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

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

3. 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

4. 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

5. 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.

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. Questions and Answers