Welcome to our
Annual General Meeting
Welcome
Philip Lewer
Chair
Housekeeping
• Fire Procedure
• Mobile Phones
• Toilets
• Photographer, videographer and animator
• Wi-Fi
Welcome to our AGM
Huge thank you for joining us…
•
Opportunity to meet our providers - Quiz
•
Today’s agenda:
•
Overview of achievements and progress in 2013/14
•
The CCG’s finances in 2014/15
•
Looking ahead – plans for the future (responding to you)
•
GP members
•
Mini AGM for children and young people - dragon’s den’ style
•
Open question and answer session
Introductions
Dr Andy Harris, Clinical Chief Officer
Mark Bradley, Chief Finance Officer
Matt Ward, Chief Operating Officer
Dr Alistair Walling, GP Executive Director
Review of the year
2014-2015
Dr Andy Harris
Clinical Chief Officer
Our Organisation
NHS Leeds South and East Clinical Commissioning Group (CCG) was created
in April 2013 and is a membership organisation made up of all the 43 GP
surgeries in South and East Leeds.
Our job is to understand what the local people who live in the area need
from health services and to plan, monitor and pay for them.
There are three CCG’s in Leeds. Each of the three CCG’s lead on different
services and we manage the following:
• Children and maternity services
• Community health services
• Continuing health care services (children and adults)
• Safeguarding (children and adults)
• Joint commissioning with social care services (Better Care Fund and the
Transformation Programme – also known locally as “Inspiring Change.”)
Our Organisation
Leeds South and East
Annual Report 2014/15
• Annual Report 2014/15 gives balanced and fair view of progress
and performance, including:
• Progress against strategic aims
• Working with others
• Being a good employer
• Achievements within challenging financial environment
• Assured by NHS England
Strategic Aims
The Landscape
• Leeds city wide Joint Health and Wellbeing Strategy
• City Wide Five Year Strategy for Health
• Our Two Year Operational Plan -Local commissioning AND city wide:
• Children’s and Maternity Services
• Community health services
• Continuing Healthcare
• Safeguarding
• Joint commissioning with social care (including Better Care
Fund)
Highlights of the past year
Potential Years of Life Lost (PYLL) from causes considered
amenable to healthcare
- Meeting our goal to reduce mortality (death) rates in
South and East Leeds.
- Latest data revealed an 8.5% reduction in deaths from
conditions which can be improved by health care.
- Promoting the benefits of lung and bowel cancer screening
- Enhanced alcohol support service and smoking cessation
clinics.
Reduction in Acute Admissions/Non elective admissions
- To be provided by Thu AM
Highlights of the past year
Maternity Services Review
- A new strategy for maternity services
- Focus on how best to support women’s emotional and
mental health and providing personalised care.
Children’s and Young People’s Emotional Health
- Review of emotional health services
- 11 recommendations -to transform services and
improve access and experience
- Including joining up support between schools and
health providers, having a single point of referral into
services and providing online support for young
people.
End of Life Care
- Review of end of life care with new strategy to ensure that
everyone has a dignified end of life experience that closely meets
their needs.
Highlights of the past year
Seven Day Services
- Community services seven days a week
- Expanding key community services to cover seven days in order that patients do not
have to stay in hospital when they could be cared for at home or in the community.
The services include:
• The Early Discharge Assessment Team
• Community Discharge Facilitation Team
• End of Life Care Home Facilitator
• Community Bed Management Team
• Leeds Community Equipment Service.
House of Care - self management
- Supporting people to manage their own health effectively,
especially when they have long term conditions
- Relieve pressure on the NHS and support wellbeing.
- Patients have a full care plan, managed by a small number of
clinicians so to ensure their care is seamless and meets needs
NHS Standards
As well as planning and funding local services in South and East
Leeds, we have a key role to play in monitoring the National NHS
standards and ensuring they are met in our area. Standards for
patients have improved during the year in a number of areas as a
result of our work and that of other NHS organisations.
These areas are:
• Waiting times for outpatient appointments in gastroenterology
• Waiting times for diagnostic tests
• Waiting times for urgent appointments for patients referred
with breast symptoms
• Waiting times for A&E
Annual Governance Statement
Governance statement – stewardship of the organisation
The system of internal control has been developing and
strengthening throughout our first year.
The Head of Internal Audit Opinion states the CCG can take
"significant assurance“ from its system of internal control.
Sets out continuous improvement with development of new
approach to governance with creation of Quality Committee;
Finance, Activity & Performance; and Audit and Governance
Committees from April 2014.
External audit reviewed and confirmed Governance Statement
reflects the CCGs operations and risk management arrangements.
Annual Accounts
2014/15
Mark Bradley
Chief Finance Officer
Key Financial Indicators & Financial Duties
Indicator / Duty
Performance
CCG Allocation
The CCG achieved a surplus of £10,869k, £83k greater
than the planned level of £10,786
Cash Limit
The CCG operated within its maximum cash drawdown
allowance
Better payment Practice Code The CCG Achieved this target
The CCG received two allocations, one of £353.2m for the purchase of healthcare and £6.2m for
Running Costs in South & East Leeds.
£7m of Historic surplus from the PCT effectively rolls forward each year - no CCG was allowed to
use these in 14/15 without permission from NHS England
The CCG proactively increased its surplus by £3.9m (Inc. CHC Risk Pool) in 14/15 with the
intention of drawing this down in 15/16.
CCG has received £3.5m non recurrent funds in 15/16 to invest in dual running
and efficiency programmes
How did we spend our money?
Annual Accounts 2014/15
KPMG act as the External Auditors of the CCG.
They concluded:
•
•
•
•
•
Unqualified opinion of the CCGs 2014/15 financial statements
No matters arising from Use of Resources review meaning CCG has
adequate arrangements in place to secure economy, efficiency and
effectiveness in its Use of Resources
Unqualified Group Audit Assurance Certificate to the National Audit
Office regarding Whole of Government Accounting with no exceptions
Accounting policies, estimates and financial statements been used and
prepared in line with Department of Health Manual for Accounts
KPMG commented on the high quality working papers provided by the
finance team which enabled the audit to progress smoothly
Wider Financial Performance
• Foundation Trusts ended the year with a net
deficit of £349m, £339m worse than plan
• NHS Trusts ended the year with a net deficit of
£485m, £77m worse than plan
• FTs have told Monitor that 2015/16 is likely to
be even tougher financially
Strategic Financial Context
• Financial Challenge is significant across the
Health Sector
• Impact of further reduction in Local Authority
cuts will have an impact on health
• Wider pressures on providers will have an
impact on commissioners
Strategic Outlook
•
CCG has £3.5m additional non recurrent funds in year
due to its financial stewardship
•
Forecasting to deliver our financial targets in 15/16
and provide additional funds targeting our strategic
aims around prevention whilst supporting additional
funds for winter resilience
•
Strategically the focus is on developing New Models
of Care
Local Commissioning Plans - Film
The CCG Two-Year
Operational Plan 2015/16
Matt Ward
Chief Operating Officer
Our Plans for 2015/16
• We want to make sure that people in our area are able to live
long and healthy lives, both now and in the future, and our
plans set out how we will do that
• Our Plan has been developed with help from…
Our staff
NHS
Planning
Guidance
Our 43
GP
member
practices
Public
Health
Leeds
NHS Five
Year
Forward
View
Members
of the
public
Patients
Partners
in health
& social
care
Our Plan on a Page
How we will spend the money
• Total budget of £370m
Health
improvement
through
local
“To improve
the health of the
whole population
and
reduce
inequalities in our communities”
commissioning
• Social Prescribing – the service will assess and link people with
social, emotional or practical needs to a range of non-clinical
• Leeds Forward - enhanced alcohol treatment sessions in the
community,
• Smoking cessation –piloting new services whilst also promoting
current quit schemes that support people to stop smoking
• Promote the NHS Health-check – encouraging people between 40 –
74 take their free NHS Health-check test
• Third Sector Grant Scheme – working with Leeds Community
Foundation, the purpose of the scheme is to support the
development of projects led by local community and voluntary
sector groups
Achieving a balance between good physical and
mental health
• Increasing Access to Psychological Therapies (IAPT) – in 2015/16
we will be part of a citywide review on how our community
mental health services are provided in Leeds from next year
• Dementia care in Leeds – from October 2015, there will be four
Memory Support Workers in South and East Leeds, working with
our Neighborhood Teams and GP practices in supporting newly
diagnosed patients
Quality and Innovation
• Leeds Institute for Quality Healthcare – sharing ideas to find
better ways to deliver care and reduce variations in outcomes for
patients
• Medicines Optimisation – our Pharmacist medicines review
service will review patients medicines across a range of clinical
areas and needs
Providing care closer to home
• With an ageing population, living with multiple long-term conditions,
care closer to home will support people to stay healthy and live
independently for longer
• In 2015/16, one of the ways we will be providing care closer to home is
through the House of Care Model - putting patients with long term
conditions at the centre of their care
Developing services for children and young
people
• Five Year Maternity Strategy – launched on 30 June 2015, the
strategy was developed based on the experiences of services in
Leeds of women and their families
Priorities for 2015/16 include:
• Personalisation
• Perinatal mental health support
• Support for women with learning disabilities
• Best Start Zone in South and East Leeds –support to families,
linking them to local services that will ensure every child in South
and East Leeds has the best start in life
Building sustainable Urgent and Emergency care
in Leeds
We need to ensure that urgent and emergency care services are well
prepared to be able to cope with an increase in demand during peak times
of the year
• Planning for winter – extra appointments, marketing campaigns keeping
people well and out of a&e
• First Aid Training for Parents – to support parents to increase confidence
in caring for, and making the right decisions, for their children
Member Engagement
Dr Alistair Walling
Associate Director of Primary
Care
GP – Ashfield Medical Centre
Our Members
The CCG is a member organisation. GPs are a fundamental part of
commissioning!
Why is it important that we are involved?
As GPs, we have a unique insight into the needs of our patients
As GPs, we often have a career long relationship with our community
• Our patients
• Our workload
• Our future
How do we get involved?
Engaging Our Members
Clinical Lead
surgeries
Extranet
Video blogs
New
Ideas
Bi-weekly
members ebulletin and
email
Animation
Face to face
‘ScribbleLive’
comment
forum
Our Primary Care Schemes -14/15
• 14/15 Practice Engagement Scheme
• Utilising structured and nationally recognised
approaches to management of patients with one
long term condition
• Peer review to share best practice around cancer
care
• Integrated working with neighbourhood team
• Winter Scheme - balancing unplanned admissions with
increased capacity in Primary Care
• Bowel Screening - Primary Care Influence with nonparticipants
• Enhanced Care Homes Provision – extended to meet
the needs of those in care home with Nursing Provision
Member input - Enabling Long Term
Condition Management
• 42 Practices signed up
to implement House of
Care
• 24 (58%) practices
implemented in
advance of start date of
1st April 2015
• Key LTCs are Diabetes
and COPD
Member input – Enabling Incident Reporting
160,000
100%
90%
140,000
80%
120,000
70%
100,000
60%
80,000
50%
40%
60,000
30%
40,000
20%
20,000
10%
0% 0
37
84
Apr-09
Jul-09
Oct-09
Jan-10
Apr-10
Jul-10
Oct-10
Jan-11
Apr-11
Jul-11
Oct-11
Jan-12
Apr-12
Jul-12
Oct-12
Jan-13
Apr-13
Jul-13
Oct-13
Jan-14
Apr-14
Jul-14
Oct-14
Jan-15
Apr-15
Jul-15
Oct-15
Jan-16
Age-sex corr. contacts per 1,000 patients per month
Apr-09
Apr-09
Jul-09
Jul-09
Oct-09
Oct-09
Jan-10
Jan-10
Apr-10
Apr-10
Jul-10
Jul-10
Oct-10
Oct-10
Jan-11
Jan-11
Apr-11
Apr-11
Jul-11
Jul-11
Oct-11
Oct-11
Jan-12
Jan-12
Apr-12
Apr-12
Jul-12
Jul-12
Oct-12
Oct-12
Jan-13
Jan-13
Apr-13
Apr-13
Jul-13
Jul-13
Oct-13
Oct-13
Jan-14
Jan-14
Apr-14
Apr-14
Jul-14
Jul-14
Oct-14
Oct-14
Jan-15
Jan-15
Apr-15
Apr-15
Jul-15
Jul-15
Oct-15
Oct-15
Jan-16
Jan-16
DAs
Number of appointments per month
Pressure Faced by Primary Care in LSE
5,000.00
4,500.00
4,000.00
3,500.00
3,000.00
2,500.00
2,000.00
1,500.00
1,000.00
Monthy variation (95%)
500.00
Annualized Diff. to Trend
0.00
• Over the past four years the number of completed appointments offered LSE
practices has increased by 6.3% year-on-year
• This represents a 5.1% per year increase about demographic growth
• The proportion of consultations led by GPs has remained relatively constant
at around 50% of all consultations
Significant Difference
Member input - Enabling Understanding
of Primary Care Workforce in LSE
41% of LSE GPs
are 45-55 years
of age
56% of Practice
Nurses are 45-55
years of age
67% of Practice
Managers are 4555 years of age
Supporting Primary Care Development to secure a stable
Resilient Primary Care For Our Population
•Establishment of South & East Leeds General
Practice Group
Working with:
•
•
•
•
Comprising 27 Leeds South and East
Practices
Covering Population Footprint of
215,767
New Models of Working Team in LSE CCG
Establishment of support Practices to
achieve statutory safe and effective
practice and clinical environments
Infrastructure/Capital Grant Bids
Supporting Primary Care Development to secure a stable
Resilient Primary Care For Our Population
Practice Nursing
Professional
Development and
Nurse Leadership
Programme
Scope of Co-Commissioning
Level 1
Greater CCG
involvement in NHS
England decisionmaking
 CCGs and AT
collaboration.
 No new governance
arrangements
required.
 No formal approval
process.
April 2015
Level 2
Joint decision-making
by NHS England and
CCGs
Level 3
CCGs taking on delegated
responsibilities from NHS
England
 Joint responsibilities
with AT
 New Governancelegislative reform order
to develop joint
committees- needs
CCG constitution
change
 CCGs assume full
responsibility for primary
care commissioning
 Liability remains with
NHSE
 CCGs assurance to
manage conflicts of
interest
To be Determined
Primary Care Quality Improvement Scheme
Quality Pre Requisites:
Datix
Workforce
tool/
Leeds Care
Record
EPACCS
Yellow card
Level 1: Continuation of 14/15
Systematic
approach
COPD
House of
Care
Cancer
Peer
Review
Integration
with NTs
Care
Homes
Member
and Nurse
meetings
Level 2:
All aspects of level
one
House of Care for
minimum of 3 LTCs
Systematic approach
to minimum of 3 LTCs
Level 3: Collaboration between practices
Currently Under Redevelopment
Using Principles of
Collaborative Working and Innovation for Local Need
Leeds South and East CCG
Children’s and Young
People’s AGM - The
feedback
Q&A Session