1. Annual General Meeting

2. Reflections on
Dr David Supple
Clinical Chair

3. Who we are
and what we do
We are responsible for improving the health and wellbeing of people living in Brighton and Hove
We make sure everyone has access to high quality care across the city
We are led by GPs, nurses and other healthcare professionals
We plan and buy (“commission”) most of the healthcare services in the city
This year we spent £366m and we have to ensure money is spent in the most effective way

4. Overview of 2016-17 Challenging first half of the year
Given ‘Inadequate’ assurance rating by NHS England
Resulted in legal directions by NHS England
Significant changes and improvements have been made in second half of the year
We have made real progress in many areas, particularly:
Waiting times for treatment going down
Improved access to urgent care

5. Overview of 2016-17 Governance Governance review Clinical structure
We have worked with Brighton & Hove City Council to develop Caring Together
Big step to improving health and care of the city
Renewed focus on engagement
Improved membership engagement
Staff conference
Big Health and Care Conversation

6. Overview of 2016-17 Federating general practice
Working with our members to develop a ‘federation’
Working at scale to provide more resilience to practices and improved access to services for patients
Co-commissioning
CCG agreed to take over full ‘delegated co-commissioning’ from April 2017
Previously commissioned by NHS England
We are now responsible for commissioning general medical services

7. Look back at
Adam Doyle
Accountable Officer

8. Our performance Improvements in national standards A&E waiting times
Waiting times for treatment
Diagnostic waiting times
Treatment for cancer
Financial stability
Achieved a balance budget
Improvements in organisational development
Staff survey
Membership engagement
Governance

9. National standards A&E waiting times
End of last year over 85% of patients seen and treated
Significant improvements
Waiting times for treatment
Performing better than planned throughout
Diagnostic waiting times
Performance improved
Achieved better than national standard at end of the year
We are measured against a number of national standards, which are important in ensuring we deliver the best possible healthcare. More detail of these in the full Annual Report. We have struggled to meet some of these targets in the past, but this year we have made some real improvements, including:

10. National standards Treatment for cancer
Performed well for patients seen by specialist within two weeks of referral
Achieved national standard for patients seen in 31 days from decision to treat them
Improvements needed to ensure patients seen within 62 days from urgent referral to first definitive treatment
Mental health access
Need to do more in services to Improving Access to Psychological Therapies (IAPT)
Procured a new service which started this month

11. Local priorities Helping patients manage their own healthcare
MyLife online directory – ‘one stop shop’ for information on conditions, services and support
Supported pilot for social prescribing to help vulnerable patients
Transforming primary care
Delegated commissioning
GP federation
Locally commissioned services
Alongside the progress we have made against national targets, we have also been made progress in the key local targets that we set ourselves for the year. These are set out in the full Annual Report but some of the achievements included:

12. Local priorities Improving mental health
Trained GPs in managing patients with serious mental illness
Provided emotional and mental health support to pupils in secondary schools
Launched a mental health anti-stigma campaign called #IAMWHOLE.
Integrating health and social care
Improved services for homeless
Better at identifying patients with chronic obstructive pulmonary disease (COPD)

13. Local priorities Developing care closer to home
Integrated diabetes service
Programme that identifies people at risk of developing diabetes
Medicines management
Better Care Pharmacists working with GPs to review medication of most vulnerable patients
#HELPMYNHS campaign to raise public awareness of self-care

14. Our challenges - demand
Increasing hospital admissions
Increasing number of patients with complex needs
Increasing demand on GPs
Increasing number of patients in hospital are fit to go home
Population is increasing
2003: 278,00
2024: 298,400
Across the country, demand on services is increasing. Nationally hospital admissions between 2003 and 2016 increased by 65%.
The health and care needs of these patients has become more complex, which has added further pressure of services.
Demand on our GPs is at unprecedented levels.
Nationally last year we saw a record number of patients medically fit for discharge (6,200) , an increase of 22% in previous year alone.
The population is going up – the population of Brighton and Hove in 2003 was 278,00 and is expected to rise to 298,400 by 2024

15. Our challenges - inequality
Higher rates of children in care than the rest of England
Higher rate of older people live alone compared to rest of England
500 extra deaths each year because of inequalities in Brighton and Hove
Brighton and Hove does significantly worse than England on:
Alcohol specific hospital stays
Drug misuse
Sexually transmitted infections
Smoking related deaths

16. Our challenges - funding
Nationally, the funding is not keeping up with the increasing demand
We have to find ways to work more efficiently and effectively
We have to look at getting best value for money in everything we do
Finish with…on the subject of funding, here is our Chief Finance Officer Pippa to present the annual accounts. Full accounts are available in the Annual Report.

17. Annual Accounts
Pippa Ross-Smith
Chief Finance Officer

18. What we spend

19. Our finances
Last year we spent £366m and we achieved a balanced budget
Independent auditor’s opinion of financial statements:
“In our opinion the financial statements give a true and fair view of the financial position of NHS Brighton and Hove CCG as at 31 March 2017 and of its net operating costs for the year then ended”
“…have been properly prepared in accordance with the Health and Social Care Act 2012 and the Accounts Directions issued thereunder.”

20. Our finances We achieved all our NHSE mandated business rules
The Better Payment Practice Code requires the CCG to aim to pay all valid invoices by the due date or within 30 days of receipt of a valid invoice, whichever is later
The target percentage to be achieved is 95 per cent, this has been reached
The CCG has achieved all targets in

21. Our finances
We have to ensure we get value for money out of every penny we spend for our local population
Next year is likely to be financially challenging for the CCG
We have to look at the best way to deliver services with the funding available

22. Looking ahead to
Dr David Supple
Clinical Chair

23. Looking ahead: Caring Together
New programme that builds on work that is already underway in the city to improve local health and social care
Sets out how we can improve and transform:
Adult and children’s services
Physical and mental health
Social care
Public health
GPs and pharmacies,
Community,
Voluntary sector
Hospital services

24. Looking ahead: Caring Together Aims: Helping people to stay healthy
Keeping people out of hospital
Improving care after being referred
Making it easier to see GPs when needed
Preventing people ending up in A&E
Treating mental health equally
Giving children and families a better start
Making better use of medicine
Supports wider plans to transform health services across Sussex and East Surrey

25. Looking ahead: Engagement The ‘Big Health and Care Conversation’
Significant amount of engagement for the rest of 2017
Launch event on 4 July
We will be going out to the public to get their experience and views on what matters to them in health and social care
Feedback will help us shape and influence our plans for the future

26. Improving access to primary
and urgent care
Dr Tim McMinn
GP Clinical Lead

27. Context Important part of Caring Together
Currently have multiple options for accessing urgent care (111, Walk In Centre, A&E, out of hours GP, ambulance, GP extended hours)
When one part fails – patients will go elsewhere
Need to simplify and integrate services
Patients need to be directed smoothly to most appropriate service with one call
Information sharing

28. PATIENT 111 NHS 111 & Clinical Hub model 999 GENERAL PRACTICE INTERNET
SELF CARE
PHONE
111
DENTAL
EMERGENCY
DEPARTMENT
999
PHARMACY
CLINICAL TRIAGE
HEAR and TREAT
PALLIATIVE CARE HUB
MENTAL HEALTH HUB
EXTENDED
PRIMARY CARE
SERVICES
COMMUNITY HUB
GENERAL
PRACTICE
IN HOURS
OUT OF HOURS
ROVING GP
UCC
WIC
GP A&E
OOH
VISITING
REG GP
APPT or VISIT
CLINICAL HUB

29. NHS 111 New service in place for April 2019
Commissioned across seven CCGs in South East
Clinical triage and decision making within service
Review of geographic options and clinical pathways
Appropriate diversions
Use of care plans/shared information
Care Home Line
Self care options

30. Clinical Navigation Hubs
Conditions where:
not 999 or self care (managed within 111)
not dental, not repeat prescription
not community/specialist pathway
Sensitive to local services
Local Care plans – Mental health, Palliative Care
Single point of access for first contact with local clinicians
Clinician triage and booking into appropriate services
Community clinics, Ambulatory Care, Extended GP appointments

31. ‘Front door’ of hospital
Particular problems - 4 hour targets, increasing demand, increasing acuity, capacity in hospital, capacity in community services
Increase in capacity in Urgent Care Centre
£30m investment in short stay beds on Acute Floor
Improved ‘front door’ assessment
Primary Care Streaming

32. Extending primary care access
Currently have multiple services providing Primary Care services
Currently have different types of service, different workforce mix on different pay scales, different IT systems and communication
Competition for same workforce
Confusion for patients on where to go for what condition and when

33. Questions from the public?

34. Thank you