Enfield Patient Participation Groups Enfield CCG: Commissioning Intentions and New Models Of Care Graham MacDougall Director of Commissioning September 2016

Content Strategic Drivers Update on New Models of Care Commissioning Intentions Next Steps Local clinicians working with local people for a healthier future

Local clinicians working with local people for a healthier future Strategic Drivers CCG Special Measures and Financial Recovery Local Integration of Health and Social Care CCG Improvement and Assessment Framework Right Care Sustainability and Transformation Plans (STPs) Local clinicians working with local people for a healthier future

CCG Special Measures & Financial Recovery CCG one of 9 under special measures mainly due to financial issues Spending more than we earn Aggressive financial recovery Need to consult on difficult choices including any decommissioning Local clinicians working with local people for a healthier future

Local Integration of Health and Social Care All local health and social care areas need to have integration plan for 2020 by end of this financial year We need to define the level of our integration ambition Impact of STP and NCL CCG structure on local commissioning Local clinicians working with local people for a healthier future

CCG Improvement & Assessment Framework Four domains: Better Health, Better Care, Sustainability and Leadership, Better Health – includes prevention Better Care – early cancer diagnosis, new waiting times, choice in maternity services Sustainability – financial recover, delivery through new models of care Leadership – involvement in developing the STP Local clinicians working with local people for a healthier future

Right Care Established transformation programme at NHSE using benchmarked data on activity, spend and outcomes – comparison with peer CCGs Improve the value that the patient receives from their own care and improve the value the whole population receives from the investment in healthcare Enfield has higher rates of surgical interventions in Musculoskeletal (MSK) conditions by around £800K – redesign of MSK system to offer greater options than surgery. Other areas include Cardio Vascular Disease (CDV) and Mental Health Local clinicians working with local people for a healthier future

Sustainability & Transformation Plans (STPs) North Central London footprint developing 5 year strategic transformation plans to bridge the health and wellbeing gap, care and quality gap, efficiency and financial gap Transformation at scale of multi-provider systems using new models of care Elective care, out of hospital care, mental health, urgent and emergency care, primary care Significant impact on local commissioning plans Next submission end of September Local clinicians working with local people for a healthier future

New Models of Care 50 vanguards nationally 9 Primary and Acute Care Systems (PACS) 14 Multi-Specialty Community Providers (MCPs) 6 Enhanced Care Homes (ECH) 8 Urgent and Emergency Care Providers (UECP) 13 Acute Care (AC) Local clinicians working with local people for a healthier future

New Models of Care Still fairly embryonic and developing their systems of care and therefore assessing impact Range of governance arrangements Overlaps between the different models MCPs significant focus on out of hospital care for complex populations – older people, people with Long Term Conditions – integration across providers to improve patient experience, easier access, co-ordinated care, reduce unnecessary activity from the system Local clinicians working with local people for a healthier future

New Models of Care PACS: Integrated delivery across a pathway with integrated teams across acute, primary care and community, focus on LTCs, advice and info and self care UEC: enhancing mental health provision, increasing access to primary care clinicians at front end, self care and self management, Click, Call, Come In, rapid response, single unified budget All are enabling collective responsibility for populations Many taking outcomes based approach to delivery – changing the commissioning currency Future proofing demand management Local clinicians working with local people for a healthier future

Commissioning Intentions We cannot carry on spending in the same way Getting the best value for what we spend – we spend £1.5m more on Procedures of Limited Clinical Effectiveness than neighbouring CCG Meet our national and constitutional targets Scale up delivery via the STP Take account of 2017/19 two year contracts Make best use of technology – e.g. Tele-dermatology Develop new models of care with local providers to best shape future care and demand. Where does it make sense for providers to integrate delivery to ensure collective responsibility for a population Local clinicians working with local people for a healthier future

Commissioning Intentions Maximise the impact of current investments within contracts Some major service transformations in mental health are commissioning local nursing home provision for people with dementia as alternative to long terms beds within Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) and commissioning complex rehabilitation for mental health patients from BEHMHT to enable local provision on Chase Farm site. Local clinicians working with local people for a healthier future

Commissioning Intentions We are likely to have some very hard choices to make in order to balance our books These choices will need to be consulted on with our public and other stakeholders These may include: PoLCE criteria for hip & knee replacements hearing aids IVF hernias haemorrhoids sterilisations care closer to home community services Local clinicians working with local people for a healthier future

Commissioning Intentions Medicines Management: we spend £30m on repeat prescribing, mostly initiated by pharmacist. Do we have robust medication reviews to help manage some of this Right Care: reducing variations in spend and activity using the benchmarking data Local clinicians working with local people for a healthier future

Next Steps Draft commissioning intentions signalled to providers and public by 30 September Include north central London level Sustainability and Transformation Plan (STP)intentions for 2017/18 and 2018/19 in line with 2 year contracts and towards delivery of 5 Year Forward View Include any new national planning guidance Consult on any material changes to service provision, particularly any hard choices Local clinicians working with local people for a healthier future