1. Commissioning process/update Patient reference groups AAPs Health networks

2. Background – Why! Durham Dales and Easington (DDES) Clinical Commissioning Group (CCG) developed a two year plan in April 2014 which is being refreshed in light of new national guidance and local priorities. A revised list of commissioning intentions for 2015/16 was developed and shared with locality clinical leads and member practices at the DDES wide meeting in October 2014 The executive were asked to review the draft list of commissioning intentions and to provide feedback based on key questions, noting however, that DDES is in year 1 of its 2 year plan and therefore this review process is primarily to ensure that there are no gaps in the planned programme of work (rather than to add to the list of priorities). Following engagement with member practices, the CCG is now sharing with governing body and our stakeholders what we feel should be our priorities to seek their feedback.

3. During this engagement process, we will be communicating to patients, public and other stakeholders that their feedback, if related to our current priorities, will be used, where relevant, to inform the refreshed plan. If the feedback is related to new areas, we will review and consider the feedback at this stage and then revisit it at future stages of the planning cycle to go through a robust prioritisation. A pro forma has been developed to capture feedback from our members We are currently sharing our early draft with patient representative groups, area action partnerships and health networks at meetings throughout November, December and January 2015. To engage the wider public, an open engagement event is being planned for 14 January 2015. A patient focused information document has also been produced, which will be used as a key communication document in engaging patients and the public in the commissioning planning process.

4. Last year you said we did ! Following feedback: YOU SAID Bring hospital services into the community To attach Mental Health to the practices To have joint health and social care assessments To put in place hub and spoke arrangements within a federation To have outpatient specialities within practices To not forget about offenders health To have other forms of communication with my GP practice To integrate with Local Authority, Housing and Public Health To have a set up like the old mini cottage hospitals WE DID This is within the 2 year and 5year Commissioning Strategy Implement Integrated Primary Care Model for Mental Health County Durham Joint Health and Wellbeing Strategy reflected in the development of integrated services as part of the Better Care Fund A plan for life in development, regular federation contact Developing outpatient review programme at each specialty review Area Team are responsible for this service Primary Care Strategy and DDES CCG funded incentive scheme, via use of technology to increase access and communication., Website, facebook page, twitter, GP teamnet County Durham Joint Health and Wellbeing Strategy also linked with the Better Care Fund and Health and Wellbeing Board, ISIS integrated care, frail elderly and many more Funding currently would not support

5. DateActivity October 2014Internally refresh the 2 year work plan based on updated information OctoberShare with member practices and seek feedback by 7 th November NovemberShare draft work plan 2015/16 with executive and governing body to agree process and seek input November 2014 – January 2015Share with stakeholders what we feel should be our priorities and why, using the public document developed. To include Area Action Partnerships (AAPs), Patient Reference Groups (PRGs) and health networks. Engagement team leading on development and implementation of process; AAP links, heads of service assisting on delivery of information and seeking feedback. November/DecemberShare with providers November /DecemberShare progress with member practices/executive DecemberReview against new planning guidance December/ JanuaryPrioritise work plan using robust tool JanuaryStakeholder event planned for 14 th January 2015 to share work plans, discuss priority areas, and invite feedback January/FebruaryShare with member practice / executive for sign off January / FebruaryDraft plan submission February / MarchPublish intentions Timescales (2014-2015)

6. The two year plan covers 12 work programme areas and incorporates a number of projects. Further work was undertaken to identify the CCG’s top priorities for 2014/15 (all of which are anticipated to remain for 2015/16): –Urgent care –Primary care –End of life –Diabetes –Frail Elderly –Demand Management –Mental Health and Learning Disabilities (added November 2014)

7. Commissioning Priorities for April 2014 to March 2016 What! Priority AreaIn this priority area, DDES CCG aims to: To further develop access to health care services over 7 days a week  Work with General Practice to improve the availability of patient appointments across 7 days of the week  Work with hospitals to ensure that services, including scans and testing, are available 7 days a week and are maintained at a consistently high standard seven days of the week To ensure community based services are joined up and working well with other aspects of health and social care  Work more closely with local government to plan and buy services across health and social care  Continue to improve current community-based services, such as nursing and physiotherapy  Increase the community services that provide support for people in their home and in community-based settings to allow people to leave hospital sooner or avoid hospitalisation altogether  Provide care closer to home whenever appropriate  Keep people independent for as long as possible, avoiding residential and nursing homes where appropriate To continue to improve mental health and learning disability services so that they are given the same priority as physical health  Improve GP diagnosis of people in the early stages of dementia  Review the patient care pathway in dementia treatment, improving patient experience and health outcomes  Provide support for more people with learning disabilities to move from in-patient / institutional settings into supportive community settings, whilst increasing available community support services  Support patients to recover from episodes of poor mental health (including those in crisis) more quickly, to return home from hospital more quickly and help to prevent further episodes

8. Priority AreaIn this priority area, DDES CCG aims to: To ensure that commissioned services are delivering the best outcomes and value for money  Review services regularly to keep up with the changing needs of the local population, to keep improving health care for all, and to ensure that public funds are used appropriately  Implement clinical systems and GP referral pathways that are joined up with hospitals and neighbouring CCGs, where relevant  Ensure prescribing of the most beneficial medicines to help patients stay as well as possible  Understand why some patients are re-admitted to hospital soon after discharge in order to identify potential areas of improvement  Review GP referrals to hospital to ensure appropriateness To ensure the health system is set up to best manage busy periods (such as winter flu season)  Improve ambulance performance, such as response times  Improve patient transport for non-emergency visits to hospitals or other medical appointments  Review of urgent care services  Improve patients’ access to their own GP for urgent issues  Increase patients’ use of 111 for non-emergencies  Reduce unnecessary visits to hospital  Evaluate what and how services can be delivered closer to patients’ homes by health care professionals with knowledge of their medical history To improve cancer diagnosis and treatment  Ensure GPs identify and support their patients who are at high risk of developing cancer  Improve the diagnosis of cancer at an earlier stage in order to reduce the number of cancer deaths in the under 75 age group  Look closely at cancer services and patient care pathway to identify any gaps  Work with the local authority to improve prevention services, improve people’s experience of cancer services and improve outcomes for people with cancer

9. Priority Area In this priority area, DDES CCG aims to: To improve palliative care and end of life services  Ensure that GPs regularly develop and review plans with patients who may be nearing their end of life  Improve services and options for people who are at the end of their life, providing the best possible support, including the choice of dying at home To review current services and contracts and explore where new contracts could results in improvements for patients  Review contracts coming to completion as well as those identified for potential improvement; services such as weight management, wheelchair and other adaptive equipment, continence, 111, Choose and Book  Review maternity services (as part of a region-wide review of how best to provide maternity services) in order to continue to ensure that mothers and their babies receive treatment that keep them as healthy as possible To redesign and develop patient care pathways to improve patient outcomes  Review patient care pathways for a number of conditions, including diabetes and breathing problems (respiratory related conditions such as asthma and COPD), stroke, cardiovascular disease, back pain  Identify when patients could benefit from healthcare provided in their home, GP surgery or elsewhere in the community (rather than in hospital)

10. Priority AreaIn this priority area, DDES CCG aims to: To work with local government to improve public health and the other aspects that impact on people’s health  Work with local organisations and government to find ways to positively affect people’s health and well-being  Continue to ensure that those who are eligible for personal health budgets are offered the opportunity to use them, in order that they have more control over the decisions about how to improve their health  Focus on identifying gaps in services for alcohol abuse To further understand and put in place what is needed to support health services over the next 10 years  Understand the present and anticipated needs in workforce and take measures to address these, working with Health Education North East  Support healthcare providers during transition periods such as services moving out of hospitals and into the community To improve outcomes for children  Ensure services for children address their mental health needs  Redesign and develop services for children with diabetes, emergency admissions, breathing problems (respiratory), obesity

11. Aims of co-commissioning The overall aim of primary care co-commissioning is to create a joined up, clinically-led commissioning system which delivers seamless, integrated out-of- hospital services based around the needs of local populations. Improved provision of out-of hospital services for the benefit of patients and local populations; A more integrated healthcare system More optimal decisions to be made about how primary care resources are deployed; A more collaborative approach to designing local solutions for workforce, premises and IM&T challenges to develop a joined up system; For this year, the scope of primary care co-commissioning is general practice services. The commissioning of dental, community pharmacy and eye health services is more complex than general practice with a different legal framework. As such, our emerging thinking is that it is out of scope for joint and delegated commissioning arrangements in 2015/16. However, we recognise the ambition in some CCGs to take on a greater level of responsibility in these areas and we will be looking into this for future years with full and proper engagement of the relevant professional groups Joint decision-making by NHS England and CCGs CCGs taking on delegated responsibilities from NHS England Greater CCG involvement in NHS England decision- making

12. Feedback