The Turnaround Challenge
Workshop in SWF, 5 December 2012
 Brief introduction to




Mid Essex Clinical Commissioning Group (CCG)
Your local NHS – the current position
The “turnaround challenge”
How we are tackling the challenge
Your views?
 New organisation to take over from PCT
 Board led by GPs, senior nurse,
public health, social services rep,
3 lay members
 Working in shadow since 1 April 2012
 “On the job” managing & planning
 50 member practices
 Applying for authorisation – Nov 2012
 Establishment - 1 April 2013
Dr Lisa Harrod-Rothwell
Chairman, Mid Essex CCG
 Commissioning – planning & buying healthcare
 Not providing – that’s Central Essex Community
Services (CECS)
 Assess local needs, listen to people
 Plan in partnership
 Design services, agree contracts
 Manage quality & performance
 Manage the annual budget –
£540m in total for mid Essex in 2012/13
CCGs responsible for around £390m
NHS
Commissioning
Board
Clinical
Commissioning
Group (CCG)
• National body
• Holds CCGs
to account
• Contracts
with GPs &
others
• Commissions
specialised
services
• Local body
• Led by
clinicians
• Plans & buys
your health
care
• Joint planning
with local
authority
Local authority
Service providers
• Health and
Wellbeing
Board
• Joint strategic
needs
assessment
• Health and
wellbeing
strategy
• Public health
• HealthWatch
• Hospital
e.g. MEHT,
Braintree,
Springfield
• Community
e.g.CECS
• Mental health
e.g.NEPFT
• Vol. orgs.
 Brief introduction to




Mid Essex Clinical Commissioning Group (CCG)
Your local NHS – the current position
The “turnaround challenge”
How we are tackling the challenge
Your views?
 Performance & quality among best in region
 Over 95% patients treated within 18 weeks
 Over 98% cancer patients treated within 31 days
 90% stroke patients on specialist stroke unit
 Over 99% mental health patients followed up within
7 days of leaving hospital
 Patient experience survey shows improvement
 Brief introduction to




Mid Essex Clinical Commissioning Group (CCG)
Your local NHS – the current position
The “turnaround challenge”
How we are tackling the challenge
Your views?
If we took no action…
 We would be overdrawn by £12.8m at end of year
 Bigger challenge in 2013/14 – an ever widening gap
 We would be unprepared for ageing population
▪ 12% increase by 2035
▪ Increase in frailty, long term conditions, dementia
 So we are managing two things…
 2012/13 - quick action to finish year in balance
 2013/14 & beyond – transform services & secure the NHS
for the future
Overall three main factors …
 Managing with limited funds –
our allocation one of the lowest
 The activity we can afford –
we spend more than other
similar areas
 Service transformation –
plans take time to put
into practice
£1.3k per head
(PCT spend last yr)
Others up to £2.2k
Activity increase
not always right
for good care
Need to review
and “ramp up”
 Brief introduction to




Mid Essex Clinical Commissioning Group (CCG)
Your local NHS – the current position
The “turnaround challenge”
How we are tackling the challenge
Your views?
Savings solutions
£000
Existing service transformation schemes
1,803
Tighter criteria for some NHS services
1,687
Ensure contracts adhered to
465
Stop expenditure where possible
1,008
Budget underspends
2,118
Technical accounting adjustments
1,949
Draw down on reserves
3,787
12,817
Examples of existing schemes
 Health & social care for people at home
 Rapid assessment for frail& older people




– avoid hospital emergencies
Multiprofessional teams for end of life
care at home
Closer work with nursing homes to avoid
hospital emergencies
Practices managing referrals working with
central team of clinicians
Prescriptions for less expensive drugs
Examples of tightening criteria
 Team to manage treatment at A&E
 Reduce unnecessary use of ambulance
 Review clinical policies, ensure they are




adhered to
“Stop before the op” smoking restriction
Improve physio self-care, reduce wasted
appointments
Comply with national guidelines on drugs
Mental health rapid assessment to reduce
admissions
We are not talking about “cuts”
Don’t be misled by the press
Urgent care
•Redesign out of hours services and NHS 111
•GPs working in A&E
•Rapid assessment for older people
•Working with nursing homes
•Integrated teams for people at home
•Mental health rapid assessment
Frailty
•Proactive care for high risk patients
•Integrated care teams – community matrons
•24/7 single point of contact for frail people
•Tele-health
Long term
conditions
•Prevention and early diagnosis
•24/7 single point of contact for people with long term
conditions
•Care plans and shared records
 Brief introduction to




Mid Essex Clinical Commissioning Group (CCG)
Your local NHS – the current position
The “turnaround challenge”
How we are tackling the challenge
Your views?
Group discussion
 Short term:
▪ Your views on what should we stop or change?
 Long term:
▪ Your ideas for doing things in a different way?
▪ What do you want us to pay attention to?