NHS Telford & Wrekin QIPP Plan 2014/15

Transcription

1 NHS Telford & Wrekin QIPP Plan 2014/15 Taking Care of Telford and Wrekin Every patient experience matters - Every clinician is involved "Telford and Wrekin Clinical Commissioners will deliver high quality, equitable, safe and locally driven care. Despite our finite resources, patients and clinicians together will strive for the best possible healthcare in Telford and Wrekin". 1

2 Contents 1. Summary Report 2. Appendix 1 Current 13/14 Position 3. Appendix 2 Summary of 14/15 Plan 4. Appendix 3 Detailed 14/15 Plan 2

3 1. Summary 1.0 Introduction This plan is a working operational document. It has been put together by GP leads with Heads of Commissioning. While wider engagement is still required to ensure plans are also informed by patient views we are optimistic that there will be a collective ownership to deliver changes that improve patient experience and reduce costs. The plan includes brief details of each scheme, and where savings will come from. 2.0 Progress to date Despite the upheaval of organisational change during 2013/14 the CCG came close to meeting all QIPP targets. The table at Appendix 1 shows progress against each area and indicates that at month 9 we have a gap of 744k outstanding. 3.0 QIPP governance Governance Structure The governance structure for the CCG as described in the CCG s Constitution is shown in the diagram below: CCG GP Practice Forum CCG Governance Board Audit Committee Remuneration Committee Planning, Performance and Quality Committee Patient Roundtable Individual Funding committee Policies and Priorities Committee QIPP Board QIPP Sub Committee The Staffordshire and Lancashire CSU Business Intelligence team provides monthly monitoring information to the CCG s Programme Management Officer who then produces a monthly report based on this information and narrative from the Lead Commissioners. This report is submitted to the QIPP Sub- Committee and the PPQ meetings for discussion. Planning, Performance and Quality Committee oversees and provides assurance on performance and quality of commissioned services. The CCG s Programme Management Officer provides a QIPP report for PPQ meeting. QIPP Board is a joint Board with Shropshire CCG which oversees the delivery of QIPP targets by the CCG s shared providers in the local health economy. QIPP Sub-committee oversees the delivery of the CCG s own QIPP targets and the development of new QIPP schemes for consideration. The QIPP Sub-Committee meet with Lead Commissioners every third Tuesday of the month and the chair of the QIPP Sub-Committee is Mr. Dylan Harrison. 3

4 The function of the QIPP Sub Committee is to scrutinise detailed schemes, to provide assurance to the Board that these will deliver and to closely monitor progress. If targets are not being met, then the group will steer work identifying contingency proposals to ensure that there is no drift. In this way the plan will remain dynamic, and the QIPP group will prompt rapid action to accelerate progress, or revisit the viability of schemes. 4.0 Patient engagement The principles of patient centred planning are critical to the CCG ethos. All QIPP schemes must be informed by robust patient engagement. To date not all schemes have been sufficiently informed by such consultation and completing this will be a priority during March/April Delivery of the transformational changes during 14/15 will be in partnership with patients /15 QIPP schemes The QIPP schemes all support CCG objectives and commissioning intentions to improve the quality of care and patient experience. Fundamentally the drive is to offer safe alternatives to hospital based care when appropriate, through design of more cost effective care pathways. The summary of the 2014/15 proposed QIPP plans is attached at Appendix 2. Total gross savings are currently identified at a target level of 6m. The schemes also contribute to achievement of National Outcomes Framework, NHS constitution and achieving the 6 characteristics in the Everyone Counts guidance which are strongly influencing the CCG 2 and 5 year strategic plans:- 1. A completely new approach to ensuring that citizens are fully included in all aspects of service design and change and that patients are fully empowered in their own care. 2. Wider primary care, provided at scale. 3. A modern model of integrated care. 4. Access to the highest quality urgent and emergency care. 5. A step-change in the productivity of elective care. 6. Specialised services concentrated in centres of excellence. The details of each scheme are included at Appendix Invest to save Given the challenging financial environment the CCG has taken a hard approach to ensuring QIPP schemes that require investment will deliver a good return in terms of both patient benefits and financial benefits. An initial list has been amended to take out schemes that did not appear viable and while we have a reasonable level of confidence in those now included we need to scrutinise some of these further, while continuing to identify still more to ensure we can meet the challenging target. The list of proposed non-recurring investments required to pump prime the QIPP schemes is included in the detail in Appendix 3. 4

5 Appendix /2014 Current Performance QIPP Update End of December 2013 Target for the Year Extrapolated Actual Extrapolated Variance YTD Target YTD Actual YTD Variance Planned Care Total 1,324,000 1,600, , ,999 1,449, ,931 Urgent Care 2,023,000 1,143, ,703 1,508, , ,570 Medicines Management 750, , , ,108-40,608 Mental Health 700, , , , , ,175 Total 4,797,000 4,053, ,929 3,589,042 3,315, ,206 5

6 Appendix /15 Summary Plan Scheme What will it look like? Link to objectives and planning framework Gross Savings Planned Care Revised pathways for planned care to deliver more care closer to home To encourage access to confirmation regarding lifestyles advice and ensuring people have a positive experience of care To increase life expectancy and reduce health inequalities To address long term conditions management and treatment and to enhance quality of life 2,631K Urgent Care Avoidance of admissions to hospital and reduction of 0-1 LOS by supporting patients in the community Case Managers training and educating providers (care homes) To improve commissioning of effective, safe and sustainable services, which deliver the best possible outcomes, based upon best available evidence To increase life expectancy and reduce health inequalities 2,197k Mental Health/Children s Services Modernise Mental Health Services by improving community support Ensure people are cared for close to home and possibly widen the scope of people eligible for admission Have services provided locally to ensure the delivery of high quality care 490k Medicines Management Promote evidence based/cost effective prescribing across primary care and review prescribing within secondary care To improve commissioning of effective, safe and sustainable services, which deliver the best possible outcomes, based upon best available evidence To increase life expectancy and reduce health inequalities 750K TOTAL 6,068k 6

7 Planned Care Detailed Plan Appendix 3 Scheme Baseline Activity month 7 Forecast to year end Baseline Cost month 7 Forecast to year end Target Reduction in Activity From acute contracts Target Reduction in Cost Investment Net saving How will this be achieved A reduction in OP activity from the main Acute providers 450,000 Reduction in Long Term Conditions Activity Respiratory 234 1stOP ,799 44,226 FUP , ,936 General 146 medicine 1stOP* ,791 26,426 FUP* , ,587 Cardiology 498 1stOP ,877 82,668 FUP , ,352 Diabetes 1stOP , ,925 FUP , ,725 Endocrine1stOP , ,550 FUP , ,520 Flo Simple Telehealth Pulmonary Rehabilitation Nebulisers 7 day cover for respiratory nurses Respiratory Consultant working in community team Breathless helpline (OOH) Donnington Community Cardiology Increased Community provision will reduce the demand for secondary care provision, patients will be given better local access to these support services, more self care support. All of these services are currently operational so will offer 12 months of activity. Total 218, , ,137, , , ,915 7

8 A reduction in OP activity from the main Acute providers 450,000 Reduction in referrals - Ophthalmology 1stOP , FUP , , , ,375 The Practice Ophthalmology Service Roll out of further Community Optometry Projects - Occular Hypertension, low vision, Paediatrics, Cataract Triage. We have been working jointly with SaTH to improve Ophthalmology capacity across both SCCG and T & W CCG and schemes are fully supported by SaTH, Local Optoms and both CCGs. There is recognition by secondary care consultants that local optometrists will be needed to support the secondary care service for it to meet its RTT. The Practice is operational and will continue to deliver in 2014/15. Optometrists will be trained during the first quarter to deliver new schemes - Childrens Pathway, Stable Glaucoma and low vision. Post-operative cataract is implemented and will continue in 14/15. 8

9 Reduction in referrals - Pain 1stOP , FUP , Community Pain Service Start back tool will be implemented from 1st April - 5 Physiotherapists, form SaTH, APCS and The Maddocks, completed their training March Self help tools -sign post patients to Pain website for self care guidance through link on CCG website. The Community Pain Service commences on 1st April 2014, is set up on Choose and Book, will be delivering a Community Pain Management Service from 6 T & W GP practices. They have the capacity to take all Pain Management referrals and will undertake inpatient procedures, injections, at Haughmond View in Shrewsbury which will also be operational from 1st April Currently there no appointments available for Pain Management at SaTH so patients will be referred to community pain services from 17th March for appointments in the first week of April. Patient choice will be exercised across the 6 T & W practices in the first instance. The Community Pain Service is presenting to the CCG GP forum so all GPs will be informed of the service and an information letter will also be circulated to raise awareness of all GPs. Procedures , ,000 94,000 10,000 9

10 Reduction in referrals - T&O 1stOP ,232, Increase in community MSK and Physiotherapy activity Direct access Nerve conduction Studies MRI - Activity includes some procedures to be identified Additional capacity for MSK pathway will be delivered from 1st April by Shropcom - APCS MSK. Practitioners have been recruited and additional capacity planned to improve pathway waiting times. Physiotherapy capacity will be supported to ensure waiting times are kept to 4 weeks for routine. Direct access to Nerve Conduction Studies will reduce unnecessary referrals to secondary care for the treatment and management of carpel tunnel. There are two providers currently ready to undertake this for T & W patients at below tariff rates. FUP ,520, , , ,000 10

11 Reduction in referrals - Urology 1stOP , Male LUTS pathway. Discussions are underway with Continence Assessment Service to improve pathways for Male urology patients. Pathways will be implemented to reduce the number of referrals for assessment from SaTH and release capacity for primary care referrals. This will be expected to start delivering this service by May Procedures , Reduction in referrals - Gynaecology 51,093 37,554 13,539 1stOP , Tendering new Community Service. Agreed at PPQ in November New Gynaecology service will be commencing in November 2014, figures have been adjusted for this start date. Continence Service will continue to implement the continence pathway and discussions planned for the provision of physio to extend the scope of this service further. FUP , Procedures , , ,000 24,000 11

12 Dermatology 1stOP , FUP , Procedures , ,000 70,000 18,000 Endoscopy Dermatology Services at Donnington and Woodside are well established and will continue to provide the only local dermatology service for patients in T & W 75 34,000 27,000 7,000 TOTAL ,466, ,197, , ,914 Highest referring practices Reduction in GP referrals -OP Cardiology , Paediatrics , Dermatology , ENT , Gastroenterology , Ophthalmology , Orthopaedics , Gynaecology , Urology , , ,767 Total ,428, , ,767 Endoscopy services at Wellington road Medial practice are well established and will continue to offer a community diagnostic service for patients to be managed in primary care. Specifically targeting the high referring practices to ensure pathways are being followed. Practices will be contacted to discuss referrals and expected to change referral profiles throughout the year. 12

13 Consultant to Consultant Referrals - Sath only Nephrology Cardiology General Medicine Respiratory Urology Gastroenterology Gynaecology ENT Pain Management , ,680 72, ,587 81,986 61,083 21,209 38, , ,543 Total , , ,543 New to follow up ratios- Sath only FUPs Breast Surgery ENT General Medicine Neurology , , , , Reducing Consultant to Consultant referrals. This will be implemented once Consultant to Consultant policy updates have been approved. Reducing the new to follow up ratios in with the Regional averages 132, ,532 Total , , ,532 13

14 Advice and Guidance - Sath Only OP Cardiology ENT Gynaecology Neurology Orthopaedics Respiratory Urology , , , , , , , , ,136 Raising awareness of GPs for use of Advice and Guidance. This will be on-going throughout 2014/15. Total ,189, , ,136 A reduction in Procedures undertaken in Secondary Care - 350,000 Procedures of Low Clinical Value As policy 574, ,739 Total procedures 574, ,739 A reduction in the Pathology Contract - 200,000 Pathology 200, ,000 Total Pathology 200, ,000 TRAQS cost 413, ,000 Revision of policy. This will be implemented when signed off by CCG. Quality and cost improvements to the SaTH Pathology contract. On-going in 2014/15 Total PLANNED CARE ,805, ,630,552 1,506,006 1,124,546 14

15 Urgent Care Detailed Plan Scheme Baseline Activity month 7 Forecast to year end Baseline Cost month 7 Forecast to year end Target Reduction in Activity From acute contracts Target Reduction in Cost Investment Net saving How will this be achieved A primary care service will be at the front door of A&E at PRH triaging and streaming patients to appropriate service; primary care, pharmacy, self-care with advice and guidance, ED. The scheme intended to; Reduce inappropriate use of ED Proof of concept test an approach that reflects national direction of travel to develop Urgent care centres A&E Primary Care at Front Door , ,000 Efficient and effective use of resources right place, right skills, right time Improve and support patients ability to selfcare through real time advice, written information and signposting. Over time it is expected to contribute towards reducing reattendance at A&E and promote self-care and use of alternative sources of support and advice e.g. pharmacy The National Urgent and Emergency Care Review evidence of A&E attendances highlights a rise by approximately 2% year on year which is mirrored locally. Primary care at ED front door 15

16 0-1 LOS , ,000 Work with QP groups Emergency Transport 150, ,000 Reducing conveyance through scrutiny of performance and application of contract rules Frail & Complex 422 reduced admissions, 125 reduced LOS admissions, 70 EOL admissions and 25 reduction in Falls 1,077,000 1,000,000 77,000 Development of an integrated model of care that will reduce admissions and LOS at SaTH. Care Home Admissions , ,000 Case Managers to provide training and education to providers, assess, plan, test, monitor, ensure nurse prescribing and rescue medication for identified residents Total URGENT CARE ,197,000 1,000,000 1,197,000 16

17 Medicines Management Detailed Plan Scheme Medicines Management Baseline Activity month 7 Forecast to year end Baseline Cost month 7 Forecast to year end Target Reduction in Activity From acute contracts Target Reduction in Cost Investment Net saving How will this be achieved 750, ,000 The Medicines Management QIPP schemes aim to ensure that value for money is further enhanced while quality of care is maintained or improved by optimising the use of medicines. All of the schemes promote evidence based, cost-effective prescribing. Medicines optimisation is about ensuring that patients get the best possible health outcomes from their medicines, whilst the NHS makes the best use of its medicines resource. Medicines Key Performance Indicators (KPIs) will be used to support this QIPP work stream. All of the KPIs are evidence based and aim to improve quality of care. A number of the KPIs are specifically targeted at reducing the risk of harm associated with medicines. Total MEDICINES MANAGEMENT 750, ,000 17

18 Mental Health Detailed Plan Scheme Baseline Activity month 7 Forecast to year end Baseline Cost month 7 Forecast to year end Target Reduction in Activity From acute contracts Target Reduction in Cost Investment Net saving How will this be achieved Church Parade 109, ,000 Reimbursement from Local Authority for 1x respite bed SSFT Intermediate Care, IAPT, RAID, CDW Worker Total MENTAL HEALTH 381, , , ,000 This has already been agreed as an extension of 13/14 schemes and contracts waiting to be signed 18