QIPP initiative analysis: summary by PCT by type – shown cumulatively for

impact on gapBy PCT by Type Bexley Lewisham Lambeth Bromley Greenwich SouthwarkEnd of life care 0 0 1,224,000 0 0 776,000Estates and other 7,840,000 1,449,900 8,947,850 2,454,900 11,924,517 24,718,569Long Term Conditions 7,709,568 0 0 99,837 8,832,294 0Maternity 0 485,606 760,172 0 1,132,216 874,199Mental health 5,000,000 6,000,000 11,200,000 2,000,000 4,800,000 7,537,469Planned care 29,236,558 60,767,445 63,954,757 30,928,109 38,809,708 66,099,628Primary care 0 8,810,000 10,078,000 3,316,000 40,419,832 8,169,000

Staying healthy 0 0 0 -5,200,000 0 0Urgent Care 8,951,160 31,931,670 41,663,189 9,448,324 27,163,301 42,820,946Total 58,737,286 109,444,621 137,827,969 43,047,170 133,081,869 150,995,811

QIPP initiative analysis: detail by PCT by yearBexley 10/11 11/12 12/13 13/14 14/15

End of life care 0 0 0 0 0Estates and other 1,568,000 1,568,000 1,568,000 1,568,000 1,568,000Long Term Conditions 45,000 1,916,142 1,916,142 1,916,142 1,916,142Maternity 0 0 0 0 0Mental health 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000Planned care 759,662 7,119,224 7,119,224 7,119,224 7,119,224

Primary care 0 0 0 0 0Staying healthy 0 0 0 0 0Urgent care 0 2,237,790 2,237,790 2,237,790 2,237,790Total 3,372,662 13,841,156 13,841,156 13,841,156 13,841,156

Lewisham 10/11 11/12 12/13 13/14 14/15End of life care 0 0 0 0 0Estates and other 125,300 250,600 358,000 358,000 358,000Long Term Conditions 0 0 0 0 0

Maternity 0 121,402 121,402 121,402 121,402Mental health 0 1,500,000 1,500,000 1,500,000 1,500,000Planned care 3,152,008 8,478,672 13,688,655 16,378,922 19,069,189Primary care 0 2,040,000 2,170,000 2,300,000 2,300,000Staying healthy 0 0 0 0 0Urgent care 476,435 6,006,160 7,576,207 8,812,420 9,060,447Total 3,753,743 18,396,833 25,414,264 29,470,744 32,409,038

Lambeth 10/11 11/12 12/13 13/14 14/15

End of life care 0 306,000 306,000 306,000 306,000Estates and other 7,669,247 5,350,728 -1,218,442 -726,288 -2,127,394 Long Term Conditions 0 0 0 0 0Maternity 0 190,043 190,043 190,043 190,043Mental health 1,000,000 1,200,000 3,400,000 4,100,000 1,500,000Planned care 4,540,890 9,491,840 14,303,372 16,640,676 18,977,979Primary care 3,406,000 3,692,000 2,580,000 210,000 190,000Staying healthy 0 0 0 0 0Urgent care 1,631,137 8,098,815 9,735,707 10,736,943 11,460,587

Total 18,247,274 28,329,426 29,296,680 31,457,373 30,497,215

Bromley 10/11 11/12 12/13 13/14 14/15End of life care 0 0 0 0 0Estates and other 0 249,900 735,000 735,000 735,000Long Term Conditions 0 7,044 30,931 30,931 30,931Maternity 0 0 0 0 0Mental health 0 500,000 500,000 500,000 500,000Planned care 1,649,819 5,491,103 7,880,173 7,953,507 7,953,507Primary care 0 1,734,385 3,674,807 6,793,958 11,250,907Staying healthy 0 -1,300,000 -1,300,000 -1,300,000 -1,300,000 Urgent care 1,887,816 1,890,127 1,890,127 1,890,127 1,890,127Total 3,537,634 8,572,559 13,411,038 16,603,522 21,060,471

Greenwich 10/11 11/12 12/13 13/14 14/15End of life care 0 0 0 0 0Estates and other 1,983,625 2,610,794 545,709 3,204,694 3,579,694Long Term Conditions 175,244 2,164,263 2,164,263 2,164,263 2,164,263Maternity 0 283,054 283,054 283,054 283,054Mental health 0 480,000 960,000 1,440,000 1,920,000Planned care 3,559,087 8,087,314 8,367,587 9,147,860 9,647,860Primary care 2,744,637 3,998,001 7,883,428 12,896,883 12,896,883Staying healthy 0 0 0 0 0Urgent care 6,311,110 5,213,048 5,213,048 5,213,048 5,213,048Total 14,773,703 22,836,473 25,417,089 34,349,801 35,704,801

Southwark 10/11 11/12 12/13 13/14 14/15End of life care 0 344,000 144,000 144,000 144,000Estates and other 15,174,367 4,409,465 3,734,737 700,000 700,000Long Term Conditions 0 0 0 0 0Maternity 0 218,550 218,550 218,550 218,550Mental health 1,600,000 2,226,469 1,611,000 1,050,000 1,050,000Planned care 5,102,495 9,911,419 14,613,984 17,028,571 19,443,158Primary care 4,643,000 1,269,000 1,219,000 1,038,000 0Staying healthy 0 0 0 0 0Urgent care 1,949,823 8,246,981 9,856,151 11,028,467 11,739,525Total 28,469,686 26,625,883 31,397,422 31,207,588 33,295,233

Cumulative impact of initiatives on cumulative gapCumulative Surplus/(Deficit) 10/11 11/12 12/13 13/14 14/15

Bexley -1,863,612 -2,166,212 1,518,895 9,477,358 21,896,424Lew isham 4,746,269 -8,802,263 -25,759,056 -45,734,137 -68,978,426 Lambeth -12,488,274 -32,991,202 -52,971,829 -71,055,373 -86,619,668 Bromley 3,347,548 2,457,664 -2,063,338 -9,593,241 -19,424,731 Greenw ich -10,192,758 -26,231,117 -47,744,824 -77,310,830 -112,623,571 Southw ark -27,174,686 -51,544,168 -77,544,813 -105,101,800 -134,608,078 Total -43,625,513 -119,277,298 -204,564,965 -299,318,023 -400,358,050

Annual Surplus/(Deficit) - Post-QIPPBexley 1,509,050 13,538,556 17,526,263 21,799,618 26,260,223Lew isham 8,500,011 4,848,301 8,457,471 9,495,663 9,164,748Lambeth 5,759,000 7,826,498 9,316,053 13,373,829 14,932,921Bromley 6,885,183 7,682,674 8,890,036 9,073,620 11,228,981Greenw ich 4,580,945 6,798,115 3,903,381 4,783,796 392,060Southw ark 1,295,000 2,256,401 5,396,777 3,650,600 3,788,954Total 28,529,189 42,950,546 53,489,982 62,177,126 65,767,888

Cumulative Surplus/(Deficit) 10/11 11/12 12/13 13/14 14/15Bexley 1,509,050 15,047,606 32,573,869 54,373,487 80,633,710Lew isham 8,500,011 13,348,313 21,805,784 31,301,446 40,466,195Lambeth 5,759,000 13,585,498 22,901,552 36,275,380 51,208,301Bromley 6,885,183 14,567,857 23,457,893 32,531,513 43,760,494Greenw ich 4,580,945 11,379,060 15,282,441 20,066,237 20,458,297Southw ark 1,295,000 3,551,401 8,948,178 12,598,778 16,387,733Total 28,529,189 71,479,735 124,969,717 187,146,843 252,914,730

Cumulative impact of initiatives on cumulative gap

In £m’s

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Menu of improvement opportunities

Initiative: Right Care, Right Place

Focus:Reconfiguration of local secondary services in as part of shift to polysystems (e.g. outpatients and diagnostics)Redesign of certain planned and LTC pathways (e.g. diabetes, COPD, MSK, sexual health, end of life and dementia) Decommission and/or introduce evidence based thresholds for PoLCEPrimary care management of out patient referrals

Rationale:Currently no structured or integrated care for COPD and adult asthma patientsImprove the diabetes care pathway and ensuring delivery of a greater part of the pathway in the community. Expand the current model of service and use the Long Term Conditions models for delivering a Heart Failure service in the community. Establish Referral Management Centres as part of a package of measures to address referral management

Outcomes:Savings will be achieved by decommissioning – in year 1 and 2, with patients actively discharged to primary care. Implementation of LTC Development Programme will raise the standard of primary care to achieve Tier 1 services. From year 3, savings will be achieved by continued primary care management and shift to community based walk-inmulti-disciplinary clinics. Target to shift 80% of OP activity to community settings

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Initiative: Specialist services

Focus:KCH is accredited as a HASU and Major Trauma CentreGSTT has the Dimbleby Cancer centreVascular inpatient services across KCH and GSTT are to be centralized onto one site

Rationale:Improve access to cancer servicesImprove secondary prevention for cardiac and vascular diseases.Prevention and improved management of stroke and heart disease

Outcomes:Decentralizing some of the ambulatory specialist services (inc. chemotherapy) across SELCentralising of specialist services e.g. aspects of cardiac Centralise the number of paediatric inpatient unitsReductions in hospital admissionsImproved quality of services to those who are at the end of their lives

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Initiative: Cancer

Focus:Implement the CSL Cancer model of care

Rationale:Overseeing enhanced recovery after surgery (ERAS) in all acute trusts in a range of

tumour sites.Meeting the 14 day turnaround from the cervical screening test to receipt Implementing the acute oncology measures for all trusts with an A&ECommissioning new models of care for systemic therapy servicesImplementation of revised tariff and recharge mechanisms for commissioning of systemic

therapy services

Outcomes:ERAS14 day TurnaroundEstablishment of an acute oncology service in all hospitals with an A&ESystemic therapy

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Initiative: Urgent Care

The focus of this initiative is:Development of Urgent Care Centres Diversion to primary care for primary care interventions

Rationale:Build on the success of the rapid response teamSingle point of telephone access to urgent careProviding greater clarity for local people on how to access these services.

Outcomes:Reduced inappropriate use of A&EBetter management of primary care conditions in primary careIncrease the number of terminally ill cancer and non cancer patientsenabled to die in their own home.

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Initiative: Medicines management

Focus:Drugs related savingsMaximising the scope for further in year savings on drugs. New contract monitoring processes for high cost drugs

Rationale:The growth rate in 2009/10 for primary care prescribing was 2.9%Increase for 2010/11 on 2009/10 spend was 1%Current forecast is £1million overspend on primary care prescribing budget of £35million.

Outcomes:Reductions in spend achieved by:ProcurementClinical effectiveness/VFM Leverage increased buying power of purchasing consortia / more effective procurement of clinically

effective drugsEnforce compliance for drugs for OP prescriptionsEnsure drugs are used within guidelinesIncreased use of generics and reduced variability on prescribing