For submission 24 Nov 2016 1 - Scarborough & Ryedale CCG · 11/24/2016 · Delivering the 2017/18 and 2018/19 ‘must dos’ 1. STP The creation of the HCV STP offers challenges

For submission 24 Nov 2016 1


NHS Scarborough & Ryedale Clinical Commissioning Group (CCG) Operational Plan 2017-19

Linking our plan to the Sustainability and Transformation Plan

NHS Scarborough and Ryedale CCG is a partner in the Humber, Coast and Vale (HCV) STP and as such we have contributed to the development of the overall plan submitted in October 2016. SRCCG strategic component of the STP is the Ambition for Health programme which outlines our programme of work aimed at securing a financially and clinically sustainable local health and social care economy. The governance framework is shown below and priorities on page 3:

NHS England

Vale of York

Scarborough & Ryedale

North Lincolnshire

North East Lincolnshire

York, Easingwold & Selby

Integration and

Transformation Board

Health & Wellbeing

Boards

Overview & Scrutiny

Committees

Local Government

Forum

Provider Alliance

NHS Improvement

Healthwatch Governing Bodies

HCV Programme Board

Executive Group

(CCG COs)

Ambition for Health

Steering Group

Programme Board

Hull

East Riding of Yorkshire Lincolnshire

Finance

Communication

Out Patients

Integrated Care MCP

Primary Care

Acute & diagnostics

York/Scarborough

A&E Delivery Board


The Strategic Priorities of the STP

Helping People Stay Well

Tobacco control

Identifying and acting early

Preventing Cardiovascular Disease

Implementing prevention at scale

Place Based Care

Increasing how patients can see their GP

Health & Social care integration

Creating the Best Hospital Care

Improve quality of hospital services

Alternatives to A&E attendances

Local maternity systems

Supporting People through Mental Health

Providing services to avoid unnecessary hospital stays

Best start and secondary prevention for the under 5s

Maintain independence of people with dementia

Reduce Out of Area placements

Making the best use of our resources

Plan hospital services at HCV level

Plan local services at place level

The Strategic Priorities of Ambition for Health

Healthy lifestyles

Helping people lead healthy lifestyles, supporting them to

take control to prevent illness

Care at Home

Improving the care provided at home and in the

community so that health & social care services work

more closely to prevent people needing hospital

treatment

Sustainable Services

Ensuring Scarborough Hospital and other major services

are of a high quality and are financially and clinically

sustainable


The common thread driving both strategies is the need to deliver financially and clinically sustainable services and the recognition that prevention and improving the health of our population is fundamental to achieving our ambitions. During 2017-19 the CCG will concentrate on the following priorities: Healthy lifestyles:

Implementing the Cardio Vascular Disease (CVD) Strategy to Prevent, Detect, Manage and Improve Outcomes. Encouraging weight management and smoking cessation Supporting independence and self-management

Care at Home: Commissioning with North Yorkshire County Council an integrated health and social care model to provide out of hospital care Developing a primary care/community out-patient model Supporting people to stay at home when appropriate or return them to home quickly after hospital stays

Sustainable Services: Delivering the Five Year Forward View in primary care and mental health

Securing a sustainable future for Scarborough Hospital Collaborative Commissioning across the HCV STP footprint Joint Clinical Thresholds for elective care across the HCV STP footprint Implementing urgent & emergency care standards across HCV STP footprint

Specialised commissioning:

The CCG awaits the outcome from the NHSE Yorkshire and Humber review of specialised rehabilitation services for complex neurological conditions and will appraise the options for the future commissioning of these services. We will aim to work collaboratively to support the development of the Yorkshire and Humber wide commissioning pathway with standards as set out in the NHS England Specialised Rehabilitation for patients with complex needs service specification. The aim of the review is to improve and standardise the quality and availability of specialised rehabilitation for patients with complex needs due to acquired brain injury as set out by the British Society of Rehabilitation Medicine (BSRM) and the Commissioning Guidance for Rehabilitation (NHS England 2016 https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/improving-rehabilitation/)

https://www.england.nhs.uk/ourwork/qual-clin-lead/ahp/improving-rehabilitation/


Personal Health Budgets (PHB):

The CCG will be working with colleagues in the Partnership Commissioning Unit to explore how we can expand the PHB on a wider scale than at present. To meet the CCG target by 2019 the CCG will need to have placed 132 clients on a Personal Health Budget and 264 clients

on a PHB by 2021. (Derived from the population of 132,763.) The number of clients currently receiving PHBs is 15 and the graph below demonstrates the trajectory..

Long-term conditions ,

23%

Mental Health ,

25%

Continuing Healthcare ,

14%

End of life , 11%

Equipment and

Wheelchairs, 19%

Learning disabilities ,

4%

Children , 3%

NHS Scarborough and Ryedale CCG

0

50

100

150

200

250

300

2016/17 2017/18 2018/19 2019/20 2020/21

NHS Scarborough and Ryedale CCG

Level at Q2 2016/17 Trajectory towards 2020/21 ambition


The CCG Vision for 2020 and beyond….

Prevention, Self-Care and Education:

Life expectancy for people living in our most deprived areas is reduced by as much as 12 years compared with those living in the least deprived areas. This statistic can be linked to people leading unhealthy lifestyles, such as being overweight, smoking and/or drinking too much alcohol. This can lead to early deaths from things like heart disease or stroke and the development of chronic disease such as diabetes. We want to raise awareness of the risks associated with leading unhealthy lifestyles and support people to change their behaviour. The CCG already has an extensive engagement and education programme for patients, carers and staff. We currently maximise media opportunities such as radio, press, twitter and face-book to run campaigns such as “Winter Well,” “Right Care First Time,” “Winter Well,” “Dry January,” “NHS Health Checks” on a rolling programme which will continue and develop over the forthcoming years. The CCG funds a “Protected Time for Learning” programme and hosts four clinical education workshops for all primary care staff giving them the opportunity to discuss multiple topics such as dementia, mental health with primary and secondary care clinicians. We work closely with Public Health colleagues and they are a partner in the Ambition for Health programme.

To ensure safe, affordable clinical services for our population our plans need to be ambitious. Continuing with the status quo is not an option. We are committed to developing a model of sustainable services in Scarborough and envisage Scarborough Hospital site becoming primarily a ‘hot’ acute and diagnostic site, providing the essential ‘red line’ services of Emergency and Urgent Care, Obstetrics, and Paediatrics. Following national guidance on the future model for urgent and emergency care services, the emergency care model will be a guideline compliant centre supported by multi-disciplinary emergency medical, ambulatory care, and orthopaedic trauma streams. Elective hospital care will be delivered according to acuity and complexity. Working with all providers across the STP footprint, complex cases will be managed in the larger specialist units at York and Hull. Intermediate and minor electives (including the majority of Orthopaedics) will increasingly be delivered at Bridlington Hospital. Outpatient care will be separated into one-stop diagnostic assessment service in the acute hospital and routine management and support provided in primary care (supported by consultant led advice and guidance service). Our aim will be to reduce out-patient attendances by up to half of that currently seen in the outpatient departments by various service redesign initiatives including reducing unnecessary appointments, expanding the use of technology and developing new pathways of care. Adult Out of Hospital Care will be transformed by the emergence of integrated provision (see draft model page 6). Working with North Yorkshire County Council our intention is to jointly commission health and social care across Scarborough and Ryedale utilising pooled budget arrangements and potentially new contract mechanisms leading to:

Improved prevention through single contact system of advice, guidance, signposting and direction into community support. Rapid access to community response for those in crisis or stepping down from acute care Combined care teams to provide planned care and proactive management of chronic diseases



Mental Health services: In addition to maintaining a small bed base, we will increasingly focus on supporting good mental health in other care settings and delivering the Five Year Forward View for Mental Health. This will include working with our main provider to strengthen primary care based support and integration with our wider partners such as North Yorkshire Police. In response to the Five Year Forward View for Primary Care, we are committed to primary care being at the heart of the transformation programme. This will be delivered by new models of demand management, practices working more closely together, and new models of skill-mix (for example through the wider use of Physician Associates). Major milestones:

Milestone

Target Start Date Forecast Completion

Community Frailty Teams

October 2016 December 2016

Emergency care model testing – Phase 1

Autumn 2016 December 2017

Emergency care model testing – Phase 2

January 2017 September 2017

Acute medical model – phased approach

October 2017 April 2019

New integrated community model ‘Go live’

October 2017 October 2017

Elective expansion at Bridlington

April 2017 April 2019


Delivering the 2017/18 and 2018/19 ‘must dos’

1. STP The creation of the HCV STP offers challenges and opportunities to SRCCG as we embrace the new way of working with a consistent aim to deliver the Five Year Forward View. The underpinning “triple aims” as set out in the Five Year Forward View – “Health and Well-being, Quality of Care, and Efficiency” are driving all national, regional and local health plans. In addition to developing and implementing the Ambition for Health programme, the CCG will work closely with our STP partners. An STP Collaborative Commissioning Group has been established to take forward collaborative commissioning approaches across the STP footprint with a view to:

Exploring opportunities for collaborative commissioning Agreeing a set of priority work areas Developing a work plan identifying timelines and lead arrangements to proceed with projects

SRCCG has been allocated the lead for elective thresholds, cardiovascular and out-patients transformation.

Clinical Thresholds – the aim is to agree a consistent set of clinical thresholds which will be adopted by the six CCGs and shared with the Acute Providers in the STP. This will help to achieve equal access to services for patients across the STP and deliver efficiencies.

Diabetes – the initial concept is to develop community diabetes services with in-reach into secondary care when appropriate. Out-patients – the Ambition for Health programme has already agreed a radical transformation of out-patient services to facilitate a shift of

activity into primary/community settings. Our aspiration would be to share principles and models across the STP. An STP contracting group led by SRCCG has been established to look at new contracting possibilities for 2017/18 and the possibility of moving to lead commissioners and single acute contracts. This may add a risk to the December timeline of final contract sign off. 2. Finance

2017-19 Activity Modelling The CCG reviewed the pre-populated NHSE forecast outturn figures and has made some adjustment to these to take into account full year effects actual activity at Month 6. The FOT for First Attendances has a large positive adjustment due to the submission of unbundled radiology activity under specialty code 812 by

York FT. This activity was not previously submitted to SUS in 2015-16 and this can be seen in the step change in the monthly figures from April


2016. As this will continue to be submitted in this way we have adjusted the FOT to take this into account, but will show as a significant growth compared to previous years. Growth is modelled at 2.1% in 2017-18 and 1.9% in 2018-19. This is in line with agreed STP growth assumptions. CCG demographic population based on ONS population estimates is expected to be 0.7% and 0.8% for 17-18 and 18-19 respectively. The use of STP growth assumption allows for a level of service growth and expected backlog for recovery of RTT to delivery the constitution standards although RTT plans for recovery at our main provider York FT are expected to deliver in Quarter 4 of 2016-17. Therefore we would expect any additional activity over and above the level of service growth to be minimal. 2017-19 Waterfall Diagrams The Waterfall diagram for 2017-18 is shown below illustrating the movements from 2016-17 forecast outturn to 17-18 and 18-19 proposed activity plan activity. As stated above, there are a number of adjustment to pre-populated forecast outurn for first attandance consultant led outpatient activity, which includes an adjustment for diagnostic radiology activity expected in 2017-18. The NHSE techincal methodology does not remove this activity and so to ensure consistency in NHSE monitoring and reporting for 2017-18, the CCG have included the full year effect of this change in the revised FOT. This activity along with other specility based activity i.e obsterics, physiotherapy etc, is contracted outside of the PBR currencies and does not form part of our contracted outpatient figures. The impact of planned QIPP schemes on activity are included within the transformation section of the diagram and are based on current QIPP schemes in development at this stage. These QIPP schemes include potential opportunities to be realised through the RightCare programme by service redesign. There is also expectation that changes to referral and treatment threshold criteria for BMI and Smoking at the latter half of 16-17 will continue to have an impact in the following year.


2017-18 waterfall chart


2018-19 Waterfall chart

Waterfall Charts.xlsm


Delivering NHS RightCare Opportunities: We have established an internal CCG RightCare programme team led by the Chief Officer supported by two Governing Body GPs and the Head of Planning and Assurance. The areas, according to RightCare analysis where we may find opportunity to improve clinical practice and improve financial efficiency are cardiovascular (CVD), MSK and gastroenterology. We have already agreed a strategy for CVD and are currently focusing on prevention and education in primary care. Part of the changes in CVD will see the development of community diabetes services as part of the integrated health and social care model. In addition to the work that the CCG is planning, there will be opportunities to explore RightCare at an STP level and we are having discussions within the collaborative group to define how this may be taken forward at scale. Quality Innovation Improvement and Productivity Plans (QIPP) have been developed in draft and will be refined over the coming weeks in order that we are ready to make necessary service transformation in early 2017/18. Plans to-date include:

Emergency Care/Non elective admissions:

RightCare CVD RightCare Respiratory RightCare Gastrointestinal conditions Primary Care Frailty model Integrated out of hospital model

Elective Care:

Redesign radiology/pathology pathways Optimising care/elective thresholds RightCare MSK Demand Management Out patients transformation programme STP wide commissioning

Prescribing:

RightCare opportunities The QIPP programme will be challenging and requires primary care and community to work at scale to facilitate the transfer of activity from secondary care. The QIPP Steering Group is responsible for overseeing delivery of the plan and reporting into the Finance and Contracting Committee.

3. Primary care

See separate submission


4. Urgent and emergency care

Delivering the 4 hour and ambulance response standards and meeting the four priority standards will be a challenge for a system currently

failing to deliver in these areas. However, the CCG is part of a system-wide response with expertise from the Emergency Care Intensive

Support Team, led by the A&D Delivery Board and will work in partnership to implement new ways of working and improve the flow of

patients throughout the whole system. Extensive monitoring and reporting systems are being established in the A&E Delivery Board. The

CCG pro-actively takes part in service improvement initiatives and problem solving within the emergency and urgent care departments of

Scarborough Hospital and facilitates joint working between the different providers. We will continue to strive to meet the standards and

improve care and experience for patients Some of the proposed areas of service re-design are listed below:

To ensure patients are managed appropriately at the front door to avoid admission via ED, we will continue to work with our current providers of ED and urgent care service to develop the front door acute assessment model to include:

Continued development of Ambulatory Care

Implementation of a Frailty Team based in ED with MDT support and rapid access to specialist for Comprehensive Geriatric Assessment, and primary, community and social care services to ensure patients are transferred to most appropriate care setting.

Working with urgent and emergency care providers to refine and develop the streaming process and introduction of Clinical Navigator role.

Implementation of the Acute Medical Model will provide rapid access to specialist assessment.

Implementation of Ambulance concordat initiatives to improve ambulance handover will be achieved by:

Supporting YAS crews to consider self-handover (SH) at every safe opportunity and develop a single ambulance handover escalation plan that is aligned to internal/external response plans.

Working with ERCCG and Bridlington MIU to facilitate ambulance crews to access the MIU rather than transporting patients to SGH. Undertaking demand/activity analysis to understand ambulance demand and look to develop a service delivery model around gaps in the

current (out of hospital) service provision across the system.

Development of Out of Hospital infrastructure and pathways to support patients to go home as soon as appropriate by:

Developing and implementing jointly agreed pathways across health and social care, improving reablement capacity and developing a single point of access for all partners.


Delivering the 4 priority standards of timely access to first consultant review, access to key diagnostics, access to ongoing consultant directed interventions and ongoing consultant review will be overseen by the A&E Delivery Board.

Currently providers are undertaking base line assessments, following which gap analysis will help to develop an action plan to deliver the

standards for heart attack, vascular, stroke, major trauma and children’s critical care. The standards will then be rolled out to all other medical and surgical acute specialties.

5. Referral to treatment times and elective care

Streamlining elective care pathways:

The CCG is leading a collaborative programme of work to transform out-patient care and shift activity into primary/community settings. During 2016/17/18 we aim to transform care in high demand specialties including:

Dermatology, gynaecology, rheumatology, cardiology, orthopaedics, ENT, urology, respiratory medicine and general surgery. In addition, the CCG is committed to achieving wholescale improvements in the performance and quality of services for patients with

ophthalmic conditions and will work with STP partners to collaboratively commission ophthalmology as well as community diabetic services.

Meeting the constitutional standards:

Delivering this standard remains a challenge for the CCG and we will continue to monitor RTT waiting times and work with partners in the STP to maximise elective capacity and review elective care pathways to support the delivery of this standard.

The locality ambition is to increase elective capacity at Bridlington Hospital site which will reduce elective cancellations and further support deliver of the standard, whilst allowing the Scarborough hospital site to focus on acute admissions and rapid access to diagnostics.

Implementation of clinical thresholds and clinical triage will ensure that only appropriate patients are referred into secondary care

Delivering patient choice and achieving 100% use of e-referrals:

The CCG continues to invest in the Referral Support Service (RSS). A main function of the RSS team is to contact the patient offering them choice of


secondary care appointments. Once contact is made with the patient and where possible, the team then books their appointment at their chosen hospital on their chosen date and time.

As part of the Ambition for Health programme the CCG and our partners have committed to work towards the 100% e-Referral target during 17/18 and at an agreed date when electronic systems are in place and tested, paper referrals will no longer be acceptable.

Implementing the Better Births strategy:

To implement the national strategy we will:

Develop a commissioning strategy

Implement service re-design

Monitor the Provider’s action plan and seek assurance that recommendations are being implemented

Our main acute provider has shared action plan priorities for 17/18 including:

Personalised care – reviewing individual care plans and review of current homebirth provision

Continuity of Carer – Learning from adopter sites and exploring the possibility of a “homebirth” team

Improved postnatal and perinatal mental health:

Exploring the provision of perinatal mental health services

Reviewing the current post natal provision and considering the provision of birth reflection appointments

Multi-professional working:

Considering the developing of established multidisciplinary training and evaluate its effectiveness

Continue to peer review SI investigations and share the learning

Reducing stillbirths, neonatal and maternal deaths:

We will work with providers to implement all aspects of the “Saving Babies Lives” care bundle

Increasing access to evidence based specialist perinatal mental health care:

The CCG bid for community fund was unsuccessful in 16/17 but we will re-shape and resubmit a bid in 2017/18


6. Cancer

Cancer is one of the CCGs clinical priorities and an area in the CCG Assurance Framework where we need to make improvements. Current and future actions include: Implementing the Cancer Taskforce report:

SRCCG has representation on the Cancer Alliance and will actively collaborate to implement the recommendations. The cancer alliance will be acting as the delivery arm of the STP to support delivery of the 96 recommendations. SRCCG leads the locality cancer group and this will continue to be pivotal in leading local delivery

Improving one year survival rates:

Continued progress in reducing the proportion of cancers diagnosed following an ED admission by improving the 2ww referral process, continued education in primary care and local public awareness campaigns.

Ensuring timely referral of suspected cancer via improved electronic 2ww system e.g. CCG is investing in technology and training for GPwSI in dermatology.

Be Clear on Cancer public campaigns. Continued collaboration with Cancer Research UK to develop cancer champions. Delivery against Risk Stratified pathways in breast, prostate and colorectal cancer. The aim across the STP is to ensure that all survivors of cancer have access to consistent support packages.

Delivering the 62 day standards: Currently individual organisations within the STP manage diagnostics in isolation. The collective aim is that by managing capacity more efficiently across a wider footprint, we will be able to commission and provide better use of our diagnostic equipment and electronic sharing of imaging. The STP and cancer network are working closely to improve the 62 day standard. This will include:

Undertaking capacity & demand reviews to secure adequate diagnostic capacity. Review of lung pathway (across STP) to stream line pathway. Continued review & implementation of the Inter Provider Transfer Policy.


7.Implementing the Five Year Forward View for mental health:

The CCG is committed to delivering Parity of Esteem:

Additional psychological therapies:

Work with provider to understand workforce resource implication to meet targets Expand IAPT services Develop joint agency plans with the provider to meet access and timeframe targets Implement employment advisors in IAPT units Participation in NHS England programme for digitally-enabled IAPT (details to be available autumn 2016

Additional services for children and young people:

Develop crisis intervention as part of the all-age urgent care pathway Intensive intervention service to prevent admissions and support step down NICE compliant Autism and ADHD pathway Implement actions resulting from Local Transformation Plans for children and young people’s mental health to be published on 31 October

2016 Develop joint agency plans with the provider to achieve targets

Expand capacity for people experiencing first episode of psychosis:

Agree joint agency action plan to achieve new standard Identify meaning and implications of CCQI assessment and develop action plan

Increase access to individual placements for people with severe mental illness in secondary care:

Collect data to create a 2017/18 baseline Develop plan with TEWV (under current contract) to offer support providing placements, writing CVs etc

Commission community eating disorder teams:

Baseline current performance against access and waiting time standards and plan for improvement in 17/18 Commission a hub and spoke model across York and North Yorkshire to ensure a dedicated eating disorder team is accessible in all areas.


Reduce suicide rates:

Retain membership of NY Young Persons Suicide Prevention Steering Group Implement multi-agency suicide prevention plan Support Student Mental health Network

Maintain dementia diagnosis rate:

CCG working towards Dementia Friendly Status with dementia friendly champions and awareness training for all staff Implement new primary care dementia follow-up pathway

Continue to input into North Yorkshire dementia strategy

Evaluate and improve current pathways

Undertake review of services against NHS implementation guidance focusing on post diagnostic care and support

Eliminate Out of Area Placements:

Develop joint agency plans to monitor all OAT for all bed types Agree performance mechanisms to ensure demonstrable reduction in acute OATs

8. People with Learning Disabilities:

A GP practice pilot has been undertaken to increase levels of uptake and quality of AHC in Primary Care. Now planning to roll out

to all practices.

Increase of Annual Health Checks and Health Action Plans is being monitored through a CQUIN scheme with the Learning

Disability Provider.

Work being undertaken as part of the Self-Assessment Framework to improve uptake of AHC and cancer screening. Multi-

Agency Cancer screening group in place to facilitate increase is cancer screening for those with a Learning Disability. SRCCG

Macmillan GP involved in this work

CCG website improved to facilitate access to information for patients/carers with learning disabilities

Implement North Yorkshire partnership plan for enhanced community provision.


Develop alternatives to hospital care, crisis services and community support. Develop and implement enhanced community support model

9. Improving quality in organisations:

The Scarborough and Ryedale Clinical Commissioning Group (SRCCG) implemented a Quality Assurance Framework which was approved by the Governing Body in July 2015. The CCG continually reviews the Framework for effectiveness of implementation via the Quality and Performance Committee. The Framework sets out core objectives for commissioning for quality and how the CCG is mobilising and using their resources to meet them. Planned areas of development are set out in the framework, which formed the basis of the 2015/16 work programme and is also informing the work plan for 2016/17 and beyond. The result is expected to consolidate arrangements and secure a higher level of assurance. The Framework covers the following areas:

Commissioning for quality Safeguarding Improving quality in primary care Embedding quality structures and process Building for the future.

As part of the CCG audit plan for 2016/2017 it was agreed that Internal Audit would undertake a review of the implementation of the Assurance Framework. This also included considering the arrangements being planned for ensuring quality improvement and performance management in primary care..

Overall Assessment: Significant Assurance

The review found that the Governing Body receives assurance on the management of risk at the CCG by receiving the latest risk registers from the Committees in addition to the Governing Body Assurance Framework Report which is received at each meeting. A review of minutes of the Quality and Performance Committee, Primary Care Co-Commissioning Committee and the Partnership Commissioning Unit Board (PCUB) found that they were providing reports to the Governing Body as required by their terms of reference. For the Q&P Committee this included the Bi monthly Quality and Performance Exception Reports and the full quarterly report on Commissioning for Quality and Outcomes. The CCG has assigned a designated Adults Nurse Safeguarding lead from the PCU and a designated Children’s Nurse Safeguarding lead at the CCG and the two safeguarding leads are members of the Quality and Performance Committee and provide reports on Adult and Children


safeguarding respectively at each meeting. The PCU Adult Safeguarding Team carries out all the health and clinical related safeguarding work on behalf of the Scarborough and Ryedale CCG in partnership with the Local Authority, CQC and the Police. Adult Safeguarding reports are provided to the Governing Body and included in the PCU six monthly progress reports and the PCU annual report. The Executive Nurse at the CCG is a member of the North Yorkshire Safeguarding Children’s Board and also a member of the CCG Quality and Performance Committee for reporting on issues into the CCG. The Governing Body receives a six monthly update on the PCU’s work programme, this covers Continuing Healthcare, Children and Maternity Commissioning, Mental Health Commissioning provided on behalf of the CCG’s. For the Primary Care Co-Commissioning Committee assurance includes PCCC exception report highlighting areas of concerns such as workforce resourcing issues where standards fall below expectation and reports on actions being taken to remedy. Quarterly returns are reported as submitted to NHS England confirming that the CCG has self-certified that it is meeting statutory duties relating to delegated authority for Co-Commissioning Primary Care Services. One off Reporting, is reported separately, for example the Partnership Commissioning Unit Annual Report 2015/16 was presented to the

Governing Body at the May 2016 meeting.

The CCG leads the CMB sub quality group with our main provider and associate commissioners where quality of secondary care services

are discussed and issues raised and recorded.

The CCG Quality & Performance Committee meets monthly to drive forward the integrated commissioning plan, monitor delivery against key

aims and objectives, report progress and provide assurance to the Governing Body that the services we commission are of a safe clinical

quality.

The CCG Assurance Framework data highlighted areas for improvement and action plans have been developed and implementation and

monitoring of progress is underway:

Cancer:

Proactive support to all GP Practices from SRCCG GP Macmillan Lead – includes education, service improvement and redesign

Launched NICE guidance for suspected cancer through practice visits and use of cancer button on RSS.

Implementation of site specific referral forms for 2 week wait referrals

Implementation of electronic 2 week wait referrals and use of teledermatology


Promotion of Be Clear on Cancer campaigns to educate public to attend with worrying symptoms through active communication and

engagement

Clearer inter-provider transfer plan to address delays against the 62 day wait target resulting in a better experience and outcome for

patients

Implementation of the MacMillan recovery package

Continuing support to staff

Dementia:

Dementia Awareness sessions for all staff - ongoing

New Primary Care Dementia Follow Up Pathway – follow up Abbreviated Mental Test (AMT) score from acute hospital episodes – Go

live Nov 16

Improved Memory Service support to GPs - Nov 16

Introduction of Diadem Tool to support diagnosis in Primary Care – Nov 16

Named “Dementia Coordinator” in each Practice by Jan 17

NHS Scarborough and Ryedale CCG as a Dementia Friendly organisation by Apr 17

Better clarity for GPs re recording of data

Diabetes:

SRCCG have an ongoing programme of Practice Nurse education linked to NICE Guidance

Practice Nurse Diabetes Day planned, facilitated by Secondary Care Colleagues

Senior Practice Nurse seconded to SRCCG has gained experience working with and receiving training from the Advanced Diabetes

Podiatry Team – all Practice Nurses receiving additional training regarding foot health and Diabetes Management in General Practice

SRCCG are planning a re-launch of the importance of referral to Structured Education which reiterates how Primary Care colleagues

are pivotal in ensuring that patients are referred, encouraged to attend, and the benefits of this. Includes looking at different options

and working with national Diabetes UK team.

Engagement with all SRCCG GP Practices to support participation in the National Diabetes Audit. (timing and process issues present

last time have been addressed therefore confident of high uptake)

Learning Disabilities:

A GP practice pilot has been undertaken to increase levels of uptake and quality of AHC in Primary Care before rolling out more

widely. Now planning to roll out to all practices

Increase of Annual Health Checks and Health Action Plans is being monitored through a CQUIN scheme with the Learning Disability


Provider.

Work being undertaken as part of the SAF to improve uptake of AHC and cancer screening. Multi-Agency Cancer screening group in

place to facilitate increase is cancer screening for those with a Learning Disability. SRCCG Macmillan GP involved in this work

CCG website improved to facilitate access to information for patients/carers with learning disabilities

Maternity:

Main provider working towards the implementation of the ‘Saving Babies Lives’ care bundle

All still births are peer reviewed and all neo natal deaths are referred to coroner

A working group meets regularly to discuss the Scarborough smoking rates and the ‘Baby Clear’ scheme has recently been

implemented.

Choice will be included in the new maternity strategy which is included in ‘Better Births’

Clinical group established under the Ambition for Health programme with remit to determine clinically and financially sustainable

service for Scarborough

Mental health:

Development of primary care support

Protected time for learning – Mental health features each time

Risks to delivery:

Competing STP and CCG priorities Current statutory arrangements in the NHS and Local Authorities add to complexity Local clinical and financial instability across all sectors National publicity regarding potential complex change leading to further instability and staff concerns

Plans require primary and community to work at scale – infrastructure and staffing not yet in place to accommodate shift of activity

Documents

For submission 24 Nov 2016 1 - Scarborough & Ryedale CCG · 11/24/2016 · Delivering the 2017/18 and 2018/19 ‘must dos’ 1. STP The creation of the HCV STP offers challenges