Barking and Dagenham CCG Commissioning Strategy Plan
Contents 1 Vision and strategic goals Context 2 B&D CCG priorities 3 4 BHRUT viability: long term financial modelling Appendices: 2013/14 commissioning timetable 2
Vision and strategic goals “Improving health and health outcomes for local people through clinically led commissioning of sustainable, safe, high quality local health services” • Address the health needs and health inequalities of our population by prevention of ill health and promotion of wellbeing • Improve the quality of health services, standards of care and outcomes for local residents across all health services, hospital, primary and community services • Deliver strategic and transformational change needed to ensure high quality and sustainable services into the future • Ensure financial sustainability and deliver best value for money for services commissioned • Develop an urgent care strategy that supports the public in using primary care
Contents 1 Vision and strategic goals Context 2 B&D CCG priorities 3 4 BHRUT viability: long term financial modelling Appendices: 2013/14 commissioning timetable 4
SECTION 2. CONTEXT WORKING DRAFT Population profile Barking & Dagenham has a relatively young Barking & Dagenham has a deprived population population compared to the England average compared to the rest of London Total population 1 Map showing deprivation (IMD national quintiles) in Barking 173,375 Number registered with B & D GPs 2 191,073 & Dagenham by LSOA (IMD 2010 Score) 1 – most deprived quintile England NHS B & D CCG 5 – least deprived quintile Key findings or issues ▪ Young population ▪ High proportion of children ▪ Particularly high number of 0-5s ▪ Low proportion of over 65s ▪ Barking and Dagenham is 8th most deprived area in London ▪ Large new housing developments planned 7th most deprived of 31 PCT areas in London 3 Male Female 1 DH Expo Book 2012 2 NHS Information Centre 2010 3 IMD 2010 - average score 5 SOURCE: Network of Public Health Observatories 2011, NHS IC 2010/11, ONS 2012
Provider landscape • Main acute provider, BHRUT, is challenged financially, and second largest acute provider, Barts Health, is running a deficit • Main acute provider has serious quality issues • 6 th lowest number of GPs per weighted population in London, 0.56 GPs/1000 weighted population, compared to London average of 0.66 • 74% of GP practices have 3 or fewer GPs, compared to national average of 46%
Quality improvement areas for providers BHRUT Overall progress has been made on the recommendations made by the CQC. Action is needed on: • Health Acquired Infection • Serious Incident Management: • Eliminating Mixed Sex Accommodation National GP patient survey • Formal Complaints • Impression of waiting time at surgery • National Cancer Patient Experience Survey • Rating of nurse giving you enough time 2011-12 • Confidence and trust in the nurse • National Hip Fracture database outputs • Overall experience of out-of-hours GP services NELFT • Infection Control and Prevention Training Compliance • Serious Incident Management • Safeguarding Children Training Compliance • Ofsted/CQC recommendations to B&D Trust/PCT and LA • Problems with Health Visiting Recruitment
Contents 1 Vision and strategic goals Context 2 B&D CCG priorities 3 4 BHRUT viability: long term financial modelling Appendices: 2013/14 commissioning timetable 8
BHR CCG priorities • Commission safe, sustainable, high quality services for the local population • Integrate care • Redesign urgent and emergency care services • Staying healthy • Increasing productivity
B&D CCG proposed priorities 2013-18 Developing a locality-led approach to provision of integrated health and social care services that will have an early impact on: • Urgent care • Children and young people • Integrated care – for older people and people with long term conditions
Opportunities: Urgent care • Developing a locality model for primary care urgent care • Review Walk in Centre provision in Barking • Increase utilisation of urgent care centres at KGH and Queen’s Hospital and review provision of UCCs • Implementation of NHS 111 including Co- ordinate my Care (for end of life care)
Opportunities: Children and young people • Review Child and Adolescent mental health strategy including Improving Access to Psychological Therapies • Implement CQC recommendations for Looked After Children and Young Offenders • Review speech and language therapy for children with special educational needs and disabilities • Short breaks for carers • Review urgent care pathway for children (linked to urgent care above)
Opportunities: Integrated Care Strategy • BHR Integrated Care Coalition agreed Case for Change and to develop integrated care strategy to achieve a viable sustainable health and social care system. • Integrated care strategy focuses on frail, older people and those with long term conditions • Service model has been developed - based on locality focus of delivery of care and more care provided closer to home • Improved productivity for community services will allow a reduced community bed-base for BHR to provide more activity in the community
Other key opportunities • Planned care – reducing secondary care activity and managing demand • Maternity – B&D births at Barking Birthing Centre and Newham • Productivity - Medicines management and contract review • Cancer – implementing London models of care and standardisation of pricing • Mental health – improving access to psychological therapies and review of CAMHS services (see children and young people priority above) • Primary care – continuous quality improvement and review of enhanced services
Contents 1 Vision and strategic goals Context 2 B&D CCG priorities 3 4 BHRUT viability: long term financial modelling Appendices: 2013/14 commissioning timetable 15
BHR CCG approach to achieving high quality and financial balance • GP leaders and CCGs fully support the HealthforNEL programme agreed in October 2011 • Collaborative commissioning across the Integrated three CCGs has been designed to ensure a consistent and coherent integrated care Care Strategy strategy to wrap around BHRUT, reducing the complexity and enabling pathways to be streamlined. • Collaborative BHR CCGs leadership team established to drive whole system change focusing on 3 programmes: – Implementation of integrated care and out of Acute hospital strategy (many of BHRUT Trust LTFM productivity gains will require system support reconfiguration e.g. LOS reduction requires all partners to ensure appropriate discharge and post acute care in place). – Acute reconfiguration programme driving up quality standards – BHRUT LTFM: delivering a viable Trust
BHRUT viability: long term financial modelling • CCGs want to see BHRUT become a viable high quality local provider for their residents and recognise their role Closing the gap in supporting BHRUT to deliver . by 2016/17 • BHRT estimated “do nothing” financial gap is c£126m by 2016/17. • The Trust, supported by E&Y is PFI Gap funding £16m working on developing a more robust £16m long term clinical and financial Trust productivity strategy. savings £94m • Discussions are ongoing about options to bridge the remaining gap, e.g. potential to repatriate some work back to BHRT currently flowing into central London. • Financial risk arrangements will be considered through this process.
Contents 1 Vision and strategic goals Context 2 B&D CCG priorities 3 4 BHRUT viability: long term financial modelling Appendices: 2013/14 commissioning timetable 18
Commissioning Timetable for 2013-14 August 2012 September October November December January 2013 February March April EY support to development of integrated care commissioning strategy and outline business case Baseline of current services Options development Modelling of economic impact Options appraisal Dev. of strategic outline case EY support to development of BHRUT long-term financial model and clinical strategy Commissioning intentions and priorities agreed 1 st draft Commissioning strategy Final Commissioning strategy plan plan agreed by CCGs agreed by CCGs CCG Completion of Production of Refinement of allocations provider delivery detailed provider expected plans provider delivery plans delivery plans Contracts signed Contract negotiations NELC Board Meetings Integrated Care Coalition Meetings CCG board meetings Health and Wellbeing Board Meetings
Comments Members are invited to comment on: • Progress made towards strategic goals • Priorities for 2013-18 • The QIPP opportunities outlined in the strategy
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