CCG Merger Proposal Consultation Event St Peter’s in the City, Derby Thursday 9 August 2018 St Peter’s in the City, Derby

Dr Chris Clayton Chief Executive Officer Derbyshire CCGs Welcome Dr Chris Clayton Chief Executive Officer Derbyshire CCGs

What NHS commissioning does NHS commissioning in England is the process of planning, buying and monitoring health services NHS Clinical Commissioning Groups (CCGs) pay for GPs, hospitals including A&E, Urgent Care Centres and Minor Injuries Units, mental health services community services, and many others CCGs took over responsibility for planning, paying for and monitoring local health services in April 2013 CCGs are responsible to the Government via NHS England who monitor their performance

Why CCGs were established To strengthen local decision making about how the NHS health and care budgets are spent CCGs combine the expertise of local family doctors (GPs) and clinicians together with NHS managers All are represented on our Governing Bodies who along with expert lay members are responsible for making all our spending decisions In Derbyshire there are currently four Clinical Commissioning Groups with a budget of £1.6 billion

Our area A great deal of work taking place across the system to address the financial gap. The NHS in Derby and Derbyshire has an estimated financial gap of £80m for 2018/19. This means services we fund will cost £80m more this year than the annual budget we receive.  This is before savings required by local authorities is factored in.  The financial challenge is therefore significant and despite saving millions of pounds over the last three years across health and social care Derbyshire still has this financial gap and it must be addressed.  

Many things have changed since 2013 New models of care reflect changing patient needs, for example, bringing care closer to people’s homes The health and care system nationally and locally is under ever increasing pressure from our ageing population and very significant budget challenges

Many things have changed since 2013 Since 2016 each county has a Sustainability and Transformation Plan (STP) which brings all the organisations who are responsible for health and care together, eg, CCGs, local authorities, hospital trusts, mental health trusts and others In Derbyshire our STP is known as Joined Up Care Derbyshire and we have a very strong focus on local decision making which we call Place

Why change things now? Commissioning needs to be more efficient to meet the pace of change required to meet ever changing patient needs The STP footprint is for the county through Joined Up Care Derbyshire but four CCGs making different commissioning decisions In Derbyshire we have a financial gap of £80 million this year so we must do everything we can to be as efficient and streamlined as we can be to resolve this

New Derbyshire wide vision Creating a Derbyshire wide vision for services to support better health outcomes Enabling sustainable and affordable services at the same time as ensuring quality Taking a consistent and equitable approach to commissioning Creating a strategic commissioner to drive change across the local health economy

Why can’t we simply do it? Each CCG is a statutory body set up in law and each has its own constitution We need to request a change in the statute to merge the four CCGs and create a single one for Derbyshire We must consult with patients, public, families, carers, our GP members, politicians, our stakeholders and others to see whether people agree that this proposal is right for Derbyshire We are here today to listen to your views We are also asking all 116 GP practices to vote on whether they think this is the right thing too

Why we think it will work better Whilst we cannot change the law we can make some changes that will make us more efficient and we have already started that process including: In 2017 our Governing Bodies decided work together more This included going from four Chief Executive Officers, Chief Finance Officers and Executive teams to one of each for Derbyshire We are currently restructuring our organisation to reflect a county wide approach We have introduced a team with responsibility for addressing the financial challenge for the county

Important things to retain New models of care – we must continue to develop new ways of working and pathways of care so that we best meet the needs of our patients Financial capacity and capability – we must continue with our county wide approach to addressing the financial challenge Localism – we know that is very important to our public, patients, clinicians to understand local and community health and care needs

Place Alliances will ensure that we retain the local decision making and influence Our Places Erewash Bolsover & North East Derbyshire Chesterfield High Peak Derby City Amber Valley South Derbyshire Derbyshire Dales What will Place do Working much more closely with our providers to benefit the local community Deliver a variety of services in the community to support the CCG vision Supporting teams working closely with GPs and Practices Ensuring local health needs are met by utilising the community resources Supporting Places to create and agree new pathways and better ways of care for the local community

What happens next? Our consultation period closes on 14 August 2018 We will process and evaluate the results of the public consultation and the GP membership voting process This will help to determine whether our public, patients, GPs believe that this is the best way forward for Derbyshire and we will submit a recommendation to our Governing Bodies

What happens next? There is a rigorous process of approval panels with NHS England. This adds a further level of assurance that the proper process has been followed If our proposal is agreed we will start our implementation plan as quickly as possible and with an aim to operate as one CCG for Derbyshire by April 2019 If our application is not acceptable we will continue with our four CCGs but we believe that this is not the best outcome for Derbyshire

Questions and Answers