Transcript (pptx, 6.82 MB) - Stafford and Surrounds CCG

Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Annual General
Meeting
26th July 2016
The healthiest place to live and work by 2025
as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Welcome and
Introductions
Dr Paddy Hannigan
Chair
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Annual Report &
Annual Governance
Statement
Andrew Donald
Chief Officer
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Annual Accounts
2015/16 Financial position
Paul Simpson
Director of Finance
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
How we spent the CCG’s money
Stafford & Surrounds CCG Finance Report
Month 12 (1st April - 31st March 2016)
Revenue Resource Allocation
Annual Budget
£,000
-169,176
YTD Budget
£,000
-169,176
YTD Expenditure
£,000
-169,176
14,853
93,720
25,849
16,832
19,403
2,531
173,188
14,853
93,720
25,849
16,832
19,403
2,531
173,188
15,315
92,109
27,331
17,365
19,208
1,794
173,122
462
-1,611
1,482
533
-195
-737
-66
3,210
3,210
3,267
57
176,398
176,398
176,389
-9
7,222
7,222
7,213
-9
Repayment of prior year debt
18,744
18,744
18,744
0
Culmulative position (Surplus)/Deficit
25,966
25,966
25,957
-9
Expenditure
Mental Health
Acute
Primary Care
Cont Care & FNC
Community
Other
Total HCHS
Corporate/Running Costs
Total Expenditure
In Year position reported at Month 12
YTD Variance
£,000
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0
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Commentary on 2015/16
Stafford & Surrounds CCG Financial Summary
•
The CCG delivered its control total of £7.213m (with a small “underspend” of £9k). This is a significant milestone in the CCGs
recovery back to financial balance.
•
Stafford & Surrounds CCG have a cumulative deficit of £25.957m
•
The main financial variances in 2015/16 were as follows
* The Acute, Mental Health and Community Services contracts combined 2015/16 financial position is a £1.344m
underspend. The position is based on initial contracting information to the end of February (Month 11) for the majority of
contracts.
* The Continuing Healthcare financial position at year end is a £533k overspend.
* Primary Care Services ended the financial year 2015/16 with a significant overspend of £1.482m which mainly relates to
prescribing (£1.551m).
•
CCG Audit – Compliance with legislation
* The audit opinion is that the financial statements give a true and fair view of the financial position.
* The CCG received an unqualified opinion on the value for money measurement on the basis the 2016/17 is in balance.
* The opinion against the regularity measurement was also qualified on the basis of the in year deficit.
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
The healthiest place to live and work by 2025
as
Analysis of Contract Expenditure
£000's
13,729
Analysis of Acute Expenditure
£000's
6,368
15,542
15,542
5,229
804
8,001
4,821
836
12,793
6,368
5,229
804
4,821
58,509
836
58,509
Wolverhampton
UHNM
Wolverhampton
Robert Jones & Agnes Hunt
UHNM
Ambulance
Robert Jones & Agnes Hunt
Shrewsbury & Telford
Rowley Hall
Ambulance
Other Acute
Shrewsbury & Telford
Staffordshire & Shropshire FT
Rowley Hall
Starfish Mental Health Services
Other Community & Mental Health
Other Acute
as
Forward Look
Revenue Resource Limit
£ 000
Recurrent
Non-Recurrent
Total
Income and Expenditure
Acute
Mental Health
Community
Continuing Care
Primary Care
Other Programme
Primary Care Co-Commissioning
Total Programme Costs
Running Costs
Contingency
Total Costs
Surplus/(Deficit) In-Year Movement
2016/17
2017/18
2018/19
171,420
174,779
178,178
-25,957
-25,956
-20,057
145,463
148,823
158,121
92,359
14,744
18,143
17,324
24,417
894
167,882
88,818
15,262
18,782
19,695
25,975
945
169,476
89,841
15,107
18,591
21,876
26,439
971
172,824
2,681
2,681
2,681
857
874
891
171,420
173,031
176,396
1,748
1,782
-
Commentary
• The financial plan is for the
CCG to return to financial
balance in 2016/17. This will
enable the CCG meet the
statutory obligation of
remaining within its
Revenue Resource Limit
• The surpluses planned in
2017/18 & 2018/19 will
enable the CCG to fully
meet the national rules for
CCGs to deliver a 1%
surplus.
as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Project
Showcases
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Dr Paddy Hannigan, Chair and GP
Tracey Cox, Senior Primary Care
Development Manager
Atrial Fibrillation (AF)
• AF is one of the most common forms
of abnormal heart rhythm (5% of over
65s)
• It is a major cause of stroke – 20% of
strokes & tend to be severe
• In England, there are approximately 12,500 AF related strokes
per year
• 49% of high risk patients with AF on a practice register may not
be taking anticoagulation for stroke prevention
• There is a need to improve the management of AF in Primary
Care
• Recent NICE Guidance also indicated aspirin used as stroke
protection is inadequate
AF Management
• Control heart rate if too fast
• Medication to prevent stroke
• CHA2DS2-VASc , HAS-BLED scores used to ascertain risk
and treatment needs
Anticoagulation
• Clear NICE guidance that aspirin not effective in preventing
strokes
• Warfarin thins the blood but needs regular monitoring, measure
INR and check within the therapeutic range (2.0-3.0)
• Time in Therapeutic Range (RTT) important as addresses if
sufficient anticoagulant cover
• Newer anticoagulants called NOACs, these do not need regular
monitoring so easier to manage but still require monitoring but
give anticoagulant cover
• Stafford and Surrounds CCG decided to run the PCAF project
to improve the prevalence of AF and optimise anticoagulation to
prevent stroke and the consequences of catastrophic effects of
stroke in high risk patients
• Project supported and funded by Pharma (Pfizer)
• PCAF project was a Consultant cardiologist supported service
delivered locally at General Practices
Project Aims
• Improve the quality of AF register
at practices
• Improve the knowledge and skills
of general practice workforce
• Ensure all high risk patients are
anticoagulated and optimally
managed
• Reduce the expected numbers of
stroke in the Stafford and
Surrounds CCG population
Results
• Patient records reviewed : 140,130
• Virtual Reviews undertaken: 60
• Face to Face review: 410
• New patients treated with anticoagulation:
219
• Overall the attendance for reviews was 83%, those who did not
attend had a note added to clinical record to allow GP to follow
up at a later date
• 219 patients were started on treatment
• There was a 60/40 split on patients taking NOAC or warfarin
• 91 patients had there warfarin changed to NOAC as there
treatment with warfarin was sub therapeutic
Objectives Met
• Improved prevalence registers of AF at practices
• Practice education on AF and management
• More patients anticoagulated and sufficiently protection
• Up to 30 strokes were expected within the 12 months if no
intervention was put in place as suggested by the GRASPAF tool
• In total, at least 10 strokes prevented
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Antibiotic prescribing
and antimicrobial
resistance
Sam Buckingham
Pharmaceutical Advisor
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Antimicrobial Resistance – A growing problem
•asThreatens treatment and prevention of infections
• A serious threat to global public health.
• Worldwide issue - new resistance mechanisms emerge and
spread globally.
• Already significant bacterial resistance to urinary tract
infections, pneumonia, tuberculosis among others.
• Patients with drug-resistant bacterial infections are generally:
• at increased risk of worse clinical outcomes and death
• consume more health-care resources than patients
infected with the same bacteria that are not resistant.
• By 2050 will lead to over 10million deaths worldwide
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Antimicrobial Resistance – A growing problem
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Antibiotic Guardian and Antibiotic Awareness
Key Messages
as
• Right drug, at the right dose, at the right time and the right
duration
• AVOID unnecessary lengthy durations of antibiotic treatment
• AVOID inappropriate use of broad-spectrum antibiotics
• Communication is key – patients need information on expected
course of illness.
• Consider backup/delayed prescriptions when appropriate
• GPs are also encouraged to focus on antimicrobial stewardship
and to use the RCGP TARGET toolkit.
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/465879/AG_and_Antibiotic_Awareness_Key
_messages_2015_FINAL.pdf
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Local antibiotic prescribing improvements
The CCG has been supporting practices and prescribers to review
as
antibiotic prescribing locally.
During 2015/16 the CCG has:
• Reduced overall antibiotic prescribing by 8.3%
• Reduced broad spectrum antibiotic prescribing by 12.6%
The reductions are particularly evident in period October 2015 –
March 2016 where over 20% reduction in broad spectrum
antibiotics has been seen.
Despite excellent progress NHS Stafford & Surrounds
remains above national average for antibiotic prescribing.
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
NHS Stafford &
Surrounds CCG
National Average
The healthiest place to live and work by 2025
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
NHS Stafford &
Surrounds CCG
National Average
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as
Patient Information Resources
When should I worry booklet
• Developed by Cardiff University
http://www.whenshouldiworry.com/training-in-use-of-the-booklet.php
• Key information for parents and carers:
•
•
•
Symptom / condition specific advice
Management / self care sections
Contacts / summary
European Antibiotic Awareness patient information leaflet
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Next Steps and Key Public Messages
To
astackle antimicrobial resistance requires professionals and
patients working together.
A public awareness campaign is planned for winter 2016
In addition, there are a few things that the public can do:
• Manage self-limiting conditions like flu, coughs and colds with
over-the-counter preparations
• Discuss symptoms with your community pharmacist
• Remember symptoms can take time to improve
• Don’t expect antibiotics every time you see the doctor
• Take antibiotics as prescribed and complete the full course
• Do not share or use other people’s antibiotics
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Organisational
Development
Ian Baines
Director of Transformation
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
OD – Key achievements in 2015/16
•as
Good Organisations – invest in themselves and their staff
• Good Achievements 2015/16 but difficult outlook 2016/17
• 3 CCGs – 1 Management Team
OD Programme:
• Ensure our people are able to grow and develop
• Seamless integration of management team
• Great place to work
Tools used:
Group Work, Feedback,
Mind Maps, Prioritisation
Exercises, Open
Questions, STAR Model
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
The Values Diamond
as
Next Steps
• Embed our Values Diamond
• Start the “practicals” in terms of
delivery:
• Eliminate the duplication
of process
• Management Skills
Programme
• Health and Well Being
• Masterclasses
• Branding
• Reporting and visibility
• Understand the wider context –
links to Councils, Sustainability
and Transformation Programme
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Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Back to Basics or
Prevention is
Better than Cure
Encouraging people to take
advantage of prevention
opportunities within health care
Ruth Goldstein, Public Health
Speciality Registrar
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Back to basics OR Prevention is better than cure
as
Stafford and surrounds
England
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Stafford and Surrounds Demography
as
% aged 0 to 4 years
2015
CCG
Value
4.8%
% aged 5 to 14 years
2015
10.2%
11.4%
% aged under 18 years
2015
18.1%
20.7%
% aged 65+ years
2015
21.9%
17.1%
% aged 75+ years
2015
9.5%
7.8%
% aged 85+ years
2015
2.6%
2.3%
Deprivation score (IMD 2015)
2015
13.1
21.8
Indicator
Period
England
Value
5.9%
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
How can we stay healthy into our old age?
as
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
‘Health care’ ways to keep our population as
as
healthy
as possible for as long as possible
• Take up all opportunities for vaccinations (this will
decrease the number of people with predictable
preventable illnesses such as influenza and
pneumonia)
• Take up screening opportunities so any illnesses
can be diagnosed before they becomes too
serious to treat
• Take prescribed medicines as prescribed
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Uptake of national screening programmes
as
Period
CCG
uptake
England
uptake
2014/15
75.2%
73.5%
Females, 50-70, screened for breast cancer within 6 months
of invitation
2014/15
76.0%
72.8%
Persons, 60-69, screened for bowel cancer within 6 months
of invitation
2014/15
62.4%
57.6%
Abdominal Aortic Aneurysm screening
2014/15
83.8%
79.5%
2015/16
45.0%
47.9%
Programme
Females, 25-64, attending cervical screening within target
period
NHS Health Checks
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Vaccination rates
as
Vaccination
Stafford and
surrounds %
uptake
England %
uptake
MMR vaccination
93.6
92.3
Dtap/IPV/Hib vaccination
98.3
95.7
Seasonal Influenza
Over 65s
At risk population (< 65)
Pregnant women
68.8
45.2
41.5
71.0
45.1
42.3
Pneumococcal
62.6 (43.4-78.2)
69.8
Shingles
70 year old’s vaccinated since 2013
78 year old’s vaccinated since 2013
39.45 (6.3-76.4)
45.5 (13.8-76.7)
46
46
Human Papilloma Virus
93.7
89.4
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Long term condition monitoring
as
Primary care offer all patients with long term
conditions such as heart disease, high BP etc. an
annual review.
Lots of patients don’t attend as they don’t think they
need to.
People prefer to wait until they feel ill rather than
check their health is OK….(BUT we all MOT our cars,
why not our bodies)
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Why don’t we get 100% uptake of preventative
as
measures?
•
•
•
•
•
•
Public perception of safety
Public awareness of benefits
Convenience
‘It won’t happen to me’
Confusion in the messaging
Fear……
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
What can the CCG do to increase uptake of
as
preventative
healthcare?
•
•
•
•
•
Publicise need for engagement
Make it easy to have vaccinations/screening
Make sure record keeping is accurate
Keep reinforcing the needs and benefits
Don’t assume people read their post!
The healthiest place to live and work by 2025
as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Taking prescribed medicines as intended…….
as
• An estimated £300million of medications are wasted
annually within primary care in England1
• Equivalent to over £750,000 within NHS Stafford &
Surrounds CCG
Some wastage is inevitable however a lot of
waste is preventable
50% waste is thought to be avoidable
1 Evaluation of the Scale, Causes and Costs of Waste Medicines (November 2010), York
Health Economics Consortium/The School of Pharmacy, University of London
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as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Not only do our GPs prescribe the medicine
as
(because,
in their expert opinions, it will help the
patient) but our pharmacists dispense it and
then we have to collect the waste returned to
pharmacies and pay for it to be incinerated!
• Across South Staffordshire
over 20 tonnes of
pharmaceutical waste is
produced every year.
• In Stafford & Surrounds 7
pharmacies had over 100kg
of pharmaceutical waste
collected in Jan 2014.
The healthiest place to live and work by 2025
as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
Medicine waste is inevitable but WE can do
as to reduce the quantity
more
Patient’s responsibilities
•
•
•
•
Only order what’s needed
Be honest
Talk to GP and pharmacists
Don’t stoke-pile
CCGs responsibilities
• Keep on the radar through
press/social media etc.
• Support local initiatives
through medicine management
• Work with care home and
secondary care
GP surgeries and
community pharmacies’
responsibilities
• Discuss medicine use with
patients
• Have repeat ordering system
with built in checks
• Talk to each other about
systems/processes and
patients
• Never assume anything!
The healthiest place to live and work by 2025
as
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
To conclude…..
as
Prevention IS better than cure….we need to do more
prevention and less waiting until things go wrong
• We need to do more to encourage the population to
take up offers from the NHS like Vaccinations,
screening and Long Term Condition clinics.
• Need a more honest discussion with patients about
their prescribed medicines.
The healthiest place to live and work by 2025
June 2016
Purpose of the TWB programme
•
Together We’re Better is a commitment from all partner organisations to
work together to bring about transformational and sustainable change to
better meet the needs of local people and improves lives
•
The local NHS and councils are working together to produce a five year
sustainability and transformation plan (STP) across Staffordshire and
Stoke-on-Trent
•
The local health and care system will only become sustainable if it
accelerates its work on prevention and care design
•
This will require:
o
Planning for the population of the whole of Staffordshire and Stoke-on-Trent
o
System leadership through team working across all organisations
o
A process involving clinicians, patients, carers, citizens and local community
partners, including the independent and voluntary sectors, and local
government
Why do we need to change?
Population health challenges
Between 2014 and
2019 the number of
people aged 85
years and over will
rise by 22%
Diabetes and Coronary
Heart Disease
prevalence exceeds the
national average in 5 of
6 CCGs
One in five people die
from causes that are
thought to be preventable
– around 2,100 deaths
every year
One in 10 children aged
four to five is obese one in five by age 11.
Two out of three adults
have weight problems one in four is obese.
Half the CCGs exceed their
peer average for injuries
due to falls (in people aged
65+)
Stoke-on-Trent was 30%
above the national average
Cancer mortality is the
primary reason for
premature deaths and is
higher than average for 4
out of 6 of our CCGs
Why do we need to change?
Quality of care challenges
800 patients are admitted to
hospital every day - 330 are
unplanned
Almost 60 are readmitted
within 30 days of discharge
20% of health and care
costs for those aged
under 65 years, and
30% for those aged
over 65 years are spent
on hospital care
The number of people
offered reablement services
to recover and regain
independence (1.4%) is
lower than the national
average (3.1%)
A third of people in
a hospital bed at
any one time don’t
need to be there
Local hospitals had
higher attendances
at A&E than their
peer average
4
The acute hospitals in
Staffordshire and Stokeon-Trent have failed to
meet the waiting time
target between 2012/13 to
2015/16
Why do we need to change?
Financial challenges
High A&E
attendances
Ageing
population
Length of hospital
stay & readmissions
Current financial
position
Staffordshire and
Stoke-on-Trent’s
health deficit is
£160m (2015/16).
This does not
include social
care.
Forecast financial position for 2020/21
If we do nothing, the recurring deficit in 2020/21 is currently forecast to be
£275 million.
Add in the cost pressures in social care, this forecast currently increases to
£367 million
Addressing key challenges
Workstreams
Frail Elderly and
LTC
Urgent and
Emergency care
Planned care
Enhanced
Primary and
Community Care
End of life
Cancer, Mental Health, Prevention and Well Being
Enabling workstreams
Next steps
•
The draft Sustainability and Transformation Plans was submitted
on 30 June 2016. This will be followed by face to face meetings
with national leaders, consideration, feedback and assurance of
final plans
•
All programme workstreams are meeting regularly to work through
plans and to identify key projects that will be progressed
•
Meaningful engagement with the public, health and care
professionals, voluntary sector, workforce and organisational
stakeholders will play a fundamental role at all stages of
transformation
•
A dedicated programme workstream has been set up to ensure all
transformation initiatives plan in and deliver meaningful
engagement and consultation where needed
•
All organisations involved in the programme will identify people to
act as champions of the programme, to extend the reach of
engagement across Staffordshire and Stoke-on-Trent
Starting the conversation
•
Do you think we have the right priority areas?
•
Is there anything you think we have missed?
•
What role can patients and the public play in
helping us to transform the priority areas?
•
How can we ensure meaningful engagement?
•
Do you represent a community group? Would you
like to be one of our programme champions?
Cannock Chase Clinical Commissioning Group
South East Staffordshire and Seisdon Peninsula Clinical Commissioning Group
Stafford and Surrounds Clinical Commissioning Group
as
Public Questions
Andrew Donald &
Dr Paddy Hannigan
The healthiest place to live and work by 2025