Transcript Presentation - Enfield CCG

Patient and Public Engagement Event
Getting the best value for every NHS
pound
Wednesday 20 July 2016
Green Towers Community Centre, 7 Plevna Road, Edmonton N9 OBU
Welcome
Teri Okoro
Lay Member for Patient and Public Engagement
Housekeeping
• No fire alarm is planned today. If you hear the alarm,
please make your way outside
• Please turn your mobile phones off or put them on
silent
• There is a disabled toilet on this floor. The main toilets
are downstairs on the ground floor
• You have a local GP and an NHS manager on each of
your tables. They are here to lead the group
discussions. We have three group work sessions
today.
• Please help yourself to refreshments throughout the
event.
Local clinicians working with local people for a healthier future
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Listening to you
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Your feedback is important to us today
We want to work closely with local people to develop our plans
Today we are going to focus on our plans for the next year
We will ask you to fill in a feedback form (in your pack) about today’s
event. Please tell us what you what think of today and tell us about
topics you would like to see at future events.
We would like you to get more involved in the CCG:
• Join your GP practice’s Patient Participation Group (PPG). Ask your practice if you can
join. We have an active PPG network and an elected PPG representative Litsa Worrall
who sits on the Governing Body
• Volunteer to be a patient representative and help us improve services for local patients
forms are available.
• Attend a Governing Body Meeting – dates are advertised on our website, on Twitter
and in the Enfield Independent
• Follow us on Twitter @EnfieldCCG
• Sign up to our mailing list – contact [email protected]
• Visit our website www.enfieldccg.nhs.uk
Local clinicians working with local people for a healthier future
Agenda
10:00am-10:05am
Welcome - including introduction for new GB members
Teri Okoro, Lay Member for Patient and Public Engagement 10:05am-
10:20pm
CCG Financial Position and future commissioning plans
Rob Whiteford, Chief Finance Officer
10:20am-10:40pm
Introduction to the group work sessions
Teri Okoro, Lay Member for Patient and Public Engagement
10:40am-12:40pm
Three workshops each lasting 40 minutes
GP Governing Body Members and CCG commissioners lead discussions on:
Repeat Prescribing- Dr Jahan Mahmoodi and Paul Gouldstone
Paediatric Assessment Unit - Dr Mo Abedi and Claire Wright
Future of Primary Care GP Services – Dr Janet High and Deborah McBeal
12:40pm-12:55pm
Panel questions and answers
Your opportunity to ask any questions to our panel of clinicians and NHS managers
12:55pm
Thank you and event closes
Teri Okoro, Lay Member for Patient and Public Engagement
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CCG Financial Recovery &
Future Commissioning Plans
Rob Whiteford, Chief Finance Officer
The Financial Challenge – Now and Next Year
2015/16
Assurance from various business
Actual In-Year Deficit
partners / service providers as well
as internal sources of assurance
(management and Internal Audit)
Capped In-Year
Deficit
£14.4m
2016/17
£7.7m
SBS Service
Auditor
2017/18
No In-Year Deficit
£0m
Internal
Audit
CSU Service
Auditor
McKesson
Control
Service Auditor
Self Assessment
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Financial Position and QIPP
• Planned 16/17 deficit of £14.9m including £9.9m
QIPP programme
• NHS England rejected 16/17 plan of £14.9m
deficit and required an additional £7.2m of QIPP
opportunities – a deficit of £7.7m
• Due to scale of current QIPP programme,
difficult decisions are necessary
• We want to engage to quickly identify and
implement clinically led opportunities
Local clinicians working with local people for a healthier future
Financial Position and QIPP
Programme Allocation
2015/16
£k
350,833
2016/17
£k
352,469
2017/18
£k
355,678
Running cost allowance
7,019
7,046
7,095
Total
357,852
359,515
362,773
Acute services
228,838
237,095
236,756
Mental Health Services
46,651
48,942
49,903
Community Health Services
25,207
25,442
26,325
Continuing Care Services
22,559
22,308
22,857
Prescribing
42,648
41,813
45,699
Other Programme Services
18,362
16,171
13,460
Running Costs
6,987
7,046
7,095
0
1,798
1,778
Total expenditure
391,252
400,615
403,873
Surplus/(deficit)
(33,400)
(41,100)
(41,000)
RAB Adjustment
19,000
33,400
41,100
(14,400)
(7,700)
0
5 Year Plan
Contingency
In year surplus/(deficit)
Progress on additional QIPP of £7.2m
£7.2m
Required
QIPP
Schemes include:
1. Complex Care
2. Medicines Wastage
3. Re-procurement of CSU Services
4. POLCE reduction
5. Clinically led change through RightCare
£3.6m
Schemes
Identified
£1.8m
Risk
Rated
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Areas of focus for savings
Our Right-Care Programme
Outlier RightCare
Type
Pathway
Transformation
Champion
O&S
O&S
S
O
Other
Other
CVD
Cancer
MSK
Mental Health
Respiratory
Neurological
Matt Rogers
Maggie Jeffreys
Florence Cantle
Asifa Mian
Julian Chiew
Thomas Araya
N/A
Complex Patients
Tara Dear
SRO
Graham MacDougall
Jahan Mahmoodi
Jane Pike
Graham MacDougall
Deborah McBeal
Aimee Fairbairns
Rob Whiteford &
Aimee Fairbairns
Gov Body Lead
Jarir Amarin/Robert
Elkeles
Jahan Mahmoodi
Janet High
Chitra Sankaran
Mo Abedi
Hetul Shah
Angela Dempsey
Our RightCare opportunities are £10.3m per annum, and £1.3m in 2016/17
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Other savings opportunities
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Vacancy freeze in corporate departments
Shared posts with Barnet as opportunities arise
Contribution from partner CCGs
RightCare – clinically led schemes
We need to deliver £5.4m recurrently in 2016/17
from these initiatives.
• Do this and achieve our QIPP of £12.0m in
2017/18 we are in recurrent balance
Local clinicians working with local people for a healthier future
North Central London’s
Sustainability and
Transformation Plan
• Every health and care system has been tasked with producing a multi-year
Sustainability and Transformation Plan (STP) – to become sustainable and
deliver the NHS Five Year Forward View – better health, better patient care and
improved efficiency
• North Central London partners are collaborating to develop and agree a plan –
includes clinical commissioning groups, hospitals and local authorities
• The plan will provide access to transformation funding
Our financial plan for 2016/17 was initially a deficit of
£14.9m, which was subsequently altered to £7.7m by
NHSE
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Strategic aims and objectives
To develop a sustainable plan that improves health, improves patient care and improves
efficiency.
A high level case for change is being developed that provides evidence that significant
transformation to the delivery of healthcare services is needed over the next 2–5 years.
From this initial evidence and engagement with senior leaders across all NCL health and
care organisations, we have identified a set of priorities:
1.
2.
3.
4.
5.
6.
7.
Transforming urgent and emergency care
Transforming care for those with severe and enduring mental illness (SEMI)
Primary care transformation: developing an enhanced offer from primary care
Optimising the use of the estate
Prevention and self care: better health for North Central London
Care for those with chronic complex needs
Care for those in child and adolescent mental health services (CAMHS)
To deliver against these priorities we are establishing a substantial programme of work.
The programme will have strong clinical leadership and a strong clinical focus.
Feedback and
Questions
Repeat prescribing
Dr Jahan Mahmoodi, Clinical Director
Repeat prescribing
can be defined as:
“a partnership between the patient and
prescriber that allows the prescriber to
authorise a prescription so it can be repeatedly
issued at agreed intervals, without the patient
having to consult the prescriber at each issue.”
In our financial position and with limited
resources, we need to think carefully how we can
best spend our budgets, and this year we want to
think about how we can reduce wastage
associated with repeat prescribing
Local clinicians working with local people for a healthier future
Cost
• Around 10% of the CCG’s budget is spent on GP
prescribing.
• In 2015-16 5.2 million items were prescribed by Enfield
GPs at a cost of £37.8 million.
• Over 95% of items dispensed are on free prescriptions
• Repeat prescriptions accounted for more than half the
items dispensed in 2015-16
Local clinicians working with local people for a healthier future
Quality and safety issues
in repeat prescribing
• Medications are ordered on behalf of patients by
pharmacies without the patient being contacted for
confirmation are often over ordered or ordered too
soon
• Many patients who receive repeat prescriptions
often end up with too much medicine and stockpile it
at home. This medicine will eventually go out of date
which is another risk to patient safety and it requires
safe disposal through local pharmacies
Local clinicians working with local people for a healthier future
What can GP practices,
pharmacies and patients/carers
do to improve safety and reduce
wastage from the repeat
prescribing process?
Proposal:
In the future, patients will be asked to confirm with their pharmacy or through
their GP practices website what items they need every month rather than the
items being automatically issued. GP surgeries will not accept repeat
prescription orders from pharmacies without proof that the patient has
requested the items.
• What do you think of these plans?
• How do think it would impact the way you or people you know order
medicines?
• How could the CCG help member practices educate patients if we
recommended a change to this system?
Local clinicians working with local people for a healthier future
Paediatric Assessment Unit (PAU)
at Chase Farm
Hospital
Dr Mo Abedi, Chair
Claire Wright, Head of Strategy and Children’s
Commissioning
About the PAU at Chase Farm
Hospital
What does the Chase Farm PAU do?
• Consultant led service that enables children aged 0-18 to be assessed, treated
and observed by trained paediatric staff
How do patients access this service?
• Referrals to this service are made by the Urgent Care Centre (UCC) at the Chase
Farm site, or by your GP or other services. The PAU is not a self-referral unit
which means you cannot just turn up or make appointments directly
What happens next?
• In most cases a child or young person would be assessed and treated and sent
home. However if a child or young person is deemed to be more appropriately
seen in another setting then there is a transfer protocol in place from Chase Farm
to the other hospital sites
Clinical review of the PAU
• A review of the PAU has taken place in line with last year’s commissioning
intentions
• The review was chaired by Enfield CCG’s Governing Body lead for children and
involved clinical staff from the Royal Free Hospital, including clinicians who work
in the PAU
• The review group was asked to review the effectiveness of the current model in
the context of the overall provision for children
Issues
Range of urgent care services for children
The PAU at Chase Farm is one of many options for children who need urgent care
in Enfield. Other choices include: calling NHS 111, visiting your GP practice,
attending the urgent care centres (at Chase Farm, Barnet or North Middlesex
Hospital) or contacting GP Out of Hours services (via NHS 111), or in a lifethreatening situation, visiting A&E (Barnet and North Middlesex).
Patient choice
Parents are given a choice of which PAU they would like to attend.
There are more attendances at the other PAUs (at North Middlesex and Barnet
Hospitals)
Low attendance
In the last year (2015) the majority (94%) of the children or young people who
presented at Chase Farm’s Urgent Care Centre were seen and treated by the staff
there without needing a referral to the PAU. Only a few (6%) of these patients
needed to be referred into the Chase Farm PAU for observation and treatment and
of those less than 1% were transferred to Barnet or North Middlesex Hospitals for
further care.
Issues continued
Staffing and skills
The PAU at Chase Farm is staffed by a paediatric consultant and two nurses on rotas.
The more patients that clinicians see, the more skilled they become. If clinicians can’t
see the patient numbers recommended by their Royal College, then it’s likely that
recruitment and retention of staff could become difficult in the future.
All the PAUs provide clinical advice and guidance for Enfield GPs, however a limited
number of GPs use this service.
Cost
The cost of the PAU service at Chase Farm is £409,000 per year.
A PAU would usually be funded by the Payment by Results tariff (payment for each
attendance) but for the Chase Farm PAU but this would not cover the cost of providing
the service with the current levels of attendance.
Enfield CCG is a financially challenged CCG. The NHS has limited funds and spending
decisions impact on other services.
Chase Farm redevelopment
The Chase Farm Hospital site is being redeveloped by the Royal Free London NHS
Trust. Enfield CCG as lead commissioner for the Chase Farm Hospital site has an
opportunity to influence how children’s services are provided at this site in the future.
Your views
Due to the low attendances at the unit the CCG is considering how the
provision of children’s urgent care will work at the Chase Farm site in the
future
What are your thoughts on the issues raised by the review?
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Range of urgent care services for children
Patient choice
Low attendance
Staffing and skills
Cost
Chase Farm redevelopment opportunities
Are there any other issues that we need to consider?
Next steps
We will be undertaking more engagement on this over the summer. Let us know
if you want to get involved or have any suggestions for groups we can visit.
Local clinicians working with local people for a healthier future
Future of Primary Care GP
Services
Dr Alpesh Patel, Primary Care Clinical Lead
Deborah McBeal, Director of Primary Care
Commissioning and Deputy Chief Officer
The Patient Offer
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Your practice will be open during routine hours of 8 am – 6.30 pm Mondays - Fridays
You will have a choice of appointment including flexible length of appointment time
appropriate to your needs – named/same doctor for continuity of care or with a GP/Nurse
for rapid access for urgent problems
You will have access to extended opening hours of 8 am – 8 pm 7 days a week across
Enfield
You will only need to make one contact to make an appointment - in person/by phone or
on-line
You will have on-line access to view your medical record, order repeat prescriptions and
make appointments
You will have access to a greater range of services nearer home, reducing the need to
travel to hospital
You will be supported to self care and purchase medicine over the counter where this is
available
You will be prescribed the most clinically and cost effective medicine
You will received care in safe and suitable premises that support your well-being
Your practice will identify patients who would benefit from co-ordinated health and social
care with a named clinician and will proactively review you on a regular basis
Clinicians across local health and social care will have access to a sub-section of your
medical record to provide seamless and co-ordinated care
Local clinicians working with local people for a healthier future
Primary Care Work In
Progress
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IT
– Digitalisation of records to free up
practice space for clinical services
– Integrated Digital Care Record
– Patient online services
– Electronic consultations
Estates
– Local Estates Plan developed
– Space utilisation surveys
– Silverpoint opening in Autumn
2016
– Feasibility studies planned for
Chase Farm, Alma and Ladders
Wood regeneration areas
– Potential new premises and
extensions being scoped in all
four localities
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Workforce
– General Practice Nurse
programme – 5 new GPNs by
February 2017, 8 new GPNs
by February 2018
– Practice Nurse and Practice
Manager mentoring schemes
introduced
– Workforce planning underway
Services
– Integrated Commissioning
scheme from July 2016
– AF and Pre-Diabetes scheme
from October 2016
– GP See and Direct
– 8am – 8pm / 7 day GP Service
Local clinicians working with local people for a healthier future
Group feedback
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Key dates for your diaries
Governing Body meetings in public
28 September 2016 – time and venue to be confirmed
Annual General Meeting
28 September 2016 1-2:30pm Dugdale Centre Thomas Hardy House, 39 London Road,
Enfield, EN2 6DS
Patient Participation Group (PPG) network meeting
For Chairs and members of PPGs and staff at member
Practices who support patient groups only.
Tuesday 6 September 2016, 6.30 – 9pm, Executive Suite, Dugdale Centre, Thomas
Hardy House, London Road, Enfield, EN2 6DS
Tuesday 6 December 2016, 1.30 – 4.30pm, Executive Suite, Dugdale Centre, Thomas
Hardy House, London Road, Enfield, EN2 6DS
Patient and Public Engagement meeting
For all Enfield residents and local stakeholders.
Wednesday 16 November 2016 2 - 5pm
Wednesday 2 March 2017 2 - 5pm
Venues and agendas to be confirmed nearer to the dates of the events.
Please email [email protected] to be added to our email and be notified
of news and events.
All events are advertised on our website: www.enfieldccg.nhs.uk
Twitter @EnfieldCCG and in the local press.
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Panel questions and
answers session
Ask us
anything!
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Thank you for attending
today’s event
For more information
www.enfieldccg.nhs.uk
Follow us on Twitter @EnfieldCCG
Contact: [email protected]
0203 688 2814
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