CCG Annual General Meeting

CCG Annual General Meeting
23 April 2017 CCG Annual General Meeting 15 July 2015 [Document title]

Ealing CCG AGM Agenda Item Time Subject Presenter 1 6.30 - 6.40
Welcome & Introduction Minutes of Annual General Meeting held on 17th September 2014 Dr Mohini Parmar (Chair , Ealing CCG) 2 About Ealing CCG 3 6.45 – 7.05 Overview and achievements in Working in Collaboration across North West London CCG achievements Clare Parker (Chief Officer, CWHHE CCGs) Tessa Sandall (Acting Managing Director, Ealing CCG) 4 7.05 – 7.15 Our priorities for Tessa Sandall 5 7.15 – 7.20 Quality & Safeguarding Dr Jonathan Webster (Director of Quality and Patient Safety , CWHHE CCGs) 6 7.20 – 7.35 Annual accounts Budget David Tomlinson (Interim Chief Finance Officer, CWHHE CCGs) 7 Close Questions from the public and close Plenary

About Ealing CCG Dr. Mohini Parmar, Chair, Ealing CCG Jonathan Webster
Director of Quality, Nursing and Patient Safety

RAJ CHANDOK About Ealing CCG Became statutory body on 1 April 2013
Background Became statutory body on 1 April 2013 GP-led organisation with 79 member practices GPs leading the CCG mean they can use patient feedback to directly influence decisions – patients are at the heart of what we do Serve GP registered population of 420,000 Commission (buy) urgent care, planned hospital care, community health services, mental health services Aim to ensure that highest quality care is delivered for our local population Work in partnership with providers, Ealing council, voluntary and community organisations Joined collaborative with Central London, West London, Hammersmith & Fulham and Hounslow CCGs in December 2013 which better reflects our patient pathways with providers RAJ CHANDOK [Document title]

Focus on improving care for residents of Ealing
23 April 2017 Focus on improving care for residents of Ealing Extended Hours Primary Care GP Federation Primary Care Transformation Interactive workshops for people living with long term conditions Training for GPs and clinicians Primary Care Self Care Community Services Review Additional investment for District Nursing Community Services Mental Health Transformation agenda Shifting Settings of Care Acute Psychiatric Liaison Mental Health Joined up delivery of care Focus on Integration Intermediate Care ICE Review and implementation of recommendations EIICS Procurement (jointly with local authority) Voluntary Sector Voluntary Sector Grants to support Self Care, inclusion in community and respite Community and voluntary sector (CVS) organisations to bid for funding to provide alternative community care services CLARE PARKER Planned and Urgent Care Dermatology service MSK Waiting list initiative [Document title]

Working in Collaboration across North West London
23 April 2017 Working in Collaboration across North West London Clare Parker, Chief Officer, CWHHE CCGs [Document title]

Collaborative working with neighbouring North West London CCGs
Collaborative with Central London, Hammersmith & Fulham, Hounslow and West London CCGs Shaping a Healthier Future with 7 CCGs in North West London

Our Vision of Care Hospital reconfiguration
Improved hospitals delivering better care 7 days a week, more services available closer to home Primary Care transformation Self management Mental Health Transformation Promoting Wellbeing and improving mental health for North West London Whole Systems Integrated Care Multi- disciplinary Care co-ordinated around the patient, led by the GP Better out of hospital services, greater access to GPs at convenient times and locations 7 days a week People are empowered to manage their own wellbeing and health

Primary Care Transformation
Network-based services Online services and convenient appointments Common IT network Out of hospital services Primary care joint co-commissioning

Whole Systems 9 Early Adopters, unique models of care
Co-produced Integrated Care Toolkit Information & Data Sharing Facilitating expert input and sharing best practice Next steps: Launch & Sustain, Change Academy, Pooled budgets, Evaluate

Mental Health Mental Health & Wellbeing transformation
NWL Crisis Concordat Acute psychiatric liaison services Primary Care Plus Dementia strategy and framework

Acute Reconfiguration
A&E from Hammersmith and Central Middlesex Hospitals NW London Urgent Care Centres 24/7 Ealing Hospital maternity, neonatal & paediatric transition Implementation Business Case development 7 day services Engagement and communications

A&E Changes Review Changes made to Emergency Departments at Central Middlesex & Hammersmith Hospital In September 2014, the Emergency Departments at Central Middlesex Hospital and Hammersmith Hospital were closed. 2 reviews were recently published examining these closures, summarised below: Shaping a Healthier Future – Benefits Realisation Review The changes to A&E were delivered safely and on time Staffing and levels of cover have been increased Staff have been up-skilled to deliver higher quality of care Patient experience scores remain high All 9 urgent care centres now operate 24/7 NHS England – Independent Review A&E performance worsened in October to December 2014 This was due to localised increased demand, and increased acuity of patients; it was not related to the A&E changes The assurance processes used in preparation for the change were extensive The assurance process should have undertaken further testing of hospitals’ key assumptions and further sensitivity testing

23 April 2017 Maternity Transition The birthing unit at Ealing Hospital closed on 1 July 2015. Summary of maternity changes: Increased senior consultant cover in maternity units and moving towards 24/7 consultant cover on the labour ward Improving the midwife-to-birth ratio Upgrading facilities at all six hospital sites Continuing to deliver antenatal and postnatal care locally in Ealing Ensuring that for most women the care they receive before and after the birth is provided by a midwife from the same hospital as where they give birth. Expanding the number of community midwives and investing in the home birth team Providing a midwife-led unit alongside every maternity unit in North West London The Governing Body in May also shared the planned changes to services as follows: Paediatrics Services Introduction of a new Rapid Access Clinic at Ealing Hospital Paediatric inpatients will transition by 30 June 2016 Neonatal Services Neonatal care will be relocated to the six remaining neonatal units in North West London Changes will take place at the same time as the maternity transition Gynaecology Services All gynaecology services will remain at Ealing Hospital in a revised form which strengthens patient access More senior clinical cover during core hours (changing from 9am-1pm to 9am-5pm on weekdays) and also cover on weekends (from zero hours to 9am-1pm) in Ealing’s Emergency Gynaecology Unit Out-of-hours, emergency gynaecology consultant cover will be provided at Northwick Park CLARE PARKER [Document title]

Achievements in 2014-15 Tessa Sandall
Acting Managing Director, Ealing CCG TESSA SANDALL Jonathan Webster Director of Quality, Nursing and Patient Safety

Achieved surplus of £10.5m against a plan of £8.7m
23 April 2017 Achievements in (1/2) Achieved surplus of £10.5m against a plan of £8.7m Focus maintained on patient and lay involvement – examples include Shifting Settings of Care, Integrated Model of Care and Cardiology projects Local Priority target achieved, with 6074 care plans completed for patients over 75 in Ealing Primary care provider Federation (Ealing GP Limited) for all 79 GP practices established as a legal and management structure entity Procurements completed and contracts awarded for: Pathology, RFS, Rehabilitation Beds, and Dermatology service Intermediate Care Service (ICE) review completed, and immediate recommendations implemented Common IT Platform (SystmOne) implemented in 77 out of 79 Ealing General Practices ‘Right Care Campaign’ launched in conjunction with other NWL CCGs, to encourage local people to use the NHS services wisely All practices signed up to EPS2 (Electronic Prescribing system), and are now on Choose & Book Commissioning Intentions for developed through extensive co-production , in consultation with the CCG staff, Governing Body, joint commissioning colleagues from LBE, patient and public, PPGs, lay partners and the CCG membership Held Governing Body elections for North Southall , Sessional GP , South Central Ealing , South North Network Lead and Practice Manager role CLARE PARKER [Document title]

Achievements in 2014-15 (2/2) 23 April 2017 CLARE PARKER
Community Transport Pilot launched in November; evaluation completed by year-end , and decision made to extend the pilot until March 2016 and provide complete coverage across Ealing Lay Partners actively involved in Contract and Service Monitoring for the Out of Hospital Services being commissioned through Primary care and the Prime Ministers Challenge Fund Confirmed the decision to transition maternity services from Ealing Hospital in October Governing Body meeting and reviewed assurances for safe transition in March Governing Body meeting British Medical Journal awarded Argyle Care Home Service awarded the ‘Primary Care team of the year’ The CQC rated the Cuckoo Lane GP practice as outstanding in its provision of primary care Primary care services to Nursing Homes expanded; offering care to 800+ nursing home residents Mental Health and Wellbeing transformation progressed – Shifting Settings of Care, Acute Psychiatric Liaison Out of Hours CAMH services review completed Dementia diagnosis rate increased from 55% at the end of 13/14, to 63% at the end of Joint work with WLMHT and Dementia Concern to implement a plan for the new pathway for Cognitive Impairment and Dementia Service Improving Access to Psychological Therapy (IAPT) Recovery performance exceeded the target Primary care co-commissioning formally launched on 1st April 2015, following voting from membership and GB CLARE PARKER [Document title]

Patient, Public and Lay Engagement in 2014-15
23 April 2017 Patient, Public and Lay Engagement in Throughout the commissioning cycle we involve our patients and public and our Health Watch colleagues and representatives in a number of ways: Procurement Cardiology -1 Lay partner and Health Watch lead GP Out of Hours - 1 Lay partner Contract and Service Monitoring Quality and Safety Committee - involves Health Watch and is chaired by a Lay Member Finance and Performance Committee - is chaired by a Lay Member Service Planning, design, redesign & decommissioning Out of Hospital Services - commissioned with Lay partners involvement throughout the process Ealing Integrated Intermediate Care Service - designed through patient and public involvement Maternity Service at Ealing Hospital – new pathway re-designed & re-commissioned with patient involvement Commissioning Intentions Commissioning Intentions - developed following feedback from patients throughout the year using open meetings with service users and Ealing GP Practice Patient Participation Groups (PPGs) Strategy Development Ealing Integrated Model of Care - key strategic plank for Integrated Care in Ealing, with the development of roles for non-clinical care coordinators, voluntary sector care navigators, Aligned to Joint Care Teams with GPs and Self-Care Strategy Used simulation event with 175 people and involvement of patient at a strategic level and at a project stakeholder group CLARE PARKER [Document title]

Success Story: Ealing Community Transport Pilot
23 April 2017 Success Story: Ealing Community Transport Pilot The Pilot in numbers 985 - Trips from November ‘14 to May ‘15 328 - Trips taken in May ‘15 61 - GP surgeries signed up to the pilot 32 - GP surgeries actively using the service Summary PlusBus for Health - a project aimed at: reducing the number of GP house calls and no-shows at surgeries improve the well-being of patients and provide opportunities for patients to leave their homes and increase social contact More consistent access to community services Scope of pilot - to transport patients struggling to attend healthcare appointments due to disability, limited mobility or other complex health problems to a growing range of primary care and out of hospital services in Ealing Scale - Started with 5 GP surgeries in November ’14 and now working with 32 surgeries in the Ealing area. Evaluation of pilot and positive feedback from Patients / Carers / GP practices - advised the CCG to extend the pilot to March 2016, and include Southall and Acton with a view to fully commission future delivery by Ealing Community Transport (ECT) The ECT pilot model has provided: real evidence of improvements in patient experience more efficient use of GP services CLARE PARKER [Document title]

Other Success Stories 23 April 2017 Argyle Care Centre
Cuckoo Lane Practice The Argyle Care Home Service was awarded the ‘Primary Care team of the year’ It was recognised for its substantial effect on the health and wellbeing of the wider community through its lead role in the GP for Nursing Home scheme The Argyle Care Home service worked with GPs to schedule visits to homes lasting four hours per 50 patients per week, and provided urgent care with a doctor on call 8am to 8pm every day of the year The judges at the BMJ awards commended the care home for its great outcomes for patients through preventing unnecessary hospital admissions and the general satisfaction amongst its patients, relatives, carers and home managers This service will continue to work with the care home to see its patients receiving the right care, at the right time, in the right place The CQC completed a comprehensive inspection of the Cuckoo Lane practice on the 28/01/2015, and rated the practice as outstanding It was commended for being well-led and providing responsive and effective services It was also outstanding for the care provided to older people, people with long term conditions, families, children and young people, people living in vulnerable circumstances and people experiencing poor mental health (including people with dementia) Findings showed that the practice had sufficient arrangements in place to ensure patients are kept safe, and adapt quickly if things go wrong Observations from the CQC also showed that patients that felt well treated, with dignity and respect Patients are satisfied and like being able to attend the surgery CLARE PARKER [Document title]

Priorities in 2015-16 Tessa Sandall
Acting Managing Director, Ealing CCG TESSA SANDALL Jonathan Webster Director of Quality, Nursing and Patient Safety

CCG Priorities in 2015-16 (1/2) 23 April 2017 CLARE PARKER
7 day a week primary care services access within networks Deliver full suite of Out of Hospital services and commission contracts at Ealing GP Limited level Develop GP based integrated care and coordination, including Care Planning and Case management, Care Navigation, Community Transport, Joint Care Teams and Care Ordination Procure, mobilise and launch whole systems integrated Ealing Intermediate Integrated Care Service (EIICS) and new Cardiology Service Implement Child and Adolescent Mental Health Services Out of Hours new service model Collaborate with neighbouring CCGs to resolve cross border issues and develop cohesive pathways/processes for the NWL population, including UCC/111 and MSK Implement Atopic services for children, and introduction of community specialist service Increase the number of Health checks and Action Plans completed for patients with Learning Disabilities in Ealing Deliver Local Improvement Scheme, which has been signed off by Local Medical Committee and NHS England CLARE PARKER [Document title]

CCG Priorities in 2015-16 (2/2) 23 April 2017 CLARE PARKER
Achieve a 67% Dementia diagnosis rate, through close working with care homes, GP practice, providers, and the Voluntary sector Improve the identification of and support for carers, increase the number of Carer Friendly Practices Award Voluntary Sector Grants for information services, to support planning, Self Care, Counselling, inclusion in the community and respite Models of Care Scheme; developing care plans with patients , to be rolled out to Southall and North Localities Develop a patient engagement strategy, to provide a structure for PPE committee to discharge its individual and collective patient participation duties Implement agreed Perinatal Mental Health service Continue Community Transport Pilot; covering across Ealing, and develop plan for commissioning this service Increase use of IT to support engagement with patients online; complete the update of the Ealing CCG website and pilot the use of Twitter Build upon long standing and constructive working relationship with Ealing Community Voluntary Services (ECVS) and Health Watch CLARE PARKER [Document title]

Patient, Public and Lay Engagement in 2015-16
23 April 2017 Patient, Public and Lay Engagement in Strengthening our online presence Increase engagement with patients of working age through social media and online presence Improve engagement through the CCG website and pilot the use of Twitter Supporting patient involvement Review mechanisms for recruiting patients and public, especially from a more diverse background Ensure involvement opportunities are accessible and engagement is meaningful and sustained Evaluate impact of involvement and engagement on each stage of the commissioning cycle and service outcomes Develop and implement a robust and sustainable reimbursement policy Carer’s Project with GP practices Increase engagement with carers while addressing local health needs and identified health inequalities CLARE PARKER [Document title]

Quality & Safeguarding
23 April 2017 Quality & Safeguarding Dr Jonathan Webster, Director of Quality and Patient Safety, CWHHE CCGs [Document title]

Patient Experience & Equalities
Quality & Safeguarding Safeguarding (Children & Adults) Core membership of the Local Safeguarding Children Compliance with Care Act Safeguarding Adult Boards Established Commissioning Framework developed to support learning from serious cases MCA project with Bucks University Medicines Management Audits undertaken in practices around medicines use in respiratory disease and diabetes Work to ensure incidents are reported in line with the National Learning and Reporting System Repeat prescribing policies reviewed and audits undertaken to assess compliance with policy Quality Improvement Quality schedules streamlined and embedded within provider contracts Standardised performance indicators for maternity services Transformed the access to and the delivery of ‘essential Skills’ training for nurses working In GP practices The Infection Clinical Network detects trends in infections and works across providers and with national bodies to provide solutions Quality Achievements Patient Experience & Equalities Reviewed all patient and staff experience data to help us understand what is working and what needs improving Worked with providers to improve the quality of reporting on patient experience and equalities Delivered projects in partnership with local providers and the local community to improve the way we capture experience from often excluded group e.g. My Health My Say Strategy Development Patient Experience Strategy embedded Quality and Safety Strategy nearing completion Integration with clinical pathway and service redesign Quality Assurance Development of standardised quality schedules enabling benchmarking across provider organisations Improvement in safety data for assurance Increased number and spread of clinical assurance visits to providers Quality role in the procurement process e.g. Respiratory, Community Independence Services and Cardiology Revised Quality reporting to allow greater scrutiny of all providers at local CCG level Greater scrutiny of trust systems for infection prevention

Annual Reports and Accounts
23 April 2017 Annual Reports and Accounts David Tomlinson, Interim CFO, CWHHE CCGs [Document title]

NHS Finance Language Surplus not profit Deficit not loss
23 April 2017 NHS Finance Language Surplus not profit Deficit not loss Control total - the planned surplus / deficit for the year - fixed and cannot be missed without agreement Surpluses bigger than plan are nearly as bad as deficits Underperformance – where activity is lower than plan, and we spend less than intended Over-performance – where activity is higher than plan, and we spend more than intended QIPP – Quality, Innovation, Productivity and Prevention – NHS language usually used to denote savings or cost reduction plans CLARE PARKER [Document title]

23 April 2017 Financial duties Most of our income comes straight from the Department of Health (DH) Called Revenue Resource allocation (or Capital Resource allocation for capital spend) Can be recurrent - fixed and then subject to an annual uplift; or non recurrent - usually small amounts for specific purposes The total of the allocations that we receive is called the Revenue Resource Limit (RRL) (or Capital Resource Limit – CRL) We have a statutory duty not to exceed our RRL or our CRL – i.e. we aren't allowed to spend more than we are given We receive a separate allowance to pay for our running costs – this is set at £25 per head of population. Again we are not allowed to exceed this amount We are not allowed to borrow money or go overdrawn. We are also not allowed to hold more than 1.25% of our March cash drawdown amount as cash at year end. CLARE PARKER [Document title]

Financial strategy Our high level financial strategy is therefore:
23 April 2017 Financial strategy Our high level financial strategy is therefore: Our 3 year planning is based on a c.6.3% uplift to our revenue allocation. This is consistent with the allocation that has been published for Allocations for onwards are not yet known. The CCG needs to generate sufficient QIPP savings to offset the growth in demand for services year on year The CCG needs to strengthen its underlying financial position, by only committing reserves non recurrently where possible and using them to pump prime new services that will lead to reduced costs (i.e. investing to save). CLARE PARKER [Document title]

2014-15 Financial Position 23 April 2017
ACHIEVEMENT OF STATUTORY FINANCIAL DUTIES The Clinical Commissioning Group is required to report in its account on the following statutory duties: Significance – Is the CCG living within its means in its healthcare commissioning activities? Significance – Does the CCG plan and control capital projects effectively? (Limited given the restrictions placed on CCGs with the regards to asset ownership) Significance – is the CCG spending more or less than it is authorised to do in Total and in respect of Programme (healthcare) and Administration (running cost allowance) activities? Duty Plan/ Allowance Actual Variance Expenditure must not exceed income Compliant N/a Duty Plan/ Allowance Actual Variance Capital resource used does not exceed the amount specified in Directions £0k Capital resource used on specified matter(s) does not exceed the amount specified in Directions Duty Plan/ Allowance Actual Variance Revenue Resource limit £443,172 £432,645 £10,527 Revenue resource use on specified matter(s) does not exceed the amount specified in Directions £0 Revenue administration resource use does not exceed the amount specified in Directions £9,155 £9,150 £5 CLARE PARKER The CCG did not have a capital resource allocation for 2013/14, and spent no money on capital assets. [Document title]

2014-15 Summary of Net Expenditure
23 April 2017 Summary of Net Expenditure Commissioning Area £m Acute £240 Mental Health £47 Continuing Care £15 Community £46 Prescribing £40 Primary Care £18 Corporate & Estates/ Other/ Incomplete £28 Planned Surplus £9 Total £443 CLARE PARKER The table and chart above show how the CCG spent its money. The highest proportion of spend goes on acute services, at 54% of total expenditure. [Document title]

Underlying position Ealing CCGs financial position is as follows:
23 April 2017 Underlying position Ealing CCGs financial position is as follows: At 1 April 15: Brought forward surplus £10.5m, underlying (recurrent) surplus £11.8m Plan 31 March 16: Carry forward surplus £4.9m, underlying (recurrent) surplus £14.6m (3.13%) The CCG is 6.2% below the level of funding it would receive if funding were based on a fair shares, rather than historical, basis. This means that we expect to receive growth in funding above the average NHS level for the next few years. CLARE PARKER [Document title]

Budget David Tomlinson, Interim CFO, CWHHE CCGs

Key financial risks The key financial risks we are facing are:
23 April 2017 Key financial risks The key financial risks we are facing are: Short term Acute over-performance Delivery of QIPP Ensuring delivery of savings from Spend to Save Investments Medium term Capitation target and the pace of change towards this Demographic risks of ageing population Delivery of the out of hospital agenda Better Care Fund (Social Care integration fund) Whole Systems Integration Agenda CLARE PARKER [Document title]

2015-16 Budget Commissioning Area Plan £’000’s Acute Contracts 239,977
23 April 2017 Budget Commissioning Area Plan £’000’s Acute Contracts 239,977 Mental Health Services 49,510 Continuing Care 19,480 Community Services 55,747 Prescribing 42,796 Primary Care 17,652 Other Services 40,629 Total Programme Costs 465,791 Running Costs 8,262 Net Operating Expenditure 474,053 Planned Surplus 4,889 Revenue Resource Limit 478,942 CLARE PARKER The planned surplus for is £5.6m lower than the surplus delivered in At month 2 we remain on track to deliver the planned surplus. [Document title]

Questions and Answers Plenary

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