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Hammersmith and Fulham CCG
Annual General Meeting
6 October 2020
Welcome to Hammersmith and Fulham CCG’s
Annual General Meeting
2
Today’s agenda:
Welcome and AGM James Cavanagh, CCG Chair
Achievements 2019/20 James Cavanagh, CCG Chair Janet Cree, CCG Managing Director
2019/20 Annual Reports and Accounts
Jenny Greenshields, Chief Finance Officer
NW London plan 2019/20: Janet Cree, Managing Director
Finance Jenny Greenshields, Chief Finance Officer
Quality Diane Jones, Director of Nursing & Quality
CCG Covid-19 Response CCG Governing Body Members
Questions
James Cavanagh, CCG Chair
Who We Are and
What We Do
Dr James Cavanagh
Chairman
Who we are and
what we do
4
• NHS Hammersmith and Fulham CCG plans and buys healthcare services for the borough and ensures these are of good quality and value for money.
• We work with clinicians, patients and carers to make sure your health and social care services are effective and coordinated.
• We have 29 GP member practices for a population of over 250 000
• We don’t commission alone but as part of an Integrated Care Partnership and in accordance with the NHS’s long term plan
• We are part of the North West London collaboration of clinical commissioning groups along with Ealing, Harrow, Hillingdon Hounslow, Central London, West London and Brent
2019/20
Some Key Achievements
Dr James Cavanagh Janet Cree
Chairman Managing Director
Achievements 2019/20
6
Primary Care
• Primary Care Networks (PCN) were established and commenced delivering population-based care in line with national service specifications
• Completed the procurement and roll out of the online consultation offer to complement existing access channels
• PCNs have recruited new roles building the pharmacist and link worker staffing base to provide population-based care
• Agreed joint working principles with PCN Clinical Directors and the GP Federation to support the development of PCNs and deliver on shared priorities
• Pride in Practice programme was rolled out across general practice to provide training and support to strengthen and develop primary care services’ relationship with their LGBT patients.
Achievements 2019/20
7
Perinatal Mental Health
• Received a positive CQC report highlighting consistently good practice across the board including examples of outstanding practice
• Positive feedback from peer review including: “There is a clear sense of strong leadership, coordination and organisation in the service, as well as a strong ethos.”
Early intervention in Psychosis (EIP)
• Expansion of service to treat all people between the ages of 14-65 with a first episode of psychosis
• Royal College of Psychiatrists audit puts us as one of the top performing EIP services for Cognitive Behavioural Therapy, employment support and support for carers .
Achievements 2019/20
8
Children’s Mental Health
• Successful application to NHSE to be a trailblazer site for the
implementation of mental health support teams in schools.
• Established Dynamic Support Register and multi-agency oversight for children and young people with ASD and/or Learning Disability at risk of admission to inpatient mental health or residential settings
• Agreement to jointly commission an Intensive Behaviour Support Team for children and young people with behaviour that challenges.
Achievements 2019/20
9
Patient and Public Engagement
• Maintained a strong and effective Patient Reference Group
• Continued to increase the number of groups and individuals
on our stakeholder list
• Undertook a full consultation on the proposed overnight
closure of Hammersmith Hospital Urgent Treatment Centre
• Established a Patient Participation
Group support programme with
Healthwatch Central West London
• Provided support to SOBUS to help
facilitate community involvement
Annual Report and
Accounts
19/20
Jenny Greenshields
Chief Financial Officer
Financial Position 2019/20
The below table shows that the CCG delivered its planned deficit of £6.7m in 19/20. The CCG also achieved its financial duties with regards to Running Costs.
How we spent your money – £352.9m in 2019/20
The pie chart below shows a breakdown of CCG expenditure by programme area.
NW London plans
2019/2020
Janet Cree
Managing Director
14
Our vision for NW London Integrated Care System (ICS) is to reduce
inequalities and achieve health outcomes on a par with the best global
cities.
Care will be integrated within a single system, focused on the needs of
the individual and unhindered by organisational boundaries.
We will combine our collective resources, clinical expertise and local
knowledge to build a fair, effective and accessible health service for all.
In 19/20 we started working towards our
vision for NW London:
This meant that key focuses for the year were:
• The development of our five year (Long Term Plan)
• Working towards a single CCG and building relationships as part of
our Integrated Care Partnership and local borough partnerships
• The Covid19 pandemic changed accelerated our focus and joint
working.
Our five year plan
15
• We developed a five year strategic plan with our partners, public and
stakeholders.
• This plan was developed to meet the new national requirements set out in the
NHS Long Term Plan, to improve the quality of patient care and health
outcomes, while focusing on building an NHS fit for the future.
• It also focuses on reducing local health inequalities and variation in services
across NW London.
• To deliver our ambitions set out in the plan, throughout 19/20, we have focussed
on seven interconnected areas:
Clinical and care strategy
16
In conjunction with our five year plan we developed our clinical and care strategy. The clinical strategy has nine clear priorities for delivery in 2020/21: • Access to specialist opinion • Frailty/last phase of life • Care planning • Long term conditions • Early detection of cancer • Social isolation • Safer care – maternity • Proactive urgent care • High intensity users
17
A single CCG for NW London As part of merging the eight CCGs we are making the following six
commitments:
1. Move resources across NW London and within boroughs to
reduce inequalities over the next four years
2. Increase our proportion of investment in out of hospital
services, as a first step we will level up investment in
primary care services outside the core contracts
3. Ensure consistency in services across NW London
4. Ensure equity of access to services, to enable our
providers to improve outcomes for patients and reduce
health inequalities
5. Patients and GP member practices will continue
to be involved in the single CCG and at local level
6. We will devolve decision making on delivery and integration
of services to neighbourhood and borough level as our
integrated care partnerships develop.
In September 2019, the CCG
agreed that a single CCG for
NW London was the right
direction of travel. It was also
agreed that 20/21 would be a
transitional year focused on
financial recovery, developing
a single CCG operating model
and working through financial
implications.
Our system’s financial
challenge
Jenny Greenshields
Chief Financial Officer
Financial position
19
2019/20
• The year ended with a deficit of £50.9m
for the NW London CCGs – this is in
line with our plan.
• Five CCGs reported a deficit (Brent,
Central, Ealing, Hammersmith & Fulham
and Harrow).
• The major pressure in 19/20 was acute
spend.
• Achievement of the 19/20 plan was
largely through non-recurrent measures,
therefore our underlying deficit has not
improved significantly.
2020/21
• A new financial regime was put in place
for 2020/21 following the Covid19
pandemic.
• For the first six months of the year we
are expecting to receive a resource
allocation that matches both our Covid
and non-Covid spend.
• NHS providers receive a block payment
to meet their costs and the opportunity
to claim for a ‘top-up’ of this block
payment is insufficient to cover their
costs.
• We are awaiting guidance on what the
funding arrangements will be for the
second half of the year.
20
Reduction of the deficit
• Whilst we achieved the planned deficit target, the underlying position remains broadly the same at the end of the year at just under £100m
• We have continued to reduce our management costs under-spending by £6m against budget
• Towards the end of the financial year we did start to see a reduction in acute (hospital) activity growth, which should impact on future costs
System alignment • Our five year plan is a combined plan for
providers and commissioners
• Introduction of new payment regime moving
from purely costs and volume for acute
contracts to agreed contract values with
marginal rates for over and under
performance
Controls established • Vacancy freeze and review of interim staff
continued through 19/20
• Investment Scrutiny Panel imbedded to review
every proposed contract change or new
business case
System recovery • System recovery linked to five year plan and
key programmes of work
• Development of ICS (Integrated Care System)
recovery work streams
• Focus on schemes that will deliver system
wide savings
What we have achieved
21
Returning to financial balance as a system Covid-19 has significantly changed the way we are working as a health system in NW
London with activity from both providers and commissioners being refocused on the Coivd-19
response and recovery.
Therefore our original 20/21 commissioner and provider cost recovery plans have not started
to deliver or be monitored in the normal way. However there are areas where transformation
across the system has been accelerated beyond our plan and areas that are currently on
hold that may or may not restart after Covid-19 activities have been normalised.
The focus for the immediate future in order to return the system to financial balance will be
to:
• Reset 20/21 commissioner and provider cost recovery plans
• Alignment with ICS recovery work streams
• Determine gap to financial balance and
• Determine further ICS Recovery work stream opportunities.
Quality
Diane Jones
Chief Nurse and Director of Quality
Quality in 2019/20 The CCG has a statutory duty to report on the performance of services as defined in the NHS
Constitution. In addition, it has a remit to improve quality within the services that it commissions
The CCG uses three domains to monitor quality of services and measure quality improvement:
– Patient experience
– Patient safety
– Clinical effectiveness
During 2019/20 the Quality Team has:
– Undertaken quality assurance support visits to primary and secondary care as well as care
homes to support quality improvements
– Been a central resource for all clinical quality issues e.g. supporting robust systems for
sepsis management in a trust
– Undertaken and reviewed Quality Impact Assessments (QIA) and Equality Health Impact
Assessments (EHIA) for pathway changes in commissioned services
– Worked with providers of care and the Care Quality Commission (CQC) where there are
quality concerns (and good practice) to support system learning and improvement
– Supported the GP quality alert process to highlight quality concerns to trusts for their
investigation and resolution.
Patient experience
Engagement
The CCG work with and talk to patients and the public about our services feedback is shared and discussed at CCG Committees and Governing Body meetings.
Complaints
The CCG analysed trends and themes relating to complaints received during 2019/20 with key themes being:
Delays within the Continuing Health Care process (CHC) claims
Disputes about the outcomes of CHC assessments and nursing home placements
The NWL CCGs’ IVF policy
The introduction of a new policy relating to injections to treat patients suffering from lower back pain
Introduction of Prescribing Wisely and NHS England’s guidance relating to medicines that should not be prescribed routinely in primary care.
– ensured lessons learned were disseminated for wider learning, e.g. through discussion at team meetings or multi-disciplinary professional meetings, incorporated in to training
Continuing Health Care (CHC)
– Ensuring that individuals are appropriately assessed to identify if they have a “primary health need”
– If need is determined then a package of care was commissioned by the CHC team and reviewed in line with national guidance
– As a result of complaints received our systems and processes have been strengthened
Patient safety
Serious Incidents (SIs)
Our service providers reported 933 serious incidents (Sis) in 2019/20, Imperial was
the highest reporter as they report all 12 hour breaches in A&E as SIs.
Treatment delay, maternity and diagnostic incidents are the top three types of
incidents reported.
Maternity cases are high due to the number investigated by the Healthcare Safety
Investigation Branch which would not normally meet SI criteria.
In the majority of cases, providers identify learning and create actions to address the
learning which is monitored locally.
The CCG is developing new ways of reviewing and closing SIs with wider
involvement of provider partners.
Safeguarding
• The CCG has worked with partners to ensure effective arrangements are in place to
meet the safeguarding framework requirements for Children & Adults
Clinical effectiveness
Medicines management
– CCG pharmacists worked with GPs and other providers to:
• Identify opportunities for quality improvements
• Increase effectiveness of joint working with secondary care
• Find and investigate any medicine incident related harm
Infection Prevention and Control (IPC)
– Worked with providers to ensure that appropriate systems and processes are in place
to ensure the risk from healthcare associated infections is minimised
– Ensure outbreaks are managed and lessons are learnt/shared across the system
– Identified the preparedness required for the COVID-19 outbreak
Clinical effectiveness
– NW London’s Policy Development Group worked with healthcare providers across the
system to develop evidence-based polices
– We undertook an analysis of CQC quality ratings for providers and set out a plan to
support improvements in areas assessed as below good.
Local response to
COVID-19
Governing Body Members
Covid-19 pandemic
28
• February and March 2020, saw the focus of the organisation shift to
support and react to the Covid19 pandemic.
• The CCG worked as part of the NW London health and care partnership to change ways of working and staff were redeployed to support the emerging situation.
• A lot of work happened in a short space of time and the development of our NW London system ensured that we had a united response in terms of implementing national guidance, sharing resources and ensuring that as a system we provided the best possible outcomes for all patients through the crisis.
An overview of the 19/20 response
29
February • Community testing centres and services were set up - the Heathrow isolation hotel was also opened. March onwards • Rapid expansion of intensive care capacity • Hospital and community services were changed to reduce the spread of the virus
• Outpatient appointments were provided virtually
• Across London, emergency powers were put in place
to maintain urgent cancer and cardiac care in hubs and the private sector were brought in to resume elective surgery
• In our GP practices video and telephone appointments were set-up and hot clinics were then launched to provide dedicated sites to see patients with symptoms of Covid19
• A dedicated programme of support for care homes, including greater GP support, infection control guidance and dedicated point of contact with the CCG.
The NHS is now working on the recovery, and ensuring services can be safely maintained in the event of a second wave this winter
Joint working / mutual
support & at scale
working
New model – total
digital triage, home
visiting, escalated
care clinics
Recovery focused on
priority groups based
on those most
affected by COVID
Shielded patients –
mutual aid groups
& link workers
Additional support
to care homes
Covid-19 Response
Primary
Care
Triage and streaming of
patients during first wave
Self assessment of
readiness for
reopening of
services in relation
to IPC
Virtual and physical
visits from NWL IPC
Lead to help provide
1:1 advice where
needed
NWL checklist to
ensure compliant
with obligations as
employer and
health care
provider
Online training re
IPC provided to all
practices and guidance shared
Covid-19 Response
PPE support
throughout and
ongoing
Infection
Prevention
Control
4 CQC registered
nursing care homes in
H&F
GP clinical lead in
each care home
PPE champions
identified in each
care home to
support ongoing
correct use of PPE
and infection
prevention and
control
Care home clinical
advice provided
by *6 111 out of
hours service
Pharmacy and
medication
support put in
place to facilitate
medication
supply
Covid-19 Response
All nursing home
residents tested
weekly as part of a
pilot with Dementia
Research Institute
and Imperial.
Care Home
support
Additional
support 8am-
12 midnight 7
days per week
from Imperial
(ICHT) frailty
team
Use of digital technology
has accelerated since
the start of the pandemic
Feedback and
evidence tells us that
there is digital poverty,
with inequality in
access and ability to
use the technology
Working with
local and NWL
partners to
reduce the digital
inequalities that
have become
more apparent
since the
outbreak of
Coronavirus
Covid-19 Response
Focus on
digital
We continually raise
awareness that digital is
just one option and face-
to-face appointments will
be offered to those who
need them
Between May and
July, 78 per cent of
people who use
eConsult say they are
either very satisfied
or satisfied with the
service
Promptly send all of the latest
Coronavirus information to
our patients and stakeholders
Maintain a strong two-
way conversation
through monthly PRG
meetings
Working with a
new Healthwatch
and others to
address patient
concerns and co-
design patient
involvement Covid-19 Response
Patient and
public
engagement
We are well-
represented on the
NWL EPIC steering
programme which has
a focus on Covid
recovery
Questions
Dr James Cavanagh
Chair