Integrated Plan
2012 to 2015
1
Contents
1
2
3
4
Introduction
Context
2.1
Population Health Overview
2.1.1 Demographics
2.1.2 Health Inequalities
2.1.3 Diabetes
2.1.4 COPD
2.1.5 Coronary Heart Disease
2.1.6 Cancer
2.1.7 Older People
2.1.8 Dementia
2.1.9 End of Life Care
2.2
Provider Landscape
2.2.1 General Practice
2.2.2 Leicestershire Partnership Trust
2.2.3 University Hospitals of Leicester
2.2.4 Other Acute Care Providers
2.2.5 East Midlands Ambulance Service
2.2.6 Voluntary Sector
2.3
Partner Landscape
2.4
Financial and Economical/Environmental Context
2.5
Commissioning Services Based on Health Profiles
Review of Delivery 2011/12
3.1
Transformational Funding
3.2
Community Hospital Developments
3.3
Cancer
3.4
Prescribing
3.5
Leicester, Leicestershire and Rutland Programmes
3.5.1 Urgent Care – LLR Emergency Care Network
3.5.2 Frail Older People’s Pathway
3.5.3 Right Care Programme
3.5.4 Primary Care Key Performance Indicators
3.5.5 National Key Performance Indicators
Vision, Values and Strategic Aims
4.1
ELR CCG Vision and Values
4.2
Strategic Aims
4.3
Communication of Vision, Values and Strategic Aims
Page
6
10
20
27
2
5
6
7
Delivering our Strategic Aims
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5.1
Deliverables
5.1.1 Transform Services and Enhance Quality of Life for People
with Long-Term Conditions
5.1.2 Improve the Quality of Care
5.1.3 Reduce Inequalities in Access to Healthcare
5.1.4 Improve Integration of Local Services
5.1.5 Listening to our Patients and Public
5.1.6 Living within our Means
5.2
Three Year Delivery Plan
Transformational Programmes for 2012/13
36
6.1
NHS Operating Framework Guidance
6.2
LLR Transformation Fund – 2012/13 Approach
6.3
Allocation of Funds
6.3.1 Long-Term Conditions
6.3.2 Diabetes
6.3.3 COPD
6.3.4 Frail Older People
6.3.5 Emergency Care
6.3.6 Information Management and Technology
6.3.7 East Leicestershire and Rutland Integrated Care Model
Operational Priorities and Plans
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7.1
Local Priorities
7.1.1 Pathway Re-design
7.1.2 Reduce Health Inequalities
7.1.3 Mental Health
7.1.4 Cancer
7.1.5 CVD
7.1.6 Delivery of ELR Key Performance Indicators
7.1.7 Research and Development
7.1.8 Other Enablers
7.2
NHS Operating Framework
7.2.1 Dementia
7.2.2 Care of Older People
7.2.3 Carers
7.2.4 Military and Veterans
7.2.5 Health Visitors and Family Nurse Partnerships
7.2.6 Use of Telehealth and Telecare
7.2.7 Mental Health
7.2.8 Patient Experience and Feedback
7.2.9 NHS111
7.2.10 Travellers
7.2.11 Compliance with the Equality Act
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7.3
7.4
8
9
10
Delivery of LLR QIPP Programmes
SHA Ambitions
7.4.1 Pressure Ulcers
7.4.2 Making Every Contact Count
7.4.3 Quality and Safety in Primary Care
7.4.4 Quality Governance
7.4.5 Local Government Partnerships
7.4.6 Create a Revolution in Patient Experience
7.5
Children, Young People and Families
7.5.1 Partnership Working
7.5.2 Maternity – Improve 12 Week Access and Pathways
7.5.3 Healthy Child Programme
7.5.4 Mental Health Services for Children and Young People
7.5.5 Children and Young People with Disability and Long-Term
Conditions
7.5.6 Non-Elective Care
7.5.7 Complex Care
7.6
Authorisation
Provider Development
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8.1
Community Hospitals Developments
8.2
Review of Minor Injury Units
8.3
Extension of Patient Choice of Community Provider (Any
Qualified Provider Approach)
8.4
Leicestershire Partnership Trust (LPT)
8.5
University Hospitals of Leicester NHS Trust (UHL)
8.6
Best Use of Local Healthcare Estate
Draft Commissioning Intentions for 2013/14
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9.1
Developing Commissioning Intentions
9.2
Timetable for the 2013/14 Planning Cycle
9.3
ELR CCG Commissioning Principles
9.4
Draft Commissioning Intentions 2013/14
9.4.1 Shared Commissioning Intentions LLR
9.4.2 East Leicestershire and Rutland-specific Commissioning
Intentions
Partnership and Collaboration
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10.1 Health and Wellbeing Boards
10.1.1 Leicestershire Shadow Health and Wellbeing Board
10.1.2 Rutland Shadow Health and Wellbeing Board
10.2 Local Authorities and Social Care
10.3 LLR CCGs
10.4 Out of Area Commissioners
10.5 GEM CSO
10.6 Voluntary Sector Providers
10.7 Universities and Education
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11
12
Communication and Involvement
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11.1 East Leicestershire and Rutland Patients and Carers
11.2 East Leicestershire and Rutland Constituent GPs and CCG Staff
11.3 Partners
11.4 Local Involvement Network (LINks) and Healthwatch
Implementation
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12.1 Financial Plans
12.2 Governance Framework
12.3 Framework for Delivery of Programmes
12.4 Contracts and CQUINs
12.5 Management of Risk
12.6 Organisational Development
12.7 Communications and Engagement
Appendix 1: Leicestershire Joint Strategic Needs Assessment
Appendix 2: Rutland Joint Strategic Needs Assessment
Appendix 3: National and Local Target Priorities – Delivery for 2011/12 and Targets
for 2012/13
Appendix 4: Stakeholder Engagement to Develop our Strategic Aims
Appendix 5: Together Health Inequalities Action Plan 2012 - 2015
Appendix 6: ELR CCG Primary Care Quality Indicators
Appendix 7: East Leicestershire and Rutland Financial Strategy and Plan
Appendix 8: QIPP Savings – 2011/12 and Projected for 2012/13
Appendix 9: East Leicestershire and Rutland Future Years Financial Plan 20132015
Appendix 10: ELR CCG Board Assurance Framework
Appendix 11: Development of Joint Health and Wellbeing Strategies for Leicestershire
and Rutland
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1
Introduction
In July 2010, the Department of Health (DH) published the White Paper Equity and
Excellence: Liberating the NHS. In January 2011, the Coalition Government placed
before Parliament the Health and Social Care Bill, which outlined the measures they
wished to put in place in order to achieve their overall vision.
The Bill proposed the creation of a new network of organisations: Clinical
Commissioning Groups (CCGs) for the governance, strategic planning, and
commissioning of health and social care services in England; as well as official
bodies (NHS Commissioning Board and regional offices, and Healthwatch) to
scrutinise the delivery of CCGs on behalf of patients.
Whilst the reforms underway have led to the creation of some new organisations,
they have also both phased out others, and changed the roles of some existing
bodies, such as local authorities and NHS healthcare providers.
To facilitate the transition, arrangements were put in place that would support the
NHS in moving from its current state to the proposed new structure, with the
intention of being fully operational by 2013/14.
Figure 1: The Emerging NHS Landscape, Leicester, Leicestershire and Rutland
NHS Commissioning Board (NHS CB) Primary Care (Including GPs, Dentists, Chemists,
Opticians); Specialised Commissioning, Offender
Health, Military/Veteran’s Health;
Secondary Dental Services
Clinical Commissioning
Groups -
NHS CB Local Office
Leicester City Council
Leicestershire County
Council
East Leicestershire and
Rutland CCG;
Rutland County Council
West Leicestershire CCG;
Leicester City CCG
Leicester,
Leicestershire &
Rutland PCT Cluster
Commissioning
Support Organisations
(NHS Leicester City and
NHS Leicestershire County
and Rutland)
Providers NHS Trusts and
Foundation Trusts;
Acute and Community;
Community Health
Services; Voluntary and
3rd sector; Independent
Sector
Emerging provider
market
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East Leicestershire and Rutland Clinical Commissioning Group (ELR CCG) was
established in March 2011 in ‘shadow’ form. The CCG comprises General
Practitioners from 34 practices in the South and East of Leicestershire and Rutland,
working across the areas of Melton, Rutland, Market Harborough, Blaby District,
Lutterworth, and Oadby and Wigston. We serve a registered population of around
315,000 patients, over 35,000 of whom live in neighbouring areas. As a group we
decided to focus on improving the quality and delivery of services for our patients,
and on reducing health inequalities across the area.
We are part of the national pathfinder programme, testing concepts for clinical
commissioning and exploring how emerging CCGs will best be able to undertake
their future functions.
We have a firmly established Board, which is responsible for managing the transition
period until March 2013, while overseeing the implementation of the CCG’s plans for
the future. Board members include GP clinical leads, a nurse, and independent lay
members, with members of LINks in attendance.
The first six months of ELR CCG’s existence focused on developing strong clinical
leadership and engaging local GP practices, both through effective localities, and at
a CCG level. This approach was supported through discussions at practice level, via
a series of practice visits and meetings conducted by ELR CCG’s Clinical Chair,
Chief Operating Officer and other GP Locality Board Members. The meetings
provided an opportunity for the CCG governing body and leadership team to listen to
our constituent GPs and to gain a greater understanding of the services, pathways
and processes they wanted to change and/or commission differently in the future.
ELR CCG recognises the interdependencies across the healthcare system. We have
focused on building strong foundations for collaboration with other local
commissioners, including the other two CCGs within Leicester, Leicestershire and
Rutland: West Leicestershire, and Leicester City; social care and our two regional
local authorities, Leicestershire County Council and Rutland County Council; and
other partners. We have been an active participant in the development of the
Leicestershire and Rutland Health and Wellbeing Boards and the setting of our
shared strategies and priorities (see Appendix 11).
ELR CCG is committed to involving patients and carers, partner organisations and
the general public in our work. To ensure that our commissioning priorities meet the
needs of local people, we have undertaken a period of engagement with a wide
range of stakeholders. This engagement will be on-going as we continue to evolve
and develop as a commissioning organisation.
Feedback from all of our stakeholders – patients and carers, member practices,
clinicians, staff and partners - has informed the development of our vision, values
and strategic aims. These include the elements of local healthcare that we wish to
transform most significantly in the longer-term, and are as follows:
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
Transform services and enhance quality of life for people with long-term
Conditions
With a particular focus on COPD, diabetes, dementia and mental health

Improve the quality of care
Focusing on clinical effectiveness, safety and patient experience, with specific
goals to deliver excellent community health services and improve the quality
of primary care

Reduce inequalities in access to healthcare
Targeting areas and population groups in greatest need

Improve integration of local services
Between Health and Social Care, and between Acute and
Primary/Community Care

Listening to our patients and public
Commitment to listen, and to act on, what our patients and public tell us

Living within our means
Effective and efficient use of public money
Alongside our own strategic aims, we also recognise that there are a number of
other strategic developments and priorities, both regionally and nationally, to which
we remain committed. Furthermore, there are a number of more operational areas
where we know we need to make improvements to ensure better local healthcare in
line with England and ONS Cluster averages. These additional priorities are in the
context of the overarching NHS Planning Framework and other relevant guidance,
including, but not limited to:
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NHS Operating Framework (2012/13)
NHS Outcomes Framework (2012/13)
NHS Midlands and East Regional Commissioning Framework (2012/13)
SHA Ambitions (2012/13)
LLR Integrated Plan (2012/13)
Joint Strategic Needs Assessment
Shadow Health and Wellbeing arrangements
Transforming our health care system – Ten priorities for commissioners (The
Kings Fund 2011)
NHS Constitution
In order to deliver our strategic and operational priorities, we know that there are a
number of key enabling programmes that we need to deliver. Examples of these
include ensuring the best use of local healthcare estate, the development of our
CCG and its people, and developing collaborative arrangements with partners.
Our strategic approach is shown pictorially in Figure 2 below. This strategy pyramid
outlines our vision, values and strategic aims, together with our key operating
priorities and supporting strategies and plans. Key to our achievement of these are
the development of clinical leaders, and engagement and involvement with key
stakeholders, in particular, patients, carers and local people, member practices,
clinicians, staff and partners.
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Figure 2: East Leicestershire and Rutland CCG Vision and Strategy
Our Integrated Plan has both informed, and reflects the Leicester, Leicestershire and
Rutland (LLR) Integrated Plan, demonstrating our commitment to the LLR vision to
ensure that services are ‘right-sized’ and delivered in more cost effective settings,
where it is safe and appropriate to do so. ELR CCG is also committed to contributing
to the LLR health and social care economy both through collaboration, and by
delivering high quality, integrated and consistent results. Our strategy reflects local
emerging health and wellbeing priorities for Leicestershire and Rutland, and we
remain focused on delivering Leicester, Leicestershire and Rutland QIPP (Quality,
Improvement, Productivity and Prevention) programmes.
This Integrated Plan describes the current context within which the CCG operates,
and details our commissioning strategy, encompassing strategic and operational
priorities for 2012/13 and beyond. It will be updated annually to reflect the yearly
NHS Planning Framework, emerging local health trends, partner strategic priorities,
and the needs of local people.
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2
Context
This section provides an overview of the key health and population demographics of
East Leicestershire and Rutland, the area served by our CCG. It also describes the
key providers from whom we commission services.
2.1
Population Health Overview
ELR CCG has been actively involved in developing a joint understanding of local
needs and priorities across health and social care. This involvement has been
through membership of the Joint Strategic Needs Assessment (JSNA) steering
group; Health and Wellbeing Boards, and their Staying Healthy sub-groups;
participation in stakeholder events for JSNA Health and Wellbeing Boards; and a
CCG Board review of strategic priorities emerging from the 2012 JSNA refresh.
Various JSNA stakeholder engagement events have been held to inform the
development of the local JSNA for Leicestershire and Rutland. Key findings from
both JSNAs are summarised within this section.
Copies of the JSNA summaries for Leicestershire and for Rutland can be found in
Appendix 1 and 2 respectively.
2.1.1 Demographics
ELR CCG has an estimated population of approximately 315,000 based on the
number of patients registered with GP practices in 2011/12. Just over 35,000 of
these patients live in neighbouring areas; whereas around 46,500 people live within
East Leicestershire and Rutland but are registered with neighbouring CCGs.
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Figure 3: East Leicestershire and Rutland by Registered Population, and
Location of GP Practices
The map above shows practices with different symbols/colours according to the CCG area. ELR
CCG’s GP practices are shown as bright red crosses. Practices are located according to the centroid
of their postcode recorded by the Organisation Data Service (branch practices are not shown). Local
Authority boundaries are shown as yellow lines and ELR CCG’s geographical boundaries as thick
red lines. Mixed red/yellow lines indicate shared LA/CCG boundaries.
50.6% of our population is female, which is similar to the England average of 50.2%.
The average life expectancy within East Leicestershire and Rutland is 80 years for
men, and 83.9 years for women, both of which are higher than the England average.
In 2009 there were 2,701 deaths of people resident in East Leicestershire and
Rutland; 851 of these were premature (i.e. before the age of 75). Among the
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premature deaths, the highest percentage was from cancer (34%), followed by
cardiovascular diseases (22%), and respiratory disease (16%).
Figure 4: Population of East Leicestershire and Rutland by Age
A quarter of the population of East Leicestershire and Rutland is under the age of
20, and around 25% are aged 60 and over. The number of people aged 60 and over
is higher than the England average, and our older population is predicted to increase
over the next 10 years, with an estimated 31,500 additional people aged 60 years
and over; 7,500 of this population will be aged over 85 years. This, coupled with a
lower than England average birth rate, would indicate that we have an ageing
population.
The health of our local population is generally better than the overall population of
England. However, there is a significant number of people affected by ill health,
including GP-diagnosed Coronary Heart Disease (10,800 people), hypertension
(44,010 people), and diabetes (12,960 people).
Accounting for 72% of all deaths, the major killers for East Leicestershire and
Rutland CCG are:
 Cancer
 Cardiovascular disease
 Respiratory disease
High numbers of people are affected by the major risk factors for ill health. Around 1
in 6 adults (over 50,000) in East Leicestershire and Rutland smoke, and 1 in 5
(around 53,000) drink alcohol above safe levels (increased or high risk).
The CCG currently has high levels of non-elective activity when benchmarked
against similar health economies. Without a focused approach and active
12
intervention, the ageing population will increase the gap between expected and
actual activity. Elective activity is consistent with the national average.
In terms of prescribing activity, ELR CCG spends £75,338 per 1,000 population
compared to £79,662 nationally. However, the rate of growth in spending over the
last three years has increased by 6% against a national average growth of 3%.
2.1.2 Health Inequalities
Health inequalities can be defined as the differences either in health status, or in the
distribution of health determinants between different population groups.
The population of ELR CCG as a whole has relatively low levels of material
deprivation, compared to other parts of England. In comparing the various areas
where our population live against the rest of England, we rank overall as 200 out of
212 CCGs for deprivation (where 1 is the most deprived). Nevertheless, there are
significant pockets of disadvantage in areas on the edges of Leicester City and
within the market towns.
Within East Leicestershire and Rutland CCG, there are areas that have poorer
health outcomes. The main areas affected are in Oadby and Wigston. These
inequalities in health need to be addressed. Significant health inequalities exist for
other minority and hard to reach groups, e.g. Black and Minority Ethnic (BME), and
travellers.
Around 14% of school children are from black or minority ethnic groups and 11% of
children are living in poverty. This is similar to, or better than the England average.
Infant and child mortality rates are similar to the average, as are breastfeeding
initiation levels.
Although the health of children in East Leicestershire and Rutland is generally
similar to or better than England’s average, we recognise that there are key pockets
of socio-economic deprivation, particularly in Melton, Rutland and Wigston.
Men and women in one area of Wigston have a significantly lower life expectancy
than the England average. The same area of Wigston has a significantly higher rate
of respiratory disease mortality than the England average, and higher (although not
significantly so) rates of CVD, cancer mortality and adult smoking. Although not as
significant as in Wigston, other pockets of greater need exist in other parts of East
Leicestershire and Rutland, including Melton, Harborough and Blaby.
Evidence suggests that the most effective way to reduce the gap in life expectancy
in the short-term is to improve the management of diseases (including CVD and
COPD) and their risk factors (including smoking, alcohol, hypertension and diabetes)
that predominately affect the socially excluded.
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2.1.3 Diabetes
In 2010/11, 13,177 patients in East Leicestershire and Rutland were registered with
their GP as having diabetes. This is an estimated diabetes age-specific prevalence
rate of 5.3%, which is similar to the England average (5.5%).
In 2005, there were approximately 290 deaths from diabetes in people aged
between 20 and 79 years in Leicestershire County and Rutland. This represented
around 11% of all deaths in that year.
2.1.4 COPD
In 2008/9, there were 106 deaths from chronic obstructive pulmonary disease
(COPD) in East Leicestershire and Rutland. This is a rate of 8.5 per 100,000
population, which is lower than the England average (11.8 per 100,000 population).
Overall, there has been little change in the trend of COPD across Leicestershire
County and Rutland over recent years.
2.1.5 Coronary Heart Disease
In 2010/11 there were 10,544 patients registered with coronary heart disease (CHD)
in East Leicestershire and Rutland. This GP recorded prevalence of 3.4% compares
to a model based estimate of actual prevalence of 5.1%.
The difference would indicate that there are approximately 3,000 patients with
undiagnosed CHD in East Leicestershire and Rutland. For premature mortality, there
were no areas of East Leicestershire and Rutland with CVD mortality rates
significantly higher than the England average. However, there was clear variation
between areas with above average rates (including parts of Oadby and Wigston and
Melton), and areas where rates were significantly better than the England average
(including parts of Harborough and Rutland).
2.1.6 Cancer
Although there is some variation across East Leicestershire and Rutland, rates of
premature mortality from cancer are either significantly lower than, or similar to the
national average.
Based on Quality and Outcomes Framework data, the GP recorded prevalence of
cancer is higher than the England average (1.9% of the registered population).
However, higher prevalence of cancer may be indicative of better diagnosis rates,
which is probable given the higher survival rates within the local area.
2.1.7 Older People
In 2010, there were approximately 80,100 people aged over 60 in East
Leicestershire and Rutland, and 16,000 aged over 80. The population of East
Leicestershire and Rutland aged over 60 is estimated to increase by around 60% by
2030.
Around 14,000 of the population aged over 75 in East Leicestershire and Rutland
lived alone in 2010. This number is predicted to rise to 26,200 by 2030, an increase
of 87%.
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In 2010 there was an estimated 25,400 people in East Leicestershire and Rutland
over the age of 65 with a long-term illness. By 2030, this is predicted to increase to
around 42,900, an increase of 69%. The 2009 JSNA noted particular increases in
dementia (63% by 2025), and hypertension (17% by 2020).
This increased burden of disease could lead to increased hospital activity linked to
age, unless there is a change in the way care is delivered. Between 2008 and 2018,
non-elective inpatients are estimated to increase by 18% across Leicestershire
County and Rutland, bed days by 26%, and elective inpatients by 15%.
2.1.8 Dementia
In 2010 there were around 900 people in East Leicestershire and Rutland with
diagnosed dementia. By 2030, the number is estimated to double to around 1,800
people. As advocated by the National Audit Office in their value for money report
2007, investment in improved and expanded Dementia care management,
incorporating earlier diagnosis, is essential to increase the quality of lives for patient
and carers; the quality, effectiveness and experience of care; and to reduce both
healthcare, and societal costs.
2.1.9 End of Life Care
National studies report that over half of people would prefer to die at home. In 2010,
half of deaths in East Leicestershire and Rutland took place in hospital, and around
one quarter took place at home.
2.2 Provider Landscape
ELR CCG commissions services for the population of East Leicestershire and
Rutland to the value of approximately £315million. We hold contracts ranging from
small grants to the voluntary sector, to £116million with our main acute provider,
University Hospitals of Leicester (UHL). A breakdown of the CCG’s 2012/13 budget
by provider is shown below in Figure 5.
Figure 5:
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2.2.1 General Practice
ELR CCG comprises General Practitioners from 34 practices in the South and East
of Leicestershire and Rutland, serving patients in the three locality areas of Melton,
Rutland, Market Harborough; Blaby District and Lutterworth; and Oadby and
Wigston; together with surrounding areas. (See Figure 3 above for specific GP
practice locations and registered populations).
2.2.2 Leicestershire Partnership Trust
Employing almost 7,300 staff, Leicestershire Partnership NHS Trust (LPT) provides
a range of mental health, community health, and health and wellbeing services for
patients living within East Leicestershire and Rutland CCG. Community health
services transferred to the Trust in early 2011 as part of the national Transforming
Community Services programme.
The community health services element of LPT incorporates 1,900 staff, such as
district nurses and health visitors, working within community teams across LLR in
ten community hospitals, various health centres, minor injury units, a walk-in centre,
schools, residential homes and in patients' own homes. It also provides
physiotherapy, occupational therapy, podiatry, speech and language therapy,
nutrition and dietetics services, and community dentistry.
Shown in Figure 6, the community hospitals located within East Leicestershire and
Rutland are as follows:
 Market Harborough District Hospital
 St Luke’s Hospital, Market Harborough
 Rutland Memorial Hospital
 Feilding Palmer Hospital, Lutterworth
 Melton Mowbray Hospital
 St Mary’s Maternity Hospital
The overall budget for LPT from LLR commissioners is £250million. ELR CCG’s
budgetary contribution for mental health and learning disabilities services is in
excess of £24million; and for community health services, £29.5million.
Figure 6 below shows the various acute and community hospital providers from
whom we commission services.
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Figure 6: Map of Acute and Community Hospitals Across Leicestershire,
Leicestershire and Rutland and Neighbouring Areas
2.2.3 University Hospitals of Leicester
Our principal acute provider, UHL, is one of the biggest and busiest NHS trusts in
the country, incorporating the Leicester General, Glenfield and Royal Infirmary
hospitals. UHL has more than 10,000 staff providing a range of services primarily for
the one million residents of Leicester, Leicestershire and Rutland. UHL offers a
number of specialist treatment centres and services in cardio-respiratory diseases,
cancer and renal disorders, which means that the Trust provides care for up to a
further three million patients from across the rest of the country.
2.2.4 Other Acute Care Providers
We also commission acute care from other providers, including out of county NHS
Trusts, and a range of Independent Sector Providers such as Spire Leicestershire,
Nuffield Leicestershire, and Nations Treatment Centres at Nottingham.
2.2.5 East Midlands Ambulance Service
East Midlands Ambulance Service NHS Trust (EMAS) provides emergency 999,
urgent care and patient transport services for the 4.8 million people within
Derbyshire, Leicestershire, Rutland, Lincolnshire (including North and North East
Lincolnshire), Northamptonshire and Nottinghamshire. They employ over 3,200 staff
at more than 70 locations, including two control rooms at Nottingham and Lincoln,
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with the largest staff group being accident and emergency personnel. ELR CCG’s
annual budget for EMAS is £8.3million.
2.2.6 Voluntary Sector
We fund a number of voluntary sector organisations through grant agreements.
These grants enable a contribution towards the funding of voluntary sector or charity
organisations who deliver local services with a healthcare element. Services range
from mental health services and palliative care, to children’s services and support for
carers. Providers include Alzheimers Society (carer’s support service); Carer’s
Action (carer’s support); LOROS hospice (end-of-life care); and The Laura Centre
(support for adults and children affected by the death of a child).
2.3 Partner Landscape
ELR CCG works closely with all our partners to transform and improve healthcare
within our local communities. Over the last 12 months, we have actively engaged
with partner organisations to forge vital links, to build on existing relationships, and
to develop new and improved relationships with clinicians, patients and carers,
public members, staff, partner organisations including local authorities, and other
commissioning agencies.
We have many partners, and have key working relationships with the following:
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Leicester City CCG
West Leicestershire CCG
Out of area CCGs
Leicestershire County Council (including social care services)
Rutland County Council (including social care services)
Voluntary sector providers and charities
Emergency services, i.e. police and fire
Leicestershire and Rutland LINks, and other patient and carer representative
bodies
De Montfort University
Leicester University
Health and Wellbeing Boards
Greater East Midlands Commissioning Support Organisation (GEM CSO)
More information on how we collaborate with key partners can be found in section
10.
2.4 Financial and Economic/Environmental Context
The economic climate in which we operate remains a challenge for all NHS
organisations. We have assumed zero growth for the foreseeable future, and our
commissioning intentions are modelled primarily on this basis. We recognise the
need for service improvements to deliver better quality of patient care and
experience in the long-term, whilst reducing clinical variation, eliminating waste and
delivering better value for money. This we will achieve through on-going recurrent
investment; investment of our transformational fund into the delivery of longer-term
strategic priorities; and through delivery of our QIPP (Quality, Innovation, Productivity
and Prevention) programmes.
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2.5 Commissioning Services Based on Health Profiles
The demographics of the population, along with existing health equalities, are a key
consideration when developing our annual commissioning intentions. The
commissioning of local NHS services involves the CCG working with public health,
providers, partners and local communities, to identify and understand patients’
needs and to design services to meet those needs. This is done by working within a
structured and planned process called the ‘commissioning cycle’, demonstrated in
Figure 7 below. This process is continuous to ensure that services are developed
and improved based on provider performance, patient experience and outcomes,
and emerging health trends. The commissioners of services lead the process for
deciding how best to provide services and for making this happen.
Figure 7: The Commissioning Cycle
Assess Needs
Manage
Performance
(Quality,
Performance and
Outcomes)
Clinical Decision
Making
Review Current
Service Provision
Clinical, and
Patient and
Public
Involvement
Manage Demand
and Ensure
Appropriate
Access to Care
Decide Priorities
Design Service
Shape Structure
of Supply
19
3
Review of Delivery 2011/12
During 2011/12 ELR CCG has focused on delivering or preparing to deliver a
number of strategic and transformational priorities for the CCG. The identification of
these was clinically led, following extensive consultation with member practices,
including discussions at locality meetings and visits to every practice by the
Accountable Officer and members of the senior management team.
We have also worked collaboratively with other CCGs and strategic partners to
identify and deliver system-wide priorities. This section outlines the key activities
undertaken, together with highlights of progress during our first year of operating in
shadow form.
3.1 Transformational Funding
In order to prioritise investment of transformational funding for 2011/12, ELR CCG
considered the health needs assessments of our area. Led by clinicians and
supported by feedback from member practices, this showed that:






Long-Term Conditions are very common in the East Midlands with over
590,000 households reported as having at least 1 person with a Long-Term
Condition
Patients with Long-Term Conditions account for almost 80% of GP
consultations
Patients with Long-Term Conditions utilise around 40% of hospital/urgent care
bed days
Care between primary, secondary and community services in general is very
fragmented and more integration is needed
More prevention and earlier detection is essential to improving outcomes
Better care planning with greater patient involvement is required to empower
patients towards more self-care.
Taking these findings into consideration in 2011/12, we established a Long-Term
Conditions programme utilising transformational funds. This placed an emphasis on
COPD, Diabetes and End of Life Care.
Each practice within ELR CCG was asked to subscribe to the “Achieving Excellence
in Long-Term Conditions Programme”, which focused on achieving a co-ordinated
approach to Diabetes, COPD and End of Life.
The programme looked to undertake clinically-led commissioning with the objective
of improving health outcomes, as well as reducing the variation in clinical quality. It
focused on the training and development of practice clinicians; screening support to
improve prevalence and early diagnosis; and the provision of structured clinical care
as per a defined pathway. It aimed to improve capabilities and efficiencies in primary
care, reduce emergency admissions, and facilitate an improvement in the integration
of care between primary, secondary and community services.
20
As a result:
 31 out of 34 GP practices signed up to the Long-Term Conditions programme
 A nominated GP and practice nurse from every practice undertook diabetes
training modules at University of Leicester to improve the management of
type 2 diabetics within primary care (this training will be continued in 2012/13)
 27 practices have undertaken spirometry accreditation/reaccreditation
 22 practices attended educational sessions provided by LOROS that focused
on end of life care.
 We delivered a 5.7% reduction in outpatient attendances
 There was a 3.6% reduction in emergency spells (by month 8 of 2011/12)
 There has been an increase in the numbers of diabetes patients with more
complex needs who are now cared for within primary care
 Patients with indicators of COPD then received either pulse oximetry, or an
onward referral to pulmonary rehabilitation. Many practices have purchased
the necessary supporting equipment. In 2012/13 these practices will be
undertaking a clinical review of patient records to determine the accuracy of
their current COPD patient list.
3.2 Community Hospital Developments
ELR CCG has confirmed our commitment to developing community hospital services
by approving the next phase of development at the St Luke’s Hospital site in Market
Harborough.
ELR CCG carefully considered the options for developing hospital services in Market
Harborough, under delegation from the NHS Leicestershire County and Rutland
Trust Board in March 2011.
The CCG decided to push forward with plans to see the new hospital development,
which has received widespread support from clinicians, patients and local people
following extensive consultation and engagement. However, the CCG has secured
£4million NHS capital funding and a further £250k of transformational funding, rather
than through the originally proposed private finance initiative arrangements. This
ensures that the CCG avoids a more expensive, long-term ‘mortgage’ commitment.
In September 2011, ELR CCG announced its plans, which should see the longawaited new hospital development open by 2014. The new development will see
improved services for patients and significant benefits to local healthcare, with the
provision of a variety of services on one site in the town. The plans will include
increased diagnostic and treatment facilities, leading to more patients being seen
and treated more quickly, and closer to home. This will in turn assist ELR CCG in
decommissioning activity in acute hospital settings.
21
Services to be provided by the new hospital development include:
 Cardiology
 Maxillofacial
 Dermatology
 Minor plastic surgery
 Diabetic medicine
 Neurology
 Endocrinology
 Ophthalmology
 ENT
 Paediatrics
 Gastroenterology
 Respiratory medicine
 General medicine
 Rheumatology
 General surgery
 Trauma and Orthopaedics
 Gynaecology
 Urology
ELR CCG will continue to involve the local public in plans for the new development,
particularly in the search for a new name, and in determining a new home for Market
Harborough War Memorial on the existing Market Harborough District Hospital site.
3.3 Cancer
As part of the Long-Term Conditions work (see section 3.1) we have encouraged
primary care to adopt best practice in terms of early diagnosis and treatment of
Long-Term Conditions. This assessment also helps to pick up early cancers as part
of the diagnosis of the condition, particularly where a patient’s condition has
worsened e.g. prolonged cough for COPD sufferers may lead to a chest x-ray and
spirometry; or prolonged weight loss and confusion for patients with dementia may
lead to further tests.
This process has helped us to improve the number of patients diagnosed with
cancer. In Leicestershire and Rutland the number of patients referred has increased
from 11,280 (2010/11) to 12,577 (2011/12, indicating an increase of 10% in referral
by GPs.
As part of our prevention agenda we have also commissioned alcohol liaison
workers and further interventions in general practice to provide lifestyle advice, e.g.
in terms of smoking cessation or misuse of substances. These will also help to
reduce the incidence of cancer in the longer-term.
We have also worked in partnership with LOROS (the Leicestershire and Rutland
Organisation for the Relief of Suffering) to deliver workshops to 28 member
practices. These focused on both improving the adherence to pathways for patients
at the end of their lives, symptom management and maintaining comfort and
wellbeing, advance care planning, and how to approach the topic of End of Life
treatment with patients and carers.
3.4 Prescribing
We believe that efficient prescribing results in better outcomes for patients. We have
therefore focused on normalising prescribing across East Leicestershire and Rutland
to reduce variation between GP practices. We have applied QIPP targets to GP
practices where spending is higher than expected for their registered population, and
have worked with those where it is lower to help improve patient outcomes. In some
cases this has resulted in an intended increase in prescribing costs, for example the
prescribing of new insulin analogues. Whilst there has been a related increase in
prescribing costs over recent years to bring us more in line with the England
22
average, spending has now levelled off and we remain focused on our QIPP
prescribing target to improve the quality of patient outcomes whilst eliminating
unnecessary cost and variation.
Our focus on prescribing cost-effective statins as part of our QIPP priorities in
2010/11 has resulted in £21,291 annualised savings in 2011/12, with further savings
planned for 2012/13. Our prescribing targets in relation to QIPP 2012/13 will be
achieved through a combination of targeted medicines management input at practice
level; and strategic input via regular QIPP performance reports to all practices.
Transformation funding has been approved for a Care Homes Medication Review
project which will optimise the prescribing of medication and reduce adverse patient
outcomes.
3.5 Leicester, Leicestershire and Rutland Programmes
ELR CCG remains committed to on-going collaboration with other commissioning
partners across Leicester, Leicestershire and Rutland (LLR) to achieve system-wide
change throughout health and social care. As such, the CCG is an active participant
in a number of LLR-wide programmes, with clinical and other leads playing a key
role in programme boards and teams, and in advocating and enabling change within
the East Leicestershire and Rutland area. Key on-going developments in 2011/12
have already led to success in terms of Quality, Innovation, Productivity, Prevention
(QIPP) programmes in the areas described in the following sub-sections.
3.5.1 Urgent Care – LLR Emergency Care Network
In March 2011, the LLR Emergency Care Network agreed a set of outcome success
measures across the LLR healthcare system.
Despite surges in emergency department attendance, the year-end performance
against planned activity for LLR commissioned patients stood at 0.2%. The
emergency admission trend shows a similar decrease. Although the system did not
achieve the 4-hour performance target in 11/12, key improvements across the
urgent care system have enabled patients to be assessed, treated and discharged in
a more efficient manner.
In order to ensure that these developments continue to deliver sustainable
improvement and consistent delivery of standards, the Emergency Care Network will
continue to oversee progress in 2012/13. System-wide projects include:

Mental Health Liaison in the Emergency Department:
The introduction of a psychiatric liaison service within the Emergency
Department from 9am to midnight, 7 days a week.

Early discharge:
Discharge by 1pm at UHL with a revised discharge process designed and
embedded in 20 acute wards with planned rollout across UHL in 2012-13;
Discharge by noon in Community hospitals, with a revised discharge process
designed and embedded.
23
Discharge to assess - The LLR PCT Cluster in partnership with University
Hospitals of Leicester NHS Trust have worked together to provide patients with
temporary two-week placements in local nursing homes, where they can be
assessed and re-located to a permanent residence equipped with an individually
tailored package of healthcare.
BEDs – the UHL BED Before 11:00 Project is focused on improving both the
quality and timeliness of patients’ discharge or transfer of care.

East Midlands Ambulance Service Improvement
Improve EMAS GP urgent conveyance rate (8am-8pm) and alternative pathway
for conveyance to Urgent Care Centre/8am to 8pm centres/and Walk in Centres
for category ‘c’ minor calls.
3.5.2 Frail Older People’s Pathway
Significant progress has been made across LLR in the design and implementation of
services to reduce emergency care for frail older people, and to bring services closer
to home.
In November 2011, the non-weight bearing pathway was introduced. From this time
until the end of March, 340 acute bed days were saved. This was as a result of UHL
working with the local authority to spot-purchase beds to move stable non-weight
bearers (overwhelmingly older people) out of acute beds and closer to home, or in
some cases actually back to home with enhanced support.
The Frail Older People’s Advice and Liaison Service (FOPALS) has resulted in
weekly clinics in most of the county hospitals, in addition to a weekly ward round to
review frail older in-patients. This year they will also be delivering some care home
and domiciliary visits to support GPs and community nursing.
The FOPALs service has resulted in a reduction in referral to transfer time for older
patients needing therapy, from 2.8 days to 1.8 days for county patients and from 4.7
days to 1.78 days for city patients. This is as a result of extensive partnership
working between all stakeholders across LLR.
There was also an increase in discharge before midday across county hospitals from
an average of 26% in 2010/11, to 40%. Discharge from UHL by 1pm increased from
13% to 17.5%.
3.5.3 Right Care Programme
The LLR Right Care Programme was established to improve the use of evidencebased medicine, and to reduce clinical variation in line with the recommendations
made in the Innovation, Health and Wealth (2011) paper and the Right Care 2nd
Atlas of Variation (2011). The programme has initially focused on eight clinical
procedures with the aim of ensuring high quality, clinically appropriate care, whilst
releasing funds to be re-invested or saved. Procedures include:




Hip replacement surgery
Knee replacement surgery
Carpal Tunnel surgery
Cataracts
24

Tonsillectomy
Clinical thresholds for the identified procedures were implemented from June 2011
with full year savings in 2011/12 for ELR CCG projected to be £700,000.
3.5.4 Primary Care Key Performance Indicators
The focus on practice engagement has delivered performance improvements in five
primary care priority target areas in 2011/12. Linked to our primary care QIPP
programme, these areas will continue to be a priority in 2012/13, and are as follows:

Increasing the number of NHS Health Checks being carried out: 65.5% of
people were offered NHS Health Checks in 2011/12. In 12/13 we expect this
number to increase as we are offering financial incentives to practices that
achieve the 65% target set by the SHA. We are also asking practices to
submit monthly performance data as opposed to quarterly.

Increasing the number of GPs with extended opening hours: 24 out of 34
practices provided extended hours in 2011/12. We are introducing a new
Extended Opening Hours Local Enhanced Service (LES) for 2012/13 to make
it more flexible. We expect the majority of practices to sign up to this

Increasing the use of Choose and Book (CAB) within general practice:
67% of referrals were booked through CAB. We have applied an incentive of
£1 upfront payment for practices signing up to the GP Support Framework.
This requires practices to use CAB and we expect this to continue to improve
in 12/13.

Increasing the number of Learning Disability (LD) Health Checks being
carried out: 77.56% of LD clients had a health check in the last 12 months.
We are working collaboratively with the LD facilitators to continue to improve
uptake and have amended the LD LES to require practices to provide monthly
performance data as opposed to quarterly.

Improvement in the reported patient experience in relation to Long-Term
Conditions in the GP survey
3.5.5 National Key Performance Indicators
The performance of health services that we commission is measured against a
number of national key performance indicators. At the beginning of the year 2011/12
we agreed to focus on improving a number of areas as follows:




Percentage of people seen within 4 hours in A&E
Percentage of people who spend at least 90% of their time on a stroke
unit
Percentage of people who have a TIA who are scanned and treated within
24 hours.
Percentage of people offered a health check, and percentage of people
who have received one
25


Percentage of women who have seen a midwife for a full health and social
care assessment by 12 week and 6 days of completed pregnancy
Percentage of people who commence treatment within 18 weeks from GP
referral to the start of hospital treatment
Action plans were developed to address each area and we have made good
progress over the last year on setting the foundations for future improvement of
these targets; we have already seen a positive change in a number of them, for
example, NHS health checks. At the beginning of the year the number of NHS health
checks carried out was below the planned target. Over the year we ran a campaign
across all practices and localities, and redeveloped the pathway. This resulted in a
significant improvement in performance, from 453 health checks offered and 81
received in quarter one, to 7,382 offered and 4,837 received by the end of the year.
Over the past year we have set in place a number of actions required to deliver a
stepped improvement in performance in the stroke pathway. This will enable us to
improve performance against both stroke-related targets. We have worked with our
main acute provider, UHL, to deliver plans for 2012/13, including direct booking to
the TIA clinic and on-going commissioning of the early supported discharge team.
With regard to the delivery of the 18-week target, significant work has been
undertaken with acute providers and the total number of incomplete pathways has
decreased over the past year as a result. This on-going programme will continue
and will help to improve future performance. In the meantime, this target remains
somewhat problematic.
Further information on our work to improve emergency care performance and
improving the 12 week access to maternity assessment can be found in sections
6.3.5 and 7.5.2 respectively.
A copy of our National and Local Target Priorities: Delivery for 2011/12 and Targets
for 2012/13 can be found in Appendix 3.
26
4. Vision, Values and Strategic Aims
This section outlines ELR CCG’s vision, values and strategic aims. These were
developed following significant engagement with member practices, patients, carers
and members of the public, staff, clinicians and partners. A more detailed account of
some of the discussions and events that took place can be found in the Appendix 3.
It should be noted that our local values underpin those set out within the NHS
Constitution, and as such should be taken together with these. Resulting from a
nationwide engagement programme led by Lord Darzi in 2008, these values are:
 Respect and dignity
 Commitment to quality of care
 Compassion
 Improving lives
 Working together for patients
 Everyone counts
4.1 ELR CCG Vision and Values
ELR CCG developed our Vision and Values during a series of Board Development
sessions in 2011, incorporating suggestions and feedback from a variety of
stakeholders, including ELR CCG staff, GP practices, patients and carers,
representatives from LINks, partner organisations and local community groups,
including learning disability support groups and the traveller community.
The results can be seen at Figure 8, with the vision central to our values:
Rol
out
Figure 8: ELR
CCG Vision and lValues
27
4.2 Strategic Aims
The CCG has undertaken extensive engagement to ensure the involvement of key
stakeholders in the setting of our key strategic aims. Various meetings and other
activities, such as locality GP meetings, Patient Participation Groups, engagement
events and surveys took place over a period of nine weeks with member practices,
community and secondary care clinicians, Leicestershire and Rutland LINks,
patients, carers and the public, and partners, including local authorities and
members of the Health and Wellbeing Board. We discussed the findings of the Joint
Strategic Needs Assessment in conjunction with local knowledge of healthcare
services, and developed our strategic aims for the following three years.
We also discussed our emerging priorities with partners at the Health and Wellbeing
Board meetings of both Leicestershire County, and Rutland County. This was to
ensure both support from partners, and alignment with Health and Wellbeing interim
priorities as follows:
Leicestershire Health and Wellbeing Board Interim Priorities:
i.
ii.
iii.
Improving health and wellbeing and reducing inequalities
Improving service integration
Improving efficiency and balancing the economy
Rutland Health and Wellbeing Board Interim Priorities:
i.
ii.
iii.
iv.
v.
Staying Healthy: Improving health and wellbeing and reducing inequalities
Complex Needs: Improving outcomes for people with complex needs
Children, Young People and Families: Improving care and support
Sustainability: Improving efficiency and balancing the economy
Cross-cutting themes
Further details relating to the development of Health and Wellbeing priorities and
strategies can be found in Appendix 11.
We asked for input and feedback, and the views of all members were taken into
consideration. Emerging themes were formally reviewed by the public health team
with respect to both alignment with population health needs and Health and
Wellbeing Board priorities, and the potential to tackle health inequalities. The
resultant report was discussed by partners at a later Board meeting, helping us to
ensure that our strategic aims and the priorities of both Health and Wellbeing Boards
were mutually supportive. This work was then shared with a wider audience through
a series of open engagement events across East Leicestershire and Rutland.
Our strategic aims also align closely with the areas of focus identified by the
Leicestershire LINk. These are mental health and social care.
We are confident that as a result of this robust programme of engagement, our
commissioning priorities directly respond to the needs of local people, and also
reflect wider partnership aims. A more detailed account of this work can be found in
Appendix 4.
28
Our strategic aims:
 Transform services and enhance quality of life for people with LongTerm Conditions
With a particular focus on COPD, diabetes, dementia and mental health

Improve the quality of care
Focusing on clinical effectiveness, safety and patient experience, with specific
goals to deliver excellent community health services and improve the quality
of primary care

Reduce inequalities in access to healthcare
Targeting areas and population groups in greatest need

Improve integration of local services
Between Health and Social Care,
Primary/Community Care
and
between
Acute

Listening to our patients and public
Commitment to listen, and to act on, what our patients and public tell us

Living within our means
Effective use of public money
and
In addition to the strategic priority areas identified above, ELR CCG recognises that
the maternity and child health agenda is vast and complex. It is clear that the
Government sees ‘Getting it right for children and young people’ (Sir Ian Kennedy:
September 2010) as a key priority for commissioners and this is clearly reflected in
the challenges relating to maternity care, health visiting, non-elective care, LongTerm Conditions, safeguarding, complex families and their care, and Child and
Adolescent Mental Health Services (CAMHS). ELR CCG is committed to working in
partnership with a range of organisations to improve quality and productivity across
universal, targeted and specialist services to improve outcomes for infants, children,
young people and their families. Further detail on how we plan to deliver these areas
of care can be found within section 7.5.
4.3
Communication of Vision, Values and Strategic Aims
We recognise that communicating our vision, values and strategic aims is key to our
success in realising them. We have communicated and engaged with member
practices, key clinicians, staff, partners, patients, carers, members, and others to
ensure that they are aware of them, that they subscribe to and support them, and
that everyone is committed to delivering them in collaboration together. We have
delivered presentations at locality meetings and key partner meetings, for example
the Health and Wellbeing Board and District Council health forums; spent time
talking directly with practices during face-to-face visits; held staff briefings; and
shared information in our staff and public member newsletters.
More work to involve stakeholders and to communicate our vision, values and
strategic aims will take place over the summer of 2012 with open engagement
events, media releases, the launch of our website and further meetings with key
partners and stakeholders. This will raise awareness further and encourage
29
subscription and collaboration. We recognise that this is an on-going process and,
therefore, sharing our vision, values and strategic aims will remain a fundamental
part of all future communications activity.
Central to our communications approach is the development of our ‘strategy on a
page’ which outlines our vision, values and strategic aims and how they link to other
priorities and plans, including the NHS Framework and collaborative working with
partners. This strategy ‘pyramid’ (see Figure 2 in section 1) also depicts the central
importance of clinical leadership, and of involvement of clinicians, staff, partners and
member practices in delivering our vision.
In terms of more specific engagement and communications arrangements, our
Involving and Informing Strategy sets out our key stakeholders and how we will
engage with them on an on-going basis.
30
5
Delivering our Strategic Aims
This section sets out our plans for delivering our six strategic aims as identified
within section 4.2 above.
5.1
Deliverables
We have developed a number of deliverables against each of these areas as shown
in the table below. These have been developed following stakeholder involvement
and feedback as described within section 4 above. Aligned with the local JSNA,
specific areas of focus have been influenced strongly by the views of patients and
clinicians; the priorities agreed by our Health and Wellbeing Boards; and the focus
areas identified by LINks. For example, following a public meeting in Oadby and a
strong consensus of opinion from patients, carers and local clinicians, we have
strengthened our plans to improve mental health services (see 7.1.3 and 7.5.4).
Deliverables are set out within the following sub-sections:
5.1.1 Transform Services and Enhance Quality of Life for People with LongTerm Conditions
 Further develop training and education in primary care thus reducing patients'
reliance on secondary care services including end of life care


Expand current COPD scheme to provide better condition management and
improve prevention
Develop community based diabetes service

Investment in improved and expanded Dementia care management

Optimise use of Telehealth and assistive technology to improve patient self
management and treatment within primary care
5.1.2 Improve the Quality of Care
Reduce variation in primary care, for example:
 Equitable access to primary care services



Improve appropriateness of referral to other services
Appropriate prescribing
Improve disease prevalence rates and earlier diagnosis

Equitable access to health checks for all patients including hard to reach groups

Continuous improvement and learning through clinical peer review
Delivering excellent community health services, for example
 Extending patient choice of provider for a range of community and mental health
services through use of local and national Any Qualified Provider (AQP)
processes



Redesign and procure elective care services including out patients
Diagnostics and day surgery to bring care closer to home and improve patient
choice and experience
Deliver efficiency by maximising use of community services
31

Assure delivery through collaboration with main providers ensuring ‘value for
money’ for all partners.
Improving the quality of patient services and experience
 Continuously improve the quality of care within our providers, including acute,
mental health and community services using contractual processes as a lever

Triangulate commissioning and provider data with patient safety data and patient
and carer feedback, including from complaints, reference groups and
engagement events, to inform areas requiring improvement and attention and to
ensure on-going improvement

Build on governance processes already in place to share patient feedback and
experience information with Board, committees, staff, member practices and
partners to inform decision-making and raise the quality of services


Ensure the continuous improvement of quality and patient and carer
Experience through the routine contractual performance management process
5.1.3 Reduce Inequalities in Access to Healthcare
 In partnership with social care, deliver the Together Health Inequalities Action
Plan 2012-2015, covering supporting families, mothers and children; engaging
communities and individuals; preventing illness and providing effective treatment
and care; and addressing the underlying (wider) determinants of health.
 Increase access to smoking cessation services

Work with providers to achieve the standards of care as set out within the
UNICEF/WHO Baby Friendly Initiative

Identify shared budgets and plans with Local Authority partners and the Health
and Wellbeing Boards to target geographical areas and groups with health
inequalities

Continue to support nutrition and lifestyle services in targeted neighbourhoods
as part of local obesity care pathways
Continue to support targeted services in children’s centres for referral of
vulnerable parents or families, e.g. through increasing health visitors and
providing outreach workers for families


Develop healthcare services tailored to the needs of specific priority groups, e.g.
military, and travellers.
32
5.1.4 Improve Integration of Local Services
 Extend integrated working across health, social care and all third sector
organisations e.g. voluntary services to enable delivery of seamless end to end
care pathways




Work with local authorities to address the health and social care needs of
specific groups e.g. military families; travellers
Deliver value for money for all partners whilst improving overall health outcomes
by maximising benefit realised by appropriate use of social care funding
Improve the quality of care in Care and Nursing Homes and those who are
housebound
Ensure more seamless, joined up care between primary and secondary care
through clinicians from these areas working collaboratively to improve a number
of pathways, including diabetes, frail older people, COPD and integrated care.
This will also facilitate better working relationships.
5.1.5 Listening To our Patients and Public
 Embed effective public engagement and consultation processes within the
organisation to ensure patients are involved fully and appropriately in
decisions about their own care and local health services
 Integrate patient experience, complaints and quality data with feedback from
public engagement and consultation activity to provide patient-centred
insights to our commissioning decisions
 Build strong relationships with key stakeholders and partner organisations,
ensuring effective partnership and collaboration to deliver integrated care
and the best possible services for our patients Develop a wide range of ways
for local people to access reliable information about health and local health
services, ensuring information is available in a variety of formats tailored to
people’s needs, and making the best use of technology
5.1.6 Living Within our Means
 Work collaboratively with public health and other partners to ensure that financial
resources are targeted towards delivering priority local needs

Ensure that collaborative arrangements for contract management secure the
financial needs of ELR CCG

Deliver QIPP targets for LLR and ELR CCG

Ensure good financial management from Board to budget holder, including the
investigation any variances from plan


Deliver training to ensure that budget holders have the appropriate capability
Ensuring that financial implications of pathway changes and other programmes
are understood and planned for

Ensuring flexibility in financial planning to adapt to changing needs and
circumstances

Adherence to financial governance framework
33
5.2 Three Year Delivery Plan
Early in 2011/12, we agreed a three-year approach to delivering our strategic aims.
In our first year we are paving the way to ensure that we have the appropriate
foundations for future success, e.g. through developing robust collaborative
arrangements and relationships with partners, engagement and involvement of
stakeholders, training and development of primary care clinicians, and the
development of a comprehensive governance framework which will also ensure the
successful delivery of programmes
In our second year we will implement our programmes and plans if we have not
done so already, ensuring that we continue to involve stakeholders and learn from
the changes we are making. We will also ensure that service developments and
future plans are reflected in contract arrangements for following years. We will
continually monitor the changes we are making to ensure that they are having the
intended impact on improving patient outcomes and experience.
In our third year we will review and evaluate the changes we have made. We will
secure funding for on-going investment where programmes have been implemented
successfully, and revise our plans for areas that may not have had the expected
outcomes.
By the end of the third year we expect to see a successful step change in all our
strategic aim areas. We will share learning and will celebrate the positive changes
made. However, we will also recognise that there is much more to be done, and we
will be clear on both how we plan to sustain the changes made, and how we plan to
continue to improve for the future. We will formally revise our strategic aims at this
time to ensure alignment with emerging health trends, the strategic aspirations of
partners such as the Health and Wellbeing Board, and the opinions of local people
and clinicians.
We are committed to ensuring clinical leadership and clinical involvement in all of
our programmes. For this reason our GP Board members have clinical portfolios
supported by senior responsible officers to oversee and ensure the delivery of each
of our clinical programmes. Each work stream includes strong representation from
various clinical professions, social care, and management as appropriate to the
programme. Where common areas of interest exist, e.g. COPD and Frail Older
People, our ELR CCG programmes and clinical leads link into those of the LLR
collaborative (see section 12.2).
Year 1: Paving the Way

Finalising and ensuring robust governance arrangements

Getting the basics right

Understanding the needs of our local population through local JSNAs and
stakeholder engagement, and involving stakeholders to agree priorities

Developing our vision, values and strategic aims to inform the overall
direction of ELR CCG

Involving and engaging with patients, public, member practices, clinicians,
34
staff, partners and others

Bringing primary care clinicians up to a common level of understanding and
competence in the detection and management of conditions such as cancer,
diabetes, dementia and COPD, and improved referral

Increasing the number of patients with conditions detected earlier on

Reviewing our local healthcare estate to ensure we can use it in the best way
possible in the future

Developing good relationships with partners and building strong foundations
for collaborative working

Establishing work streams and programmes, ensuring both excellent clinical
leadership and involvement throughout, and joint working with partners
wherever possible and appropriate.
Year 2: Launching our Plans










Use the findings from reviews, research and best practice to inform the
direction of travel for this year and beyond, e.g. integrated care, best use of
local healthcare estate
Roll out the plans, either as pilots or in full. These will include new and revised
care pathways, and transformational work such as Diabetes, COPD, Frail
Older People and End of Life. It will also include initiation of the Integrated
Care Team programme to implement an integrated approach to community
care of patients with chronic co-morbidities
Implement the recommendations from the local healthcare estate review
Continue to deliver training and development within primary care to improve
earlier identification, prevention, and on-going management of conditions
Deliver training and education for patients to facilitate self-care and enable
them to make more informed choices about accessing services
Assess how risk stratification tools and techniques investigated and piloted
might support the ELR CCG Long Term-Conditions programme
Ensure good performance management and progress against plan. Review
where progress has not been as expected and revise proposals accordingly
Continue to strengthen partnership and collaborative arrangements
Build service changes into the contracting round for the following year
Continue to involve stakeholders on an on-going basis.
35
Year 3: Seeing Results

Consolidation of learning from the Long-Term Conditions pilots to inform the
commissioning of robust integrated pathways, which deliver care in
appropriate settings in a way that is sustainable and meets the needs of the
local people

Continued implementation of the integrated care pathway

Build changes into future contracts to ensure the appropriate levers for
sustainable, affordable change

Secure funding to ensure the on-going delivery of successful programmes

Develop and apply learning from pilots and programmes undertaken and
revise commissioning intentions and approaches accordingly

Involve all key stakeholders in evaluating the impact made on patient and
carer experience and outcomes

Share learning and celebrate success, whilst recognising the areas where
more work is needed

Continue to commission services based on emerging themes from national
frameworks

Revise strategic aims for following years to align with joint health and
wellbeing strategy and local health trends and priorities.
36
6
Transformational Programmes for 2012/13
This section outlines the transformational programmes agreed by the LLR
Commissioning Collaborative Board (see section 12.2) for investment during
2012/13 in both local East Leicestershire and Rutland schemes, and in LLR
schemes to be delivered jointly by commissioning partners. ELR CCG has ensured
that all programmes will contribute directly to the delivery of our six strategic aims
(see section 4.2).
6.1 NHS Operating Framework Guidance
The NHS Operating Framework sets out a requirement for all PCTs to set aside 2%
of their income to invest non-recurrently in supporting service transformation.
The purpose of the Fund is to reinforce delivery of existing priorities by accelerating
the pace of service transformation. All schemes must therefore be able to
demonstrate that they will make a direct and significant contribution to at least one of
the following categories:
 National priorities and commitments as set out in the NHS Operating
Framework
 Regional priorities and commitments (ambitions) as set out in the SHA Plan
 Local priorities and commitments as set out in the PCT Cluster Integrated
Plan and the three CCG commissioning priorities
 The LLR QIPP work streams
 Provider-specific CCG commissioning intentions
 Internal provider efficiency and cost base reduction
6.2 LLR Transformation Fund - 2012/13 Approach
Following the allocation of transformational funds to support pre-committed contract
arrangements with providers, the NHS 111 service (see section 7.2.9), and the
restructuring of commissioner and provider organisations across LLR, a total of
£9.3million remained for investment by the three CCGs and the LLR PCT cluster in
key transformational programmes.
For this year, it was agreed that resources will be allocated at commissioner level, rather
than by provider. This means that the relevant ‘stake’ of the overall transformational fund
will be clearly visible in terms of each of the three CCGs operating in Leicester,
Leicestershire and Rutland, and the LLR PCT Cluster.
The fund will be managed jointly by the three local CCGs and the Cluster, with investment
decisions taken through the LLR Commissioning Collaborative Board (which
incorporates representatives from ELR CCG). This process will enable the four bodies
to invest jointly in LLR-wide priorities whilst also retaining the ability to tailor funds to local
need where this is appropriate. Most importantly, in terms of preserving autonomy, final
sign-off for using each commissioner’s respective ‘stake’ will rest with their appropriate
governing body. Governance oversight will remain with the LLR PCT Board as the
statutory body.
ELR CCG has assessed and, where necessary, prioritised each proposed scheme
against the following criteria agreed by the three LLR CCGs:
37






Extent of contribution to strategic priorities/aims (see section 4.2)
Potential to reduce running costs of the NHS
Evidence base to support proposed service change/intervention
Level of clinical support
Ability to measure and monitor impact
Overall value for money
All bids were required to provide contingency arrangements which detailed what
might happen in the event of slippage in spending, or different outcomes to those
expected. Each project is formally measured against a number of locally-agreed
performance indicators, which are reviewed via the Transformation Steering Group
(ELR) and by the Commissioning Collaborative (LLR). These contingency plans
provide appropriate measures to take in the event that plans are not on track.
ELR CCG’s priority bids were then submitted for consideration by the LLR
Commissioning Collaborative Board in conjunction with bids from the other two LLR
CCGs.
6.3 Allocation of Funds
As many of the priorities were common to all three CCGs across LLR, the
Commissioning Collaborative Board agreed on a collective approach across five
areas.
Following the initial approvals stage, £2.3million of the transformational fund remains
unallocated. Total allocated funding for each LLR work stream is detailed below in
Figure 9.
Figure 9: LLR Transformation Funding Allocation 2012/13
Diabetes
COPD
FOP / Dementia / Care Homes
Emergency Care
IM&T
LLR Diabetes Group
COPD Working Group
LLR FOP Group
Emergency Care Network
IM&T Working Group
£1,000,000
£1,000,000
£2,000,000
£2,000,000
£1,000,000
Total Priority Investment Budget
£7,000,000
Five work stream groups have been identified to take this work forward. They will
adopt a LLR integrated pathway approach and involve representation from each
CCG. The agenda for each work stream reflects both the overarching LLR aims, and
the individual priorities of each CCG as outlined in their transformation funding bids.
Specific work stream aims and activities are outlined within the following sections.
6.3.1 Long-Term Conditions
The Department of Health defines Long-Term Conditions as a condition that cannot
at present be cured, but can be controlled by medication and other therapies.
38
Examples of Long-Term Conditions are diabetes, dementia, heart disease and
chronic obstructive pulmonary disease.
East Leicestershire and Rutland CCG recognises that patients with Long-Term
Conditions require a better quality of care that is more evidence-based and
structured. With our increasing older population, there will be an associated increase
in burden of disease with ever more people living with Long-Term Conditions.
As part of our key role to deliver sustainable improvement in the quality of Primary
Care and with this health need identified, the CCG will focus on the transformation of
care for patients with Long-Term Conditions. This will mean more co-ordinated,
integrated management of care, which is proactive and consistent across the health
and social care economy, and which results in improved outcomes.
To support the transformation from non-planned to planned care we will improve
health outcomes by investing in innovation in Long-Term Conditions and Telehealth.
Patients, GPs, Public Health and CCG clinicians have helped us to identify the need
for the development of a high quality, clinically-led and accessible service to improve
care in diabetes, COPD and other Long-Term Conditions.
All of our Long-term Conditions work streams (detailed in 6.3.2 to 6.3.4) are
underpinned by interactive, locally delivered educational events.
6.3.2 Diabetes
In 2011/12, we focused on training and education to improve skills within primary
care. This enabled GPs to treat more patients within a community setting, allowing
us to shift more activity from secondary care into primary care.
In 2012/13, further training is being scheduled to strengthen existing primary care
services, which support patients with diabetes. These courses will aim to achieve
both better clinical outcomes, and a reduction in multiple outpatient attendances.
They will also facilitate the offer of care closer to home for the patient. Additionally,
ELR CCG is planning to pilot the greater use of Diabetic Specialist Nurses. Current
provision is fragmented across the county and recruitment of additional nurses will
ensure a more equitable level of service provision, allowing for existing gaps to be
addressed.
A team of diabetes specialist nurses will work within a community setting, liaising
with primary care and holding clinics within GP practices. They will help to improve
skill levels in practices and support the Long-Term Conditions education programme
being rolled out across ELR CCG.
Key benefits from implementing this project will be:
 Reduction in health inequalities
 Increased levels of patient satisfaction
 Creation of a ‘left shift’ in activity (the movement of care to a lower cost
setting closer to home where it is safe and appropriate to do so)
 Improved levels of control and outcomes with no reduction in quality of
service
39
 Reduction in new referrals
 Reduction in the number of patients under active follow up within secondary
care
The wider health economy is looking at the development of an integrated Diabetes
pathway across Leicester, Leicestershire and Rutland, which is outlined below at
Figure 10. The work planned within ELR CCG complements and supports this
model. There is a clear focus on shifting care into the community, increasing skilled
capacity in primary care, and empowering patients to manage their condition. A
project group with strong representation from ELR CCG will take this piece of work
forward.
Figure 10: Integrated Diabetes Care Pathway for LLR
Primary care
‘The Necessary Nine’
1. Screening
2. Prevention
3. Regular review/
surveillance
4. Prescribing
5. Insulin
6. Patient education
7. Cardiovascular
8. Housebound/care homes
9. Outcomes/audit
Primary care
(core)
Primary care
(enhanced)
Specialist support
for primary care
Secondary and
Tertiary care
‘The Super Six’
Complex
care
1. Inpatient care
2. Insulin pumps
3. Renal
4. Foot
5. Children/adolescents
6. Pregnancy
6.3.3 COPD
In 2012/13 ELR CCG aims to improve the quality of care received by patients with
COPD. We also aim to increase the level of support to GP practices so that more
screening can be undertaken to improve and increase the identification of patients
who are at risk. This will be achieved by further education in primary care, improved
screening resources and improved access to relevant equipment and hand-held
records. This project will improve overall consistency and reliability of patient care,
and enable earlier clinical interventions, which can improve long-term outcomes and
will support patients in managing their conditions better.
40
6.3.4 Frail Older People
Funded by transformational funding, a number of initiatives are planned for 2012/13
to improve the care of frail older people. The aims of these projects are to:

Promote the health, wellbeing (including mental health) and continued
independence of older people through early intervention and prevention of
chronic illness, and by developing reablement and rehabilitation services to
improve and maintain older people’s functional abilities.

Promote the dignity and respect of older people by ensuring that staff across
health, social care and residential settings are appropriately trained to assess
and meet the needs of older people

Reduce the number of unnecessary admissions to hospital and excessive
lengths of stay by supporting pathway redesign. This will enable the “left shift”
of resources in areas such as end of life care, support of carers, risk
predictive modelling, and falls. These pathways will require the creation of
integrated health and social care teams working with primary care to provide
more holistic care to avoid some of the current patterns of over use of acute
care services.
Support the specialist assessment, treatment and care of frail older people in
crisis across community, primary and secondary care by developing greater
integration between specialist geriatric medical services both within
emergency care settings and outside of hospital
Work with other bodies such as the Emergency Care Network to ensure that
discharge processes for older people are as efficient and robust as possible
so as to avoid extended lengths of stay, delays in transfer and readmissions.


ELR CCG is also piloting the use of Risk Predictive Modelling and a case mix tool,
initially in five GP practices. This software will enable identification of patients who
are at most risk of hospital admission due to their current health status. Patients with
Long-Term Conditions will be treated on the basis of the totality of their health
needs, and those identified as high risk will be given a care and self-management
plan.
Projects are planned that will aim to realise the potential of care homes to reduce
emergency hospital admissions. GPs will have the option of admitting their patients
to a local care home with whom they have a good working relationship, instead of to
hospital.
The benefits of delivering this programme include less risk of hospital acquired
infections, a reduction in hospital emergency admissions, greater continuity of care,
reduced loss of independence and reliance on care homes, and care closer to
home.
Additionally, an amount of £349k from social care transfer monies has been
allocated to improve the safeguarding of vulnerable older people in care homes.
41
6.3.5 Emergency Care
Monitored on a monthly basis through the Emergency Care Network governance
structure, partners from across health and social care focus on a number of
initiatives to improve emergency care across Leicester, Leicestershire and Rutland.
These include:







Improving discharge from acute hospitals by 1pm, and from community hospitals
by midday
The development of a community IV antibiotics service to prevent stays in the
acute setting and bring care closer to home
Access to care home beds to support acute discharge for patients awaiting care
packages
Earlier conveyance of patients referred by GPs to the acute hospital, to reduce
unnecessary admissions
‘Choose better’ campaign to provide patients with appropriate information to
make informed and responsible decisions about accessing care
A GP/consultant hotline for urgent review of patient cases to increase
communication between primary and secondary care and enable more timely,
better clinical decision-making
Implementing the Hospital at Night scheme to enable fuller medical cover and
access to services around the clock, whilst preserving time for doctors’ training
6.3.6 Information Management and Technology
This work stream focuses on the delivery of a number of IM&T (Information
Management and Technology) initiatives, including electronic outpatient letters and
electronic prescribing to be implemented within our main acute provider, the
University Hospitals of Leicester (UHL); GP system migrations and upgrades; online
access to patient records; systems training; and Telehealth. A joint clinical lead has
been appointed by West Leicestershire, and East Leicestershire and Rutland CCGs
to champion IM&T developments across the two CCGs.
6.3.7 East Leicestershire and Rutland Integrated Care Model
In addition to developments through Transformation Funding, ELR CCG has
prioritised £400k investment in the development of an Integrated Care Model for
implementation across East Leicestershire and Rutland. This has been matched by
a £500k contribution from Leicestershire County Council.
Research tells us that improved care co-ordination can have a significant effect on
the quality of life of frail older people, and people with multiple Long-Term Conditions
(Hofmarcher et al, 2007). As part of a three-year strategy, we aim to build fully
integrated health and social care teams, based around local populations. This model
will see improved integration of local services across health and social care, and will
involve care providers from:
 the acute sector
 community health
 GP practices
 social care
 voluntary and private sectors
42
The care teams will focus on providing better, local and faster access to care, and
improved services for patients with chronic complex conditions. They will provide
patient-centred care, supporting self-management and reducing unnecessary
admissions to hospital. This will be facilitated by empowering patients to maximise
self-care, risk profiling patients, and enabling joined-up working between the various
and previously diverse care providers.
The first stage of implementation in 2012/13 will see ELR CCG embark on a wider
engagement process, where we will bring together members of the stakeholder
teams in addition to utilising current stakeholder forums. This will involve a series of
meetings and workshops with individuals and groups including patients, carers and
staff from the various providers. We will use patient experience narratives to
highlight our vision.
Those involved will be asked if we can improve integrated care, and what an
integrated approach might look like for local teams. This approach will elicit ‘best
practice’ models for the local population, ensuring that organisations and individuals
are signed up and willing to work in new ways to improve outcomes for their
patients.
This three-year programme is a key enabler to the delivery of our strategic aims as
follows:
 Delivering care closer to home
 Use of care homes for “step up” / “step down” beds
 Improved care and outcomes for frail older people and patients with dementia
 Shift of activity away from the acute sector to the community.
 Care for Long-Term Conditions being mainly community based
 Delivery of community-based reablement initiatives in partnership with the
Local Authorities
By the end of 2012/13 we will have an agreed new model of care that informs contracting
rounds so that a move towards the integration of care pathways can commence in
2013/14.
43
7.
Operational Priorities and Plans
This section outlines the key operational priorities for ELR CCG in 2012/13. These
have been identified as a result of triangulating findings from the JSNA, with
feedback resulting from engagement with constituent GP practices and other local
clinicians, experts and partners; and with data comparisons between local outcomes
and ONS cluster/England performance. We have also undertaken extensive
consultation with patients, carers and members of the public to determine priorities
and areas for improvement.
Our operational priorities link directly to the following:









NHS Operating Framework (2012/13)
NHS Outcomes Framework (2012/13)
NHS Midlands and East Regional Commissioning Framework (2012/13)
SHA Ambitions (2012/13)
LLR Integrated Plan (2012/13)
Joint Strategic Needs Assessment
Shadow Health and Wellbeing interim strategic priorities
Transforming our health care system – Ten priorities for commissioners (The
Kings Fund 2011)
NHS Constitution
Achieving improvements in these areas will ensure that we are getting the basics
right for our patients and carers. Addressing requirements as set out by the NHS
Operating and Outcomes Frameworks is essentially a ‘must do’, and might be
considered as the CCG’s ‘licence to operate’.
7.1 Local Priorities
Following engagement with our various stakeholders, including member practices,
clinicians and local providers, a number of local commissioning themes have been
identified to inform our operational priorities for 2012/13. ELR CCG has ensured that
these priorities link with local Health and Well-Being Board priorities and the five
pillars of the NHS Outcomes Framework, which are as follows:





reduce the number of people dying prematurely;
enhance the quality of life for people with Long-Term Conditions
help people to recover from episodes of ill health or following injury
ensure that people have a positive experience of care
ensure that patients are treated and cared for in a safe environment and that
they are protected from avoidable harm
Our priorities also link with the two high level outcomes detailed within the social and
public health outcomes framework, which are: to increase healthy life expectancy;
and to reduce differences in life expectancy and healthy life expectancy between
communities.
44
7.1.1 Pathway Redesign
We have a number of areas where we wish to improve patient and carer services
over the coming year. These are presented below by organisation/contract. Work
involves the review of pathways, development of service specifications, and
implementation of recommendations and best practice.
University Hospitals of Leicester NHS Trust
o Diabetes community-based model
o COPD community-based model
o DVT Service
o Early Pregnancy Assessment Service (EPAU)
o Elective activity shift into the community (safe and cost-effective)

Leicestershire Partnership Trust (Mental Health)
o Crisis Resolution Health Team
o Improved choice in mental health
o Adherence to formulary and 28 day prescribing
o Single point of access (SPoA)
o Personality disorder pathway

Leicestershire Partnership Trust (Community Services)
o Adult Community Nursing
o Adult Physiotherapy
o Intermediate Care

Primary Care
o Glaucoma pathway (Optometry)
o Enhanced Services (outcome of current commissioning review)
o Clinical peer review (continual learning and improvement)

Out-of-County (increasing influence sought e.g. Right Care)

East Midlands Ambulance Service
o Admission protocols

Derbyshire Community Foundation Trust (Access to diagnostics at
Community Hospitals)
7.1.2 Reduce Health Inequalities
We recognise from the JSNA that, alongside specific groups, such as travellers and
military families, there are a number of geographical areas with inequalities in health,
such as life expectancy and prevalence of cancer, cardiovascular disease (CVD),
respiratory diseases (in particular COPD), and other long-term conditions including
diabetes. These areas have higher levels of deprivation, and include
neighbourhoods within Oadby and Wigston, Blaby, Harborough, Melton, and
Rutland.
Both Health and Wellbeing Boards share our strategic aim of reducing health
inequalities and we will work collaboratively with our partners to develop and
45
implement plans to improve health and wellbeing in key areas. Discussions have
already commenced with Leicestershire County Council to consider the possibility of
joint investment to target certain localities.
Key areas of focus to improve health in the longer-term include:





Increasing access to smoking cessation services
Promoting breastfeeding and the achievement of the UNICEF/WHO Baby
Friendly Initiative
Tackling obesity and physical activity, e.g. through nutrition and lifestyle
services
Delivering targeted healthcare services and support for families and
vulnerable parents through local children centres, e.g. Surestart
Reducing alcohol-related harm through identification and brief intervention
In collaboration with partners, we are committed to delivering the Together Health
Inequalities Action Plan (2012-2015), a copy of which can be found in Appendix 5.
This action plan covers the following areas:




Supporting families, mothers and children
Engaging communities and individuals
Preventing illness and providing effective treatment and care
Addressing the underlying (wider) determinants of health
Furthermore, we are ensuring that all of our programmes of work consider the
opportunity to reduce health inequalities as part of their key objectives. For example,
with Long-Term Conditions we have expanded community-based services which will
help to improve access and which, we believe, will benefit disproportionately those
with the greatest of health needs. These programmes include the initiative to reduce
emergency admissions through better management of CVD risk factors within
primary care, such as the monitoring of cholesterol, blood pressure and DM
(Diabetes Mellitus), and the more appropriate use of aspirin.
We have also increased opportunities for patients to access lifestyle risk
management services, including stopping smoking, exercise referral and alcohol
brief intervention services.
ELR CCG has recently reviewed its local enhanced services, including alcohol brief
intervention and long-acting reversible contraception, with the specific objective of
increasing equity of access.
7.1.3 Mental Health
Improving the quality of mental health services is one of the key areas of focus for ELR
CCG and for the Health and Wellbeing Boards. NHS Operating Framework requirements
for mental health services will be delivered collaboratively across the LLR PCT Cluster
during 2012/13 and will include:
46




Improved access to psychological therapies as part of the commitment to roll-out
fully by 2014/15 so that services remain on track to meet at least 15% of disorder
prevalence
Improved physical healthcare of those with mental illness to reduce their excess
mortality
Improvements in offender health
Improvements in targeted support for children and young people at risk of
developing mental health problems such as ‘looked after’ children.
We are also undertaking work across a number of mental health-related pathways.
These are detailed below.
Dementia Pathway
Working jointly with partners, ELR CCG is the appointed lead for the implementation
of a joint health and social care commissioning strategy for dementia. Led by a
Board GP, the aim is to integrate health and social care commissioning to result in a
co-ordinated dementia pathway. This will include a new memory assessment
pathway, where GPs will receive specialist dementia training and work more closely
with specialist psycho-geriatricians and specialist memory assessment nurses.
There is also a focus on ensuring greater support for carers.
For those people living with dementia and their carers, GPs will promote referrals to
dementia advisors (commissioned by the local authority), who will provide support
and advice following their diagnosis. The three LLR CCG GP leads for dementia will
continue to engage with all stakeholders, in particular the three Local Authorities and
our main acute care provider, UHL, to improve the detection of dementia and to offer
support to people with dementia in the general hospital setting. Funding has been
allocated to develop elements of this pathway and to expand specialist in-reach
dementia care for patients living in care homes. It is envisaged that this pathway
redesign will enable GPs to support more people with dementia and to improve
dementia diagnosis rates.
A Local Enhanced Service, funded by £200k of recurrent funds, will deliver an
agreed Shared Care Scheme to facilitate the use of new pathways, and so lead to
better and earlier identification of patients with dementia.
Improving Access to Psychological Therapies
We are part of an LLR-wide programme, led by West Leicestershire CCG, to review
the provision of IAPT services in Leicestershire. This review will ensure that all
aspects of mental health care continue to be provided at a primary care level using a
stepped-care approach.
Mental Health Facilitators, who support people with Severe Mental Illness, are
working alongside IAPT therapy workers in primary care to provide an innovative,
comprehensive primary care mental health service. This is assisting GPs both in
preventing the need for onward referral, and in supporting people following
discharge from secondary care services.
47
Acute Care Pathway
Through our contracted service development with our local mental health provider,
LPT, plans are under way to implement a new acute care pathway. This will replace
the many and varied access routes to secondary care mental health services, to
provide one single point of access. This will enable a timely response for all users
and eliminate the confusion between “emergency”, “crisis”, and “urgent” response
services. This follows both user and GP feedback about the requirement for more
timely access to services at times of greatest need.
Mental Health Care Cluster Pathways
We will deliver local plans to implement the national mental health Payment by
Results (PbR) care cluster. This will enable better planning of services, including
staff capacity and capability, and will ensure that providers are paid specifically on
the basis of the services provided in terms of quality and activity. This will move us
away from the traditional block contract arrangements in place. Each of the 21 care
pathways identified within the cluster will aim to improve patient care and
experience; for example, patients will be informed at the outset about what to expect
in terms of services they will receive and related waiting times.
Increasing mental health professionals
A total of £302k has been allocated to facilitate early discharge and increase the
adult mental health work force to improve the quality of patient care and outcomes.
This includes professional posts to support crisis resolution, and home treatment
and in-patient services
7.1.4 Cancer
Overall, excellent progress has been made over recent years with respect to the
target to reduce premature mortality from cancer, with the rate having dropped by
almost 20% in Leicestershire County and Rutland PCT between 1993 and 2010. We
have implemented a number of measures over the past year, linked to our LongTerm Conditions programme, which will help to improve diagnosis and to prevent
cancer (see sections 3.1 and 3.3) on an on-going basis.
In primary care we will continue to focus on the early diagnosis of cancer, and on
programmes of prevention to ensure increased survival rates and better health for
our local population. ELR CCG is committed to expanding breast, bowel and lower
GI screening as well as to increasing access to healthy lifestyle and prevention
programmes, such as smoking cessation, obesity and substance misuse. We will
work with Public Health England and Local Authorities to optimise benefits for
patients.
We will re-run a cancer audit, where member practices will look at the pathways of
patients recently diagnosed with cancer to identify delays to diagnosis or treatment.
We will use this information to focus on the key issues identified to improve the
quality of services for patients, to result in more efficient pathways and better patient
outcomes and experience.
ELR CCG plans to raise awareness of the ‘Direct access to diagnostic tests for
cancer best practice referral pathways for General Practitioners’. We have worked
with our providers to enable increased access to a diagnostic test undertaken within
48
a community setting. We are procuring via the AQP (Any Qualified Provider) route to
increase the local availability of ultrasound, and so increasing patient choice and
access.
7.1.5 CVD
Cardio Vascular Disease (CVD) is one of East Leicestershire and Rutland’s areas of
greatest inequality and therefore remains a priority. ELR CCG believes that better
improvements in health outcomes per pound invested will be achieved by investing
“upstream” in the care pathway. Early detection and treatment through improving GP
awareness of TIA and stroke referral processes is one such example of this.
Our prevention programmes in smoking cessation, obesity and lifestyle, and alcohol
misuse, as described elsewhere within this plan, form part of our strategy to improve
the health of our local population in the longer-term.
Over the last year we have also increased access to health checks. These have
increased the early detection and prevention rates across East Leicestershire and
Rutland by detecting those most at risk of developing CVD over the next 5 years.
This follows on from earlier programmes to enable early detection of conditions,
leading to a significant increase in the number of patients recorded with prevalence
of disease, for example atrial fibrillation and heart failure. These patients are
subsequently offered lifestyle advice and access to a range of programmes to help
them to reduce their overall level of risk in the longer term. This programme remains
a priority for ELR CCG in 2012/13 and significant investment has been made to
support this.
Since the publication of the National Stroke Strategy in 2007, there has been
significant progress in a number of key areas on the hyper acute and acute stroke
pathway, as well as inpatient rehabilitation and primary prevention. Going forward,
ELR CCG will ensure that this momentum is upheld, and we will remain actively
involved in the development of the stroke pathway whilst continuing to progress
these areas.
We will continue to work collaboratively with partners such as service providers,
primary care, the East Midlands Cardiovascular Network and the SHA Cluster to
maintain a focus on these key areas. The development of plans for stroke, atrial
fibrillation and heart failure will feed in to our wider Long-Term Conditions
programme.
7.1.6 Delivery of LLR Key Performance Indicators
We will continue to focus on improving performance against national targets where
we remain outliers against CCGs with similar population profiles. Action plans are in
place for these, both at ELR CCG and at LLR level where appropriate, and work is
already under way (see section 3.5.5). Key areas of focus for 2012/13 remain as
follows:


Percentage of people who spend at least 90% of their time on a stroke unit
Percentage of people who have a TIA who are scanned and treated within 24
hours.
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



Percentage of people offered a health check and percentage of people who
have received one
Percentage of women who have seen a midwife for a full health and social
care assessment by 12 week and 6 days of completed pregnancy. (See
section 7.5.2)
Percentage of people seen within 4 hours in A&E (see 6.3.5)
Percentage of people who commence treatment within 18 weeks from GP
referral to the start of hospital treatment
See Appendix 3 for our National and Local Target Priorities – Delivery for 2011/12
and Targets for 2012/13.
7.1.7 Research and Development
ELR CCG understands the requirement to comply with our statutory responsibilities
regarding promoting research and development (R&D).
Through the LLR Cluster arrangements we are members of the LNR (Leicestershire,
Northamptonshire, Rutland) Comprehensive Local Research Network (CLRN) and
have included the formal governance arrangements for research within the terms of
reference of our Quality and Clinical Governance Committee.
We are committed to the policy of ensuring that the NHS meets the treatment costs
for patients who are taking part in research funded by Government and by research
charity partner organisations. We do this through the hosting arrangement we have
in place within Leicester City CCG. This includes:

A LNR Comprehensive Local Research Network (CLRN) funded research
facilitator based within the R&D team

Agreements with LNR CLRN for the provision of research management and
governance services for portfolio and non-portfolio research services
- Receipt of Research Capability Funding 2012-13 as research active
organisations
- Bi monthly R&D group meetings and research governance reporting to
Cluster
7.1.8 Other Local Enablers
There are a number of enabling programmes and activities which are critical to the
successful delivery of our strategic aims. These include:



The development of our organisation and its people, as outlined within our
Organisational Development Plan. This includes developing clinical leaders,
both for now and for the future, and ensuring the capacity and capability to
deliver our integrated plan (see section 12.6)
The finalising of service level agreements and contracts between ELR CCG and
our Commissioning Support Service, GEM CSO (Greater East Midlands
Commissioning Support Organisation) (see section 10.5)
Ensuring the best use of healthcare estate (see section 8.6)
50



The development of joint health and well-being strategies for Leicestershire and
Rutland (see section 10.1)
The agreement of collaborative commissioning arrangements with partners (see
section 12.2)
The finalising of robust programme management arrangements to deliver key
strategic and operational priorities, as outlined within section 12.2.
7.2 NHS Operating Framework
The Operating Framework for the NHS in England 2012/13 was published in
November 2011 and sets out the planning, performance and financial requirements
for the NHS in 2012/13, together with the basis for which the NHS will be held to
account. The Operating Framework sets out four key themes for 2012/13:




Putting patients at the centre of decision making
Development of the new system for delivery
Quality, Innovation, Productivity and Prevention (QIPP)
Managing and Improving Performance
It is acknowledged that 2012/13 is the final year of transition to the new
commissioning management system for the NHS.
The Operating Framework identifies a number of key areas that require specific
attention during 2012/13. We have set these out below along with our approach:
7.2.1 Dementia
ELR is fully engaged with developing the National Dementia Strategy across East
Leicestershire and Rutland. Please see 7.1.3 for more details.
7.2.2 Care of Older People
The care of older people is a strategic priority and ELR CCG has both identified a clinical
lead for Frail Older People, and signed up to an older person’s pathway (see section
6.3.4). The pathway incorporates:




Risk-predictive modelling
Reablement
Enhanced multi-disciplinary geriatric care for patients in the acute sector
Work to support patients in care homes as part of locality-integrated teams in the
community
 Greater identification and support of dementia patients (and their carers)
Delivery will be largely through integrated health and social care locality teams and
improved access to specialist geriatric care in the acute sector. This large patient group
has high levels of need, risk and cost, and offers significant opportunities to improve the
quality of care and patient experience.
51
ELR CCG will:





Improve clinical outcomes – especially in dementia, diabetes, COPD, CHD and
end-of-life care
Move care closer to the patient
Reduce expenditure on unnecessary, non-elective hospital admissions
Continue the shift towards prevention, self-care and maintaining the independence
of older people
Successfully deliver National Framework and LLR priority outcomes
Further details on ELR CCG’s plans for developing integrated working across health and
social care are included in section 6.3.7.
7.2.3 Carers
Through our clinical lead for Frail Older People, ELR CCG is the appointed lead to
implement the refreshed Carers Strategy – Supporting the Health and Wellbeing of
Carers, which relates to all carers regardless of age. This was formally signed off by the
local authority cabinets and the LLR Commissioning Collaborative Board in May 2012.
New funding has been identified from the Health and Social Care Fund to support
implementation of the strategy, and Section 256 carer contracts (formal funding
arrangements between the CCG and the local authority) are currently being reviewed. A
strategy implementation plan has been developed in order to meet national timescale
requirements.
7.2.4 Military and Veterans
An Armed Forces Champion has been identified to represent the LLR PCT Cluster and its
constituent CCGs at the East Midlands Regional Armed Forces Forum. This forum
oversees the implementation of the Ministry of Defence / NHS Transition protocol for
those seriously injured in the course of their duty.
The Leicester Disablement Service Centre has an excellent understanding of veterans’
prosthetic needs and includes a consultant-led amputee prosthetics and rehabilitation
service. They are also the prosthetics provider to the Defence Medical Service at Headley
Court and are fully conversant with the Murrison report (‘Fighting Fit’ - a mental health
plan for servicemen and veterans 2010) and the Military Covenant (2000).
The Army is repatriating two regiments from Cyprus in 2012 and Germany in 2013 to
the former RAF Cottesmore base in Rutland. This new Ministry of Defence base will
become the home of up to three further regiments as part of the Army 2020 review
and will bring significant potential health care needs, especially in maternity and child
health care. ELR CCG has led a cross-party health committee with the army and
Rutland County Council alongside all key stakeholders to make sure that the local
healthcare system is prepared for and tailored to the arrival of the initial 2,000
soldiers and their dependents.
This review of the health needs of the incoming army population and the subsequent
planning of service delivery will also help ELR CCG to plan services for the wider
Rutland health community.
52
7.2.5 Health Visitors and Family Nurse Partnership
It is clear that health visiting numbers are a top priority for the Department of Health
(DH) as set out in the document: “Health Visitor Implementation Plan 2011-2015 – A
Call to Action”. The key aim of the Programme is to improve services and health
outcomes in the early years for children, families and local communities, through
expanding and strengthening the health visiting workforce, with an extra 4,200
Health Visitors in post nationally by April 2015.
This will be achieved through:
 Implementation of local Health Visitor Implementation Plan 2011/2015 – A
Call to Action
 Increase in the number of Health Visitor training places
 Increase in the number of Health Visitors
 Review of local current service structure
 Becoming a national early implementer site - wave two
ELR CCG is working with NHS Midlands and East to deliver the Government’s
commitment to increase the number of health visitors to required levels by April 2015, and
to maintain existing delivery and continue expansion of the Family Nurse Partnership
Programme. A total of £210k development funding has been allocated to LPT for this
purpose.
7.2.6 Use of Telehealth and Telecare
ELR CCG and our partners, particularly in social care, are keen to explore the benefits of
Telehealth and Telecare as part of the on-going transformation of local services. Both
have been identified as high impact innovations in Innovation Health and Wealth
(Department of Health 2011). The LLR PCT Cluster undertook a successful Telehealth
respiratory care pilot at Glenfield Hospital. Through this we are working collaboratively
with local authority partners in the city and counties to embed Telehealth and Telecare
into joint work supporting independence, and avoiding or delaying hospital and
institutional admissions.
Headline findings of the Department of Health’s Whole System Demonstrator Programme
(2011) are now available and show that Telehealth can substantially reduce mortality, the
need for admissions, the number of bed days and time spent in A&E. It also highlights
that the key to success is to integrate these technologies into care and services. As
further programme evidence becomes available it will be considered by the LLR
Commissioning Collaborative Board to ensure integration into key service redesign work
streams including diabetes, COPD, dementia, frail older people and integrated
community teams. Taking this work forward, ELR CCG is keen to contribute to the Three
Million Lives campaign (2011) 1, and will work closely with local authorities to maximise
benefits for patients across health and social care.
1
At least three million people with Long-Term Conditions and/or social care needs could benefit from
using Telehealth and Telecare. To achieve this level of change the Department of Health is planning
to work with industry, the NHS, social care and professional partners in collaboration with a
difference, the “Three Million Lives” campaign.
53
ELR CCG will be working with the Leicester, Leicestershire and Rutland (LLR) IM&T
Delivery Board in reviewing progress with Telehealth across the LLR health
community. Together, we will consider a wider and more strategic and co-ordinated
approach to gain the maximum benefits possible from Telehealth and Assistive
Technology initiatives. Just over £1m of social care transfer funds has been
assigned to this programme.
7.2.7 Mental Health
See section 7.1.3 above.
7.2.8 Patient Experience and Feedback
Improving patient experience and using patient feedback is a theme that runs throughout
the NHS Operating Framework. It is also a SHA ambition and is supported by the NHS
Constitution.
ELR CCG will maintain a focus on improving patient experience and collating evidence
and feedback to influence the commissioning and contractual process. The LLR PCT
Cluster will also develop a Patient Revolution Action Plan for 2012/13, along with a
timetable of system activities and milestones for implementation. The LLR PCT Cluster
Director of Nursing is the lead working with colleagues to produce and implement an
agreed action plan.
As part of the implementation plan all providers will be required to ask the ‘net promoter’2
question in all patient surveys from April 2012/13, with subsequent scores in patient
survey reports expected to demonstrate a continuous improvement.
ELR CCG, initially through the LLR PCT Cluster, will work with provider colleagues to
ensure the realisation of the SHA Cluster ambition for all acute organisations to
demonstrate more than 10% improvement on scores by March 2013 (or top quartile
improvement).
ELR CCG will not only promote innovative ways to undertake real-time patient surveys,
including the use of web based tools, but will also build on existing good practice by
utilising evidence from national patient surveys. As of 1 April 2012 all acute hospitals now
have mechanisms in place for obtaining real-time patient feedback, and demonstrate
commitment to improving patient experience during 2012/13.
The information provided from real time data capture will be the subject of discussion
within the contract monitoring process to ensure that sufficient emphasis is given to rectify
any negative feedback, but also to promote good practice and share positive feedback
directly to staff at a clinical and departmental level.
2
The Net Promoter Score (NPS) - A standard net promoter question is 'How likely it is that you
would recommend our company to a friend or colleague?' and respondents indicate this likelihood on
a 10-point rating scale. Those scoring services with a 9 or 10 are promoters, those scoring 0-6 are
detractors and those between 7-8 are passively satisfied or neutral. The NPS is the difference
between the percentages of users who would recommend your services minus the percentage of
those who would not. A score of 75% or above is considered quite high.
54
The CCG has set up processes as part of our governance arrangements to ensure that
the patient’s voice is central to the activities of the CCG. Monthly reports providing a highlevel summary of engagement activity, patient experience, practice and stakeholder
feedback are presented to the Quality and Governance Sub-group of the ELR CCG
Board. These reports are in turn reflected in the monthly minutes submitted to the
Governing Body.
Quarterly reports on patient experience, engagement and feedback are received by the
ELR CCG Board for information and action as appropriate.
Patient experience and feedback reports and/or summaries will also be circulated to
relevant CCG staff to ensure that intelligence and insight about patient experience is
incorporated in the everyday business of the CCG.
7.2.9 NHS 111
The NHS 111 initiative will result in a freephone number for patients to call 24 hours a
day, 7 days a week, 365 days of the year to respond to their non-emergency healthcare
needs. It will be operated by highly trained advisers and supported by experienced
clinicians, who will assess the caller’s needs and determine the most appropriate
course of action.
The service will be supported by an electronic Directory of Services (eDoS), NHS
pathways triage system and a capacity management system. The project is being
designed in conjunction with all LLR CCGs to take into account local pathway
developments, clinically-led initiatives and desired end points that include ensuring
patients are seen in the right place, first time across the LLR urgent care system
ELR CCG, in collaboration with the LLR PCT Cluster, has opted to undertake a local 111
procurement parallel to (but independent of) the regional procurement process. This will
ensure a robust and locally driven service, tailored to the needs of the LLR population. A
locally-led pilot will commence in August 2012 and last until March 2014, at which point
the chosen provider will take over.
7.2.10 Travellers
Historically, there have been inequalities in targeted health care service for the 1,400
members of the travelling community within the East Leicestershire and Rutland
area. There has been a successful service operating in South Leicestershire, which
covers approximately 400 travellers. The learning from this is being used as the
basis for a wider service, to be rolled out in 2012 in conjunction with the county and
district councils.
ELR CCG has prioritised significant investment to tailor a service to help reduce
health inequalities amongst this section of the population. We are currently working
with public health to assess health needs and current provision. A Local Enhanced
Service will be introduced to underpin improvements in access. This year we have
added a recurrent £100k to the existing £50k fund to address health inequalities
within the travelling community.
55
7.2.11 Compliance with the Equality Act
Delivering Equality and Diversity for the CCG has been set out in our comprehensive
Equality and Diversity Strategy (2012-15) and its supporting delivery plan. We have
agreed our equality objectives in line with the Equalities Act (2010) and the LLR PCT
Cluster.
We have made a commitment to use the Equality Delivery System as the
audit/performance tool of choice to ascertain robust and meaningful knowledge that
will support our ambitions for effective equality and diversity practice throughout the
CCG. This will provide us with real-time data to deliver effective commissioning to
our patients, working in collaboration with our partners.
We have also set aside a statement of intent in relation to our Equality and Diversity
ambitions, and these have been incorporated into our Equality and Diversity
Strategy. A key focus of our strategy is that our Accountable Officer is the equalities
champion for the promotion of equality and diversity within the organisation.
We have agreed that our providers and our policies are bound by the duties placed
upon us as a public sector organisation with due regard to the protected
characteristics as set out in the Equality Act (2010). This means that our community
engagement plan; OD plan; and commissioning plan conjoin to deliver and
determine best equality and diversity practice. There are a number of examples
which demonstrate how, based on the JSNA and specific needs assessments, we
are commissioning and targeting activity at CCG level that will deliver against our
equality objectives. These include Long-Term Conditions programmes for diabetes,
COPD, and end of life care;work streams linked to frail older people and maternity
service redesign; and initiatives targeted at specific communities such as travellers,
and geographical areas with higher levels of deprivation.
All proposals for service developments are subject to comprehensive Equality
Impact Assessments which include ‘due regard’.
7.3 Delivery of LLR QIPP Programmes
The LLR health system has a track record of working collectively within an agreed
financial envelope. The two PCTs forming the LLR Cluster are going into 2012/13 with
healthy underlying surpluses. In addition, the 2% transformation funding and local
authority reablement funding will further pump prime system change.
ELR CCG QIPP (Quality, Innovation, Productivity and Prevention) programmes are
forecast to deliver a total of just under £5.8 million in 2012/13 in the following areas:
56
QIPP Description
Urgent Care - LLR Work Stream
and Clinical Variation
Right Care - LLR Work Stream
OP attendance - Clinical Variation
Peer Review
IT Solution to Care Pathway
OOC Urgent Care Reductions
Integrated Care
Prescribing
Prescribing - Cat M Drugs
Capacity & Assets
Facilities Management
Continuing Healthcare
Joint Commissioning MH
Total QIPP
£'s
776,000
731,562
221,000
200,000
100,000
975,000
1,000,000
700,000
184,480
184,480
235,440
461,200
£5,769,162
Our approach to delivering our QIPP target is to integrate the delivery of QIPP outcomes
into relevant work stream areas. In this way, the focus on reducing costs sits directly
alongside delivering improvements in quality. QIPP targets are an integral part of every
programme’s key performance indicators, against which the programme team is held to
account. For example, the QIPP deliverable for Right Care sits within the programme for
Right Care (see section 3.5.3); for Prescribing, see section 3.4; and for mental health, see
section 7.2.7.
A more detailed table outlining QIPP programmes and their respective savings can be
found in Appendix 8.
Achieving these savings is critical to the balancing of our financial plan for 2012/13, which
is attached in Appendix 7. Appendix 9 outlines the forecast QIPP savings plan from
2013/14 to 2015/16 based on current financial planning assumptions.
The LLR approach to QIPP is to be clear about pathway and service transformation, then
to reflect this in contracts with, and targets for individual provider organisations.
Opportunities for whole-system pieces of work are then assessed.
All QIPP priorities are subject to a quality impact assessment to identify both benefits and
risks to the quality of patient care. Quality indicators are in place to enable the monitoring
of provider performance against QIPP plans. This ensures early signals of deterioration in
the quality of care as a result of provider cost improvement plans (CIPs).
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7.4 SHA Ambitions
The majority of patient contacts, access, co-ordination and continuity of care is
provided within primary care. However, quality and safety can be variable and there
is currently no single defining set of measures for quality in primary care. In order to
address this, the SHA has agreed a number of priority areas in which to deliver
significant improvements in quality and safety in primary care within 2012/13.
ELR CCG is committed to supporting the achievement of the NHS Midlands and East
Strategic Health Authority (SHA) Cluster Ambitions, which are:





The elimination of avoidable grade 2, 3 and 4 pressure ulcers by December
2012
‘Making Every Contact Count’
Quality and safety in Primary Care
Ensuring radically strengthened local government partnerships
Creating a revolution in patients and customer experience
7.4.1 Pressure Ulcers
A pressure ulcer can often be a reflection of the quality of overall nursing care. Therefore,
realising the ambition of eliminating avoidable pressure ulcers will be an indicator of the
level of nursing care across a range of areas, such as hydration and nutrition.
The LLR PCT Cluster Director of Quality has been charged with leading the realisation of
this ambition. Led for CCGs by the ELR CCG Chief Nurse and Quality Officer, we will
ensure the elimination of avoidable pressure ulcers grade 2, 3 and 4 by the end of
December 2012. We are adopting a task force approach to this programme, with sign up
from all CCGs and major providers.
The aim will be achieved aided by regular monitoring information, embedded in the
contractual process to emphasise its importance. The contractual process will also
include the treatment and prevention strategies adopted by provider organisations. For
some providers the increase in data recording systems will be significant and will require
additional resources to achieve the baseline target of 100% of patients assessed in all
areas, followed by a continuous improvement in the reduction of recorded avoidable
pressure ulcers.
This data will be provided via the SHA’s NHS Safety Thermometer harm measurement
instrument, which has now been implemented in all provider contracts for 2012/13.
The LLR PCT Cluster will launch supporting documentation, such as ‘Pressure Ulcer
Assessment and Treatment’ bundles and ‘Good Practice for Nutrition and Hydration’. The
Cluster will also seek assurance from all providers, via evidence within the contractual
process, that they have an identified Board Champion and a Clinical Lead, and that
regular reports are received at their public Boards, outlining implementation and remedial
actions, as necessary.
The LLR PCT Cluster will ensure that best practice and ‘lessons learnt’ are shared
effectively via the established regular formal and informal communication systems
between providers and commissioners. This will include regular reporting on achievement
of this ambition in LLR PCT Cluster public Board reports.
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7.4.2 Making Every Contact Count
Public health teams from Leicester, Leicestershire and Rutland are working together to
support the implementation of the SHA ambition of Making Every Contact Count (MECC).
MECC is a long-term strategy that aims to help us create a healthier population and
reduce NHS costs. MECC puts the prevention of health problems and disease at the
heart of every NHS contact. The aim is to use each contact with a patient to offer
appropriate brief advice on staying healthy.
The LLR PCT Cluster has undertaken local initiatives to provide healthy lifestyle advice
via frontline NHS staff. This includes enabling GP brief interventions for alcohol, alcohol
liaison workers within the acute trust and brief interventions to provide smoking cessation
advice. This is underpinned by guidance such as alcohol identification and brief advice,
and NICE Guidance on smoking cessation.
Recent local experience of regional QIPP and CQUIN schemes for stop smoking through
acute trusts has demonstrated that a higher-level approach is the most effective way of
achieving large scale and coherent system change. The important role for the CCGs is to
ensure co-ordinated local movement on the MECC agenda that anticipates the higherlevel developments through Health Education England. The NHS Midlands and East draft
MECC CQUIN3 (whether for local or regional implementation) provides a basis for
embedding MECC in contracts and it is ELR CCG’s intention that MECC will be part of
contractual arrangements with current providers.
As part of its commitment to MECC, ELR CCG will:
 Work with the LLR PCT Cluster, secure engagement and a commitment from all
NHS organisations commissioned by them to the ambition and achievement of
agreed metrics
 Agree a work programme devised by the LLR PCT Cluster to develop and
implement health improvement training for staff, data collection and reporting
mechanisms across NHS organisations, with a potential initial focus on smoking
and alcohol
 Approve a scheme of formative and summative evaluation and agree plans for
further roll-out, including other non-NHS organisations in conjunction with the LLR
PCT Cluster
 As commissioners of NHS Stop Smoking Services, co-ordinate data collection on
sources of referral and ensure that NHS organisations develop internal data
collection mechanisms.
Timetable for implementation:





3
local model developed by July 2012
training programme implemented from August 2012
recording mechanisms in place by September 2012
monitoring and evaluation in place and undertaken from September 2012
review and plans for further roll-out by January 2013.
Supporting the SHA Making Every Contact Count Ambition - DRAFT CQUIN. February 2012.
59
7.4.3 Quality and Safety In Primary Care
This ambition aims to ensure that each CCG works with member practices to create
a definitive set of measures to improve the standard of primary care and prescribing
practice.
ELR CCG has a number of work programmes in primary care, many of which link to
our QIPP programmes, and reflect the Midlands and East SHA Ambitions.




We are currently developing Primary Care Quality Indicators for consultation
with localities and member practices; this includes quantitative and qualitative
measures associated with patient safety and experience which will contribute
to ensuring that we are successful in improving quality through alignment to
CCG priorities such as diabetes, COPD, dementia and mental health and the
retention of a strong evidence base. This will ensure validity and ownership
by our clinicians. The Quality Indicators are being shared with member
practices to inform the final framework.
A work programme has been established associated with reduction in
cephalosporin and quinolone prescribing through our targeted approach
contained within QOF indicators for Medicines Management 6 and 10
Safety of care for patients receiving warfarin is being improved through a
Local Enhanced Service for INR monitoring.
We are committed to the delivery of a new local pathway for diabetes (see
section 6.3.2) which will improve the quality of care for those managing
diabetes
7.4.4 Quality Governance
ELR CCG has developed a GP Performance Framework based on peer review. The
resulting Primary Care Quality Indicators (see Appendix 6) reflect SHA ambitions for
primary care alongside other local priorities such as Long-Term Conditions
In terms of monitoring and assuring quality for all SHA Ambitions, ELR CCG has
established a Quality and Governance Committee, which is a sub-committee of the
Board. Key elements within the regional framework include:
 an established practice of peer review within primary care which allows for clinical
debate and challenge (ambition 5)
 existing transformation schemes should target education and improved
management of patients with diabetes (ambition 4)
 oversight of the prescribing of quinolones and cephalosporin’s through the Quality
and Governance sub-group (ambition 2)
 established high quality INR monitoring services (ambition 3)
 clear detailed plans to support the reduction of Clostridium Difficile (ambition 2)
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7.4.5 Local Government Partnerships
The SHA ambitions set out the aim of ensuring radically strengthened partnerships
between the NHS and local government. ELR CCG is committed to on-going
partnerships and collaboration with local authorities. In our first year of operation we have
focused on ensuring a firm foundation for the future with our partners at Leicestershire
County Council and Rutland County Council.
We will continue to develop and strengthen our relationships with Local Authorities, and
plans include:
 The Integrated Commissioning Board comprises members from across the
County Councils and local NHS, and is chaired by a CCG Managing director. This
Board has been established to oversee the delivery of areas of joint
commissioning, such as mental health and learning disabilities, and areas of
Section 256 transfers. It ensures alignment of social care and reablement
investment to support the avoidance of inappropriate admissions and to reduce
readmissions. ELR CCG leads a number of priority areas on behalf of partners,
such as the implementation of the carers’ strategy, which is supported by £500k
from social care transfer funding.
 The development of joint commissioning arrangements and pooled budgets, for
example, Learning Disabilities, and shared targeted initiatives to improve the
quality of health and wellbeing for disadvantaged communities and groups.
 Partnership working to address common areas of concern, including safeguarding
and the development of children, young people and families services (see sections
7.5.1 and 7.5.5)
 Continued collaboration at priority workstream level e.g. emergency care projects
within the ECN portfolio, where clinical leads will continue to represent ELR CCG
and, through clinical leadership, ensure the delivery of plans within both East
Leicestershire and Rutland, and more widely across LLR.
 Joint recurrent investment of £900k into a three-year programme to deliver
integrated models of care within the community, with the aim of reducing acute
admissions through improved self-care management and preventative care. Led
by ELR CCG, the programme involves clinicians and professionals from across
social care, general practice, community care, and mental health.
 Continued involvement through leadership representation on the two Health and
Wellbeing Boards that have been established across for Leicestershire, and
Rutland
 Local government membership on the ELR CCG Transformational Steering
Group.
In addition, an on-going programme of quarterly meetings is being established to ensure
opportunities for two-way dialogue between the CCG and our local MPs. This will be
supported by regular communication and engagement with MPs and local councillors
through stakeholder bulletins and key project updates.
More information on partnership working is detailed in Section 10.
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7.4.7 Create a Revolution in Patient and Customer Experience
This SHA aim considers the innovative use of information and other feedback to
improve the experience of patients, carers and others. Aligned to this, ELR CCG has
an ambition to achieve top quartile national performance in patient experience and
outcomes.
Together with colleagues in the PCT Cluster and other LLR CCGs, we will actively
promote innovative ways to undertake real-time patient surveys, including the use of
web-based tools. We will also build on existing good practice by utilising the
evidence within the national patient surveys.
Lead nurses from across the PCT Cluster, CCGs, UHL and LPT have agreed an
action plan, which has since been approved by the ELR CCG Board. A key area of
focus has been agreed across all CCGs in relation to obtaining patient feedback.
This involves to the roll out of the ‘In Your Shoes’ project in place in LPT to a specific
patient group. This will enable clinicians, staff and others to understand patient and
carer experience from their perspective, and to highlight key areas for improvement
and development. This will greatly inform and enhance clinical and Board decisionmaking.
See also section 7.2.8.
7.5 Children, Young People and Families
With a quarter of ELR CCG’s population comprising children and young people, it is
essential that the CCG addresses the issues outlined in the following sub-sections
that are facing children’s services over the next 12 months and beyond.
7.5.1 Partnership Working
The CCG has an active role on the Children’s Trust Boards in both Leicestershire
County, and in Rutland. Both Boards have produced Joint Children and Young
Peoples Strategic Needs Assessments, which identify key areas where partnership
working is essential. All agencies work together to address these areas, which are
namely the troubled families’ agenda, safeguarding, and carers.
Troubled families
Troubled families have multiple and complex needs and therefore require significant
support from the public and voluntary sectors. Partners have agreed the twin aims of
improving outcomes for these families and their children, and of reducing the
associated cost to the public sector.
Safeguarding
We will work in partnership with Local Authorities to address issues identified
through recent safeguarding and Looked after Children and Young Peoples
inspections. These include the need to provide training for GPs and ensure access
to Child and Adolescent Mental Health Services (CAMHS).
Carers
There is a growing number of carers, both adults and children, for whom we need to
develop services and provide support. We will continue to collaborate with local
authorities and the voluntary sector to deliver a joint carers strategy.
62
7.5.2 Maternity - Improve 12 Week Access and Pathways within Maternity Services
All women should have access to maternity services for a full health and social care
assessment of needs, risks and choices by 12 weeks and 6 days of their pregnancy.
Accessing these services during this time ensures that they are able to experience
the full benefit of personalised maternity care, improve their outcomes, and enjoy a
better experience for both mother and baby.
Across ELR CCG, achievement of the ‘12 week access to maternity services’ has
been an on-going challenge. Nationally it is acknowledged that pockets of
demographic and socio-economic complexity impact on early access. This
remains an important priority in East Leicestershire and Rutland, and the CCG is
committed to improving performance. Led by West Leicestershire CCG on behalf of
all three LLR CCGs, an action plan has been agreed to cover the following:




Delivering services differently in a more targeted way to specific groups, for
example, through the involvement of local religious leaders
Undertaking a focused piece of work looking at providing intensive input to
specific areas that were highlighted as particular reasons for pregnant women
not booking before 12 weeks and 6 days of their pregnancy
Developing a local maternity focused website which will support a single point
of access.
Promotion of the wide range of maternity services available to women in ELR
CCG and the benefits of early access using various methods of
communication that are tailored to individual groups
Over the last three years, significant work has been carried out to modernise and
ensure safe and sustainable maternity and neonatal services. This has resulted in
significant investment for midwifery, neonatal and other obstetric services, and the
launch of a one-stop-shop for early pregnancy assessment (EPAU).
Over the next 12 months the CCG will continue to monitor the success of the EPAU
and will seek to improve 12 week access
7.5.3 Healthy Child Programme
The Government recognises that children and young people’s public health nurses
(health visitor and school nurses) are fundamental to ensuring better health and
wellbeing. Their unique skills in assessing health needs at both population and
community level, and family and individual child level, make them central players in
ensuring that children develop well and that parents, carers, families and
communities achieve optimum health outcomes. Plans for health visiting and family
nurse partnerships are detailed in section 7.2.5.
7.5.4 Mental Health Services for Children and Young People
Child and Adolescent Mental Health Services (CAMHS) continue to be a high priority
locally, as mental health problems in children are associated with educational failure,
family disruption, disability, offending and antisocial behaviour, placing demands on
health, social services, schools and the youth justice system. In order to improve
children’s mental health services ELR CCG will:
63




Implement a pilot to Improve Access to Psychological Therapies (IAPT) for
children and adolescents. This aims to increase access to, and use of,
evidence-based therapeutic interventions to tackle problems of depression,
anxiety and conduct disorder
Measure and tackle waiting times for assessment and treatment for services,
including a review of pathways
Support the development of a cost-effective model for paediatric psychology
and liaison across Leicester, Leicestershire and Rutland
Explore the options around pathways for children and young people with
autism, including issues relating to sensory integration
Following the evaluation of the IAPT pilot and the outcomes from the work
highlighted above, any additional investment required will form part of the 2012/13
investment process. As such it will be subject to a prioritisation process along with all
other proposed investments.
7.5.5 Children and Young People with Disability and Long-Term Conditions
Due to the changing demographics of children and young people with complex
health needs, there is an increased demand for health service provision. These
children are often young in age and require a continuing service for a number of
years. The related pressure on these families can result in inappropriate admissions
to hospital, or a breakdown in family circumstances.
ELR CCG plans to review the following pathways to ensure that they are meeting
the growing needs of the population. This will require joint work with the local
authority.
Short Breaks
It is acknowledged that the population of children and young people with life limiting /
life threatening conditions is increasing continually owing to advances in medical
technology. This factor has an on-going impact on the capacity required from a
sustainable short break service.
The CCG will prioritise a review of the current service to determine future capacity
requirements, and this will be looked at in conjunction with the personalisation
agenda.
Neurology
The paediatric neurology service has been under significant pressure since early
2011. Commissioners have agreed that work will be progressed to develop multiagency pathways across primary, community and acute care to avoid further
recurrence of these issues. This work will identify new commissioning pathways, and
will potentially have an impact on contracting and current investment arrangements.
Equipment
There are significant issues with the current processes in relation to supply of
equipment for children and young people requiring advanced medical technology,
such as ventilators, cough assist machines, humidifiers and saturation monitors. The
CCG will review the current process to develop an options appraisal, which will
determine how children’s medical equipment will be commissioned in future years.
64
7.5.6 Non-Elective Care
As already identified in section 6.3.5, work is underway to look at urgent care
pathways. As part of this there are specific pieces of work in relation to the children
and young people’s pathway.
Children’s non-elective hospital admissions have increased steadily over the last 10
years, both locally and nationally. Managing the increase in demand has required
different approaches, including the introduction of a Children’s Admission Unit (CAU)
as well as a dedicated Children’s Accident and Emergency Department (CED). This
in turn has caused some duplication in clinical and other resources and, as such, a
related increase in commissioning spend.
To reduce the numbers of attendances/admissions, and ensure effective delivery of
children’s acute care and best use of clinical resources, a whole-system change has
been agreed. This involves a single front door with senior decision makers and a
short-stay assessment area. This change is scheduled to be implemented during
2012/13.
7.5.7 Complex Care
Some children and young people require services above and beyond those currently
commissioned within the core service provision. This is owing to the nature of their
complex needs. Packages of care for these individuals are jointly financed through
health, social care and education, and are known to be costly. The Complex Care
Panel will focus on reviewing the current funding pathways in line with the
Responsible Commissioner and Personalisation agendas.
7.6 Authorisation
The next stage of development for ELR CCG is the move towards full accountability
and responsibility across the broader commissioning agenda through the
authorisation process. We have opted to participate in the first wave of applicants for
authorisation. Our review will commence on 2nd July 2012 with the submission of key
documents, followed by a site visit in September 2012, with the final decision on
authorisation made thereafter.
In readiness for authorisation, we have established an Integrated Governance
Framework, which includes our Board Assurance Framework, to provide assurance
that decisions about patient services and use of public money are made in an open
and transparent manner.
The integrated governance framework includes:
 Our Constitution
 Involvement of independent lay members through our Board membership
 Our Risk Management Strategy and Policy
 Our Equality and Diversity Strategy and Delivery Plan
 Our Communication and Involvement Strategy
 Our Scheme of Delegation and Memorandum of Understanding
 Our Standing Financial Instructions
65







Our Joint Commissioning Strategy
Establishment of Quality and Governance, and Finance and Performance
sub-committees, both chaired by an independent lay member
Establishment of the Audit Committee in April 2012
Establishment of the Contracting and Procurement Committee in April 2012
CCG Board meetings held in public from April 2012
On-going recruitment of the senior management team to maintain strong and
effective commissioning whilst working towards accreditation; these include
our Chief Operating Officer; Chief Finance Officer; Chief Nurse and Quality
Officer; Chief Strategy and Planning Officer and Chief Corporate Affairs
Officer.
The appointment of our Accountable Officer, who is also our equality
champion.
Following authorisation the CCG will discharge all of its functions through the above
processes and systems. These arrangements will also be reflected in all future
policy design to ensure transparency, probity and assurance.
Other elements either in place or underway include the following:
 Development of a shared approach to the main LLR provider contracts
through a tripartite agreement with the other two CCGs within LLR
 Creation of an organisational form that identifies:
- What will be delivered by ELR CCG
- What will be delivered collaboratively across the LLR PCT Cluster
- The process in place to finalise outsourcing requirements, pending
market developments
 Shadow Board members in place, with the recruitment of the secondary care
clinician in progress
 Running cost of CCG identified and agreed
 Structure in place to manage delegated commissioning budgets from April
2013 with the expectation that all relevant budgets will be delegated to CCGs
from 1 April 2012
 Active participant in the shadow Health and Wellbeing Board within both
Leicestershire County, and Rutland County
 Working towards the finalising of commissioning support contracts
66
8 Provider Development
We recognise that to enable excellent healthcare services for local people in the
long-term, developing the local provider market and the providers within it is
essential.
This section considers the specific development requirements of our local provider
landscape, and outlines our plans to meet them.
8.1 Community Hospital Developments
ELR CCG is committed to making effective use of health economy assets and to
developing end-to-end services in the community. This will enable more patients to
be treated closer to home where it is safe and appropriate to do so. Development of
services provided in community hospitals is a major factor in delivering this
commitment.
ELR CCG will build on the community hospital developments in 2012/13 outlined in
Section 3.2.
A key priority for 2012/13 is the redesign and procurement of elective care services
to include out-patients, diagnostics and day case surgery with the aim of providing
care closer to home, and improving patient choice and experience.
The current contract for elective care services is with Derbyshire Community Health
Services and runs until 31 March 2013. ELR CCG plans to proceed to procurement
for the East Leicestershire and Rutland elective care service bundle with the aim of
mobilising service delivery from 1 April 2013.
The strategic objectives of the project, reflecting the overall objectives of ELR CCG,
are to:
 Improve health outcomes in Long-Term Conditions through use of innovation
and technology (including Telehealth)
 Make productive use of health economy assets
 ‘Make every contact count’
 Develop end-to-end services in the community
 Address the health needs of the population
 Develop services to deal with the increasing older population in ELR CCG
 Transformation from non-planned to planned care
 Moving activity to a lower cost setting where it is appropriate and clinically
safe to do so
 Promote compliance with LLR agreed care pathways
 Improve access for patients e.g. elderly patients
 Reduce inequalities
ELR CCG is also working collaboratively with West Leicestershire CCG to model the
use of inpatient beds across Leicestershire and Rutland. This is with a view to
optimising the use of resources whilst maintaining a focus on the quality of patient
67
care. This includes working with Leicestershire Partnership Trust to facilitate earlier
discharge to care at home, to be enabled through enhanced community care. ELR
CCG’s approach of integrating community care through wide stakeholder
involvement and clinical ‘buy-in’ will improve clinical outcomes and patient
experience.
8.2 Review of Minor Injury Units
ELR CCG has a small unplanned care provision in our area, delivered through Minor
Injury Units (MIUs). Currently provided by both GPs, and Leicestershire Partnership
Trust, these are:




Oakham Medical Practice for Oakham
Latham House MP for Melton
Market Harborough Medical Centre for Market Harborough
Fielding Palmer Hospital for Lutterworth
The contracts are due for renewal in March 2013. In order to commission future
services that meet local needs, ELR CCG is undertaking a review of MIUs.
The purpose of the review is to determine the most effective and efficient minor
injuries service to meet the needs of the population of East Leicestershire and
Rutland. The review will be led by a clinician who is not responsible for delivering the
MIU services currently available, thus avoiding any issues of conflict of interest.
The MIU project team is responsible for the review of the current service, and for
design and delivery of a new model of care that is fit for an integrated health care
system. The future service will be fully integrated with other elements of the Urgent
Care System across Leicester, Leicestershire and Rutland.
The review process will be supported by a robust communications and engagement
process.
8.3 Extension of Patient Choice of Community Provider (Any Qualified Provider
Approach)
From 2013/14 onwards it will be for commissioners to decide those service areas for
which patient choice of provider should be extended locally.
ELR CCG fully supports the Government’s commitment to offering increased choice
and control to patients and to extending patient choice of provider in community
services.
Eight services were identified nationally for consideration. The three CCG’s within
LLR, together with other partner organisations, identified three service areas where
choice needed to be extended across LLR:



Musculo-skeletal services for back and neck pain
Community based Diagnostics
Continence Services (adults only)
68
These areas were chosen to reflect the greatest gaps in local health provision, the
greatest opportunity for increasing competition to drive up quality and access, and
the greatest local health needs, based on JSNA findings, local knowledge of
member practices and clinicians, and feedback from patients and carers.
ELR CCG is leading the implementation of Any Qualified Provider on behalf of the
LLR PCT Cluster with input from all three CCGs. There has been good engagement
with clinical CCG leads on the agreed service areas. As a result, the national service
specifications have been amended to reflect local need, and have been approved by
the LLR Commissioning Collaborative Board.
Patients will be offered a choice of provider in all three of the locally selected service
areas from September 2012.
8.4 Leicestershire Partnership Trust (LPT)
Over the past year LPT has worked with local CCGs on developing new relationships to
enhance relationships and commissioning arrangements, to ensure opportunities for
strong clinical engagement, and to ensure broad alignment between local commissioning
intentions. LPT’s integrated business plan reflects key service development initiatives,
such as dementia, frail older people and the redesign of the acute mental health care
pathway (see section 7.1.3).
Early in 2011, LPT decided to postpone their foundation trust authorisation process to
concentrate on the full integration and transformation of their mental health and learning
disability services (annual income of around £140m), together with community health
services (annual income £120m) which were transferred to them on 1 April 2011 as part
of the Transforming Community Services programme. They have agreed with Monitor
that they will operate for a full year as an integrated organisation and then reapply at the
end of June 2012, aiming for authorisation by the end of 2012. Securing their application
is key to organisational reputation, market share, and the achievement of greater financial
flexibilities for both the organisation and the wider health economy in terms of access to
funds for capital investment.
ELR CCG recognises the importance of the achievement of NHS Foundation Trust status
for LPT and the wider health economy, and will actively support the Trust in its
application.
8.5 University Hospitals of Leicester NHS Trust (UHL)
Financial challenges and difficulties with Accident and Emergency (A&E) performance
have resulted in UHL deferring their initial foundation trust application. The original risks
stated in the tripartite formal agreement between LLR commissioners, UHL and the SHA
are A&E performance, the nature of the contract with commissioners, and liquidity. ELR
CCG is currently working collaboratively with UHL to improve quality and patient
experience, whilst continuing to focus on overcoming the recognised challenges.
Recent intervention by the SHA resulted in additional goals for the Trust to achieve
financial balance both in 2011/12, and recurrently. In addition it was to develop a clear
service strategy to demonstrate long-term clinical and financial sustainability, the latter
being part of the LLR collaborative agreement to work together to secure service redesign
and reconfiguration. The Trust was involved in a meeting with Monitor and the SHA on 28
69
January 2012, and discussions took place with regard to a revised application and
timelines.
ELR CCG is working closely with UHL to develop pathways that will deliver the CCG
priorities whilst ensuring ‘value for money’ for all partners and improved outcomes for
patients.
8.6 Best Use of Local Healthcare Estate
Together with Leicester City and West Leicestershire CCGs, we collectively
recognise that the cornerstone of a sustainable LLR system will be reconfigured
services and sites operating at a lower cost base, without detriment to quality of
care. We are also committed to enabling care closer to home, where it is safe and
practicable to do so, through the development of community and primary care
services.
We are therefore participating in a review of local NHS estate to ensure that it is
being used in the best way possible. The LLR reconfiguration programme focuses
on delivery of the following activities:

Integrated care through the establishment of community hubs
Rationalisation of the community estate informed by demographic need. Better
utilisation of the remaining community hubs to improve key patient pathways
including frail older people, outpatient and day case

Outpatients and homecare
Significant shifts in outpatient attendances out of acute and into community
settings where it is feasible and safe to do so thereby delivering more care closer
to home whilst improving occupancy of fixed community assets

Integrated community, health and social care
Developing and implementing integrated care pathways particularly with
particular focus on care of older people, intermediate care and re-ablement

Acute care consolidation
As a consequence of the above, consolidation of complex care onto two acute
sites and fundamentally redesign the third site to provide a City centre of
excellence for planned and intermediate care, focusing on services that cannot
be provided from within City-based community facilities
Knowledge transfer and self-care – Critical to all of the above is the need for
knowledge transfer between clinicians, doctor and patient and local people
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9 Draft Commissioning Intentions for 2013/14
This section outlines our plan to develop and finalise ELR CCG’s commissioning
intentions for 2013/14.
ELR CCG’s commissioning intentions will inform both current and new providers,
and other stakeholders of:
 Changes in services or pathways that we wish to commission for 2013/14
 Work that we will undertake during the remainder of 2012/13 and 2013/14 to
underpin negotiated changes to services in subsequent years
 Any services within existing contracts for which we intend to give notice. This is
in accordance with contract terms, and in advance of undertaking a competitive
procurement process or disinvesting in the service
Commissioning intentions are usually developed as part of the NHS Planning Cycle
which will take place in the Autumn/Winter of 2012 following central publication of
guidance for 2013/14. However, we are required to demonstrate development of
draft commissioning intentions to support our application for authorisation as a
statutory body from April 2013. The commissioning intentions set out within this
section should therefore be considered an early draft. Whilst these are based on
previous engagement and consultation, further engagement with clinicians, patients
and carers, partners and others will be required to develop them further. A timetable
for this process is set out below.
9.1
Developing Commissioning Intentions
Commissioning intentions are informed by and take account of any guidance
published by the Department of Health in the Annual Planning Framework. Until
such time as this is published for 2013/14, draft commissioning intentions cannot
reflect such guidance. Nevertheless, some assumptions with regard to existing
priorities and guidance can be made at this time. These are subject to any changes
mandated by the NHS Commissioning Board on publication of the 2013/14 Planning
Framework in the Autumn of 2012.
Our commissioning intentions reflect ELR CCG’s vision and strategic priorities as
identified in section 4.2. They will also reflect the various national and regional
guidance and ambitions as set out within section 7.
71
9.2
Timetable for 2013/14 Planning Cycle
The timetable below provides an indicative timescale for the development of
finalised commissioning intentions. This is subject to publication of the NHS
Planning Framework for 2013/14.
June 2012
July to
December
2012
November /
December
2012
November /
December
2012
November /
December
2012
January 2012 /
March 2013
Development of ELR CCG Draft Commissioning Intentions
for 2013/14
Consultation with member practices and stakeholders on
Draft Commissioning Intentions
Publication of 2013/14 Planning Framework
Update / refresh ELR CCG Commissioning Intentions
further to publication of 2013/14 Planning Framework
Finalised Commissioning Intentions to providers
Agree contracts with providers in line with Commissioning
Intentions
9.3
ELR CCG Commissioning Principles
Commissioning and contracting discussions with all providers will be underpinned by
ELR CCG’s commissioning principles:
(i)
The shared objective of the health and social care economy in facing the
current financial challenge is to transform the services we offer patients, to
improve the quality and clinical effectiveness of services, delivering
services in a lower cost setting where it is safe and appropriate to do so
(ii)
In order to achieve whole system financial viability, LLR organisations will
be required to collaborate to deliver their agreed service change
responsibilities, including both disinvestments, and new investment to
improve quality and effectiveness
(iii)
All investment, disinvestment or change proposals will be preceded by
appropriate clinical engagement within and across the health community
(iv)
Added value must be demonstrated in all current and prospective services
within existing resource constraints. Existing services must demonstrate
value for money and price must be aligned to cost of delivery
(v)
Only activity that has been authorised by commissioners will be paid for;
commissioners will not fund the consequences of changes that have not
been formally agreed
72
In undertaking its commissioning functions, ELR CCG will:
a) Work with our population to identify health need and commission services
from providers best placed to meet the needs of our patients and population.
b) Commission services from providers who offer a safe and effective service;
best value for money; and timely access to appropriate, quality services.
c) Work in partnership with providers to identify new opportunities for delivery of
QIPP (Quality, Innovation, Productivity and Prevention) objectives, where
health outcomes can be improved whilst reducing costs for both
commissioner and provider.
d) Support providers to work collaboratively across health and social care to
improve patient experience of seamless service delivery.
e) Ensure all commissioned services will have agreed service specifications and
outcome measures
f) Work with all providers to ensure delivery against service specifications,
indicative activity levels, quality standards, performance targets, standards
and budgets.
9.4
Draft Commissioning Intentions 2013/14
This Plan has articulated our strategic and operational aims for delivering better
patient outcomes and experience, both within East Leicestershire and Rutland, and
across the wider Leicester, Leicestershire and Rutland health and social care
economy. Our draft commissioning intentions for 2013/14 reflect this, where some
activities of work will be delivered specifically by ELR CCG, and others will be
delivered collaboratively with commissioning partners across LLR and sometimes
more widely.
In terms of operational commissioning priorities, as defined by national and regional
frameworks and ambitions, we have assumed that these will be largely similar to
previous years. However, these are subject to change following publication of the
NHS Operating Framework in Autumn 2012.
Our commissioning intentions may also be revised to ensure closer alignment with
the final Health and Wellbeing Strategies for both Leicestershire and Rutland, once
these have been finalised later in the year.
73
9.4.1 Shared Commissioning Intentions, LLR
Section
reference

6.3.4

Continue to deliver new/improved pathways of care for frail older
people, including initiatives relating to end-of-life and care homes
The delivery of a new shared pathway for diabetes

The delivery of new dementia pathway and related initiatives
7.1.3

The delivery of the Right Care programme to reduce new to followup ratios, care closer to home, better use of clinical resource and
estate, and encourage left shift of patient activity where appropriate
Improving emergency care, including reducing avoidable admissions
to acute care, achievement of the 4-hour wait, and better detection
and management of conditions in primary and community care
3.5.3





6.3.2
6.3.5
The introduction of a psychiatric liaison service within the Emergency 3.5.1
Department from 9am to midnight, 7 days a week.
7.5.6
Implement pathway change initiatives to reduce the number of
attendances and admissions and ensure the best use of clinical
resources for children and young people
7.2.3
Implementation of the carers’ strategy (led by ELR CCG)
8.6

The reconfiguration of LLR healthcare estate as informed by the
review to be completed in 2012/13
The implementation of new pathway for COPD

Redesign of the DVT service
5.1.1

5.1.1 and
7.1.3

Implementation of 2012/13 redesign of mental health pathways,
including crisis resolution, improved choice, formulary and 28 day
prescribing, single point of access, and personality disorder
Implementation of 2012/13 review recommendations re: adult
community nursing, physiotherapy and intermediate care services
and pathways (LPT)
Implementation of 2012/13 review of glaucoma, enhanced services
and clinical peer review
Delivery of IM&T initiatives including electronic prescribing in UHL

Implementation of new care pathways (provider-specific)
5.1.1

Implementation of initiatives to secure the 18 week wait target
7.1.6

7.2.5

Increase of health visitors and implementation of family nurse
partnership programme
Implementation of NHS 111

Quality initiatives to reduce pressure ulcers (led by ELR CCG)
7.4.1

Improvements in offender health
7.1.3


6.3.3
5.1.1
5.1.1
6.3.6
7.2.9
74
9.4.2 East Leicestershire and Rutland-specific Commissioning Intentions
Community and Primary Care
Section
reference

7.4.3








Full implementation of GP performance framework, including the
primary care quality indicators
The delivery of training and education to GP practices in relation to
Long-Term Conditions, including diabetes, cardiovascular disease,
COPD and dementia
Improve support for GPs to screen for and manage COPD and other
respiratory conditions
Continue with LES for dementia to improve early diagnosis and ongoing management
Increase of health checks to enable the early diagnosis and referral
for Long-Term and other conditions, including cancer, dementia and
CVD
The implementation of risk-profiling tools (subject to clinical
recommendations following research and benchmarking)
More efficient prescribing and the prescribing of cost-effective statins
and other medicines to improve the management of Long-Term
Conditions
Re-run cancer diagnosis audit to improve patient outcomes following
more efficient pathways, from diagnosis to treatment
The implementation of the ELR integrated care pathway model
3.1, 3.3 &
6.3.1
6.3.3
7.1.3
3.5.5 &
7.1.6
5.2,
6.3.4,
6.3.7,
7.2.2
3.4
7.1.4
6.3.7

Targeted interventions in geographical areas with high levels of
deprivation, and certain groups with known health inequalities, such
as travellers and military families
7.1.2,
7.2.4,
7.2.10

The implementation of any ELR recommendations following review
of local healthcare estate
Implement a revised Local Enhanced Service (LES) for GP extended
hours
Increase access to choose and book within general practice as part
of the GP Performance Framework
Ensure the delivery of services procured via AQP, e.g. musculoskeletal, continence and diagnostics
The implementation of recommendations resulting from the review of
Minor Injury Units and the procurement of elective care services
8.6
The implementation of recommendations following the 2012/13
review of pathway to access diagnostics at community hospitals
(Derbyshire Community Foundation Trust) – with West CCG
Investment into Telehealth and other assistive technologies
5.1.1 &
8.1
Delivery of ELR IM&T initiatives including GP system migrations and
upgrades and on-line access to patient records
6.3.6







3.5.4
3.5.4
8.3
8.1& 8.2
7.2.6
75
Mental Health
Section
reference
Improve access to psychological therapies
7.1.3
Improve physical healthcare of those with mental health to reduce
excess mortality
7.1.3
Improvements in services for children and young people at risk of
developing mental health problems, CAMHS services, and IAPT for
children and young people
7.1.3,
7.5.4
Acute
Section
reference
Implementation of age extension screening for bowel, lower GI and
breast cancers
7.1.4
The majority of work is being undertaken collaboratively within acute,
but there will be implementation of local initiatives to support LLR-wide
programmes. These are to be determined in 2012/13
5.1.1
Cross-cutting
Implement the patient revolution action plan
7.4.6
Implement initiatives to ensure compliance with the Equality Delivery
System in line with our E&D Strategy and Plan
7.2.11
Implementation of child, young people and families initiatives to ensure
safeguarding and appropriate levels of support
7.5
Implement pathway improvements across paediatric neurology within
primary care, community and acute
7.5.5
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10. Partnership and Collaboration
ELR CCG recognises the importance of collaborating with partners to deliver our
strategic priorities and ultimately to improve experience and outcomes for patients
and carers. We also recognise the important, wider role that we play in socioeconomic terms, working with local authorities and councils, police and other
emergency services, schools and universities, local people and other partners, to
improve the quality of life for the local population.
We are committed to working collaboratively with partners, in terms of both health
and social care, and the wider socio-economic agenda. We have already
established good working relationships with key partners, building on those already
in place with our predecessors. This focus will continue with the development of
collaborative agreements and working arrangements with other CCGs, local
authorities and health and well-being boards, and others.
This section sets out some of our key partners and our plans for strengthening links
with them.
10.1 Health and Wellbeing Boards
ELR CCG is an active participant in the Health and Wellbeing Boards in
Leicestershire and Rutland, with the Accountable Officer and Chief Operating Officer
attending meetings bi-monthly (Leicestershire) and quarterly (Rutland). Through our
involvement with the Boards, we have refined our own vision and priorities in order
to align with, and complement the strategic intentions of other Health and Wellbeing
members where appropriate. Closer working has also strengthened relationships
between health and social care, and has facilitated integrated commissioning.
10.1.1 Leicestershire Shadow Health and Wellbeing Board
Leicestershire’s Health and Wellbeing Board has been established with a
commissioning-focused membership. This includes three county councillors; two
district councillors; four CCG representatives; two LINks representatives; one LLR
PCT Cluster representative and the Directors of Public Health, Adults and
Communities and Children’s and Young People’s services. It is a formal ‘early
implementer’ and is actively engaged with the Department of Health’s programme of
HWBB Accelerated Learning Sets, with the Director of Public Health leading one
national learning set on improving the health of the population.
A substructure has been established including the Staying Healthy Board, JSNA and
Joint Health and Wellbeing Strategy Steering Board, Substance Misuse Board and
Integrated Commissioning Board. Members of ELR CCG have been actively
involved in each of these groups. Development sessions have been undertaken and
a number of business meetings held. Interim priorities for 2011/12 have been
established from existing strategies, commissioning intentions have been agreed
and an Outcome Framework for these priorities is in development. The JSNA refresh
is in progress, as previously planned, with the production of a Joint Health and
Wellbeing Strategy due for completion in Autumn 2012.
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10.1.2 Rutland Shadow Health and Wellbeing Board
Although not an official ‘early implementer’, Rutland has made good progress in
establishing and developing its shadow Board. Formal membership of the Board
includes the Director of Public Health and both GP and managerial representation
from ELR CCG. Broader PCT representation has been provided by the LLR PCT
Cluster Chair, a consultant in public health and a partner NHS Trust director
supporting Leicestershire County Council (LCC).
ELR CCG’s chief operating officer and public health consultant programme director
have played a key role in the Board development group, with public health leading
specific work to agree the strategic priorities and supporting structure for the Board,
and to develop action plans and an overarching outcomes framework.
As part of the supporting structure, the public health consultant chairs the Staying
Healthy Rutland sub-group that will deliver the Board priority to improve health and
reduce health inequalities in Rutland. This group includes members of ELR CCG.
10.2 Local Authorities and Social Care
See section 7.4.5
10.3 LLR CCGs
It is vital that we collaborate with other CCGs across Leicester, Leicestershire and
Rutland to commission services and to develop new and improved pathways which
span across the local health and social care community. Working together will also
enable economies of scale in terms of procurement, as well as efficiencies in terms
of pooling resources. We have agreed a number of areas where between us we
share or host resources on behalf of other CCGs, and we have established joint
committees to oversee common areas of healthcare, such as the management of
LPT and UHL contracts, or LLR QIPP programmes. We have agreed a
Memorandum of Understanding for how we will operate together through the
Commissioning Collaborative Boards, and the Performance Collaborative.
10.4 Out of Area Commissioners
A significant number of our registered patient population lives outside East
Leicestershire and Rutland, and/or access services out of the area. ELR CCG will
work closely with commissioners neighbouring Leicester, Leicestershire and
Rutland, and will develop more formal collaborative arrangements for the future. We
are already actively involved in out-of-area monthly performance management
meetings and feed in to the associate governance framework for associate CCGs.
78
10.5 GEM CSO
Greater East Midlands Commissioning Support Organisation is our chosen provider
of support services, which will include:





Business intelligence
Human resource management, legal support and some financial management
Procurement and market management
Provider management
Communications and engagement
Greater East Midlands Commissioning Support Organisation (GEM CSO) is one of
the largest CSOs in the country with 22 CCG customers (including West
Leicestershire, East Leicestershire and Rutland and Leicester City CCGs). It covers
a total population of around 5.4 million and brings commissioning support staff
together from across 6 PCT Clusters (Leicester, Lincoln, Northampton, Derby,
Nottingham, Luton and Bedford).
The fostering of a strong working relationship with GEM CSO is integral to the
building of a strong, sustainable clinical commissioning group moving forward, as
they will be responsible for delivering key essential support services on our behalf to
assist the day to day operation of our CCG. ELR CCG is currently in the process of
agreeing a service level agreement to define the service specification and contract
terms. In the meantime we have agreed a memorandum of understanding which
extends to the other two LLR CCGs.
10.6 Voluntary Sector Providers
We recognise the importance of involving voluntary sector providers in our activities,
particularly if we are to innovate new ways of working in a more integrated way and
extend patient choice closer to home. We engage with a number of organisations as
part of our programmes, with active representation at a number of forums including
the Voluntary Care Sector Governance Group.
10.7 Universities and Education
In 2011/12 ELR CCG worked collaboratively with local universities and other local
higher education establishments. For example, the University of Leicester supported
the delivery of our Long-Term Conditions’ training and development programme. We
will continue to work in partnership as we develop training and education
programmes for general practice.
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11. Communication and Involvement
Although this section features towards the end of our integrated plan, involving
patients and the public, member practices, clinicians, staff, partners and other
stakeholders remains one of our key priorities.
In addition to fulfilling our legal duties and responsibilities to engage and consult patients,
the public and partners in decisions around service change, ELR CCG is committed to
becoming an organisation where involvement is embedded in everything we do. This
means regular, open dialogue with all of our stakeholder groups, maximising
opportunities for collaborative working and joint-solutions, and ensuring that ELR CCG is
represented at the various health-related forums throughout East Leicestershire and
Rutland.
Involving people in developing and evaluating health services is an integral part of
ensuring that local healthcare is patient focused, of high quality, and meets the
needs of our local communities.
The ambition and challenge for ELR CCG over the next few years is to deliver
services that give patients more choice, more personalised care, and which
empower people to improve their own health. This requires a fundamental change in
the relationships between health services and the patients and public we serve. We
need to move from a service that does things to and for patients, to a service that is
truly patient-led, where the service works with patients to support them with their
health needs.
We believe that effective communications and involvement can help us to bring
about this necessary change in relationships and behaviour. In addition, there are a
number of other benefits, including:







Increased patient satisfaction
More accessible, sensitive and responsive health services
Better understanding by the public of how the NHS operates, and therefore
more appropriate use of services
Better relationships between health services and the public
Greater sense of ownership of the NHS
Shared responsibilities for healthcare between NHS services, local authorities
and the public
A health service that is based on the needs of patients and carers, and not
the needs of the health service
ELR CCG has developed an approach and model for involvement (Figure 11) which
establishes mechanisms and forums at all levels of our organisation for engaging
with, listening to, and acting on the experience and views of our patients and carers,
clinicians, staff, our partners and the public.
80
Figure 11: Involvement Model
ELR CCG has undertaken a detailed stakeholder mapping exercise to ensure that we
understand who our key stakeholders are, together with their needs, preferences and
influences, and how we intend to involve them. This is set out in detail within our
Communications and Engagement Strategy. Naturally the stakeholder list will be used
and adapted to reflect the needs of individual CCG projects, and to ensure that our
stakeholders have a say on the things that matter most to them. The overarching
stakeholder groups are as follows:
Group A
Group B
Group C
Group D
Group E
Group G
Patients, service-users and carers accessing NHS services, PPGs,
PPG Chairs Network
Community organisations - includes condition specific,
religious/faith groups, elderly and young people, voluntary
organisations
ELR CCG practices – our constituent GPs, Practice Managers and
Practice Nurses
Clinicians - NHS partner organisations including UHL, LPT, DCHS
and EMAS, independent primary care contractors (dentists,
optometrists, pharmacists)
ELR CCG staff – includes all staff and Board Members
General public and local opinion formers - includes special interest
groups, patient representative bodies such as Leicestershire LINk,
HealthWatch, MPs and the media
81
We have already built strong links with various stakeholder groups, and the coming years
will see us strengthening those links and building new relationships with other
organisations, groups and individuals.
To ensure that involvement happens at all levels, we have invited stakeholder
membership on our Board, and in a number of our Project Boards. We actively
encourage our staff and Board Members to be proactive in working with stakeholders in
all aspects of our work.
Some of the key relationships that wehave established with our stakeholders are
described in the following sections.
11.1 East Leicestershire and Rutland Patients and Carers
ELR CCG is keen to maintain a focus on improving the patient and carer experience. We
will listen to patients and carers, and will collate feedback and other evidence to influence
the commissioning and contractual process
In addition to the work on capturing patient feedback outlined in sections 7.2.8 and 7.4.6,
ELR CCG is planning to develop existing Patient Participation Groups (PPGs) across the
patch and establish new groups for practices who currently do not have them.
Working with Leicestershire LINk, ELR CCG has already established a PPG Chairs’
Network which is a new forum designed to bring PPG Chairs together to share best
practice and co-ordinate the work of the PPGs across East Leicestershire and Rutland.
ELR CCG will use this forum to capture feedback from patients, producing ‘intelligence
reports’ to identify areas and practices needing development to improve patient
experience. The reports will also highlight areas of best practice.
ELR CCG has taken ownership of its segmented share of NHS Leicestershire County
and Rutland’s membership. These are patients, carers and members of the public who
have signed up to become members of the organisation. Many of them have a particular
interest in helping to shape health services and to learning more about the local NHS and
about healthy living. ELR CCG will communicate regularly with our members, who
currently total more than 4,300, and will use their views to help inform decisions on local
healthcare.
Monthly summary reports giving high-level detail of patient experience issues, including
complaints information, will be received by the Quality and Clinical Governance
Committee. Reporting to the Board, the scrutiny and oversight of this group will help keep
a regular check on performance and ensure that the patient’s voice is central to the
activities of the Board.
In turn, minutes from the Quality and Governance Sub-committee are presented to the
monthly ELR CCG Board meeting, which also receives a quarterly report on patient
experience and feedback. This ensures that key decision makers within the CCG are
privy to regular feedback from patients, carers and our public members to help inform
commissioning decision and approaches.
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11.2 East Leicestershire and Rutland Constituent GPs and CCG staff
Ensuring that our constituent GPs, practice staff and CCG staff are fully involved in all
aspects of our work and decision making is vitally important to us. Some of the key
methods we are employing include:

Regular practice visits by members of our CCG Board to discuss and share the
issues which are at the top of our agenda, and to capture views and feedback
direct from GPs, nurses, other clinicians and staff

Monthly locality meetings to share and gather information with and from
constituent GPs in each of our three localities

Regular meetings and use of the Practice Manager’s Forum

Monthly CCG team meetings and ad hoc focus groups

Regular staff briefings

Regular feedback obtained via staff surveys, forums and one to ones, with a focus
on sharing and gathering feedback on key CCG issues


Monthly newsletter to staff and constituent GPs
Shared intranet for CCG staff and constituent GPs
Additionally, ELR CCG is planning to establish a Practice Nurse Forum to ensure there is
an appropriate forum for nursing staff to share best practice, identify areas for
development and feed back their views to the CCG. It is anticipated that the stakeholder
engagement to be undertaken as a part of the development of the integrated care team
approach will also inform the establishment of additional groups which include other
clinical professions such as Allied Health Professionals.
11.3 Partners
We recognise the importance of involving and collaborating with partners. We have
focused heavily in our first year as a shadow organisation on developing robust
relationships with them. This will enable us to collaborate to deliver the optimum services
for local people across East Leicestershire and Rutland, and to contribute to the wider
agenda within LLR. More information on how we involve and collaborate with our partners
can be found in section 10.
11.4 Local Involvement Network (LINks) and Healthwatch
ELR CCG has built strong relationships with our two local LINk organisations in
Leicestershire and Rutland. Two representatives from LINks sit ‘in attendance’ at our
Board Meetings, giving them the opportunity to scrutinise and challenge our work from a
patient perspective, as well to ensure patient voices on our Board. Additionally, LINks
representatives sit on several of our key work stream project boards and steering groups.
We are drawing up a protocol, which sets out more formally our commitment to working
with our two local LINk organisations, and which clearly reflects the value we place on
their involvement in our work. This will be adapted to incorporate HealthWatch as it forms.
There will be two HealthWatch organisations in our area – one in Leicestershire and one
in Rutland. From October 2012, each HealthWatch will signpost people to information
and advice about health and social care services; and from April 2013, they will be
required to play an advocacy role for patients and carers with complaints.
83
In Leicestershire, Healthwatch also has pathfinder status and is currently developing
three work streams:



Hard to reach/seldom heard groups
Signposting
Delivery of the new Healthwatch organisation.
ELR CCG will continue to support LINks and HealthWatch and will seek ways to increase
their involvement in the commissioning and delivery of local healthcare.
84
12 Implementation
This chapter describes the arrangements in place to ensure delivery of this Strategy,
including financial plans, governance, organisational development and
communications and engagement.
12.1 Financial Plans
The primary financial strategic objective is to enable and support the CCG in
achieving our vision. The financial plan focuses on using our resources to meet the
health needs of East Leicestershire and Rutland, ensuring value for money, and fair
and efficient use of funding to improve the health and wellbeing of the population. In
order to achieve these objectives we have developed a long-term financial plan that
delivers an underlying surplus, which will enable funding to be spent non-recurrently
each year, thus facilitating transformation on an on-going basis.
Appendix 7 provides details of our financial strategy and plan for 2012/13 – 2015/16.
It should be noted that details of the allocation have been confirmed for 2012/13
only, and therefore subsequent years may be subject to change. Other influencing
factors include the publishing of next year’s NHS Outcomes Framework in Autumn
2012.
Our internal governance structures and processes will ensure accurate monitoring
and reporting of the financial position. This will be assured by both the ELR CCG
Board and, during 2012/13, the LLR PCT Cluster.
Our QIPP savings plan for 2012/13 is given in Appendix 8, and our savings plans for
2013/14-2015/16 are in Appendix 9. Along with the financial plan, these will be
monitored via the Finance and Performance Committee.
12.2 Governance Framework
ELR CCG has developed a comprehensive governance framework which will ensure
the delivery of this Strategy. This includes clear lines of accountability for delivery of
the various elements described within, and performance management arrangements
to ensure that progress is made against plan. In terms of individual responsibility,
key deliverables are written into personal objectives, which are reviewed regularly by
line managers and the committees to which they report; and on which they will be
formally appraised annually.
Where common areas of commissioning exist between the three LLR CCGs,
collaborative governance structures have been put in place. The Commissioning
Collaborative Board (incorporating the Performance Collaborative) oversees a
number of shared areas including performance management and delivery of QIPP
and transformational programmes in addition to shared contracts with providers and
other initiatives. Reports from this committee are received at each of the three CCG
Boards.
An illustration of the Board and its committees is shown in Figure 12 overleaf.
85
Figure 12: ELR CCG Governing Body and Delegated Committees
12.3 Framework for Delivery of Programmes
A programme framework is being developed to ensure the delivery of key work
streams, including those relating to our strategic aims and transformational funding.
This is shown below in Figure 13.
Each work stream has agreed terms of reference and specific deliverables. These
ensure that members are united in their focus on the work that needs to be
undertaken, and what it is expected to achieve. Whilst the programme team will be
responsible for undertaking monitoring and evaluation of progress against plan, this
will be reported into one of the Board’s delegated committees.
86
Figure 13: Programme Governance Framework
With respect to the delivery of QIPP, the Commissioning Collaborative Board is
accountable for monitoring the delivery of LLR-wide QIPP schemes. In turn, reports
from this group are reported into the three CCG Boards. The delivery of local QIPP
schemes is monitored and reported through the ELR CCG Finance and
Performance Committee, and in turn through to the ELR CCG Board.
12.4 Contracts and CQUINs
We will use contracts as our key lever to drive improvements in quality and
performance. ELR CCG has developed local CQUIN indicators for 2013/14, linked to
ELR CCG clinical priorities, including QIPP targets. These were developed during
quality workshops which involved clinical leaders. Financial values have been
agreed for each CQUIN indicator, which will be monitored in partnership with our
Clinical Quality Review Group.
ELR CCG has played an active role in the 2012/13 contracting round, with members
of our Board assigned to the major contracts, i.e. UHL, LPT (mental health and
community health services), and Derbyshire Community Health Services.
Additionally, clinical leads have been assigned to out-of-county acute contracts to
ensure that ELR CCG interests are appropriately represented.
87
12.5 Management of Risk
ELR CCG has developed a comprehensive Board Assurance Framework (see
Appendix 10) to ensure the appropriate identification and management of risks
relating to our activities. Aligned to our Risk Management Strategy and Policy (201214), this includes the mitigation of risks relating to the delivery of our Strategy,
including strategic and operational priorities. It covers all types of risk - governance,
management, quality, legal, reputational, clinical and financial.
Responsibility for updating and monitoring risks rests with the Board and its
delegated committees, and accountability at an individual level is clearly identified
against each risk.
The Strategic Risk Register is reviewed by the Quality and Governance Committee
on a monthly basis, and reports are made to the Board every quarter.
Our internal audit process is another mechanism for gaining assurance on the
management and mitigation of risk in terms of delivering this Strategy. With
accountability falling to the Accountable Officer and Board, the role of internal audit
is to provide an opinion on the effectiveness of corporate governance, risk
management and internal control.
12.6 Organisational Development Plan
Critical to the successful delivery of our Strategy, is the implementation of our
Organisational Development (OD) plan. We recognise the need to develop our
organisation and its people to enable the delivery of our strategic aims and
operational priorities. In our OD plan, we have clearly set out the gaps between
where we are now, and where we need to be, together with a plan on how we intend
to achieve this. This includes the development of current and future clinical leaders,
both at Board level and in localities; the training and development of our staff in
terms of basic and mandatory skills, and in terms of skills development, career
progression and succession planning to ensure the appropriate capacity and
capability; and the development of partnership and collaborative commissioning
arrangements.
12.7 Communications and Engagement
Communicating and engaging with our patients, carers, member practices, staff,
clinicians, partners, local citizens and other stakeholders is crucial to the effective
delivery of our strategy. We recognise that our strategy will need to remain fluid and
therefore responsive to the changing needs of our local population. Involvement our
stakeholders is therefore essential to ensure that this the case.
We encourage our local population and member practices to hold ELR CCG to
account with regard to the delivery of our Strategy. We will therefore ensure
appropriate opportunities to share and involve people in the development of our
organisation and our activities. This will range from hosting events such as the
annual general meeting, stakeholder discussion sessions, and Board meetings held
in public, to the appointment of lay members on our Board and key programme
groups.
88
We have developed a comprehensive Communications and Engagement Strategy,
which identifies our key stakeholders and how we will involve them on an on-going
basis.
89
Glossary
A&E
Accident & Emergency
AQP
Any Qualified Provider
BME
Black Minority Ethic
CAB
Choose and Book
CAMHS
Child and Adolescent Mental Health Services
CAU
Children's Admission Unit
CCG
Clinical Commissioning Group
CED
Children's Accident and Emergency Department
CHD
Coronary Heart Disease
CHS
Community Health Services
CLRN
Comprehensive Local Research Network
COPD
Chronic Obstructive Pulmonary Disease
CQUIN
Commissioning for Quality Innovation
CVD
Cardiovascular Disease
CYP
Children and Young People
DH
Department of Health
DVT
Deep Vein Thrombosis
ECN
Emergency Care Network
eDoS
Electronic Directory of Services
ELR CCG
East Leicestershire & Rutland Clinical Commissioning Group
EMAS
East Midlands Ambulance Service
EPAU
Early Pregnancy Assessment Unit
FOP
Frail Older People
FOPALS
Frail Older People’s Advice and Liaison Service
GEM CSO
Greater East Midlands Commissioning Support Organisation
GP
General Practitioner
IAPT
Improve Access to Psychological Therapies
IM&T
Information Management & Technology
INR
International Normalised Ratio
JHWBs
Joint Health and Well-being Boards
JSNA
Joint Strategic Needs Assessment
90
KPI
Key Performance Indicators
LD
Learning Disabilities
LEFT SHIFT
The programmed movement of care from acute settings to
less urgent and community settings
LES
Local Enhanced Services
LINKS
local Improvement Networks
LLR
Leicester, Leicestershire and Rutland
LOROS
Leicestershire’s Organisation for the Relief of Suffering
LPT
Leicestershire Partnership Trust
LTC
Long Term Conditions
MDT
Multi-Disciplinary Team
MECC
Making Every Contact Count
MIU
Minor Injury Unit
NHS
National Health Service
NHSCB
NHS Commissioning Board
NICE
National Institute of Clinical Excellence
ONS
Office of National Statistics
PCT
Primary Care Trust
PRG
Patient Representation groups
Q&C
Quality and Contracting
QIPP
Quality Innovation Productivity Prevention
QOF
Quality Outcomes Framework
R&D
Research and Development
RAG
Red Amber Green
RTT
Referral To Treatment
SHA
Strategic Health Authority
SPoA
Single Point of Access
TIA
Transient Ischemic Attack (mini stroke)
UHL
University Hospitals Of Leicester
UNICEF
United Nations Children’s Fund
VCS
Voluntary & Community Sector
VTE
Venous Thromboembolism
WHO
World Health Organisation
91
Version Control
Version
Description
Date
1.0
Draft version 1.0 outline of the plan submitted to the Board that includes
Inclusion of vision, values and strategic priorities, local background,
engagement, key priorities 2012/13, QIPP, Operating Framework 2012/13, SHA
Ambitions, Equality and Diversity and Transition and Reform
10/04/2012
2.0
Draft version 2.0 submitted to the Board following feedback which includes:
12/06/2012












3.0
Restructuring of sections in line with priorities.
Re-ordering of populations health overview and incorporation of/reference to
relevant elements from CCG population and performance profile
Addition of provider and partner landscape sections
Introduction added to sections to frame the narrative
General simplification of jargon
Expansion of transformational funds section to include more details of plan
for 2012/13.
Incorporation and cross reference of emerging Health and Well-being
priorities and JSNA data
Expansion of provider landscape including map.
Inclusion of breakdown of budgets for 2013/13 including graph
Strengthening of key sections, including cancer and mental health
Revision of local priorities section
Strengthen targeting of areas with health inequalities
Draft version 3.0 submitted to the Board following feedback which includes:



26/06/2012
Comparison and incorporation of published health profiles data from
NHS Commissioning Board.
Inclusion of section on research and development.
Cross-reference against authorisation criteria.
92