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Dr Nick Harding - Sandwell and West Birmingham Clinical Commissioning Group's approach to commissioning
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Dr Nick Harding - Sandwell and West Birmingham Clinical Commissioning Group's approach to commissioning


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Dr Nick Harding's second presentation at "SWB Connect", an event held in West Bromwich, 28th June 2012.

Dr Nick Harding's second presentation at "SWB Connect", an event held in West Bromwich, 28th June 2012.

Published in: Health & Medicine

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  • Pilot in LCG PENNA award Co design event involving patients, carers third sector
  • Need to check themes – 4 now
  • Need something somewhere on this Didn’t we do a table on joint commissioning
  •   internal structure – how we will do business – as a board, at sub committees, role and responsibilities of locality commissioning groups     demonstrate transparency member practices can petition to change commissioning policy direction   Accountability for the priorities set, investments made and the outcomes delivered   Currently in the process of consulting on the drafting of the document, important to be involved in shaping the development and ownership – this is your organisation........
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    • 1. Sandwell and West Birmingham CCGOur approach to commissioningDr Nick HardingMBChBBSc FRCGP MFLM DRCOG DOccMedPGDip(Cardiology)26th June 2012 1
    • 2. Our health priorities 2
    • 3. Our health needs 3
    • 4. Our health needs Health without boundaries - November 2011 4
    • 5. A wide range of services available tocommission fromComplex range of providers forhealthcare:HospitalsHeart of England (3 hospitals),University Hospitals Birmingham, Sandwell WestBirmingham, Birmingham Children’s Hospital, RoyalOrthopaedic, Birmingham Women’s Hospital andBirmingham Dental Hospital BirminghamSpecialistBirmingham and Solihull Mental Health TrustCommunityBirmingham Community HealthcareAcute & UrgentWest Midlands Ambulance Service; Range ofurgent care, walk-in and other providers – Assura,Care UK etcThird Sector – a wide range of provision e.g.over 40+ alcohol/drug dependency services 5
    • 6. RCRH Comms and Engagement Chair and RCRH Partnership Board Rep Birmingham BirminghamBlack Sandwell and City Council and SolihullCountry NHS Black SandwellCluster Country Metropolitan West NHS Cluster(Sandwell Partnership Borough Birmingham (Heart ofPCT) (NHS) Trust Council Hospitals Trust Birmingham tPCT) Birmingham Birmingham Community and Solihull Healthcare NHS Mental Health Trust Trust (BSMHT) 6
    • 7. Our strategic priorities► Instigate – intervening early to prevent problems before they occur► Integrate – putting the patient at the centre of their care► Innovate – changing the way we do things to deliver more with less► Improve – focusing on the quality and safety of services in all parts of the system► Influence – playing a full role in local partnerships, affecting the determinants of health 7
    • 8. Our plans are to:► Increase the capacity and capability of primary care, using it as a foundation for system change► Focus on the frail elderly, supporting independence and dignity in old age► Accelerate the Right Care Right Here programme - providing care in the community and treating hospitals as specialist providers► Treat mental ill health and promote wellbeing, viewing good mental health as a precondition to better physical health► Work in partnership to improve maternity and early years, giving every child the best start in life 8
    • 9. 9
    • 10. Our quality priorities Our priority How we monitor this Safety Population health is improving Effectiveness Treatments are effective Population is satisfied with their Patient experience treatments 10
    • 11. Continuously improving quality Build feedback and Annual improvement into Quality and annual commissioning Safety Plan intentions Monitor effective delivery of quality and safe care through : information at Quality & Safety Committee, Local Commissioning Groups feedback 11
    • 12. How we will ensure high quality inPrimary Care ► We want to be able to use information in a way that continuously improves services – as close to ‘real time’ as possible ► Our plan is to use same data as before – but in a smarter, more user friendly way so you can react more quickly to feedback – we can control this ► Reflected in improvements in GP dashboard ► National GP quality dashboard ► If we get the information reporting right at practice level, this will make the job easier and create a more accurate bigger picture 12
    • 13. 13
    • 14. Getting the best out of services - diabetes Patients •Regular follow up •Easy physical access •Close to home SWB CCG •Managed care •Patients •Professional opinion managed safely •Costs covered •Upstream interventions •Value for money 14
    • 15. End of life – from pilot to rollout 2012/13 ►Award winning pilot with experience-led commissioning – patients driving the process Range of events to inform strategy development e.g. Planning Alternative Tomorrows with Hope (PATH) stakeholder event (55) to agree shared vision for end of life care; review of all existing strategies, documentation and initiatives; public health and service cost data and statistics pulled together; two experience co-design events held with third sector; one to one filmed interviews with front line professionals, managers and people living with dying and carers transcribed by University of Oxford for emerging themes ►Strategy co-created with patients, carers and stakeholders ►Our strategy: “in three years time, 90% of people will die in a place they choose.” 15
    • 16. End of life –CCG rollout 2012/135 improvement workstreams have been established February2012 supported by 2 underpinning foundation programmes:► Theme 1 Tell my story – helping people to articulate end of life to be► Theme 2 Hospice everywhere► Theme 3 24:7 coordinated care► Theme 4 Keeping carers well► Theme 5 Compassionate communities – changing the culture towards dyingProgramme team established with wide range of clinicians,commissioners, carers, third sector delivering the workstreams toachieve improvements – with shared ownership. 16
    • 17. Maternity and Children’s Strategic Model of Care Experienced clinical group developed vision for Maternity and Newborn Services – October 2009: ►120,000 women aged 15 to 44 in catchment area ►Share epidemiological and economic characteristics such as high levels of deprivation ►Issues: High levels of still births and infant mortality compared to England and Wales average ►Strong evidence impact quality maternity services can make to improve health and well being of teenagers and their babies increasing number of children on path to success ►Teenage pregnancy is a key issue in Sandwell and West Birmingham 17
    • 18. So who will overview new worldCommissioners: Providers NationalNHS Commissioning Provider • Support & Board Development develop Authority • Set maximum prices • Maintain Overview and Monitor continuity of Scrutiny care Committees • Quality CQC • Safety HealthWatch Any Willing Provider Foundation Trusts Private Sector 3rd Sector Primary Care 18
    • 19. The RATAR model• Access to a Referral, Assessment, Treatment, Advice and Recovery model through a single point.• Provision of Care Closer to Home• A service based on outcomes with patients, families and carers at the heart• Integrated Care Pathways• Collaborative Care 19
    • 20. • The CCG will have as a priority the ongoing commissioning and further development of mental health and well being services.• Developments will focus on an integrated mental health service and the development of Primary Care mental health and wellbeing in the community to meet the needs of the population. 20
    • 21. Some successes already► Reduction in A&E attendance by 6%► Promotion of effective medicines management► Good examples of GPs working together► Defining agreed patient experience standards► End of life pilot - being rolled out across CCG► Dermatology – reductions in hospital attendances► Improved access – radiography available in community► Award winning patient consultation processes► Approval to go for first wave authorisation… 21
    • 22. How we currently invest in secondaryhealthcareProvider BSOL Sandwell Total £000s £000s £000’sSWBH 77,936 157,260 235196BSMHT 23,724 1,443 25,167BCPFT 230 33,915 34,145Birmingham 634 5,065 5,699Children’sSCHS 8,804 34,553 43,357BCHS 27,409 3,628 31,037 TOTAL 374,601 22
    • 23. How we work with other CCGs ► Leadership /advice – clinical senate? ► Clinical leads for commissioning for contracts? ► Nominated contract leads – how this will work: “hosted by a CCG but ensuring those CCGs with ‘significant interests’ are represented around the discussion table’ e.g. urgent care, BCHC ► Health and Well-being boards – shared strategy for city 23
    • 24. Quality Priorities 2012/13 • Developed draft CCG Quality and Safety Plan – out for consultation to members (issue 2) ] • Putting quality into all our contracts – ensuring we are commissioning for quality e.g. alcohol CQUIN • Monitoring delivery of quality and safety through Quality and Safety Committee and formal Clinical Quality Reviews (e.g. meetings, reviewing incidents/never events, visits) • Provider development • Primary Care development 24
    • 25. Thank you► Have learned a great deal already and much to build on► Remain committed to what its all about….patients and quality of care► Committed to working with the third sector, patients, carers to develop together the best healthcare Questions? 25
    • 26. 26
    • 27. 12 months on… Shared vision and strategy - We have an integrated plan which has involved all health and local authority partners Shared way of working through the Compact - for shared leadership across the NHS and local authorities Resources - Good progress has been made - a coordinated structure was established pooling the resources of four PCTs Results so far - Delivery is good - moving from forecast £50.5m deficit to £2m planned surplus; key quality and performance targets achieved 27
    • 28. Integrated Plan Greater push on transformation and delivering improvements Greater emphasis on quality and improving primary care Supporting development of future organisations More integrated working → specialised service pathways and joined up services → Councils working with health on care for older people Financial planning - Still heading off increasing financial pressures for years ahead 28
    • 29. Brief• Support the Frail Elderly ProgrammeSigned off by CEO Compact 29
    • 30. Patient/Clinician Journey Dr S Mr/s D 30
    • 31. A constitution – why? Clear and comprehensive constitutions – to ensure effective structures, strong governance systems and good relationships with practices. ►Describes our statutory responsibilities as a commissioning body ►Set out who and how you can be a member, how to leave ►Our internal structures ►Our Elections and appointment processes, and removal from office ►How we can demonstrate transparency in how our decisions are taken ►Accountability to our patients, the wider local community, local council and health and well being board ►Engagement with our membership, the wider profession 31
    • 32. The journey to authorisation ► Approval to go for first wave authorisation ► What we need to demonstrate: → Examples of how member practices are involved in decision making within the CCG/LCG → How we work together - constitution → Election process – competency and representation 32
    • 33. New NHS ParliamentKey: Accountability Department of Funding Health Right Care Right Here partnership NHS Commissioning Monitor CQC Board Licensing Providers SWB CCG Contracts BSMHT, BCP, BCHC, SWBH Partnership Local Authorities Other providers BCH, Local HealthWatch BWH, ROH, DGH, RW, SWB, WM, and I/C. Birmingham HealthWatch Patients & Public Sandwell HealthWatch 33
    • 34. 34