Council of Members 20 January 2016
Feedback on election process: Council of Members Chair and Deputy Chair Malcolm Hines, Chief Financial Officer
Minutes of last meeting: 14 October 2015 Dr. Richard Proctor, Council of Members Chair
National planning guidance, CCG commissioning intentions and update on current PMS contract review Caroline Gilmartin, Director of Integrated Commissioning Dr. Jonty Heaversedge, Chair, Southwark CCG
NHS Planning Guidance 2016/17 – 2020/21 Delivering the NHS Forward View guidance recognises that local NHS systems will only become sustainable if they accelerate their work on prevention and care redesign. NHS England is requesting local systems quicken the pace of transformation early in 2016 to build momentum for future years. Planning by individual institutions will increasingly be supplemented with planning by place for local populations. The NHS is required to produce two separate but connected plans: 1. A five year Sustainability and Transformation Plan (STP), which is a local place-based blueprint for accelerating the implementation of the NHS Forward View . The ‘footprint’ for Southwark is proposed to be south east London, consistent with the geography for Our Healthier South East London . 2. A one year Operational Plan for 2016/17 , borough-focussed but consistent with the emerging STP. 5
NHS Planning Guidance 2016/17 – 2020/21 Whilst developing long-term plans for 2020/21, the NHS has a clear set of plans and priorities for 2016/17. There are 9 ‘must do’s for local systems in 2016/17: 1. Develop a high quality, agreed STP. 2. Return the system to aggregate financial balance. 3. Develop a local plan to address the sustainability and quality of general practice. 4. Meet standards for A&E and ambulance waits. 5. Ensure >92% of patients on non-emergency pathways are treated within 18 weeks. 6. Deliver the 62 day cancer waiting standard and improve one year survival rates. 7. Achieve the two new mental health access standards (50 % of people experiencing first episode of psychosis to access treatment within two weeks; and 75% of people with relevant conditions to access talking therapies in six weeks; 95% in 18 weeks). 8. Transform care for people with learning disabilities, improving community provision. 9. Improve quality and implement an affordable plan for organisations in special measures. 6
Financial context • NHS England announced the NHS budget settlement on 17 December 2015. • This covers a five year period, with the first three years fixed allocations being issued and last two years indicative figures. • The settlement for Southwark of 3.05% in 2016-17 is below the national average of 3.4%. This is because Southwark is deemed to be some 4.2% above its spending ‘capitation target’ level. • Only Lewisham and Southwark CCGs are above target spend in south east London. • Specialised commissioning budgets have been increased by 8% to allow for increased demand and new drug regimes. • From 2017-18 onwards the Southwark budget increase drops to about 2.5% per annum and then goes back up in the last year (2020-21) to 3.7%. • Our budget for running costs has also decreased by £120k, due to our ONS measured population decreasing by 7,000 to 292,000. This measure is contrary to our GP registered lists, which now stand at c.316,000, and are increasing annually by 1-2%. 7
Commissioning intentions bring together national, regional and sub-regional strategies Commissioning intentions for Southwark Sub-regional National Regional Southeast London England London Six care pathways for Forward View 13 programmes including improvement, including Planning Guidance Transforming Primary Community-Based Care Allocations Care 8 DRAFT – FOR DISCUSSION ONLY
Aim of the CCG’s commissioning intentions We are seeking a place-based approach that delivers timely access to services that are high quality, proactive & coordinated. When taken together our commissioning intentions reflect the need to secure: • Timely access to services and a rapid return to delivery on constitutional standards . • Safe and high quality services delivered consistently (over time and across providers). • Proactive and preventative care that is coordinated between the various providers within a locality. Commissioning intentions require all providers of care to work as part of a coherent and place-based delivery system. Therefore we require significant transformation beginning in 2016/17 and including: • Rapid development of Local Care Networks , including putting in place the commissioning changes to support formal joint working. • Development of new care models in six priority service areas: urgent and emergency care, community-based care, cancer, children and young people, maternity and planned care. 9 DRAFT – FOR DISCUSSION ONLY
CCG’s commissioning intentions in context These intentions are consistent with our overall focus on populations, total system value and delivering the attributes of high quality care. We are changing the way we work and commission services so that we: Focus on total system value Focus on the ‘how’ as well as Emphasize populations rather than individual the ‘what’ rather than providers contract prices Moving away from lots of separate contracts and towards Focusing on commissioning Arranging networks of services population-based contracts services that are characterised by around geographically that maximize quality these attributes of care, taking into account people’s coherent local communities outcomes (effectiveness and experience) for the available hierarchy of needs resources 10 DRAFT – FOR DISCUSSION ONLY
Draft CCG commissioning intentions 2016/17
Commissioning intentions 2016/17: integration (children) Children and Young People • Deliver the Southwark CCG and Council Joint Wellbeing (education, health & care) Children and Young People (0-25) Strategic Framework recommendations • Prioritisation within pooled budgets on: – Early years (0-5). – Emotional wellbeing and mental health (transformation plan and working with schools on training). – Reduce pressure on crisis services: Early Start Service and children’s ‘ hospital@home ’. – Long term conditions including mental illness, through Children and Young People’s Health Partnership (CYPHP ). – Young people’s health (10 -25) risk behaviour. – Vulnerable children and young people, including: carers, YOS, neglect, LD, SEND. – Children and young people who are very overweight. – Focus on brief intervention and strengthening services working with the Council. 12 DRAFT – FOR DISCUSSION ONLY
Commissioning intentions 2016/17: integration (adults) Adult services • Align Community Multidisciplinary Team (CMDT) approaches out of hospital embedding a sustainable CDMT framework that delivers improved coordinated care of patients in the community, reducing emergency attendances and admissions and outpatient attendances. • Integrate consistent, sustainable support for people with mental health needs who are living with LTCs. This will replace models of social and psychological support which are specific to individual physical conditions. End of Life • Embedding ‘priorities of care’ (this replaces the LCP). • Continued roll out and embedding of Coordinate My Care (CMC). • Transforming Care Building the Right Support. • Developing community services for people with learning disabilities and closing inpatient facilities. 13 DRAFT – FOR DISCUSSION ONLY
Commissioning intentions 2016/17: integration (adults) Medicines Optimisation • Medicines Optimisation and Pharmacy Workforce Strategy has been approved and will be implemented. QIPP, Prescribing Incentive Scheme and investments have been identified as part of the CCG’s business planning process for 2016/17. • Set up of an integrated service for patients with LTCs (cardiovascular, mental health, etc.) • Pharmacy Workforce Transformation programme. Carers • Working within the Children and Young People’s Framework to develop a set of services that reflect the needs of a broad range of young carers, which delver a consistent and comprehensive approach, including early identification of young carers. • Work with Southwark Council to ensure that we can promote activities that enable working age carers to stay in or return to work education or training, including promotion of consistent employment practices in NHS organisations and working with the wider system to roll these out. • Improve and promote access to a range of mainstream services for carers, including health checks. • Assist Southwark Council to increase the use of personal budgets, and increasing people access to services through access to information from local health care professionals. • Promote the use of IAPT for carers. • Ensure our health services such as ERR and Night Owls are responsive to the needs of carers. 14 DRAFT – FOR DISCUSSION ONLY
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