiny Committee. Sign-Off The Governing Body is asked to agree the Commissioning Intentions for Camden CCG 16/17.