Thursday 5th November 2015

CCG Clinical Commissioning Forum

CLINICAL COMMISSIONING FORUM

THURSDAY 5 NOVEMBER 2015, 13:00-15:00

Venue: 1st Floor Education Centre, St Joseph’s Hospice, Mare Street, Hackney

AGENDA

Chair: Dr Clare Highton Agenda Items Led by

1. Welcome

Dr Clare Highton

2. Devolution Discussion

Dr Clare Highton

3. Early Years Discussion

Dr Kirsten Brown Dr Dorothy Briffa

Members will be invited to attend three Programme Boards for 30 minutes (each) to hear about their commissioning intentions

Mental Health Planned Care Prescribing Urgent Care Integrated Care Maternity Children Long Term Conditions Primary Care Quality

Discussion

Programme Board Clinical Leads

The next Clinical Commissioning Forum will be held on Thursday 3 December, 1.00pm in the 1st Floor Education Centre, St Joseph’s Hospice, Mare Street, Hackney

Hackney Devolution Pilot:

An Update

Health and Wellbeing Board4 November 2015

Why are we exploring being a devolution pilot in Hackney?

• We think it will help us address the financial challenges ahead and find a way to protect finances and access transformation funding

• There are plans to transform health and care systems nationally and within London

• These will deliver significant changes over the next 2 years in how integrated health and social care operates

• Devolution offers opportunities for ways of working that meet local areas’ needs with local commissioners, providers and patients/service working together to deliver real localism

• Hackney partners have expressed an interest in becoming a London devolution pilot and a short-term group has been meeting with representatives from across the partnership, to progress the proposal further.

What do we want?

We do not want to…

• Privatise services

• Break up the NHS

• Lose our high performing local hospital

• Have a model developed elsewhere imposed on us

What are the building blocks?• Putting patients at the heart of service design and decisions-making• Starting with adults, a focus on prevention and early intervention, living well at

home and avoiding unnecessary use of hospital care or other long-term care• Redesigning services with patients/service users to improve care by reducing

fragmentation, delays and duplications currently experienced by patients and carers

• Our current partnerships, e.g. One Hackney and City, mental health alliances• New ways of paying for care that make the best use of our resources and lead to

better patient experiences and improved outcomes • The ability to re-invest any savings back into local health, social care and wellbeing

services.

How can devolution help us?

Some of the freedoms we

need:

Financial flexibilities 

We want to explore new ways of paying for care, along with

incentives for prevention, early intervention and better care

overall

Additional local powers 

We want new local powers, such as planning powers, to improve public

health and to address the social determinants of health and reduce

health inequalities

New commissioning powers 

We want to be able to commission more services locally

Common regulatory system 

We want a simpler way of regulating our integrated health

and social care system

Estates 

We plan to work across the partners to explore how we can best make

use of our collective estates to deliver our vision.

What if we do nothing?• Possible moves towards a single CCG covering Hackney, Tower

Hamlets, Newham and Waltham Forest• Exposure to the financial challenges facing Barts Health• Less local control• Possible Challenges to the independence of the Homerton

What happens in the next few weeks?

What is our timetable if we become a pilot?

How will we take our plans forward?

Good news! City and Hackney top of QOF for many LTC measures!

27%

11%

5%14%

38%

5%

City and Hakcney CCG 2014-15 QOF results

Top CCG in EnglandSecond Best CCGThird Best CCGTop Quintile (other than 1st / 2nd / 3rd)Mid rangeBottom Quintile

QOF results 2014/15 City and Hackney ResultsTop in the country for: • Diabetes; CHD; Stroke / TIA or PAD and

BP controlled to 150/90 • CKD and BP controlled to 140/85• Diabetes and foot exam / risk

classification• AF with CHADS2 >1 and on anti-

coagulation• Asthma and COPD reviews• CKD with a urine albumin:creatinine ratio

Second in the country for:• Diabetes and BP controlled to 140/80• Newly diagnosed diabetics referred to

structured patient education• CHD patients on anticoagulation• Hypertension and BP controlled to

150/90Third for: • Diabetes and cholesterol 5 mmol/l or less• COPD and FEV1 recorded

Top Quintile on 21 measures

END | NOTES

Maternity, Children and Family Services- Early Years Contract

Children’s Programme BoardMaternity Programme Board

November 2015

What we are trying to achieve

17

• The CCG wants to commission an early years service from primary care in line with its Early Years Strategy.

• There is a good evidence base for early identification and  intervention  improving child and family outcomes.

• This must start as soon as possible, ideally before conception. This proactive care, coordinated by a multidisciplinary team including GPs, practices nurses, mental health, voluntary sector, midwives and health visitors, is beyond core and additional services under the GP contract.

• There is a continuum of opportunities to offer enhanced services to families, so we are presenting the children's and antenatal contracts under the umbrella of early years to make this focus on improved outcomes clear.

1. Proposal

18

• Opportunistic and targeted pre conception care- Outcomes • Identify and treat medical issues early (and refer on) • Health promotion e.g. folic acid, healthy weight, stopping smoking,

• Pregnancy presentation appointment- outcomes • Identifying existing and new obstetric, medical, social and psychological risks right at the start of pregnancy • Making good quality and swift referrals to maternity services including sharing needs and risks identified for pregnant

women.

• Continuation of 16w antenatal and 6 week postnatal appointments (as now) including mental health screening

• Commission service standards for children 0-19 to achieve the following outcomes with partners

• Multidisciplinary partnership working with health visitors, school nurses and paediatricians • Early intervention • Increased numbers of development checks • Increased immunisation uptake• Improved access to breastfeeding support • Coordinated approach to communication information and shared care (across Primary Care community services and

secondary care) • Equity of access and provision across City and Hackney • Access to advice

• Support for vulnerable children including carers (as now)• New patient health checks for children aged 5 – 17 (as now)• 16th birthday health checks (as now) • Quality standards for children in primary care • LTC elements of VCC moving to LTC contract, for better join up

Rationale & Benefits

19

• Rationale

• GPs are at the heart of services for families. • See and know all the family: mum, dad,

babies, children, siblings, extended family…• Usually the “first port of call” for pregnant

women so key opportunity here to offer enhanced care, right from the start.

• Seeing women, babies, children and fathers as early as possible – Prevention, Early Identification and Intervention.

• GPs can join the dots and understand the whole picture as know their patients medical and social histories.

• Can identify risks that would impact on healthy child development e.g.

• Children missing immunisations • Parental mental health problems • Social vulnerabilities like housing and

money that are impacting on family wellbeing

• Familial safeguarding risks such as DV, FGM…

• Benefits • Commissioning services based on children and family’s

journey or “the care pathway” will make it easier for families (and professionals) to navigate services.

• Model will provide continuity of care to families that also takes account of individual and family needs.

• GPs can share detailed knowledge of family histories to partner agencies who need to work more intensively with the family – e.g. health visitors, school nurses, CAMHS

• Families with additional needs (medical, social, obstetric, psychological) will be:

• Identified early • Offered appropriate support and care• Signposted or referred for additional support • Monitored via shared care plans

• Entrenched and chronic problems can be avoided – particularly on “wellbeing” issues such as support for positive parenting, confident access to services like healthy child programme reviews and getting help early for low level / emerging mental health problems.

• Young people will be supported to manage their health as they transition to adulthood

Questions for CCF

20

As clinical commissioners-• Is this clinically the right thing to do • Are there additional quality standards that we want to

commission for children's health aged 0-19• Is there anything else we should be considering as

part of this contract.