annual general meeting - southwark ccg · agenda time title presenter 14:00 welcome and...

Annual General

Meeting

30 August 2018

#SwkCCGAGM18

Welcome

Dr Jonty Heaversedge, CCG Chair

Agenda

Time Title Presenter

14:00 Welcome and introductions Dr Jonty Heaversedge

14:15 Presentation of CCG Annual Report and Key Achievements

2017/18 Ross Graves

14:35 Presentation of CCG Annual Accounts 2017/18 Malcolm Hines

14.50 Questions and answers from members of the audience All

15:00

Community Based Care – improving care for patients:

• SEL Commissioning Alliance

• Introduction

• Community estates

• Digital development

• Clinical effectiveness

Andrew Bland

Ross Graves

Rebecca Scott

Dr Jonty Heaversedge

Dr Payam Torabi & Nick Harris

15:35 Questions and answers from members of the audience All

15.50 Closing comments and thanks Dr Jonty Heaversedge

16.00 Close

3

CCG Annual Report and Key

Achievements 2017/18

Ross Graves, Managing Director

Annual Report 2017/18 and key achievements

Strong performance across CCG assurance and an overall rating of ‘outstanding’

• Overall rating of outstanding for 2017/18, an improvement from the previous two years where

the CCG received a good rating. One of only 20 CCGs nationally and three in London to receive

the top rating.

• High performance was maintained for dementia diagnosis rates, appropriate prescribing of

antibiotics, and low rates of maternal smoking.

• Improvements were seen in the proportion of cancers identified at an early stage and one-

year survival from all cancers.

• Other key achievements include outstanding ratings for the quality of CCG leadership and

patient and public engagement in commissioning health and care.

5

6

Leading and supporting delivery across national NHS standards and key local programmes

• Delivery of key NHS standards for: seeing a cancer specialist within two weeks of referral,

reduction of inappropriate antibiotic prescribing for UTI in primary care, reduction in E coli blood

stream infections.

• Worked collaboratively to support the delivery of provider improvement plans where

performance against constitutional standards is challenged.

• Over 100% increase in the use of electronic referrals from GPs into hospital care – a key tool

for offering patients meaningful choice by having all relevant and up to date information available

to inform the discussion.

• Step change in assessment pathways for NHS Continuing Healthcare meaning that

assessments follow discharge from hospital, when a person’s long-term needs are clearer.

• Stage 2 business case for Dulwich Health Centre approved by the National Investment

Committee on 20 March. Construction on the site has now started.

• Worked alongside GP federations to guide and assist four practices to move from a CQC rating

of “requires improvement” to “good”


7

Providing leadership across the local health system

• Improved response rate to 88% in 360o stakeholder survey, and improved scores in the

confidence in CCG leadership, stakeholders being given opportunity to influence plans, and

involving the right individuals/organisations when commissioning/decommissioning services.

• Leading the transformation of primary care programme across London.

• CCG members and staff have key roles in South East London’s Sustainability and

Transformation Partnership, particularly its approach to community based care, estates, digital

and continuing healthcare.

• Lead roles for LAS commissioning across south east London and for King’s College Hospital

NHS Foundation Trust for London.

• Delegated responsibility for commissioning GP practice services.

• Further established the Partnership Commissioning Team with Southwark Council, working to

deliver population based commissioning for residents.

• Lead CCG for national Diabetes Treatment and Care Programme in South London, including

completing the procurement of a Diabetes Hub to improve the uptake of structured education

• Lead CCG for SE London heading the development of tier 3 weight management service pilot


8

Taking a common approach to improving quality and driving key projects across health services

across Southwark

• Duty of Candour training launched to help GPs understand their duty to inform patients and make

a formal apology if an error has occurred in an element of care.

• The CCG are assured that our hospital providers have a robust mechanism to learn and improve

where incidents do occur.

• Rollout of Optimise RX: helping prescribers to achieve safe and quality prescribing, reducing

unwarranted variation

• Medications Safety Officer was appointed for the CCG, as were clinical champions for HIV and

Antibiotic Stewardship

• Launch of Clinical Effectiveness Southwark, providing support and clinical leadership to localise

and implement guidance using templates, facilitation and feedback.


9

Transforming services through Southwark’s Five Year Forward View, addressing fragmented

arrangements of planning and funding health and social care

• Working through the CCG and council Partnership Commissioning Team, agreed how best to use

the £31million Better Care Fund to support people at risk in the community, reduce hospital and

care home admissions and help people to be transferred smoothly and safely from hospital.

• In January 2018, the CCG and Southwark Council finalised our new Joint Mental Health and

Wellbeing Strategy.

• Agreed to take forward Southwark Bridges to Health and Wellbeing as a shared approach to

commissioning across the CCG and Southwark Council. This means commissioning for

populations rather than separate organisations.


10

Bringing organisations and professionals together

• Developing our Local Care Networks (LCNs) to play an increasing role in designing,

implementing and managing services. Significant progress was made with the launch of the new

care coordination pathway, which is delivering coordinated and person-centred care to people

with three or more long-term conditions and addresses both physical and mental health needs.

• Working with Community Southwark and the local settlement organisations (Pembroke

House and Time and Talents) in Walworth and Rotherhithe to develop ways to help mobilise and

empower people to make better choices and have more control over their lives. LCNs are

exploring how to expand the learning with other areas.


11

Empowering residents and service users

• Continuing to support people living with three or more long term conditions to contribute to

the design of our approach to joining up care. We won an award for this work at the Patient

Experience Network National Awards (PENNA) in March 2018.

• Talking to local people about what they think would improve quality in primary care.

• Engaging local residents to develop the vision for transforming mental health and wellbeing for

local people, as part of our joint Southwark mental health and wellbeing strategy.

• Transforming education and self-management for patients with diabetes.


CCG annual accounts

2017/18

Malcolm Hines,

Chief Financial Officer

Duty YTD Target YTD

Performance RAG

Expenditure not to exceed income £488,480k £486,900k

Capital resource does not exceed the

allowance £69k £50k

Revenue resource does not exceed the

allowance £467,415k £465,854k

Capital Resource use on specified matters

does not exceed the allowance N/A N/A

Revenue resource use on specified matters

does not exceed the allowance N/A N/A

Revenue administration resource use does

not exceed the allowance £6,500k £6,457k

13

Key Financial Performance Duties

14

2017/18 Annual Accounts

• Met all of the statutory financial performance duties in 2017/18.

• The CCG has demonstrated continued strong financial performance, achieving

a surplus of £11,074k against a plan of £9,743k. The main driver of the

increased surplus was the NHS England requirement not to commit the 0.5%

non-recurrent reserve which CCGs are required to establish in their planning.

• Included in the 2017/18 accounts was a non-recurrent cost of £1,277k relating

to No Cheaper Supply Obtainable (NCSO) drugs. There was also a non-

recurrent cost of £1.75m relating to the CCG’s share of a £10.5m South East

London liability with Lewisham & Greenwich NHS Trust due to the Trust Special

Administrator Agreement at South London Healthcare NHS Trust in 2013.

• In addition to the above, the CCG underspent by £43k on running costs.

• The CCG received £69k capital funding in 2017/18 and underspent by £19k

due to a late allocation of the same amount.

• CCG accounts were audited by KPMG LLP. The CCG received an unqualified

audit opinion.

15

CCG Expenditure 2017/18

16

Financial Forward View: opening allocations

Opening Allocations 2016/17 –

2020/21

2016-17

£’000s

2017-18

£’000s

2018-19

£’000s

2019-20

£’000s

2020-21

£’000s

Recurrent Allocation 393,667 403,334 413,881 425,807 441,391

Delegated Primary Care - 43,208 44,749 46,469 46,469

Non recurrent sums announced/

anticipated 1,355

Running Costs allocation 6,457 6,496 6,533 6,565 6,594

HRG4 adjustments 2,058 Made

recurrent

IR rules adjustments -5,241 Made

recurrent

Total Resources 402,124 449,855 466,518 478,841 494,454

Target surplus for the year with

drawdown 7,673 9,743 12,063 tba tba

% change over previous year’s

recurrent allocation 3.05% 2.45% 3.33% 2.55% 3.66%

17

Financial Forward View: QIPP requirements

2016/17 – 2020/21 estimated net

QIPP programme requirements

2016-17

£’000s

2017-18

£’000s

2018-19

£’000s

2019-20

£’000s

2020-21

£’000s

Total QIPP programme- net of

investment 6,659 12,393 16,550 15,428 13,950

QIPP programme as a

percentage of allocation 1.7% 3.0% 3.60% 3.3% 3.15%

Questions and answers

South East London

Commissioning Alliance:

working together to improve care

Andrew Bland, Accountable Officer

20

Why work as an ‘alliance’ of CCGs?

• Efficiencies from ‘doing things once’ where possible (and freeing up local CCG teams to focus on

things very local)

• Having an aligned approach to external discussions; e.g. our SEL ICDT (acute) team supported a

contracting round with no disputes

• Ability to respond effectively and efficiently to regulator ‘at scale’ requirements (e.g. a SEL wide

assurance approach is being developed as NHSE assures at that level now)

• Enhanced ability to attract funding/ negotiate effectively (SEL CCGs were able to secure funding

for QIPP delivery by applying ‘ at scale’ and negotiated a more significant CSU contract reduction

by doing this once for the alliance)

• Support for under-resourced/ over capacity teams by working collaboratively (QIPP leadership

and PMO being established across BGL; supported by QIPP resource funded by the Alliance)

The SEL Commissioning Alliance aims to be complementary both to the local work of CCGs

and the work of the full STP programme.

21

The system in south east London

SLaM is the key MH provider for

Lambeth, Southwark and Lewisham

Community Based Care:

making a difference to Southwark

residents


A key focus of our community based care programme is supporting

those with multiple long term conditions: Jacqueline’s story

A key focus of our community based care programme is supporting

those with multiple long term conditions: Lindsay’s story

25

Our shared vision and ambition for Southwark

Making Southwark the best place to be born, live, and grow old

Keeping people healthy, preventing illness

& supporting people to manage their

condition

• Shifting towards proactive preventative

care and early action

• Delivering outcomes that matter for the

people of Southwark

• Person-centred care planning and self-

management support

We will

achieve

this by…

Activating support from family, friends,

carers and the community

• Supporting community and voluntary

sector services to come together

• Providing better links to activities and

support in the community

• Creating opportunities for people to

support one another in their community

Providing great quality whole person care close to home

• Strengthening our workforce and removing artificial boundaries between service providers

• Better use of innovation & technology

• Quick access to specialist expertise in the community

• Better transition across health and care services; particularly in and out of hospital

• Developing our approach to neighbourhood working to coordinate care for people with

complex needs

• Making primary care more resilient and sustainable

26

The Southwark CBC Programme

Southwark Community based Care

(CBC) Programme

Local Care Networks

(LCNs)

Developing collaborative arrangements

Commissioning Development

Community estates

Interdependency

Today we are going to showcase three enabling projects that support this

programme

Quality improvement and clinical effectiveness

Digital

Supporting Community based

Care through our community

estates

Rebecca Scott, Estates Programme Director

28

What do we mean by ‘community estates’

Buildings from which our GP and community health services are provided

• These fall into three main categories

• GP Practice premises across the borough

• Health centres

• Mental health centres.

• There is a big range in size and quality.

29

Why is this an issue for us now?

More health

services being

provided in

community health

buildings

More people will be

living in the

borough

More ill health to

be prevented

through proactive

management of

long term

conditions

More health care

will be provided

remotely

Although some care will be taken away from community health facilities by the

advance of technology and proactive management, this is significantly outweighed by

the population increase we are anticipating.

The sort of space that we will need will be different

We will need more space for health professionals to provide care

Where are the hotspots we need to address?

Dulwich Locality

Peckham & Camberwell

Locality

Bermondsey & Rotherhithe

Locality Borough & Walworth

Locality

Blackfriars and

the Elephant

18,000

Canada Water 13,000

Aylesbury and

Mandela Way

10,000

Old Kent Road (SE)

32,000

Peckham and

Camberwell 5000

An estimated 78,000

additional people

30

31

A network of health centres…

Dulwich Locality

Peckham & Camberwell

Locality

Bermondsey & Rotherhithe

Locality Borough & Walworth

Locality

Canada Water

Old Kent Road

Lister Health Centre

Aylesbury

Elephant and Castle

CH

CH

CSH

CSH

CSH

CSH

CH Dulwich

(under construction)

Surrey Docks Health Centre

…to meet needs of more people and allow us to offer more services

32

What services should we be planning for?

The work we did on the ‘Developing health services in Dulwich and the

surrounding area’ project offers a useful prototype on which we can build.

A new facility

now being built

which will open

in 2020

33

What did people tell us then?

The engagement and consultation we did in preparation told us that

…as this would

be easier for

access and help

the integration

of services

they would

prefer these to

be in a more

central and

accessible

health centre…

they wanted

wider services

provided in

community

settings

local people

really value high

quality GP

services

A community health hub is a building housing a wide range of health services

under one roof.

Health services at Dulwich

General Practice

Support for people with

long term conditions and

older people

Diagnostics including

blood tests

Out-patients - including

musculo-skeletal

physiotherapy

Children’s services

health visiting and

Speech therapy

Pharmacy

Refreshments,

health

information and

voluntary sector

space

35

Social regeneration - developing our ambition

Other possible services that could be linked to Community Health & Wellbeing Hubs

General practice space

Pharmacy

Primary care children’s services

Voluntary sector presence

Diagnostics

Consultation space for multi-

disciplinary clinics

Shared support space (eg

meeting rooms)

VCS, Social Connectivity,

Physical activity programmes

Heathy eating support

Job Centre Plus

Accelerator hubs

CAB/benefits advice

Apprenticeships

LBS/RSL housing office

• wellbeing workers/navigators

• Community curated space

• Cultural and arts space

Digital access & support

Library

SIAS

Group rooms and exercise space

Wellbeing Services

Work/economic support

Housing support

Community Space

Access to council services

Information/advice

services

36

How can we link these services?

• Through putting services close to each other – even in the same building

• Through having properly managed community space for community

activities

• Through changing pathways so that people can be referred into other

services by health and care professionals.

37

Conclusion

• This is an exciting time for health services – the regeneration in the borough

is offering us the opportunity to make sure we have modern fit for

purpose health facilities.

• Our engagement work gives us a framework we can build on to make sure

that services fit our communities in Southwark

• The CCG is working closely with the council to make sure that where we can

we address the wider issues affecting people’s health and wellbeing.

Dr Jonty Heaversedge, Clinical Chair


Care through digital development

39

Digital technologies are becoming ubiquitous

Source: ONS Statistical Bulletin 2018, NHS Digital 2017

94% of all UK households have internet access and

over 90% of adults in the UK are recent internet users

Over 80% of the population between the ages of 16

and 74 use a portable computer or handheld device

to access the internet away from home or work

In 2017 NHS Choices received over 525 million visits 525m

80%

94%

People in Southwark have told us…

Following the engagement on the CCG’s digital strategy, practices and patients

involved in the discussions identified four key opportunities for digital technology

in the local system:

1. To empower people to optimise their health and wellbeing

2. To improve access to support and services

3. To reduce workload for clinicians and administrative staff

4. To facilitate multi-disciplinary team working.

Digital enables many of our priorities

For example…

• All NHS providers and GP practices in Southwark are able to access a shared care record for patients

• By 31 March 2019 all practices will have implemented eConsult our online consultation tool. It is already live in 13 practice with approximately 350 visits per week do date.

• Southwark have increased our electronic referrals by 44% over the last 12 months and are on target for all electronic referrals by GPs from October 2018.

• VisualDX is supporting GPs with advice and guidance to make effective diagnoses and referrals

Better, more joined up

experience for patients

Better clinical

outcomes

Value for money

Empowered patients

Patient Benefits from online consultation

https://econsult.net/why-econsult/patient-benefits/






Samantha, 37, Elephant and

Castle

Ongoing back pain

Working professional with a

successful but demanding

career – does not want to take

time off from work to attend

doctor’s appointment

Technologically literate

Moira (internet savvy), 74,

Dulwich

Moira was discharged from

hospital with new medications

but does not fully know how

she should take them

Moira is weak and vulnerable

and therefore can’t easily leave

the house to attend a GP

appointment

To avoid readmission Moira

needs continuity of medication

without leaving home

Peter, 57, Bellenden Road

HIV positive and suffers from a

range of other long term

conditions. Some of these are

caused by historic and current

medications. This means that

Peter has many more

appointments and treatments

than most patients.

How Digital will support patients?

Apps to

manage

conditions

Online

information

and self-help

groups

To be able to

contact the

GP online

View patient

record

Book

appointments

online

Direct

booking to

other health

professionals

e.g. physio

GPs

supported

with advice

and guidance


Care through Clinical Effectiveness

Dr Payam Torabi and Nick Harris

45

What is CES?

Clinical Effectiveness Southwark (CES) is a systematic approach designed

to tackle health inequalities.

We strive to ‘make the right thing to do, the easy thing to do’, for busy

general practice teams working in Southwark. This builds on an established

collaboration between the CCG working and General Practice to improve

outcomes (e.g. work by our Medicines Optimisation team to deliver a step

change in detection for anticoagulation and stroke).

CES is a partnership team including NHS Southwark Clinical Commissioning

Group and Southwark’s two GP federations; supported and part-funded by The

Health Foundation.

46

Informed by good practice

CES is based on the successful Clinical Effectiveness Group (CEG) in east London.

As a multi-skilled partnership we connect and learn from other local quality

improvement initiatives, enabling us to localise our approach.

AF improvements in East London

47

CES process

CES prioritise medical conditions that GPs see

and treat frequently in Southwark.

Produce local ‘GP friendly’ CES Guides.

These summarise national guidelines, highlighting

key messages relevant to our population and local

services.

‘Guides’ inform templates that GP teams use to

remind them of the important things to focus on.

These help practices record important clinical

information. Data analysis also helps inform health

planning.

CES attend practice meetings and deliver regular

training sessions to help GPs and nurses deliver

best-practice care.

48

Where are we now and what next?

CES launched its first three guides: Atrial Fibrillation (AF), Type 2 Diabetes

and Hypertension in May 2018

The second tranche of CES guides will be launched in October:

• Breathlessness

• Heart failure

• Asthma

• Chronic Obstructive Pulmonary Disease (COPD)

Further engagement over the coming weeks includes;

• Patient workshop with Healthwatch Southwark in September to explore how

CES could refine and enhance its offer of support

• Increase engagement with practices to tailor support and shape the next

phase of work

• Finalise the evaluation criteria with our independent evaluation partner, Kings

College London (KCL)

Community Based Care:

Focus for 18/19 – 19/20


50

Our areas of focus for 18/19 – 19/20

Questions and answers

Closing comments

Dr Jonty Heaversedge, CCG Chair

annual general meeting - southwark ccg · agenda time title presenter 14:00 welcome and...

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