Right Care in action
South Sefton CCG and Southport & Formby
CCG - Optimising focus and delivery
Malcolm Cunningham, Head of Primary Care
and Corporate Performance
1 NHS | Presentation to [XXXX Company] | [Type Date]
Optimising focus on reform
• Align corporate processes to support reform proposals
and delivery
• Filter proposals to those that can and should be
delivered (Prioritise the priorities!)
• Focus governing body and committee decision-making
time on reform
• Focus ALL directorates/ support functions on
proposing change, proving case for change and
delivering change
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Our vision: We want to work with the local community & other partners, to improve the health and healthcare of everyone living in south Sefton, spending money wisely, & supporting clinicians to do the best job they can
Context
Strategic
Consolidate robust Strategic
Plan within the CCG financial
envelope
Corporate Objectives
Establish the Programme
Management approach and
deliver the CCG programmes for
whole system transformation,
reduction in health inequalities
and improved CCG performance
Collaborate with the C&M CSU
to ensure delivery of successful
support to the CCG
Strengthen engagement of CCG
members, partners and
stakeholders
Improving
quality of Life
Optimising use of Secondary Care
Enhance systems to ensure
quality and safety of patient
care
Drive clinical leadership
development through Governing
body, locality and wider
constituency development
to home
Support Older People & those
with long term conditions &
disabilities to remain
independent in own homes
Support people early to prevent
and treat avoidable illnesses and
reduce health inequalities
Seek to address social &
economic issues which
contribute to poor H&WB
Ensure all children have positive
start in life
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CCG/ LA Joint
Priorities
Winter
Pressures
Children & Young People
Everyone Counts
Adults
Public Health
Fundamentals of Care
Ensuring Cost Effective ness in High Quality Tertiary Care
Financial
Challenge
Health and Wellbeing Board Objectives
Safe Care
Build capacity & resilience to
empower & strengthen
communities
Programmes
Any Qualified
Provider
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Reduce emergency admissions to secondary care
Reduce Follow Up Appointments
Reduce Readmissions
Redesigned community services to reduce hospital attendances and
manage care more effectively in a community setting
Increased independence of the frail & old
Reduction in avoidable admissions
Increased integration
Reduce non elective admissions over 65’s – 5% ‘13/14, 20% by ‘16/17
Long Term
Conditions
•
Primary Care LES primary care to improve diagnosis management of
Atrial Fibrillation
Vascular Health Checks
Further investment in community respiratory services
Primary care risk stratification
•
•
•
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Reduced admissions with LTC as primary diagnosis
Person centred, integrated primary care provision
Reduction under 75 mortality rates
Earlier diagnosis of respiratory illness
Diabetes
•
Performance management of IGR diabetes prevention pathway
with Public Health
Benchmark practices against treatment targets and offer additional
support to those not achieving.
Review training of staff in primary care in relation to diabetes
Ensure patients receive foot care/screening
Review multi-professional input into care homes
•
•
•
Decreased numbers of unnecessary emergency admissions
Increase numbers of nine processes being recorded
Increased numbers of people being referred to Healthy Lifestyle
services
Achievement of Care Programme Approach (CPA) follow up target.
Ensure full roll out of the access to psychological therapies
programme to deliver a recovery rate of 50%.
Increase Dementia detection. including care home staff liaison (51%
to 75% by 2015/16)
Refresh Sefton Dementia strategy
Locality approach via psycho-geriatrician service
Adoption of quality of life principles, safe models of care
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•
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Review ADHD services
Review of Children’s Equipment Services
Review pilot of Community Children’s nursing team
Collaborative working with NCB/LA re: Health visitor and school
health national implementation plans
Review the Health economy recommendations which result from
the Youth offending service inspection
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Implement Community Ophthalmology Schemes
Better Care Better Value benchmark indicators to support improved
performance
Any Qualified Provider procurements podiatry, audiology and MSK
Promote use of dyspepsia pathway
Commission Gynaecology community service pilot
•
Develop CQUIN increase breastfeeding rates
Develop an obesity strategy and clarify obesity treatment pathway.
Commission Alcohol Liaison Service at Aintree University Hospital
Build capacity to facilitate the provision of Identification and Brief
Advice(IBA) across ranges settings
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Programme
Management
Office
Mental
Health
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Information
Management
Technology
Innovation
Children
Value for Money
through Finance
and Contracting
Planned
Quality of Care
Improving Outcomes
Pro active case management
Reviewing patient pathways with Aintree for emergency patients
Support of the Community Geriatrician
Supporting Nursing and Care homes
Evaluation of Out of Hours service and 111
Risk stratification / Pro active case management
Investment in Community services
Health care acquired infections
Roll out of Virtual Ward
Virtual Ward
The Francis
Report
Transformational Change
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Unplanned
CQUINs
Improving Quality of Primary Care and Delivery of Community Services
Promote positive mental health
& wellbeing
Care closer
Enabling Themes
Patient & Public
Engagement
Driving Improvement in Health & Wellbeing
Growing
elderly
population
Inequalities
of health
care
System
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Prevention
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Improved integration across services
Appropriate, timely support received by patients
Improved early intervention, including increased access to Memory
Assessment Services
Ensuring patients are safe and receive safe, effective care
Improved support services for carers
Improved diagnosis rates
Increased home based assessments
Improved integration of services, including transition to Adult services
Reducing emergency admissions and EG Asthma
Reduced length of stay
Early identification of families in need of support to promote the
safeguarding of Children & Young People
Patients receive care in the most appropriate setting and to improve
the quality and experience of care for patients.
Reduced referrals to Secondary care
Better Maternal Health / Early years health
Reduce rate of alcohol related hospital admissions
Reduce length of stay linked to alcohol related hospital admissions
Increased skills/knowledge of Primary Care & key stakeholders to
identify those at risk of alcohol or drug dependency
Reduced Obesity levels
Cancer
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Compliance with cancer waits 31 and 62 day targets
Peer review compliance
Cancer CQUIN incentivise 14 day key diagnostics pathway
Optimise performance- Cancer referral 14 days
Support to GPs via Cancer Network NAEDI project
Review CAB service for patients
Undertake needs assessment for psychological support services
/physical activity programmes
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Ensure appropriate, timely Cancer treatment for our patients
Improved survival rates through early detection
Cancer Survivorship – improved support for people and families
affected by cancer
Sefton Needs
Assessment
End of Life
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Develop End of life strategy
Hospice at Home
End of Life facilitator
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To Increase the number of people at end of life dying in their normal
place of residence. + 1%
Clinical,
Community,
3rd Sector
collaboration
Primary Care
Quality
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Develop Primary Care strategy
Support improvements using the Quality Premium
•
Improved quality, capability and productivity, and capacity of Primary
care services
Medicine
Management
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Role out Optimisation plan across GP
Patient education to reduce waste
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Improved assurance that medicines are safe, appropriate, clinically
effective and value for money
Sustainable
Change
Promotion of
Self Care
Patients’ Rights: The NHS Constitution
Patient Centred, Customer Focused
Transformation of Health and Social Care at CCG Level
Financial Planning
NHS Outcome Framework
QUALITY PREMIUMS
Reducing potential years of
life lost through amenable
mortality
Reducing avoidable
emergency admissions
Improving patients
experience of hospital
services – Ensuring roll out of
Friends & Family test
Preventing healthcare
associated infections
LOCAL PRIORITIES
Reduce Respiratory Disease
admissions through A&E at
Aintree Hospital
Reduction in prescribing for
three high risk antibiotics
1.Quinolones 2.Co-amoxiclav
3. Cephalosproins
Reduce the number of GP
referred patients (during
normal working hours) who
receive an AED assessment
before being admitted into
Aintree Hospital care
August 2013
Commissioning Intentions
• South Sefton 52
• Southport & Formby 47
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5
Programme Management Office
• better continuity and maintenance of
standards;
• overview and scrutiny of all delivery activity
within the organisation;
• increased skills development and transfer;
and
• ability to collect and handover vital Lessons
Learned from one initiative to the next.
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Programme Management Office
• Our model is about sharing, learning
and improving. We want staff to use
the PMO as a resource.
• We will collect best practice and
shared it and we will monitor your
projects to keep them on track.
• Success will be improving patient
outcomes
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Programme Management Office
• Developed and tested a Case for Change proforma
• Developed a framework in which managers
can engage with the PMO
• Developed a process which sets out
responsibilities of PMO and managers
• Developed & tested a screening tool for cases
for change
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Approval Process - Development of Case for Changes through to authorisation at F&R Committee
Initiation through to PMO screening will take around 6-8 weeks so please ensure you inform PMO of potential Case for Change asap, so they can be integrated into PMO workplan schedules. The PMO will support
development of the case at all stages. Please ensure that PMO is fully involved to ensure development is in line with CCG strategic aims and meets F&R standards. Once the Case for Change has been screened it will
go to the next F&R.
All cases must demonstrate patient / public engagement. EPEG is available for advice on suitable engagement if required, however this may impact on timescales.
*NO Do
not proceed
Action
Responsibilities
Timescales
Identfiy need
Localities
Week 1
Contact PMO to initiate case for change proposal
Project Lead / Lead Clinician
Week 1
Meet with PMO to identify required support. PMO to advice on key
information/data/evidence required to ensure Case for Change is to required
standard for screening
Project Lead / Lead clinician / PMO / Analyst / Finance
Case for Change drafted and submitted to PMO for further feedback to identify
areas for development / further support via PMO
Project Lead / Lead clinician / PMO / Analyst / Finance
Case for Change refined, completed and submitted along with front sheet to PMO
Project Lead / Lead Clinician
Finalised Case for Change screened to identify priority level
PMO
Week 7
PMO submit screened case to F&R for sign off, advising of priority level
PMO
Next available F&R - Papers out 1 week before so
need final case 2 weeks prior to F&R
Decision to Proceed?
Finance & Resource Committee
Leads present & F&R
Week 1
Week 2-5
Week 5-6
Yes
Implementation
Project Lead / Lead Clinician (Project Management
support available via CSU if required)
Project, Performance and outcome monitoring - RAG rated
PMO
PMO will monitor progress of Case for Changes against milestones during development & implementation. Once scheme goes live schemes will be monitored against three criteria - Clinical improvement, Patient
satisfaction, Finance using RAG rating.
RAG RATING
3 GREEN
2 GREEN 1 AMBER
2 GREEN 1 RED
2 AMBER 1 GREEN
3 AMBER
2 AMBER 1 RED
2 RED 1 AMBER
3 RED
OUTCOME
GREEN
GREEN
AMBER
AMBER
AMBER
RED
RED
RED
Project will be monitored on monthly & quarterly basis. Projects that are not on track or do not show improvement will be RAG rated AMBER. If two consecutive quarters are AMBER, scheme will be rated RED. Two
consecutive quarters rated RED will go to F&R committee with view to disinvest.
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*Decision not to proceed to be recorded in F&R minutes.
Project
CCG Managers
PMO
Cases for change

Liaison with PMO at project
initiation
Responsibility for preparation,
completion and submission of
paperwork to F&R Committee
Ensures Business Case is
implemented within agreed
timeframes


Liaison with PMO at project
initiation
Work with lead clinician to develop
Implements within agreed
timeframes
Liaison with PMO at project
initiation
Document drafting, consultation
and completion



Commissioning
Intentions



Planning Documents
NHS Operational Plan
(Everyone Counts)
CCG Strategic Plan
Plan on a page
10







Provides advice
Works within agreed timescale to
ensure submission of business
case at next available F&R
committee
Monitors and evaluates Business
Case in CCG dashboard and
advises of progress
Ensures evidence based and
strategic fit
Monitors and evaluates in CCG
dashboard and advises of
progress
Supports planning assumptions
(data)
Ensures evidence based and
strategic fit
Monitors and evaluates in CCG
dashboard and advises of
progress
South Sefton CCG & Southport & Formby CCG - Case for Change Screening
Is the proposal affordable and meets the following criteria
1.
Does the Proposal contribute to the CCG’s strategic change programme?
2.
Does the proposal link to the NHS Outcomes Framework or the NHS Constitution?
3.
The proposal has a clear process for tracking implementation, VfM and outcomes
4.
The proposal has a clear exit strategy should there be no improvement to the three
criteria above
YES
Is there good evidence available? (E.g. Health economy is an outlier1)
NO
DO NOT PROCEED
YES
Will it deliver savings?
Will the proposal cost money?
Is the proposal cost neutral?
Rate of
Return
now
Rate of
return
< 2 years
Rate of
return
> 2 years
Rate of
return
< 2 years
Rate of
return
now
Rate of
Return
> 2 years
Cost
< 100k
Cost
100k >
< 500k
High
priority
High
priority
Medium
priority
Medium
priority
High
priority
Low
priority
Medium
priority
Low
priority
Cost
> 500k
Low priority
Procurement
route via F&R
Consider the following questions and answer yes or no
1. Does the proposal have an impact on health inequalities
2. Will the proposal improve health outcomes
3. Can the proposal be implemented in less than 6 months
1 Yes
2 Yes
3 Yes
1 Yes
2 Yes
3 No
Increase priority level by one
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1 Yes
2 No
3 Yes
1 No
2 Yes
3 Yes
1 Yes
2 No
3 No
Maintain original priority level
1 No
2 Yes
3 No
1 No
2 No
3 Yes
1 No
2 No
3 No
Reduce priority level by one
Notes 1. Use Atlas of Variation or PMBA or equivalent
Commissioning intentions - approach and timeline
Phase 1
RESEARCH
Phase 2
ENGAGEMENT
Phase 3
DELIVERY
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• Identify Variation (Triangulate) – (Sept)
• Align research with variation & share with stakeholders (Sept)
• Engagement with GPs to support commissioning plans: Board
Development (Oct)
• Agree long-list (from Phase 2) – Link to BIG CHAT
• Research Guidance & Toolkits, Best Practice, Service
Specifications & Case Studies
• Deliver through case for change process/ contract management
/ programme approach (Nov – Mar)
Right Care for Populations
The NHS Right Care website offers resources
to support CCGs in adopting this approach:
• online videos and ‘how to’ guides
• casebooks with learning from previous
pilots
• tried and tested process templates to
support taking the approach forward
• advice on how to produce “deep dive”
packs locally to support later phases,
within the CCG or working with local
intelligence services
• access to a practitioner network
Find the full series at:
www.rightcare.nhs.uk/resourcecentre
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