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

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

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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