1. The Turnaround Challenge Workshop in SWF, 5 December 2012

2.  Brief introduction to Mid Essex Clinical Commissioning Group (CCG)  Your local NHS – the current position  The “turnaround challenge”  How we are tackling the challenge  Your views?

3.  New organisation to take over from PCT  Board led by GPs, senior nurse, public health, social services rep, 3 lay members  Working in shadow since 1 April 2012  “On the job” managing & planning  50 member practices  Applying for authorisation – Nov 2012  Establishment - 1 April 2013 Dr Lisa Harrod-Rothwell Chairman, Mid Essex CCG

4.  Commissioning – planning & buying healthcare  Not providing – that’s Central Essex Community Services (CECS)  Assess local needs, listen to people  Plan in partnership  Design services, agree contracts  Manage quality & performance  Manage the annual budget – £540m in total for mid Essex in 2012/13 CCGs responsible for around £390m

5. NHS Commissioning Board National body Holds CCGs to account Contracts with GPs & others Commissions specialised services Clinical Commissioning Group (CCG) Local body Led by clinicians Plans & buys your health care Joint planning with local authority Local authority Health and Wellbeing Board Joint strategic needs assessment Health and wellbeing strategy Public health HealthWatch Service providers Hospital e.g. MEHT, Braintree, Springfield Community e.g.CECS Mental health e.g.NEPFT Vol. orgs.

6.  Brief introduction to Mid Essex Clinical Commissioning Group (CCG)  Your local NHS – the current position  The “turnaround challenge”  How we are tackling the challenge  Your views?

7.  Performance & quality among best in region  Over 95% patients treated within 18 weeks  Over 98% cancer patients treated within 31 days  90% stroke patients on specialist stroke unit  Over 99% mental health patients followed up within 7 days of leaving hospital  Patient experience survey shows improvement

8.  Brief introduction to Mid Essex Clinical Commissioning Group (CCG)  Your local NHS – the current position  The “turnaround challenge”  How we are tackling the challenge  Your views?

9. If we took no action…  We would be overdrawn by £12.8m at end of year  Bigger challenge in 2013/14 – an ever widening gap  We would be unprepared for ageing population ▪12% increase by 2035 ▪Increase in frailty, long term conditions, dementia  So we are managing two things…  2012/13 - quick action to finish year in balance  2013/14 & beyond – transform services & secure the NHS for the future

10. Overall three main factors …  Managing with limited funds – our allocation one of the lowest  The activity we can afford – we spend more than other similar areas  Service transformation – plans take time to put into practice £1.3k per head (PCT spend last yr) Others up to £2.2k £1.3k per head (PCT spend last yr) Others up to £2.2k Need to review and “ramp up” Activity increase not always right for good care

11.  Brief introduction to Mid Essex Clinical Commissioning Group (CCG)  Your local NHS – the current position  The “turnaround challenge”  How we are tackling the challenge  Your views?

12. Savings solutions£000 Existing service transformation schemes1,803 Tighter criteria for some NHS services1,687 Ensure contracts adhered to465 Stop expenditure where possible1,008 Budget underspends2,118 Technical accounting adjustments1,949 Draw down on reserves3,787 12,817

13. Examples of existing schemes  Health & social care for people at home  Rapid assessment for frail& older people – avoid hospital emergencies  Multiprofessional teams for end of life care at home  Closer work with nursing homes to avoid hospital emergencies  Practices managing referrals working with central team of clinicians  Prescriptions for less expensive drugs

14. Examples of tightening criteria  Team to manage treatment at A&E  Reduce unnecessary use of ambulance  Review clinical policies, ensure they are adhered to  “Stop before the op” smoking restriction  Improve physio self-care, reduce wasted appointments  Comply with national guidelines on drugs  Mental health rapid assessment to reduce admissions

15. We are not talking about “cuts” Don’t be misled by the press

16. Urgent careRedesign out of hours services and NHS 111 GPs working in A&E Rapid assessment for older people Working with nursing homes Integrated teams for people at home Mental health rapid assessment FrailtyProactive care for high risk patients Integrated care teams – community matrons 24/7 single point of contact for frail people Tele-health Long term conditions Prevention and early diagnosis 24/7 single point of contact for people with long term conditions Care plans and shared records

17.  Brief introduction to Mid Essex Clinical Commissioning Group (CCG)  Your local NHS – the current position  The “turnaround challenge”  How we are tackling the challenge  Your views?

19. Group discussion  Short term: ▪Your views on what should we stop or change?  Long term: ▪Your ideas for doing things in a different way? ▪What do you want us to pay attention to?