City and Hackney Clinical Commissioning Group Annual General Meeting. Wednesday 16 th July 2014 Geffrye Museum

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1 City and Hackney Clinical Commissioning Group Annual General Meeting Wednesday 16 th July 2014 Geffrye Museum

2 Welcome Our first AGM as a CCG Housekeeping No planned fire test tonight Toilets through the doors to the right Light refreshments Agenda Presentation of our performance last year Questions and Answers Informal discussion with Programme Boards

3 Introduction We are a very successful health economy Why? Our GP members High quality practices Very engaged in commissioning Homerton Excellent local hospital Provides secondary and community services Active voluntary sector Competent borough and corporation

4 Mental Health Children and young people Lowest waiting times in east London for treatment Carers and parents reporting increased levels of support Very high recovery rates: CORC Children's outcomes research consortium Homerton 1m investment in Homerton Psychological Medicine to support patients with mental health problems in the Homerton and presenting at A&E Keep people out of hospital fewer admissions Reduce unnecessary time spent in hospital Primary care Our services have improved for people with mental health and emotional problems Up-skilling primary care: improved training and services 500 patients seen by Enhanced Primary Care service Feedback from patients: the primary care service is better than before I spend more time talking to my nurse and GP than before I no longer need to be seen by the Community Mental Health Team and now I can go to my GP practice to see my mental health nurse or the GP without the other patients knowing my reason for being there

5 Mental Health People with dementia All memory clinic feedback sessions have an Alzheimer Society Dementia Advisor to support people in their local communities Lowest anti-psychosis drug prescribing in east London 10% increase in dementia diagnosis since 2012/13 meaning more people have access to early support for their illness: People with short-term problems Over 5,000 people with depression and anxiety supported (15% of all people with depression/anxiety) highest number and % in London: People with complex needs Tavistock and Portman awarded Royal College Psychiatry award for adult mental health with over 600 people with complex mental health needs receiving care in their local GP surgery 75% of users report a recovery from using this service

6 Ezetimibe Rosuvastatin Metformin & sulphonylureas Non analogue insulins Blood Glucose strips Specials (Total Cost) Specials (Cost/1000pts) Specials Cost/Item Silver dressing s Cost per 1000 ASTRO-PU Omega 3 Prescribing Innovation Joint (between CCG and Homerton Hospital), first of its type, electronic formulary to facilitate safe and cost effective prescribing. Being repeated in East London Mental Health Foundation Trust in 2014/15 Reducing waste Approximately 1M worth of medicines issued in C&H is wasted annually Patient campaign raising awareness of the costs of medicines waste Quality of Prescribing City & Hackney is in the Top 10 London CCGs for 10 out of 11 prescribing quality indicators: Indicator *CCGs without a centralised dressings service C&H Ranking of 32 London CCGs * 8 8

7 Children s Expansion of out-of-hours Children s Community Nursing team Highly skilled nursing care for children in the community Now available at the weekends Treated 103 children who would otherwise have attended hospital Vulnerable Children s Contract with GPs Focus on asthma, epilepsy and diabetes Mental Health Improving care for vulnerable children and families 16 th birthday health check Children and Families Act 2014 Working with our partners to implement these changes from September 2014 Thresholds are not changing but personalised Education Health and Social Care Plan. We will work closely with young people and families.

8 Maternity Maternity Service Liaison Committee (MSLC) The committee of approximately 15 includes local health professionals and parents to help ensure our woman s voices are reflected in the commissioning of maternity services Priorities for the coming year include: MSLC Work Plan priorities Actions A. Parents voice and experience Walking the patch postnatal Observing maternity/labour reception area B. Vulnerable women s pathway Focus groups with target populations Local VCS and parent reps to collect views and feedback C. Tongue tie service Continue to monitor need, and support pilot bid for nonrecurrent funding pilot project. D. Breastfeeding Review breastfeeding services Support campaign for Homerton to attain Baby Friendly status Community Midwifery Midwifery led clinics are being set up in GP practices and Children s Centres across the area to provide care closer to home for pregnant women

9 Maternity Socially vulnerable women

10 Long Term Conditions Contract with GP practices Tackles: our high premature cardiovascular disease mortality rate our high respiratory disease mortality rate helps people feel supported to manage their long term condition Key outputs and outcomes in 2013/14 Care plans and annual reviews:

11 Long Term Conditions Increase in % of people with diabetes in City and Hackney recently screened for retinopathy (now highest in London) Long Term Condition management Hypertension and blood pressure controlled to 150/90 Coronary Heart Disease and cholesterol controlled to 5 Coronary Heart Disease and blood pressure controlled to 150/90 Coronary Heart Disease annual review 57 Additional patients treated Diabetes annual review 583 Diabetes and blood pressure controlled 145/ Diabetes and blood sugar controlled to Diabetes and blood sugar controlled to Diabetes retinal screening 669 Diabetes cholesterol controlled to <5mmols 370 Diabetes microalbuminuria checked 584 Chronic Kidney Disease and blood pressure controlled to 140/ High risk of heart disease proxy review 127

12 Primary Care Quality Support practices to reflect on their own practice and commission services Working to promote the appropriate use of computer systems to augment good patient care Supporting an extensive programme of education and training to promote development of the primary care workforce With so much good care being delivered in primary care: one of the outcomes of this is that City and Hackney has one of the lowest outpatient referral rates in the country

13 Planned Care Early detection of cancer Working in partnership with Cancer Research UK to secure a dedicated worker to improve early detection and diagnosis of cancer in primary care. We would hope that by detecting cancer earlier we would improve survival and reduce premature cancer mortality: Total knee replacement New pathway, including increased use of decision aids for patients Increase in average health gain reported by patients of 20% Patient feedback: Felt very involved in decision-making process. Very happy with the clinic Not keen for surgery currently, this was openly discussed and respected. Felt involved in decisionmaking Diagnostics Commissioning direct access diagnostic contracts for MRI scans and Dexa scans including increasing access for colonoscopy in line with best practice recommendations for cancer pathways

14 Urgent Care Our priorities Capacity across all services Helping patients access the right service A high quality out of hours service Urgent Care Board to plan services Initiatives A&E capacity planning Work with frequent attenders of A&E Patient navigators within A&E helping patients to register with GPs and use healthcare most appropriately Building up capacity of Out Of Hours services Rapid Response & Paradoc Primary Care Capacity Improvement in performance of Homerton A&E - Additional hospital registrar and GP posts within A&E - 4hr waiting time target met 42 out of 52 weeks (average 81%) - Mean performance (on % of patients seen within 4 hours) improving over 2013/14: 90% 93% 95% 98% 100% 17/03/ /04/ /05/ /06/ /07/ /08/ /09/ /09/ /10/ /11/ /12/ /01/ /02/ /03/ /04/2014 National 4 hour target

15 Urgent Care Out of hours GP service New local provider commenced service since Dec 2013 More telephone advice by GP More visits to the Centre Increased quality of telephone advice Less visits to A&E or ambulance service Service to include nursing capacity from August Increasing Primary Care Capacity Extended Hours Evening and weekend appointments across four bases in City and Hackney Enhanced Duty Doctor Free GPs to work with Paradoc and enhanced rapid response services Free named GPs to attend to urgent care needs of High Risk Patients Joint Paramedic and GP Clinical Response service A&E and Admission Avoidance Urgent primary care cases Referrals from ambulance clinicians both on site and in control room First Two Months: 251 Patients Reduction in unnecessary taking patients to A&E Extended Hours Rapid Response Multi-disciplinary team including nursing and therapists Extended to midnight everyday and across whole weekend

16 Integrated Care Vision To focus on improving the experience of patients and service users To improve the health and quality of life for patients and carers To help people avoid emergency admission to hospital and to stay at home rather than move to residential care To ensure care is co-ordinated and easy to find Approach Focus on frail elderly people Prepare a care plan for and with each patient Ensure each patient s care is co-ordinated at the GP practice with all the professional staff (the integrated care team) Help patients find the right care for their needs Expand services available to people at home Partner with voluntary and community services

17 Patient and Public Involvement Established a well-attended and representative Patient and Public Involvement Committee, ensuring that the patient voice is at the centre of our commissioning activities Launched an Innovation Fund in response to the issues raised by the public at our consultation event in November 2013 bid for small projects suggested and run by Community and Voluntary organisations Jointly commissioned the Fund for Health with Healthwatch Hackney to understand the barriers to accessing healthcare and to understand what patients mean by patient centred services.

18 Finance highlights Delivered a 27m surplus for the year which will provide a buffer against future funding and cost pressures Manoeuvred successfully through the uncertainty of new system changes and commissioning responsibilities Financial risks managed and mitigated with a prudent view taken by the Board in deferring investment whilst funding uncertainties were resolved Robust governance process embedded within the organisation with key commissioning risks managed through Programme Boards Unqualified audit opinion issued on the accounts clean bill of health from external auditors and a good platform into Plans approved by the Board including 21m non-recurrent investment and 5.4m saving plans for the Health Economy

19 What the CCG spent in

20 Questions & Answers Jaime Bishop CCG Board Member (Patient and Public Involvement and Conflict of Interest lead) to lead questions to: Dr Clare Highton CCG Chair Paul Haigh Chief Officer Philippa Lowe Chief Financial Officer