Commissioning Plan Refresh
2015 - 2016
Context
 Five Year Forward View:
- Focus on prevention and CCG partnership working with LA/
Public Health; Obesity/ smoking/ alcohol/ other risk factors
- Development of Multi-speciality Community Providers
- Integration opportunities within Health and Social Care
Economy
- Implement primary care co-commissioning as joint
commissioners
- New models of primary care provision
- Future hospital models strategy to be developed; Capita
‘end to end review’ phase 2 to support
- Dedicated resource delivered Winterbourne View action
plan 2014/15. All cases allocated to Continuing Treatment
Review.
Financial Context
 Financial plan overview:
-
Exit 2014 / 15 with underlying deficit
Distance from target remain £12m (4.6% )
BCF contribution exceeds minimum requirement
£7.5m (3%) QIPP challenge identified
Builds in activity growth based on historic trends and
provider consultation
- Financial plans deliver NHS England business rules in full
- Provider economic models used in consultation with main
acute provider to identify cost improvement opportunities
aligned to CCG change programmes
- 10% reduction in running costs delivered
Operational Delivery 2015/ 16
 Improving Quality:
- Outcomes based commission supported by COBIC for intermediate
care
- 2 year contracts awarded in 2014/15 with all providers
- Strong quality measures within contracts
- Managed and monitored via monthly contact quality meetings
- Clinical quality focus groups themed to address areas requiring
improvement involving provider and commissioning clinicians
- Triangulation of patient experience, complaints and patient forum to
feed into quality review process
- Regular clinical audits presented from providers
Operational Delivery 2015/ 16
 Constitutional Standards:
-
Consistent use of the NHS Standard Contract
Early warning measures built into local quality standards
Planned capacity in contracts to meet RTT standards (fig1)
Delivery plans for achievement of sustainability of
Accident and Emergency performance
- Adequate capacity within Improved Access to
Psychological Therapies contract to maintain delivery.
Access delivered (Q4 2014/15) and waiting time targets
(Q4 2014/15)
Scatter plot between elective activity
plans 2015/16 and incomplete spells
(fig 1)
120,000
R² = 0.9999
Planned cumulative total EL and DC
100,000
80,000
60,000
Series1
Linear (Series1)
40,000
20,000
0
5000
10000
15000
20000
25000
Cumulative total incomplete pathways
30000
35000
Operational Delivery 2015/ 16
 Information Revolution and Transparency:
-
NHS Number as primary identify in contracts since 2014/15
NHS Number adopted by Local Authority for Better Care Fund
Electronic prescribing in all practices from 2014 /15
SystmOne provides online patient access to 23 practices
Electronic discharge summaries commenced 2012 /13
- 95% received with 21 day local quality standard for 7 days not met
- Integrated Digital Care record procurement on-going
- Stage 2 Work following on from select committee inquiry into
information sharing
- Referral Facilitation will increase electronic referral rate
Operational Delivery 2015/ 16
 Modern Health and Care Workforce:
- Training and development program for care home staff
- Support for primary care nursing workforce via Practice Makes Perfect
educational programme
- Accredited training program with Edge Hill University for nursing
revalidation
- Promoting whole system workforce plan across providers
- Working with North West Continued Professional Development
Visual
Overview
Community
Primary Care
Ambulatory Emergency
Care
Elective
Psychiatric Liaison
Sub Acute Services
Intermediate Care
Referral Gateway
Specialised
Impact
Non-Elective
Change
Programmes
Foundations
Foundations
Primary Care
 Clustering GP/ primary care services around identified population
 Delivering sustainable primary care services by integrated working
approaches and workforce skill mix
 Increased and extended hours access
 Reducing service variability and delivering consistent high quality primary
care services
 Delivery of ‘core’ Primary Care service in all practices
Impact:
 Increases accessibility of primary care services
 Reduces unscheduled acute activity
 Promotes patient self management
 Manages pro-active care
 Contributes to improved wellbeing and quality of life
for service providers and patients
 Secures sustainable Primary Care
Acuity/Complexity Model of Care
Warrington Health Plus
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By utilising collaborative approaches across primary care, deliver a range of projects to transform
care and models of delivery;
Guided Care to work with patients to manage their own health conditions and access wider
services to impact on the determinants of health and wellbeing
Risk Stratification system to focus resources on managing complex patients closer to home,
Complex Case Management to work with risk stratification to support complex patients
maintaining stability and preventing avoidable unscheduled care activity
Care Homes enhanced support to target this patient cohort, working with care homes staff to
increase skills, identify consistent high quality care interventions and prevent avoidable
unscheduled activity
Telecare to increase capacity in primary care by enhancing the range of models available to offer
health care and innovative health monitoring strategies
Impact:
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Increases the range of community support available
Promotes multi agency working and resulting potential efficiencies
Reduces unscheduled acute activity by effective maintenance of complex patients
Focuses resources for maximum benefit and return on service investment
Contributes to pro-active care improved wellbeing and quality of life
Reduces reliance on reactive primary care / community service provision by proactive interventions
Promotes patient self-care, reduces reactive care reduces long term care need
Our Map to the Future - Overview
Hospital
Services
Non
bed-based
acute
services
GP Practice
GP Practice
(With Care
Coordination)
Intermediate
Care Facility
(bed bases)
‘Primary
Care Home’
Clusters of Practices work
collaboratively; other
provider services
refocused around the
registered list
Primary Care
Home Delivery
Team
(Multi disciplinary team including
community nursing/mental
health/care coordinator/GP for
nursing homes etc.)
Paediatric
Acute Response
Team(PART)
Community Services
 Restructure of services around practice populations; with WHP and acuity model to
facilitate development
 Provision of care closer to home; delivered in cluster bases and patients own homes
 Providing responsive multi-professional interventions based on risk factors to prevent
escalation
 Working across organisational boundaries; delivering integrated approaches based on
user need
 Utilise telehealth/ telecare and integrated IT solutions to maximise efficiency
Impact:
 Increases consistency and quality of service provision
 Promotes multi agency working and resulting
potential efficiencies
 Reduces unscheduled acute activity
 Encourages patient self management
 Contributes to improved wellbeing and quality of life
Change
Programmes
Referral Gateway
 Manages effective elective referral system in partnership with primary care
Non-Elective
 Ensures referrals reach right clinical specialism
first time, prevents multiple hand
offs/ duplicate referrals for same patient
 Provides primary care with expert advice and support for condition management/
diagnostic work up prior to referral to acute
 Ensures appropriate clinical pathway management has been implemented prior to
acute referral
 Promotes best practice condition management and reduces variability of
management and referral quality
 Utilises effective choose and book system, facilitates patient choice
 Identifies service gaps for potential commissioning redesign and community
services development tier 2 services
Referral Gateway
Non-Elective
Impact:
 Reduced 1st out patient activity
 Increased use of electronic referral
 Managed patient flow for better patient experience
 Releases capacity in primary care
 Opportunities identified for tier 2 service development resulting
in reduced acute activity
 Acute costs released by use of appropriate use of community
services
Intermediate Care
 Jointly re-commission the service with LA to achieve truly integrated service
Non-Elective
 Achieve consistent delivery, against defined service specification
 Improved outcomes for service users demonstrated by robust performance
indicators
 Utilise prime provider/ contractor model to maximise efficiencies and streamline
contract management
 Provide enhanced choices for community, primary and clinicians as alternative to
acute care
 Reduces length of stay in acute care by facilitating earlier discharge
 Improved outcomes includes service users maximising independence and requiring
reduced levels of on-going support
Intermediate Care
Non-Elective
Impact:
 Reduced activity in Accident and Emergency by use of ‘step up’
 Reduced unscheduled admissions by use of ‘step up’
 Reduced length of stay by use of ‘step down’
 Improved personal independence and wellbeing for patients
 Reduced reliance on complex care packages
 Reduced long-term care placements
 Reduces discharge delays
Sub Acute Services
 Provision of sub acute service to support medically optimised patient to ‘step
Non-Elective
down’ from hospital care
 Facilitates development of ‘discharge to assess’ model to prevent unscheduled
admissions to assess
 Provision to support primary care with ‘step up’ alternatives to avoid hospital
admission for managed care interventions
 Explore multi-speciality provider models for the provision of this service (5YFV)
Impact:
 Reduced activity in Accident and Emergency by use of
‘step up’
 Reduced unscheduled admissions by use of ‘step up’
 Reduced length of stay by use of ‘step down’
 Improved personal independence and wellbeing for
patients
 Reduced reliance on complex care packages
 Reduced long-term care placements
 Reduces discharge delays
Psychiatric Liaison
Non-Elective
 Provides effective and appropriate management
and support for people with mental
health issues attending hospital
 Optimises mental health in patients admitted for physical health problems
 Facilitates access to a range of appropriate mental health and other services to avoid
unscheduled admission
 Facilitates work to achieve parity of esteem
Impact:
 Potential to impact on whole care pathway for this
patient cohort, primary, AED, tertiary and care
homes to reduce avoidable activity by effective
appropriate management
 Reduces length of stay in acute care for people with
depression, delirium and dementia
 Reduces frequent attenders at Accident and
Emergency
Ambulatory
Emergency Care
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Non-Elective
Implement further Ambulatory Emergency Care pathways to manage minor and
less complex patients (DVT Pathway implemented Q3 2014/15)
Develop collaborative model of primary care provision in AED via a Service
Delivery and Improvement Plan with Warrington and Halton Hospitals NHS
Foundation Trust. Pathways will deliver right care, right place, right professional
Supports frailty pathway by more effective and appropriate acute management,
preventing avoidable admission
Impact:
 Reduces avoidable unscheduled
admissions
 Reduces zero – 1 length of stay for clinical
assessment
 Facilitates mixed model of unscheduled
care acute provision
 Delivery of Accident and Emergency
Standard