Our 2015/16 Commissioning Plan for Governing Body 27 May 2015 Simon Hall Deputy Chief Officer/Director of Strategy and Performance
Our Commissioning Plan has Three Key Elements: Activity Finance Performance and Quality
Activity Baseline • The CCG’s activity plan has been through extensive scrutiny from NHS England. • The focus this year has been to commission enough activity to respond to a higher than expected out-turn position, to ensure our performance is secured against key targets and Constitution standards. • Our activity plans align much more closely to our contracted activity. This will enable better performance monitoring this year.
Activity : Example of 3 year trend analysis Within the local Health Economy, NHS Greenwich has experienced a significant change in our acute provider following the recommendations of the Trust Special Administrator. SLHT was dissolved on 1 October 2013 and the 3 individual hospitals were merged with other trusts. For Queen Elizabeth Hospital in Woolwich the merger was with University Hospital Lewisham and created the new Lewisham & Greenwich NHS Trust. Based upon our submission made on the 18 March 2015, our findings from this shows that there are a number of factors that impact upon our historical trends. There is insufficient baseline activity over a sustained period to provide a robust baseline. However, this explains our position compared to the methodology provided by NHS England on their growth assumptions. We have therefore used the first ten months of 2014/15 as our baseline, adjusted for BCF, QIPP, provider data changes, Clinical Decision Unit and Referral To Treatment resilience. We have applied demographic and non-demographic growth to form the 2015/16 projection.
Activity Plan 2015/16 14/15 outturn run rate M10 by POD No adjustment for seasonality Population growth Non-demographic Specific Issues RTT assessment uplift Based on ONS (1.7%) Based on local knowledge (1%) CDU Acute QIPP (£2mil) BCF (acute impact £2.3mil) Eltham Community Hospital Alliances 15/16 predicted activity
How we have contracted with our providers to secure activity • Lewisham & Greenwich Trust Could reduce admissions by more than 834 (estimated opportunity is 2,500) and Cap and collar contract agreed also reduce LOS more but still pay block – our benefit would reduce our out-turn Cap with no reduction of activity for efficiency improvement and therefore the cost of 2016-17 contract and bring us back into balance. Collar adjusted for reduction in activity by • MH strategy needed in-year to inform 834 NEL episodes of care i.e. £2.3m next year to achieve standards and (revised down from original plan) model future needs to include more Oxleas MH and Community blocked – integration between physical and mental agreement to find £880k QIPP in year to health achieve lower run rate next year • Community – separate out work into Guy’s & St Thomas’s/King’s – proposed Alliance, children etc. rebase 2016-17 block – more work to do on the final details • but contract due to be signed by end of May. Baselines have been set on outturn plus population adjustments. If we can divert Dartford and Gravesham NHS Trust – we work to community care there will be a have agreed a full PBR activity contract. financial QIPP saving
Financial overview of our Plan • • Planning 1% Surplus We are building our Local Care Networks, building on our new GP • The Plan has followed NHS business Provider Networks that were set up in rules including meeting population 2015. A key focus in the plan is investing growth, (0.7%), Non Demographic in transformation e.g. alliance, better growth (1%), Continuing Care(2%), primary care and maintaining financial Prescribing (5%) and London Health balance but also quality, productivity and Care(0.15%) and committed (1%) service improvement. Our Plan has towards Our Healthier SEL . dedicated chapters on our trajectories on • key targets and how we going to improve In addition, we have committed £12m (3.4%) investment in the Better Care services and the health of our local population. Fund (BCF) and have signed a Section 75 agreement with the Royal Borough of Greenwich. This is in addition to the £6m allocation which we funded directly in 2014/15 and is over and above our 2015/16 commitment. Our BCF contains 14 transformation projects and is expected to realise a £2.3m QIPP in 2015/16.
QIPP (Quality, Improvement, Productivity & Prevention) • • Total figure by which we need to Reduce avoidable admissions and have reduced spend by in 2015/16: reduce LOS at LGT which reduces £7.3m contract cost by £2.3m (this is in line with BCF programme of reducing • Anything not achieved in year needs unplanned admissions by 834). to be covered with non recurrent • resources (using money loaned to Medicine Management £1m (in others in previous years, reducing which we have confidence). surplus etc.) – and these will not • Gap of £4.3m could be covered by exist in the future. other savings in year (e.g. reduce • Additional £4m needed 2016/17 and continuing care spend, reduce anything not saved this year rolls planned investments, service into next year i.e. worst case £4m + redesign as outlined in the Plan). £7.3m = £11.3m • If we reduce admissions and LOS beyond our target level then this helps us invest in 2016/17.
How will we deliver? 2015/16 delivery : 2016/17 delivery based on work in 2015/16 : Eltham Community Hospital beds used to admit more people directly and reduce hospital GP Provider Network LTC contract & Year of Care admissions implementation reduces hospital admissions BCF investment in enhanced care home support, Pioneer (Stage 3) roll out across Greenwich nutritional support, CMC etc. reduces admissions 4 hour wait project plans: Frailty and alliance models reduce admission Rapid Assessment & Treatment in ED reduces New urgent care pathway embedded conversion rate by 3% Children’s urgent care pathway embedded LGT have plans to reduce simple LOS from 5 to 3 days which reduces tariff Better Care Fund (BCF): Improved discharge arrangements & reduced Impact of Connect Care; reducing social LOS (marginal saving) and reduce admission isolation, support to carers, making every rate when hospital is less full contact count Other pathway improvements from the Alliance Building on our strategic programmes in the Plan, to refresh them and deliver QIPP via a new plan in Developing a programme approach across all our 2016/17. commissioning areas in the Plan led by a new Transformation and QIPP Executive and a new Joint Commissioning Executive with the Council.
Our Must- Do’s for 2015/16 • Delivery against our contract agreements • Eltham Community Hospital opens, running and busy • Achievement of constitution targets • A&E (Qtr 3) • Cancer (Qtr 3) • IAPT recovery (Qtr 1) • Balanced budget that delivers at least £7.3m QIPP • New urgent care pathway • Implementation of new enhanced long term conditions contract • Access improved to general practice • Alliances up and running • Co-commissioning /Joint commissioning of Primary Care • Improved engagement of public and members • Implementation of Connect Care • Informed decision making based upon intelligence • Response to in-year demands
• Copies of our Plan are available on the CCG Website.
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