SOUTH NORFOLK CLINICAL COMMISSIONING GROUP Stakeholder Event 20 th November 2013 Dr Jon Bryson, Chair - South Norfolk CCG Ann Donkin, Chief Officer

Development of South Norfolk CCG –Geographic coverage –History of the organisation –Financial context To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Practices and Localities To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Deprivation To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk MSOA E (Breckland most deprived) MSOA E (South Norfolk most deprived)

Organisation Phase 1 – shadow CCG formed in July 2012 bringing together two constituencies: Mid Norfolk and South Norfolk Phase 2 – Go through ‘Authorisation’ process – now complete Phase 3 – building capacity in the CCG ‘office’ Phase 4 – engaging member practices, stakeholders and patients in delivery Directly employed staff: –10 in November 2012 –15 of 25 in June 2013 –Optimum number 35? Commissioning Support Unit Capability in Localities & Practices To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Provider landscape CCG interfaces with more than one acute care delivery system Norwich & Norwich University Hospitals NHS Foundation Trust governance risk rating AMBER-GREEN and financial risk rating 3 West Suffolk Hospital NHS Foundation Trust governance risk rating GREEN and financial risk rating 3 Near monopoly providers for mental health care, community services and ambulance services Services generally highly regarded by patients – positive Inpatient and GP Surveys Current areas of performance concern include: –under performance against key targets e.g. Accident & Emergency 4 hour wait, 18ww RTT at Norfolk & Norwich –main contract signed late: October 2012 –poor ambulance response and turnaround times To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Financial Context Stable CCG financial position but pressures in Continuing Health Care and Prescribing Legacy issues inherited from NHS Norfolk – use of non recurrent resources Quality, Innovation, Productivity and Prevention (QIPP) challenge in context of low/no growth in resources - £5 million rising to £18 million in QIPP challenge to date met by largely transactional measures CCG has no areas where it is an outlier on spend or outcome (SPOT analysis), spend per head and hospital utilisation rates are below national averages but variation at specialty level e.g. Gastro, Ophthalmology, Cardiology & Urology To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Governance & delivery To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Governance and Structure To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Governance and Structure To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Strategic Vision To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk Integrating health and social care and integrated pathways of care Case management Frail older people Redesigning elective care pathways Reviewing thresholds for surgical intervention Prescribing practice Planned care & tackling variation Reforming the urgent care system Avoiding unnecessary hospital admission Emergency & urgent care

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk South Norfolk CCG’s commissioning intentions fall into two categories: Contract negotiation - focusing on improving patient experience and the quality and safety of services Commissioning for Quality, Innovation, Productivity and Prevention (QIPP) – reviews, developments and improvements of clinical workstream priorities

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk Contract Negotiations: Compliance with best practice pathways for Stroke Care Compliance with Norfolk prescribing formulary A focus on A&E attendance to admission ratio and consultant-to- consultant referral limits with hospitals Clinical threshold controls for equipment and elective procedures

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk South Norfolk CCG’s 2014/15 QIPP Programme: Emergency and Urgent Care priorities: ‘Domino’ project (involving all partner organisations in Norfolk): Urgent same day and next day clinics Access to assessment services and diagnostic testing to reduce the need for admission Reduction of length of stay in hospital Planned Care priorities: Reviewing orthopaedic pathways and related physiotherapy services Community services for glaucoma, rheumatology and dermatology

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk South Norfolk CCG’s 2014/15 QIPP Programme: Out of Hospital Care priorities: Changes to continuing healthcare contracts and regular assessment of patients to ensure high quality care Greater involvement in community settings of Consultants for Frail and Elderly Medicine Re-procurement of patient transport services Continued development of integrated care teams and reablement services Implementation of the community bed review Development of community nursing and therapy services

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk South Norfolk CCG’s 2014/15 QIPP Programme: Mental Health and Learning Disabilities priorities: Engage closely with Norfolk & Suffolk Foundation Trust’s Radical Redesign Support the planning of the re-procurement of the IAPT service Development of Dementia pathways for roll-out in 14/15 Women and Children priorities: Children’s urgent and emergency telephone services for GPs Extension of the Early Pregnancy Assessment Service to weekends Review of the pathway for Children with Long Term Conditions

Commissioning Intentions 2014/15 To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk South Norfolk CCG’s 2014/15 QIPP Programme: Primary Care priorities: Improve the clinical management of patients in care homes and at the end of life Development of Diabetes care out of hospital settings Work with the NHS England Area Team to develop a Primary Care Strategy

Summary Population which enjoys relatively good health compared with the rest of England Generally highly regarded primary and secondary care provision Fairly stable financial environment Good relationships between clinicians across primary and secondary care An engaged and active membership across key stakeholder groups To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk

Healthy South Norfolk To deliver the highest quality integrated healthcare which is appropriate, effective, efficient and sustainable, in order to improve the health and well-being of the whole and diverse population of South Norfolk