Planned Care : Getting a GripHow can we deliver the same quality

of care while making savings?

CHANGES IN THE NHS

To see a video produced by The Kings Fund which was watched in the workshop, please click on this link:https://www.youtube.com/watch?v=8CSp6HsQVtw

AGENDA

• Welcome and introductions (10)

• Setting the context: (15)– Why Planned Care matters?– The financial and

demographic picture in North Somerset

– What do we intend to do?– How can you get involved?

• Introduction to group activity (10)

• Break• Group activity: A Vision for

Planned Care (30)• Next Steps (10)• CLOSING

Setting the context

The NHS has been asked to find savings of £20bn by 2015 to cope with rising demands.

In North Somerset, we need to find £11m of savings over the next 2 years.

…We are dealing with £15 to £20bn (in reduced costs), you don’t save that by not providing biscuits at a board meeting

Gerry O’DwyerRoyal College of Nurses

Nursing Times 2009

What is Planned Care?

Planned care covers all services provided for adults, 18 years or over, which are planned (scheduled), including all primary care, community and hospital services.

This does not include emergency (unscheduled) care.

THE LOCAL CONTEXTPlanned Care: Getting a Grip

North Somerset Total SpendingKey messages

Total Spend £252m Nearly 90% of acute

spend is with local acute providers

Fastest growing areas of spend are acute• Medical Emergency

admissions• A&E• Elective Orthopaedics• NICE• Diagnostic scopes

Accounts for 59% of all spending

How does this compare?

0.37% of NHSE budget

A cataract operation on one eye costs the NHS about £900.

A hip replacement costs the CCG more than £5,000.

Local Information• North Somerset population 202,566 (2011 census)

• 214,068 are officially registered with a GP– 97% White Ethnic – Two thirds live in Weston-super-Mare,

Clevedon, Nailsea and Portishead. – One in five are over age 65

• 88,200 households of which 29% are single owner occupied – We have Lower Super Output Areas in the

most and least deprived 1% Nationally

THE CASE FOR CHANGEPlanned Care: Getting a Grip

The need for change in North Somerset

1. Our acute hospital spend is increasing at a faster rate than our funding and faster than our growth in population.

2. Our acute hospital spend is increasing relative to our neighbours or our peers.

3. Our acute spend is increasing in the areas that we are trying to reduce.4. Non acute spend is beginning to accelerate.5. Not only is our spend higher than our allocation it is now higher than

our target allocation.6. We have signed up to deliver changes in service delivery that will save

£11m over the next 2 years.7. These savings are still largely embryonic.

Acute hospital spend is increasing faster than our funding and faster than our growth in population

GROWTH IN SPENDING 2012/13 - 2013/14

The problem is getting worse In 2013/14 growth in acute hospital

spend is £8m (6%) In 2012/13, our unfunded growth in

acute spend was £5m (4%)

This is well above what we would expect for overall population growth of 0.6%.

Even allowing for our aging population we would expect the impact of demographic change to be around £2.5m

Note: Based on M11 Contract Performance

Non-acute spend is broadly flat

This is our key cost driver

Focus Areas

• Trauma & Orthopaedics/ Musculo-Skeletal• Ophthalmology• Urology• Dermatology• Diabetes and other general medicine• Diagnostics

Our spend is not only higher than our actual allocation it is now higher than our target allocation ----

-30 -25 -20 -15 -10 -5 0 5 10

2011/12

2012/13

2013/14

Value above or below target (£m)

Distance from Target (Funding and Expenditure)

Expenditure Funding

NORTH SOMERSET NEEDS BIG IDEAS AND BIG CHANGE

In 2011/2012, our expenditure met our funding allocation

In 2012/13, the financial picture shifted into a less favourable position

In 2013/14, we find ourselves with a gap of 7% between spending and our funding. We are in the process of understanding the change.

HOW WE INTEND TO GET A GRIPPlanned Care: Getting a Grip

DECISION TO REFER REFERRAL PATHWAY OUTCOMES CHALLENGE:

Raise the bar

IMPROVE: Support GPs confidence to diagnose and treat

: OPTIMISEProvide GPs with greater clarity on pathways

Monitor and Share Fewer hand-offs Clear and agreed

protocols

DESIGNCreate different/better pathways

Patient centred Senior decision-makers

early on

REVIEWKeep quality high on the agenda

MANAGEExternal referrals

Clear + Comprehensive Pathway

Efficient + High quality

Cost Effective Copes with complexity

Appropriate Flexibility

A real time example

• Dermatology: Keeping more of the work in GP practices– 1636 referrals into Acute (April- December 2013)– Advice and Guidance– Tele-dermatology– Redesign the pathway and enable the pathway with Map of

Medicine– Explore developing GPs with special interest in dermatology

and specialist nurses– Ensuring appropriateness of referrals and prescribing

Dermatology

Present• Pathways not clear• High numbers of referrals into

acute and growing waiting list• Variation in skills and

confidence of doctors to treat• High demand on primary care

appointments• Shortage of dermatologists

nationally

Future• Effective pathway• Reduction in number of

inappropriate referrals• Greater skill and confidence in

primary care• Improve speed of access to

specialist treatments• Reduced variation in standards of

care• Improved prescribing

THE CHALLENGES ARE SIGNIFICANTOur elective T&O hospital spend is increasing relative to our neighbours and our peers

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Key Messages:Trauma & Orthopaedics spend accounts for around £18m ( 20% ) of hospital spend on outpatients/admissions There has been a sharp increase in more complex high cost procedures locally which is not mirrored nationally

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SAR Elective T&O ( HR - Reconstructions)

North Somerset Bristol South Gloucs

Key Messages

• We have a big challenge but we are getting a grip• We are NOT going to reduce costs by slashing

quality• The first year as a CCG was a period of stabilisation

but there is a renewed focus and energy• We are seeking innovative solutions to old

problems

FINAL THOUGHT

• If every GP took out one referral a week, we would save a £1m.

• The challenges are not intractable• The solutions are within reach

HOW CAN YOU HELP US?PLANNED CARE: GETTING A GRIP

Next Steps

• Exercise to gather reaction and feedback• 3 questions• 10 minutes timed discussion on each• Facilitator at each table

3. You are here!

1. North Somerset is embarking on an ambitious programme to reduce unnecessary acute activity by introducing greater efficiencies in clinical pathways, improving the quality of referrals and engaging active patient citizenship. 2. Planned Care Programme Board

Questions

• What, in your understanding, were the top 3 issues the Planned Care presentation?

• How can we engage patients and the public in transforming Planned Care in North Somerset?

• Is there a role for you/your organisation in this agenda? What can you contribute and how would you like to be involved?