1. What will a cross boundary CCG mean for patients? Colin Renwick, GP Townhead Surgery,Settle. Board Member of Airedale Wharfedale and Craven Shadow CCG

2. Airedale Wharfedale and Craven CCG ‘We believe that GP practices should have the flexibility within the legislative framework, subject to having the geographic focus described above, to form consortia in ways that they think will secure the best healthcare and health outcomes for their patients and locality.’ Commissioning for Patients Consultation Document 2010

3. Responsibilities of CCGs  Elective care e.g. outpatient referrals/planned operations.  Non elective emergency care.  111 service and urgent primary care.  Mental health services.  Community services – nurses, podiatry, health visitors.  Maternity services.  Prescribing budgets.  Will NOT be responsible for General Practice, Dentistry, Opticians, Ambulance service, specialised commissioning eg forensic psychiatry – National Commissioning Board.

4. ANHSFT

5. Deprivation – Airedale Wharfedale

6. Deprivation - North Yorkshire

7. Health and wellbeing boards Key Functions Key Functions  To assess the needs of the local population and lead the statutory joint strategic needs assessment  To promote integration and partnership across areas, including through promoting joined up commissioning plans across the NHS, social care and public health  To support joint commissioning and pooled budgets where all parties agree it makes sense

8. NHS Constitution “We put patients first in everything we do by reaching out to staff, patients, carers, families, communities and professionals outside the NHS. We put the needs of patients and communities before organisational boundaries”

9. Challenges  2 Health and wellbeing boards – political agenda.  Unwarranted variation in quality, outcomes, activity  Rising demand, limited funds and limited workforce  Too many older people in the wrong part of the system for their needs or becoming avoidably dependent or ill  Avoidable admissions to hospital or long term care, and staying too long  Health services, institutions, professional values and training not geared to the needs of the (older) people who actually use them  Crossing of Local authority boundaries –different availability of services.

10. In our favour  CCG is majority user of local DGH which is both innovative and realistic –ANHSFT.  Common Mental Health Trust.-BDCT.  Shared providers of Community nursing services ANHSFT.  Single Ambulance Trust –YAS.  Working towards integrated 111 and urgent care provider.  Significant shared public engagement work already underway

11. Potential benefits of integration Better outcomes for service user Better outcomes for service user More efficient use of resources: “right care, right place, right time” More efficient use of resources: “right care, right place, right time” Improved access, experience and satisfaction Improved access, experience and satisfaction

12. GP Community Nurses Social services Ambulance service. 111 Directory of services Voluntary sector Point of contact Telehealth

13. Outcome Independent living continues +/- support Intermediate care Palliative care Long term care Acute hospital care Early discharge

14. Integrated team, single point of contact Patient/client Social worker Family, friends neighbours Re- ablement worker GP services Voluntary sector Mental health worker Hospital based services through telemedicine Occupationa l therapist Physiothera pist Community nurse Advanced nurse practitione r

17. How will we view success?  Reduced numbers of occupied beds.  Reduced emergency bed days.  Reduced delays in transfer from hospital.  Increased use of home care services.  Decrease in number of people in long term residential or nursing care.  Improved patient experience.  Financial sustainability.

18. How will patients view success?  Seamless pathway of care reduced confusion in secondary care.  Same services available to all –no local postcode lottery.  Improved integration between primary, secondary health care and social care.  Reduction in acute admissions.  Reduction in hospital length of stay.  Less need for long term care.  Locally responsive, clinically led and managed CCG.  A CCG that has its sight firmly set on the local health economy.