Earlier Presentation Pilot Including Earlier Home Visiting Service - PowerPoint PPT Presentation

Earlier Presentation Pilot Including Earlier Home Visiting Service Healthier. Stronger. Together

Live participation: How to use Slido • Connect to Somerdale Pavilion wifi network on your laptop, tablet or smartphone: Network: SOM_Guest Password: Aqu4t3rr4 • Open slido.com • Enter the code: #GPclusterApril

Live participation: How to use Slido • Click the ‘Questions’ tab to ask a question • View other participants’ questions on the screen • Click the ‘thumbs up’ to vote for other questions you ‘like’. These will move to the top of the presentation screen.

Earlier Presentation Pilot • Earlier Home Visiting Service – 3 pilots, 15 practices – 6 months • Urgent Connect • FAST transport service • Ambulatory care enhanced in RUH

3 Pilots • Keynsham • Norton Radstock – 3 practices – 7 practices – GP model – GP model – Run by practices – Run by BEMS+ • Bath – 5 practices – Paramedic model – Run by BEMS+

It has delivered….. • 20% reduction in late presentations • Wiltshire - rise in late presentations • So pilots continuing till end of June • Roll out across all of CCG • £362k – Allocated on population – Based on costs of pilots • Evaluation will determine funding for next year

Roll out proposal • Recommendation combination – paramedic supported by GP triage – To identify most appropriate clinician • Requirement that clinician has access to records • Reporting in line with pilots current reporting • Needed to confirm impact

Timeline • 6 th April Cluster meeting • 7 th April Expression of Interest forms • 21 st April Deadline for return • 19 th May Notification of successful pilots • 1 st June Virtual Pilots start • 3 rd July Quarter 2 start of new pilots

GP Cluster Meeting Thursday 6 th April CCG Financial Position Healthier. Stronger. Together

Live participation: How to use Slido • Connect to Somerdale Pavilion wifi network on your laptop, tablet or smartphone: Network: SOM_Guest Password: Aqu4t3rr4 • Open slido.com • Enter the code: #GPclusterApril

Live participation: How to use Slido • Click the ‘Questions’ tab to ask a question • View other participants’ questions on the screen • Click the ‘thumbs up’ to vote for other questions you ‘like’. These will move to the top of the presentation screen.

How we spend our allocation

CCG Finances – Jargon buster • CCG Allocation – Based on complex formula – Weighted population • Headroom (1% = £2.3m) – “one off” investments • Surplus (1% = £2.3m) – Required under NHS finance rules • Contingency (0.5% = £1.1m)

How did we get here? 1. Changes to CCG funding allocations in 2016/17 – BaNES now £6m below our “fair shares” allocation 2. Growing demand in secondary care 3. ONS population growth – not funded 4. Unfunded costs e.g. Funded Nursing Care = £1.2m per year 5. Impact of Tariff changes = £2.2m in 2017/18

Two ways of looking at the numbers

Headline numbers • 16/17 financial outturn will be breakeven – i.e. £2.3m off target surplus • Non recurrent in year funding helped • Underlying “operational deficit” • Technical reporting of the 16/17 “headroom” – may cause confusion

How does financial problem unfold? Underlying 2016/17 2016/17 non Problem + = Surplus recurrent going into missed Support 2017/18 + Full 2017/18 2017/18 1% 2017/18 new problem surplus growth and before required + cost pressures = Savings plan i.e. Tariff impact and Demographic growth

So what if we have a deficit? • “Turnaround” director appointed • Slash and burn • Cuts to all budgets possible • Loss of local control • Loss of control of destiny

Financial recovery • To restore position fully in 17/18 would require £14.6m efficiency savings • Savings required to restore position over 3 years: – 17/18 £11.6m – 18/19 £5.7m – 19/20 £4.1m

What does this mean? 2 key messages:- • CCG has to produce a detailed plan – how we will make savings to reduce our spend to live within the budget allocated to B&NES • We are protecting primary care budgets

2017/18 Savings Plan • £11m = 5% of CCG budget • 5% savings target is the maximum deemed realistically achievable by NHSE • If delivered, avoids a deficit • Historically the CCG has delivered savings of £4m per annum

Possible responses to funding pressures 1 2 3 4 Financial Spending Response Impact on Situation decision patient care Fund from Access and other source quality Overspend maintained Deficit Budget does not cover Restrict Reduced demand access access Cut spending Dilute quality Lower quality per patient Improve Equal/higher productivity quality/access

2017/18 Identified Savings £1.9m Medicines Optimisation £2.2m Urgent Care Elective Demand Total £8.5m £1.4m Management £1.1m CHC/FNC £0.5m MSK £0.9m Finance & Business

What does this mean for primary care?

How can primary care help? 1. Your ingenuity & support 2. 4 key initiatives:- a. Urgent Care – Early Home Visiting Service b. Referral Support Service c. Medicine Optimisation d. Supporting patients be fit for surgery

Urgent Care – Early Home Visiting Service • Earlier presentation • Access to hospital if needed • Assessed / sent home earlier (if appropriate) • £362k NEW investment • WIN for patient • WIN for GPs • WIN for CCG • Further funding dependent on proof of concept

Referral Support Service • Removes work from Primary care – C&B – Smoothens out appointment process • Reduces variation in referral criteria • Supports delivery of new pathways • NEW investment • WIN for patient • WIN for GPs • WIN for CCG

Medicines Optimisation OptimiseRx Software – go live in April with 13 practices • Integrated into clinical system / supports clinical decisions • Optimises prescribing • NEW investment • WIN for patient • WIN for GPs • WIN for CCG • Aim roll out to all practices in 2017/18

Gluten Free & OTC Medicines Update Implementation Material to Practices : By Easter - Clear Guidance - Patient Leaflets - Printed letters to practices • Implementation to start after Easter Key Messages: GF ONLY : for most vulnerable Short term Analgesics & Hayfever : Self Care Exceptions : medically necessary – prescribe

Supporting patients be fit for surgery • Smoking cessation and weight loss • Harrogate pathway – Clinical evidence • Pathway for this being developed • Launch at GP Forum tbc

IFR review • Clinical audit identified non- compliance • 7 policies from Criteria Based Access to Prior Approval from November 2016 • Significant additional administration • Trial period - examination of Cataract policy • From10 th April, for cataracts, referrals direct to secondary care via Choose and Book • Later in 2017 Revision of the optometry service

Any Questions?