1. NHS Trafford Clinical Commissioning Group
RIGHT CARE RIGHT TIME RIGHT PLACE
NHS Trafford Clinical Commissioning Group
AGM
30th September 2014

2. Dr Nigel Guest, Chief Clinical Officer
Introduction
Dr Nigel Guest, Chief Clinical Officer
and
Dr Kath Sutton, Chair

3. Chief Operating Officer / Director of Commissioning and Operations
2013/14 Operational Performance
Gina Lawrence
Chief Operating Officer / Director of Commissioning and Operations

4. Our Constitution promises to update you on:
How members of the public have been involved and engaged
Delivery of our Quality Strategy
Improvements made across Primary Care Services (GP’s)

5. Annual Public Involvement
Communication and awareness program for the implementation of Trafford New Health Deal
Patient involvement in service development including personal health budgets
Development of New Health Deal Patient Reference Group to scrutinise integrated care
Recruitment to Patient Reference and Advisory Group
Equality delivery system: where local stakeholders graded us as a CCG as amber (developing) on our performance against Goal 4 of the framework.

6. Progress against delivery of the Quality Strategy
NHS Trafford CCG has a three year Quality Strategy which is in the process of being refreshed; we have three main ambitions in respect of quality these are:
Safer Care: We will ensure the care we commission is safe
Better Care: We will ensure that the care we commission is clinically effective delivering better health outcomes for our patients
Patients at the heart of care: We will ensure that we will engage, listen and respond to what our patients want at every stage of the commissioning process, to ensure our patients have a voice in everything we do.

7. NHS Trafford CCG Quality Strategy
Achievements 2013/14:
CCG hospital visits
Quality standards in all contracts
Commissioning for Quality and Innovation Schemes (CQUINs) in all providers across Greater Manchester encouraging them to use change improvement methodology to sustain change improvement
Pressure ulcers
Early warning system in place
Achievement of all locally agreed Commissioning for Quality and Innovation Schemes (CQUINs) in all providers
Expert commissioners in place
Patient engagement framework

8. Quality improvements made across primary medical services (GP’s)
Quality Improvement Programme
GP IT
Locality partnership working
Management of high risk patients

9. Areas of work commenced / completed in 2013/14
Including;
Quality and performance
Adult Safeguarding
Urgent Care services
Cancer
Patient Care Co-ordination Centre

10. Performance Highlights for 2013/14
Central Manchester Hospitals (CMFT)
Delivered the A&E standard of 95% of patients being seen, treated and discharged within 4 hours of arrival across the year
Patients’ privacy and dignity were prioritised and all patients were cared for in a same sex ward
Waiting times were kept short and all national standards were delivered
Patients on a cancer pathway received timely diagnostics and treatments throughout the year
Wythenshawe Hospital (UHSMFT)
Speedy access to diagnostic tests to support clinical decision making was achieved throughout the year
Following a stroke, most patients spent at least 90% of their hospital stay on a dedicated stroke unit
Recall systems for patients attending the breast service were changed to be brought in line with national best practice
Waiting times were kept short and national standards were delivered

11. Quality Highlights for 2013/14
Central Manchester Hospitals (CMFT)
Achieved in full the majority of CQUINs
The Quality Standards as set out in our contract with the Trust were fully met in 2013/14
CMFT has undertaken a large programme of work in relation to harm free care with a focus on pressure ulcers
CMFT were inspected by the Care Quality Commission (CQC) in December 2013, following this action plans were put in place around nutrition and records
Wythenshawe Hospital (UHSMFT)
Achieved in full 27 quality improvement indicators (CQUINs), and partially achieved 6 indicators.
The Quality Standards as set out in our contract with the Trust were met in full for the majority of areas. Where quality standards were not met in full and action plan was put in place.
Following an inspection from the Care Quality Commission (CQC) an action plan was put in place monitoring the quality of service provision.
Trafford Community Services (Pennine Care Foundation Trust)
These services achieved all CQUINs and Quality Standards last year.

12. Adult Safeguarding 2013/14 – year of partnership working and reform
Led the reform of Trafford Adult Safeguarding Board
Established Operational Adult Safeguarding Board
Implemented new governance and risk management arrangements
Implementing Prevent agenda across local health services
Working with children’s services to look at the whole family picture
Working to support implementation and develop understanding of Mental Capacity Act, 2005
Supporting the Deprivation of Liberty Safeguards
Working with NHS Providers and contractors to improve understanding of safeguarding adults
Working to improve care, standards and safeguard vulnerable people in Care Homes

13. Trafford Urgent Care Services- Planned changes to Trafford General Hospital
27th November 2013 – A&E Department closed
28th November 2013 – Urgent Care Centre opened ( midnight daily) (impact on CMFT, UHSM & SRFT)
Community Services delivering – enhanced services
in the community, including Rapid response, community Matrons, IV therapy service etc.
Travel Bureau in place to support patient transport
Travel support scheme in place by Trafford CCG to support patients
Contact numbers
Enhanced services
Travel Bureau   
Link services   

15. Trafford Urgent Care Centre
This department is open from 0800 – midnight
This department will treat:
All A&E activity delivered by ambulances(some Trafford Patients will be  taken to other hospitals due to their complexities and symptoms decision by NWAS )
All activity which self-present
The medical admissions unit will receive all admissions by GP’s
This department is fully staff with A&E staff , the department will treat a wide range of emergencies.
Patients will be treated quickly by professional and competent staff.   

16. Cancer: 2013/14 Macmillan GPs appointed:
Dr Helen Marsden – End of Life care
Dr Ann Harrison - Cancer
2013/14 Cancer was (and still is) a priority for the CCG:
To influence the development of cancer services within the local commissioning structures.
To improve cancer awareness in primary care to improve standards
To educate primary health care teams
To support pathway and service redesign
To enhance communication between all levels of care to promote a seamless service and improved patient experience.
Living With & Beyond Cancer pilot – 2 GP Practices

17. Patient Care Co-ordination Centre
A Proactive Health and Social Care System
The patient care co-ordination centre is the ‘glue’ that will hold the provision of services together
All patient journeys will go through this service
It is an essential part of our integration strategy
Will deliver efficiencies to all organisations
Patients always getting the right care at the right time
A focus on complex cases and vulnerable people

18. Patient Care Co-ordination Centre
Since October 2013 we have been running a tender process to select a provider capable of delivering the PCCC
We have spent a significant amount of time engaging in dialogue with providers to ensure that they will be able to deliver a service which meets the needs of the Trafford population
We expect the PCCC to be in place, and making a difference to patients in Trafford, by June 2015

19. Joe McGuigan Chief Financial Officer
2013/14 Financial Performance
Joe McGuigan Chief Financial Officer

20. 2013/14 Financial Duties / Performance
Trafford CCG achieved all of its financial duties for 2013/14
Delivered financial balance; achieving a surplus of 1% (£2.8m) meeting NHS England requirements.
Remained within the notified revenue Cash Limit and its running cost target (£25 per head less than 2%)
Managed to pay over 95% of its suppliers invoices within the NHS target of 30 days
Delivered £6.5m of savings, exceeding its plan by £0.5m
Had an unqualified and clean audit report; accounts and value from money perspective

21. New investments in 2013/14
£1.7m (£3m in 14/15) in Community Services, Urgent Care, Community Matrons, IV Therapies etc.
£1m key mental health initiatives; RAID/ RADAR/ IAPT
£200,000 in a new stroke early support discharge service.
£300,000 supporting new developments in COPD (chronic obstructive pulmonary disease) services
£100,000 to improve access for patients with Musculoskeletal conditions

22. 2013/14 – Where was the money spent?

23. What services did we commission from our hospitals?
29,000 ‘planned’ treatments; average £1,100 each
25,000 ‘emergency’ treatments; average £1,900 each
328,000 outpatient appointments; average £100 each
88,000 A&E attendances; average £92 each
3,900 days in critical care; average cost of £1,200 each

24. So, how much did this cost in 2013/14?

25. What other services did Trafford CCG commission?
A total of 4.8m of prescribed drugs; at a cost of £36m or just under £160 per person in Trafford
Community (c£20m) and Mental Health Services (£18m)
Funded nursing care and continuing care support and placements; at a cost of c£11m
Emergency and non-emergency ambulance services; £6.5m
GP ‘Out Of Hours’ services; c£1.7m

26. Financial Position, now and going forward

27. National and local finance looking forward
People continue to live longer; not necessarily healthier; so health illness prevention will need to be targeted to right outcomes
TCCG has to deliver savings of £22m over next 5 years; £80m across health services within Trafford economy; challenging !
Public involvement/engagement to focus on agreed investments
Clinical led re-design with General Practitioners, hospitals, social care working together to deliver sustainable better outcomes
TCCG will continue to integrate care; greater quality/efficiencies; in line with its 5 year strategic plan

28. Dr Nigel Guest Chief Clinical Officer
Future NHS Trafford CCG plans 2014/15
Dr Nigel Guest Chief Clinical Officer

29. Priorities and work underway and planned for this year
Including;
Co-commissioning
Cancer (local and Greater Manchester wide)
Cervical screening
Personal health budgets
Adult safeguarding
Mental Health (local and Greater Manchester wide)
Diabetes
Musculoskeletal Services
Community dermatology
Clinical Assessment and Treatment Service
Cardiology
Better Care Fund

30. Co-commissioning in primary care
Trafford CCG will look to take back some of primary care commissioning, including but not exclusively;
Contract management of extended GP services
Education and training
Complaints management
Development of new services
Revising existing contracts

31. Cancer (Greater Manchester level): 2014/15
Trafford CCG’s intentions as the lead organisation for cancer at a Greater Manchester level are:
Support the Specialist Teams in buying compliant services
Develop and implement revised service specifications for breast cancer and acute oncology services
Develop a GM commissioning strategy for cancer

32. Cancer (local level): 2014/15
Raising profile of Macmillan GPs
Primary Care
Analysis of cancer referrals and GP education
Dermatology audit carried out
Consider Macmillan Quality Standard Mark for practice (information/champions)
Priority areas for Trafford CCG
Palliative/End of Life
Screening with a particular focus on;
- cervical screening
- bowel screening
- breast screening
Support of Living With & Beyond scheme for a further year

33. Cervical Screening: 2014/15
Delivery of a joint Trafford CCG and Trafford Council Cervical Screening Plan
Committed to achieving the national target – striving for 80% of eligible patients to have had smear by April 2015
Joint plan contains over 15 new initiatives including:
A patient survey asking Trafford residents what the barriers are to attending for a smear
Trafford local poster and radio campaign titled ‘It only takes a minute’
Work with local community groups including BME community groups and Gay and Lesbian foundation
Intensively working with GP practices with lower than average screening rates
Bridgewater Services extending their service to offer smear for mums attending Children's Centres

34. Personal Health Budgets
The offer of a Personal Health Budgets is made to all patients who are eligible for continuing healthcare funding.
Successful implementation of Personal Health Budgets programme – patients are already using these
A group are now meeting to offer this more widely to patients
The programme works with three third sector organisations

35. Adult Safeguarding 2014/15 – year of public
engagement and participation
Implement the requirements of Care Act 2014
Further Prevent training
Revision of adult safeguarding policies and procedures
New training programmes – specialist and expert practitioner programmes for practitioners
Public engagement – Adult Safeguarding Board to be open to public from April 2015
Adult Safeguarding Reference Groups to include public representatives – shape and influence
Recruit more “lay members” to sit on Adult Safeguarding Panel Hearings
Targeted advertising campaigns throughout 2014/15
Increased public awareness of and participation in Adult Safeguarding

36. Mental Health across Greater Manchester
Association of Governing Groups (AGG) 2014/15
Leading joint working with key partners across Greater Manchester
Working with Greater Manchester Police on delivering the Crisis Concordat
Development of Greater Manchester Alcohol Strategy
Development of a learning disability standard to reduce premature deaths
Development of a Joint Health & Social Care Self Assessment for learning disabilities

37. Mental Health progress in Trafford 2014/15
Performance in line with national / local priorities
Improved access to psychological therapies
More dementia diagnosis + post diagnostic support + less meds
Working to reduce demand on Police service
Psychological liaison service in place across Trafford
More autism support
Extra community eating disorders services
Fewer restrictive secure hospital placements
Public sector reforms – Early Intervention and Working Well

38. Diabetes
People with diabetes in Trafford are more likely than the general population to have:
Myocardial infarction 83.9%
Stroke 77.2%
Hospital admission, heart failure 22.3%
Trafford Diabetes Network has been established to produce a Diabetes Strategy for Trafford focusing on prevention, early diagnosis and care.
The Strategy builds on work already done around integrated care
The Diabetes Strategy for Trafford will be presented to Trafford CCGs Governing Body in February 2015.

39. Musculoskeletal Services
Service review discovered a lack of :
integration
not enough capacity
increasing patient demand
Patients and professionals agreed that the service should be:
joined up
provided by a multi-disciplinary team
self-management and prevention focused
more capacity
A service model has been created to ensure that future musculoskeletal services will be outcome driven and not activity based and support the above requirements for a successful service.

41. Community Dermatology
Issues with capacity
Business case approved by Trafford CCG’s Management Team.
Procurement process has commenced to identify one provider - to manage conditions that do not require specialist intervention at secondary care level - across all three CCG areas to get best value.
Notice is being served on our main providers.
Two community locations to be identified.

42. (Clinical Assessment and Treatment Service)
CATS
(Clinical Assessment and Treatment Service)
Trafford’s current performance:
Year to date 2014 to M4 80% of 85% contract utilised
£753k of services used, £152k not used up to M4
GPs should continue to utilise CATS
Current contract ends Feb 2016 – Care UK will stop accepting referrals from November 2015.

43. E-consult service being set up to support GPs
Cardiology
30% of cardiology conditions are regarding irregular heart rhythm issues; 80% of these could be managed in the community
E-consult service being set up to support GPs
Supported by ECG clinical interpretation service
A Locally Commissioned Service will be set up with Primary Care for the ECG service

44. This will be £15.4m for Trafford
Better Care Fund
National initiative to improve care for the most frail and elderly residents
Brings together existing health and social care resource into one budget
This will be £15.4m for Trafford
Aims are to reduce admissions to hospital, reduce the amount of time people spend in hospital and supporting people to remain at home.
Three Projects: (next slide)

45. Health and Social care Integration
Better Care Fund
Better Care Fund
Frail and Older People
End of Life Care
Health and Social care Integration
Community health and existing social care offer to delivered as one service
Improve patient experience
Avoid duplication
Aligned to neighbourhood model
Falls Service
Reducing the amount of time people spend in hospital
Avoiding admission
Geriatrician support in the community
General practice for Nursing homes
Education to improve skills across the workforce
Improving patient, family and carer experience
Greater connectivity between services through IT
Prompting advance care planning
Supporting the voluntary sector to deliver non-clinical care

46. Post / web deadline:
5pm on 24th October 2014

47. Priscilla Nkwenti Panel Chair, Trafford CCG
Looking ahead: Introducing the NHS Trafford CCG Public Reference and Advisory Panel (PRAP)
Priscilla Nkwenti
Panel Chair, Trafford CCG

48. Public Reference & Advisory Panel
Trafford CCG is committed to putting the voice of patients, public and stakeholders at the heart of decision-making.
The Public Reference & Advisory Panel will be recruited to represent the views of the Trafford public and its representative groups.
Sub-committee of Governing Body
Meet monthly initially, then bi-monthly

49. Clinical Commissioning
Duties
Clinical Policy
Clinical Commissioning
Clinical Redesign
Performance
Prioritisation
Public engagement
Culture & values
For example:
In terms of
- Clinical Commissioning & Performance – a member of the PRAP attends the Locally Commissioned Service Group meetings, which discusses progress on work programmes for the implementation of locally commissioned and enhanced services with GP, pharmacy and optometrist providers
Clinical redesign – the PRAP will be able to review and comment on Project Initiation Documents of upcoming projects (this will be highlighted later in the presentation)
- Prioritisation – A member of the PRAP sits on the CCG’s Individual Funding Request Panel
Culture & Values – the PRAP will be involved in the evaluation of the CCG’s performance in respect of its desired culture & values
- Public Engagement – the PRAP can provide advice on the most appropriate way to engage with the public and stakeholders

50. For example:
Clinical redesign – the panel will be able to review and comment on Project Initiation Documents of upcoming projects (this will be highlighted later in the presentation).
Clinical commissioning – A PRAP representative attends the Locally Commissioned Service Group meetings, which discusses progress on work programmes for the implementation of locally commissioned and enhanced services with GP, pharmacy and optometrist providers. PRAP will also consider the delivery of commissioned services from the perspective of value for money & contribution to health of Trafford population
Prioritisation – A PRAP representative sits on the CCG’s Individual Funding Request Panel
Public engagement – PRAP can provide advice regarding the most appropriate way to communicate and engage. PRAP recently considered how best to capture patient stories from a wide selection of communities in Trafford
Culture and values – The PRAP will be a key contributor to the assessment and evaluation of the CCG’s performance in respect of its desired culture & values

51. Public Reference and Advisory Panel Representation
4 x Public Reps
 North – Shabir Abdul
Central – Gill Leng
 West – George Devlin
 South – Pat Lees
4 x Third Sector/Voluntary Organisation Reps
 Ann-Marie Jones - Age UK
 Chris Jacob - 42nd Street
 Khan Moghal - Voice of BME Trafford
 Lesley Thornton – Counselling & Family Centre
CHAIR
Priscilla Nkwenti – CCG Vice Chair/Lay member lead for engagement
4 x GP Patient Participation Group Reps
North (Ann Day to cover)
 Central
 West – John Howe
South – Lesley Spencer
1 x Trafford Healthwatch Rep
 Brian Wilkins
Following recruitment process, recruited all our public reps and third sector reps.
Still need to recruit from North and Central GP Patient Participation Groups
Ann Day from Healthwatch will cover North until we fill post. Central no-one to cover.
Would you like to ask if HW could cover or shall we try to recruit again?
1 formal rep from Healthwatch too – Brian Wilkins.
North – Old Trafford, Stretford
Central – Sale, Ashton on Mersey
West – Flixton, Urmston, Davyhulme, Partington
South – Altrincham, Timperley, Hale

52. Where does the Panel fit in?
Trafford Clinical Commissioning Group
Governance & Commissioning focus
Patient focus
Patient focus
Healthwatch Trafford
Trafford CCG Governing Body
Integrated Care Reference Group Feedback
Finance & Commissioning Committee
Quality & Performance Committee
Public Reference & Advisory Panel
GP Patient Participation Groups Feedback
- Prioritisation
- Policies
- Projects
- Locally Commissioned Services
Further opportunities for PRAP rep involvement, for example:
2 x PRAP Reps to sit on:
- Individual Funding Request Panel
- Process Review Panel
Additional groups to be developed

53. What has the panel been involved in

54. Upcoming work programme:
Projects include:
- End of Life
- Falls Strategy
- Primary Care Strategy
Respiratory Programme
Patient Care Coordination Centre – role on Programme Board
Other projects will come to the panel once they are up for redesign

55. Questions???

56. Concluding remarks