Hartlepool and Stockton-on-Tees
Clinical Commissioning Group
Dr Boleslaw Posmyk, Clinical Chair
Dr Paul Williams, Stockton-on-Tees
Locality Lead
What we aim to do in our presentation
Describe to you:
• Our journey so far
• The people we work with and on behalf of
• Our challenges, opportunities and risks
• Our plans for improvement
• How we do things around here:
Our decision making and our leadership
Meet our Team
• We are a membership organisation of 40 general
practices with devolved decision making to our
Governing Body
• Our team has a strong clinical focus, bringing
together a broad range of skills and experience
together with a passion for improving the health
outcomes of our
communities
Our Journey
Two pathfinder groups – Hartlepool and North Tees
Merged into one CCG (40 General practices) April 2012, with first Shadow
Governing Body meeting as a sub-committee of NHS Tees
Rationale for coming together:
• Shared vision and values
• Similar health needs, levels of deprivation, challenges
• Share acute, community and mental health providers
• Avoids duplication
• More financially robust
• Increased pool of clinicians willing to take on lead roles
• Small enough to maintain effective practice engagement through strong
locality focus and co-terminosity with LAs
• Offered potential for synergy and sharing of good practice
• Still able to work effectively with neighbouring CCGs especially South Tees
Hartlepool & Stockton-on-Tees CCG
Population c285,000
40 General
Practices
Hartlepool
& Stockton-on-Tees CCG
Population c285,000
40 General Practices
Meaningful Engagement - Our Stakeholders
How we are working “together”
Health and Wellbeing
Boards
Stockton-on-Tees
Borough Council
Hartlepool Borough
Council
Local
Safeguarding
Children's Boards
40 Member practices
Providers
Safeguarding
Adults Boards /
LD partnership
Public Health
Community
Groups
Patient
participation
groups
Clinical
Networks
LINks/
Healthwatch
NHS
Commissioning
Board/LAT
Voluntary
Sector
Professional
Clinical
Leadership
Other
CCG’s/Northern
CCG Forum
Meaningful Engagement – our
communities
Communication &
Engagement strategy
Local Events
PPGs
LiNKs/Healthwatch
Scrutiny Forums
Our Health Challenges
Rank distribution of electoral wards in various deprivation groups
Hartlepool and Stockton compared with England
Index of Multiple Deprivation (IMD) 2010
Most affluent wards
in England
7934
(7567) Ingleby Barwick East
7139
Park (6412)
6346
5553
Electoral
ward
rank
position
4760
3967
3173
2380
1587
793
1
Most deprived wards
in England
(17) Town Centre
Stockton
A population of ‘two
halves’
Dyke House (44)
Hartlepool
A population with
little relative
affluence
100%
51 to 100%
90%
11 to 50%
0 to 10%
80%
70%
60%
50%
40%
30%
20%
10%
0%
England
Stockton
Hartlepool
Ingleby
Barwick
Life
expectancy
Parkfield
& Oxbridge
Stockton
Centre
Men
78
74
69
Women
82
78
74
One of the
consequences
of differences in risk
are differences
in outcomes…
Life expectancy
reduces
sharply
within
very short
distances
from
periphery to centre
9 years for men
8 years for women
The starkness of inequalities in health
Our Health Challenges
Mortality from suicide &
undetermined injury; Cancer;
circulatory disease;
Gastrointestinal disease; and
Respiratory disease worse than
England mean
High levels of
deprivation
Levels of health
worse than
Average
Smoking related
deaths higher than
average
Hospital stays for
alcohol admissions
higher than England
average
High levels of
child poverty
Health
inequalities
Life expectancy
lower than
average
Healthy eating,
smoking & obesity
worse than
England average
Our Plan at a glance
J
S
N
A
Our
Vision
H
&
W
B
Our Aims
S
T
R
A
T
E
G
I
E
S
Our
Values
Our Work
streams
Our
Priorities
Reduced inequalities / Improved
wellbeing
commission high quality,
sustainable and evidence
based services that
respond to local need,
bring care closer to home
and are cost effective
Engagement
&
Patient
focus
Health &
Wellbeing
• Address
health
inequalities
• Improve
lifestyles
• Focus on
particular
groups i.e.
carers and
children
work in partnership to
reduce health
inequalities and improve
the health and wellbeing
of the population
Quality &
safety
Value,
efficiency
and
affordability
Out of hospital
care
Acute in
hospital care
• Transform
community
care (TAPs)
• Bring care
closer to
home
• Care home
managemen
t & quality
• Improve
productivity
• Choice &
quality
• Streamline
care
pathways
• Reduce
urgent care
attendances
Look for opportunities
to innovate, involving
users, carers, staff
providers and the public
in transforming services
Integrity
and
honesty
Mental
Health, LD &
Dementia
• Develop
MH/LD
• Improve
equity
• Improve
Dementia
care
• PHBs
Courage
Accountability
Medicines
Management
• Safe,
rational and
cost
effective
use of
medicines
• Reduce
variation
S
T
R
A
T
E
G
I
C
O
U
T
C
O
M
E
S
Managing Financially Sustainable Position up to 2016
Income Shifts
Underlying Cost Pressures
Technical Efficiency
Programmes
Investments
70000
60000
£’000s
50000
40000
30000
20000
10000
0
-10000
-20000
Change in
Recurrent
Income
Future planning assumptions are:
- Lower Growth
Additional
Costs from
Inflation
Expected
CQUIN
Payments
- Increase in inflation
Efficiencies
from Tariff
Efficiencies Demographic &
from Non Tariff
Demand
Contracts and
Prescribing
- Lower Tariff Efficiencies
National
- Increase in demographic demand
Local
Our QIPP Challenge
•
•
•
Benchmarking Tools Utilised to identify outliers
• NHS Comparators – emergency admissions, A&E attendances, outpatients per 1000
population
• PBMA – identify high spending poor outcomes
• PBR Benchmarking – identifies provider performance issues ie new to review ratios
• Prescribing EPaCT
• Variation in spend on specialities across Tees
• Variation across practices
What it told us – increasing activity in acute sector, prescribing above national average,
local FTs where not performing to top quartile in some areas, significant variation in
referrals, admissions and resource use across GP practices
What we did –
• Looked for evidence of effective improvement methods (Kings Fund, National QIPP
programme, Institute of Innovation programmes, VMPS/NETs)
• Engaged our practices and providers
• Developed our QIPP programme around what the benchmarks told us and grouped
these against our workstreams, developed our Delivery Plan
• Developed our monitoring arrangments
Improving Quality and Safeguarding
Improving quality is at the heart of what we
do
• Safe and tested governance with our
systems and processes
• Implementation and monitoring of Quality
Dashboards
• Robust provider Clinical Quality Review
Groups
• Development of a Quality Assurance
Framework for all commissioned services
• Embraced Legacy Document – now
preparing to receive Quality Handover
Document
• Committed to driving up quality in
primary care - GVISQ
Recognising our statutory responsibilities for
safeguarding
• Working with our Local Authority partners
• Executive Governing Body appointment
(Nurse)
• Supporting our Local Safeguarding
Children’s Boards and Adult Protection
Committee’s
Preparing for the future
Sir Robert Francis
Constitutional & Governance arrangements
Council of
members
Hartlepool
H&WB
Locality groups
x2
Governing
Body
Stockton
H&WB
Delivery
team
NECS
Workstreams
Remuneration
Audit
Partnership /
QIPP delivery
board
QPF
Governance &
Risk
Quality &
Safety
Group
CQRG
Funding
panel
Safeguarding
Boards
Capacity and Capability
GP GB
members &
locality leads
Chair
Clinical
Workstream
Leads
Chief Officer Designate /
Accountable Officer
Chief Finance
officer
Assistant Finance
Managers
Local NECS
Team &
Collaborative
commissioning
Executive Nurse
Corporate
Governance and
Risk Officer
Commissioning
development /
Deliver Manager
Corporate Office
Administrator
Partnership &
Innovations
Manager
Admin Support
Partnership
Project Officer
Head of Quality
and Safeguarding
(designated
Adults
safeguarding)
Designated
Nurse
Children’s
Safeguarding
Designated
Doctor and
LAC lead
Risks and Mitigations
• Clinical Engagement
• Improving quality & safety
• Developed different
opportunities at all levels of the
organisation
• Strong relationships, strong
governance, high awareness
• Economic environment and
financial challenge
• Robust QIPP plans & track record
of delivery, preparation,
contingency, good governance
• Hospital Reconfiguration
/ Momentum
• Evidence based Clinical mandate,
strong relationships with OSC,
good public engagement
The biggest task is alignment………..
The difference we are making
•
•
•
•
Highly effective GP, public and other stakeholder engagement
Winner of HSJ National award for Efficiency, Medicines Optimisation
Safer Care NE; Adult safeguarding award
Finalists for Commissioning Organisation of the Year (HSJ); Vision Award –
use of data, NE lean Academy; spread of innovation,
•
•
•
Reduced variation in primary care - improved clinical quality
Transformed community services – commissioning for clinical outcomes
Progressing Momentum Pathways to healthcare; redesigning 46 clinical
pathways, improving patient experience, reduced length of stay, increasing
productivity
QIPP delivery – securing financial sustainability
•