ealing ccg pmo report finance report july 2014 · cvd anticoagulation schemes (615) 72 (543) (154)...

Finance Report Month 3 2012-13

Kathryn Magson- Managing Director

Charles Wheatcroft - QIPP Programme Director

Neetika Mahan- Business Manager

Peter Buckman - Finance Lead

Ealing CCG PMO Report July 2014

Agenda

1. QIPP

a. 2014-15 Budget Finances 3

b. QIPP Schemes Summary 4-9

c. Highlight Reports for each scheme 10-25

2. Better Care Fund Projects

a. Summary 26-27

b. Highlight Reports 28-33

3. Procurements

a. Summary 34

b. Highlight Reports 35-41

4. Other Major Projects

a. Summary 42

b. Highlight Report 43-46

5. Appendix 47

QIPP Summary at Month 2 2014-15 QIPP BCF Procurement Other Projects Appendix

Local Scheme Name

Gross

(14/15)

(£k)

Reprovision

(14/15)

(£k)

Net (14/15)

(£k)

YTD Plan -

savings

YTD Plan -

reprovision

YTD Plan -

net

YTD Actual -

savings

YTD Actual -

reprovision

YTD Actual -

net

Variance to

plan FOT Savings

Variance to

plan

FOT

reprovision

Variance to

plan

Overall FOT

Variance Comments

Reflected in contracts - "flexible" contracts

Cardiology (545) 497 (48) 0 0 0 (40) 0 (40) 40 0 (545) 0 497 (48)FOT reflects that procurement will now

complete in March, not January

CVD Anticoagulation Schemes (615) 72 (543) (154) 18 (136) 0 0 0 (136) 0 (615) 72 0 (615)

615k is acute target. CCG target is

£308k. FOT reflects worse case outcome

from disputed attendance tariff.

Dermatology (1,265) 213 (1,052) (127) 21 (105) 0 53 53 (158) (1,265) (0) 213 0 (0)

Diabetes (EHT) (344) 324 (20) (86) 81 (5) (31) 0 (31) 26 (125) (219) 108 216 (3)

GP Service for Nursing Homes (1,013) 477 (536) (253) 119 (134) (57) 162 105 (239) (228) (785) 477 0 (785)Imperial NEL data is not reliable, and is

over stated.

Gynaecology (461) 200 (261) (115) 50 (65) (70) 0 (70) 5 (280) (180) 200 0 (180)

FOT reflects worse case. There are

presently no plans to spend the 200k re-

provision budget.

Intermediate Care Service (ICE) (749) 0 (749) (187) 0 (187) (65) (65) (122) (260) (489) 0 0 (489)NEL data is not reliable, and is over

stated.

MSK Pathway (761) 387 (374) (190) 97 (94) (43) 97 54 (147) (174) (588) 387 0 (588)FOT does not count saving from MRI of

£500k

Paediatric Community Nursing (97) 0 (97) (24) 0 (24) (23) 0 (23) (1) (92) (6) 0 0 (6)

Pulmonary rehabilitation (100) 0 (100) (25) 0 (25) (84) 0 (84) 59 (334) 235 0 0 235 Imperial NEL data is not reliable, and is

over stated.

Referral Facilitation Service (RFS) (576) 285 (291) (144) 71 (73) (33) 0 (33) (39) (133) (443) 50 235 (208)Plan phasing to be amended. No savings

expected until October 2014

Reflected in other contracts (e.g. Block) 0 0

Shifting Setting of Care (900) 0 (900) (225) 0 (225) (225) 0 (225) 0 (900) 0 0 0 0

Community Efficiency (368) 0 (368) (92) 0 (92) (92) 0 (92) 0 (368) 0 0 0 0

Other contractual arrangements/other

arrangements0 0 0

Prescribing (1,451) 200 (1,251) (363) 50 (313) (313) 70 (243) (70) (1,451) 0 200 0 0

Continuing Care (650) 0 (650) (163) 0 (163) (163) 0 (163) 1 (650) 0 0 0 0

Pathology reprovision (444) 0 (444) 0 0 0 0 0 0 0 (335) (109) 0 0 (109) Requires additional verification

(10,338) 2,655 (7,683) (2,147) 508 (1,640) (1,240) 382 (857) (783) (6,595) (3,743) 1,707 948 (2,795)

YTD (£000) FOT (£000)

** The accuracy of the numbers reported above has been adversely affected by

- Gaps in the Imperial Outpatients data which needed to be extrapolated

- Incorrect coding of EL and NEL data from Imperial: ECCG learnt on 17 July that Imperial have coded all their

NEL as EL and EL as NEL, this has a huge impact on the numbers derived above

*

* Continuing Care has already delivered £470k savings (refer to slide # 23)

QIPP schemes summary at Month 2 (1 of 4)

Project / Scheme Name

Type Lead Date QIPP Live / Service Go Live

Target 2014-15 Cost

Reductions £,000

Target 2014-15

Reprovision Cost £,000

RAG Highlights Next Steps

CVD Anticoagulation Schemes

Planned Care Delia O'Rourke

On going: (since 2011)

£308 £72 G - EHT are not discharging the expected volume of patients - EHT continue to dispute the reduced tariff. It is the one and only remaining issue to resolve in the 2014-15 EHT acute contract. - Discharge of patients from EHT to GP care has resumed.

' - NRM to continue to visit practices and encourage transfer of patients monitored at EHT or referred to EHT to attend community management. - To agree process by which EHT assures the CCG that only eligible patients are attending Hospital clinics.

MSK Pathway Planned Care Anjum Fareed

On going: (since Oct 13)

£1281 £387 A - Referrals for physio have increased in May to 983 against a monthly target of 939. However this is still within the 5% planned range. The first to follow up ratio for May was 1:1.2. - MSK Interface services received 549 referrals against a monthly target of 644. The first to follow up ratio for Interface is 1:1.14. The referral rate for MSK interface has consistently been below projected levels since project inception. - Initial analyses shows that MRI reductions to In-health have been greater than planned at 500 fewer MRIs (519 achieved). - There are many other issues including: inaccuracies in calculation, ECCG requirements for first and follow up activity and total activity volumes have not been adhered to. In the meantime, there are now approximately 1848 people waiting up to be seen.

- This will be pending depending on the outcome of the Executive Committee's decision on proposals. Also informed by the 23rd July meeting this years contract with EICO still has to be concluded. - Further investigation is also required to determine appropriate first to follow up ratios for rheumatology, neurology and T/O as these appear to be very high at present.

Referral Facilitation Service (RFS)

Planned Care Beryl Bevan Apr-14 £570 £285 G Organising the two workshops to discuss Internally Generated Demand protocols is proving very hard to schedule.

- Hold two workshops on IGD: 1) consultant referrals from A&E, 2) all other referrals. - Progress RFS prior approval process design with EHT

QIPP BCF Procurement Other Projects Appendix




Target 2014-15 Cost

Reductions £,000

Target 2014-15



Diabetes Planned Care Frances Horne

On going: (since 2011)

£371 £324 A - Community service is establised and providing services. - In contract negotiations, it became clear that the business case estimates for stable type II patients that can be discharged from acute has been over estimated. This means that only half of the QIPP target can be achieved. Target cost reduction figures will need to be reviewed. - Data shows that diabetes follow-ups are not reducing.

- Sixth clinic is due to open on 16th July - Review and verify the Trust's demand and capacity plan for Diabetes. - Begin process to introduce triage of the "super eight" conditions by RFS. - Follow-up on clinical audit actions. - Complete application for funding with LBE for voluntary sector support of diabetes patients - Engage Imperial, to begin the process of taking community referrals from Imperial acute.

Gynaecology Planned Care Zoe Richards On going (since May-13)

£461 £200 G - Data shows some reductions in GP referrals due to RFS action. - Imperial have implemented changes to the delivery and charging for certain Gynae procedures. - Draft LES is on extranet. There are still financial risks as unit price not agreed - Poor engagement with EHT re future options - Data analysis to revise figures and potential to remove activity

- Speak with RFS to establish if we can improve clarity of referral through to uro/gynae clinics - Liaise with EHT re potential options re model and coding - Review H&F model as potential Ealing way forward

Dermatology Planned Care Anjum Fareed

Jul-14 £1412 £452 G - The project has been mobilised and is active. Constructive feedback has been received from a patient and GPs. - Activity within the first two weeks was 102 referrals which is below the maximum expected volume in the business case. However, the business case had put forward a pathway diversion scenario ranging from 80% to 50%. A reasonable diversion rate can be agreed as referrals settle into the service. - KPIs are being met. - A fourth site is to be announced as soon as activity volumes increase. - Concordia is yet to be resolve issues around the use of Choose and Book and the provision of directly bookable slots.

- The issue making directly bookable slots available to GPs and RFS on Choose and Book needs to be resolved very soon. - Activity counting needs to be reconciled internally. - A programme of unannounced and announced inspections to be planned to ensure appropriate mobilisation has taken place. Advice to be sought from Governance lead on how to conduct this.





Target 2014-15 Cost

Reductions £,000

Target 2014-15



Intermediate Care Service (ICE)

Unplanned Care

Usha Prema On going: (since Oct 12)

£750 £0 G - Final Recommendations for new ICE service model following review, signed off by Steering Group - 30/5/14. Ealing Exec agreed key recommendations and principles of ICE Review on 11/6/14. - First ICE Implementation Steering Group held 11/7/14. Phase 1 programme of work discussed and agreed.

- Complete and sign-off ICE Review Report, and future state Intermediate Care Model at CCG Execs, Governing Body and COM - Serve contractual notice on provider of changes required - Make an initial quantified estimate of impact on non -elective admissions from implementing the new model (short term solution). -Phase 1 implementation programme to be planned and agreed.

GP Service for Nursing Homes

Unplanned Care

Charles Wheatcroft/ Sue Pascoe


£1,053 £477 G - Patients transferred to date are 855. 282 patients remain to be transferred. 4 nursing homes are resisting any transfers - Provider did not achieve the Mobilisation Plan according to the contract. Patient choice was the main cause. Resistance to transfer by nursing homes has also been an issue

- Negotiate contractual changes to reflect that fact that mobilisation did not achieve the target of 1,100 patients transferred. - Resolve IG issues, so that provider can receive SUS data, and allow triangulation between primary care and secondary care patient records.

Pulmonary Rehabilitation

Unplanned Care

Delia O'Rourke


£97 £0 A - Referrals in to the PRS scheme are running at 450 pa, against a contract target of 920 for 2014-15; despite full funding continuing - GPs are not referring the quantity of patients expected as per business case, even though COPD patients exceed 3,500 as per QOF data. - CCG options re continuation of contract and or changes to the service to be discussed with provider on 20th Aug, at Formal Contract Review.

- Hold contract meeting to review activity and marketing plan. - If no response issue a contract query in respect of referrals and patients completing the programme. - NRMs visiting practices with poor referral rates to PRS and collating feedback on the service

Prescribing Medinces Management

Bal Hampal On-going: (Continous programme for multiple years)

£1,451 £200 G - Prescribing budgets allocated on a practice level. Practice QIPP targets identified for each practice. - The Invest to Save Scheme (increasing capacity in the MMT) started on 1st April. Practice pharmacists working in GP practices to implement the QIPP areas. - The MMT have undertaken prescribing updates at the ICP MDG meetings (all 7 Health Net works have been completed).

- The MMT Pharmaceutical Advisers will be undertaking practice visits to discuss the prescribing QIPP areas and the Prescribing Incentive Scheme.




Type Lead Date QIPP Live

/ Service Go Live

Target 2014-15 Cost

Reductions £,000

Target 2014-15



Mental Health CC Mental Health

Nicola Bradley

Oct-14 £650 £0 G - Appointed named social worker (LBE), 2 x MH nurse assessors and Placement Manager (Ealing CCG)in place to review all cases ( 40 and 7 now outstanding ). Fortnightly Joint Mental Health Panel established between CCG and LBE with co-charing by WLMHT Service Manager and Ealing CCG Head of Continuing Care and Complex Placements. Joint assessments taking place with Social Services to determine health needs and then health and social care funding responsibilities taken through Panel . - Ealing CCG mental health update monthly meetings scheduled and in place to review QIPP and cases. Ealing MH CHC cases reviews being undertaken (7 outstanding)

Continue to present cases that have been jointly reviewed to Panel and agre LBE to take over funding responsibility for those cases not eligble for NHS funding . To also agree step down plans for those patients in assessment and treatment beds when appropriate. Projected forecast for further aprox £244k savings to be achieved by March 2015.

Shifting Settings of Care (Mental Care)

Mental Health

Sue Pascoe

On going (since Oct-13)

£500 £0 G - Fortnightly monitoring meetings established and commenced with WLMHT - 46 GP practices signed up to scheme at end June - Cumulative total of 30 patients discharged at end of June set against activity target of target of 76 patients - new (rising) trajectory agreed with WLMHT - Additional cost of depot injections - CCG confirmed that this will be covered centrally . - CCG provided written confirmation of funding for PCMHWs through to 31/3/15

- Continue to work with primary care to ensure 70% (55) GP practices to be signed up to scheme by 30th Sept 2014 - Further detail being sought form WLMHT re Operational Plan for delivery - Finalise funding agreement with MIND for welfare benefits and peer support work - WLMHT to finalise recruitment of vacant PCMHW - Ascertain feasibility of PCMHWs being based at Percival House

Mental Health: Productivity; Recovery Houses; Ward closure & bed reconfiguration

Mental Health

Leanda Richardson

Apr-14 £400 £0 A - Independent demand and capacity analysis commissioned and work commenced. - baseline data collected and reviewed - Model built, reviewed and refined via several workshop sessions and meetings

- Finalise model and organise handover to commissioners - Test planning scenarios using model

Paediatric Pathways Paediatrics

Zoe Richards

Apr-14 £100 £0 G - PPL audit completed and analysis undertaken. PACU review undertaken. EAS report received. Ongoing data analysis re frequent flyers and conditions being undertaken. Initial plan of service re-design scoped.

- Executive report rescheduled for September 14. Draft report with project plan required for 23rd July. Workshop with acute providers to be scheduled for July/Aug 14. On-going analysis of data re identified conditions and frequent flyers.


Milestone chart for Planned & Unplanned Care schemes (1 of 2)

PLAN ACTUAL PLAN ACTUAL PERCENT Month:

ACTIVITY START DATE START DATE DURATION

(WEEKS)

DURATION COMPLETE Date: 30 06 13 20 27 03 10 17 24 03 10 17 24 31 07 14 21 28 05 12 19 26 02 09 16 23 30 07 14 21 28 04 11 18 25 01 08 15 22 29 06 13 20 27 03 10 17 24 01 08 15 22 29 05 12 19 26 02 09 16 23 02 09 16 23 30

Wk No: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Intermediate Care Service (ICE)

ICE review 15-Mar-14 15-Mar-14 12 12 100%

Plan and commission service changes (Bix Case)02-Jun-14 11-Jul-04 5 5 20%

Mobilisation of service changes 07-Jul-14 15-Sep-14 8 8 0%

New service: on-going provision 01-Sep-14 01-Oct-14 31 31 0%

GP Service for Nursing Homes

Service mobilisation 01-Nov-13 01-Nov-13 9 9 100%

Service mobilisation extension 03-Mar-14 30-Jun-14 9 9 80%

On-going service provision 31-Mar-15 31-Mar-15 48 48 0%

Pulmonary rehabilitation

On-going service provision 00-Jan-00 00-Jan-00 27 27 60%

Referrals marketing programme 07-May-14 07-May-14 18 18 25%

Service review 07-Jul-14 20-Aug-14 9 9 0%

Referral Facilitation Service (RFS)

On-going service provision 30-Jun-14 30-Jun-14 31 31 53%

C:C & IGR referral protocol definition 30-Jun-14 30-Jun-14 15 15 0%

Prior approval process defn with EHT 28-Jul-14 28-Jul-14 15 5 0%

Start of C:C & IGR validation 01-Aug-14 01-Aug-14 34 5 0%

Start of prior approval process with EHT 01-Oct-14 01-Oct-14 26 26 0%

CVD Anticoagulation Schemes

On-going service provision 2013-14 01-Jan-14 01-Jan-14 14 14 100%

Start of Nurse lead tariff for follow-ups 01-Apr-14 01-Apr-14 9 9 40%

Contract query; activity mgmt plan letter 05-May-14 05-May-14 4 4 10%

Contract query; rectification action plan 02-Jun-14 13-Jun-14 4 4 0%

Amended service: on-going provision 02-Jun-14 02-Jun-14 39 39 0%

Jan-14 Feb-14 Mar-14 Mar-15Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15


Milestone chart for Planned & Unplanned Care schemes (2 of 2)

PLAN ACTUAL PLAN ACTUAL PERCENT Month:

ACTIVITY START DATE START DATE DURATION

(WEEKS)

DURATION COMPLETE Date: 30 06 13 20 27 03 10 17 24 03 10 17 24 31 07 14 21 28 05 12 19 26 02 09 16 23 30 07 14 21 28 04 11 18 25 01 08 15 22 29 06 13 20 27 03 10 17 24 01 08 15 22 29 05 12 19 26 02 09 16 23 02 09 16 23 30

Wk No: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66

Mar-15Apr-14 May-14 Jun-14 Jul-14 Aug-14 Sep-14 Oct-14 Nov-14 Dec-14 Jan-15 Feb-15Jan-14 Feb-14 Mar-14

MSK Pathway

On-going service provision Phase III 01-Jan-14 01-Jan-14 31 31 53%

Resolution of IAP issue 06-May-14 30-May-14 5 5 80%

Provision of WLIs 02-Jun-14 01-Jul-14 18 18 100%

Plan and commission pathway tariff 04-Aug-14 04-Sep-14 9 9 0%

Start of service, with pathway tariff 04-Aug-14 01-Dec-14 9 9 0%

Phase IV (Rheumatology & pain) definition 06-Oct-14 06-Oct-14 22 22 0%

Implementation of Phase IV services 06-Oct-14 01-Dec-14 26 26 0%

Diabetes

On-going service provision (5 clinics) 01-Jan-14 01-Jan-14 13 13 100%

On-going service provision (6 clinics) 01-Apr-14 16-Jul-14 53 53 6%

Implementation; RFS triage of GP referrals 07-Jul-14 01-Sep-14 9 5 0%

Planning: F-up discharges @ Imperial 01-Sep-14 01-Sep-14 8 5 0%

Planning: F-up discharges @NWLHT & THHT 27-Oct-14 27-Oct-14 8 5 0%

Dermatology

Tele-dermatology ITT eval & pref bidder 06-Mar-14 06-Mar-14 5 5 100%

Tele-dermatology contractdrafting & execution09-Apr-14 09-Apr-14 3 3 100%

Tele-dermatology service mobilisation 01-May-14 01-May-14 14 14 60%

On-going service provision 09-Aug-14 09-Aug-14 35 35 50%

Paediatric Pathways

PPL audit initiated 01-Apr-14 01-Apr-14 10 10 100%

PPL audit completed 10-May-14 01-Jun-14 6 6 100%

Interim Business Case 01-Jun-14 23-Jul-14 8 8 20%

CCG agree business case and direction of travel01-Jul-14 01-Sep-14 31 31 50%


Progress report – Unplanned care scheme- ICE

Name of the QIPP Scheme Intermediate Care Service Type Unplanned Care Scheme Objective An emergency admissions avoidance scheme that provides step up services in the community including step up beds. The scheme

takes referrals from GPs, and from A&E departments at both EHT and IHT. Target Cost Reduction 2014-15 £750,000 Target Activity Reduction 2014-15 957 spells Variance from plan tbc Overall RAG Status G Date QIPP Live from October-12 Current Development

Stage Design

QIPP Lead (Non Clinical - CCG/ Local Authority) Usha Prema QIPP Lead (Clinical) Dr Raj Chandok Highlights Final Recommendations for new ICE service model following review, signed off by Steering Group - 30/5/14.

Ealing Exec agreed key recommendations and principles of ICE Review on 11/6/14. - First ICE Implementation Steering Group held 11/7/14. Phase 1 programme of work discussed and agreed.

Key actions completed - ICE review has completed workshops with CCG and EHT - Future intermediate care model present by PPL, and reviewed by ICE Steering Committee. Model has two phases of implementation; 1) Quick wins in 2014-15. 2) Long term model -Final Draft Report signed off by ICE Steering Group on 30/5/14. Principles agreed by Exec on 11/6/14. -For final sign off on 25 June and GB on 2 July. Report finalised. - First ICE Implementation Steering Group held 11/7/14

Milestones achieved Planned Date (1 April 14 Baseline) Key actions next month - Complete and sign-off ICE Review Report, and future state Intermediate Care Model at CCG Execs, Governing Body and COM

- Serve contractual notice on provider of changes required - Make an initial quantified estimate of impact on non -elective admissions from implementing the new model (short term solution). -Phase 1 implementation programme to be planned and agreed.

Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation Likelihood (1 to 5) Impact (1 to 5) Total Score The revised ICE delivery model will not deliver the required increases in emergency admissions reduction

3 4 12 Initial quantified estimates to be made in May/June. But will still be high level

Trust will be too slow to implement changes, and/or negotiations to change the ICE model will become pro-tracted

2 3 6 Notice letter to be serviced in May. Trust to be consulted on final recommendations

Milestone Planned Date (1 April 14 Baseline)

Current Planned Date RAG Comment

ICE Review 15-Mar-14 15-Mar-14 Completed Review completed Final report 23/6/14 Plan and commission service changes 02-Jun-14 11-Jul-04 Planned, not at risk Phase 1 implementation to be planned Mobilisation of service changes 07-Jul-14 mid sept 14 Planned, not at risk New service - on-going provision 01-Sep-14 01-Oct-14 Planned, not at risk


Progress report – Unplanned care scheme – Pulmonary Rehab Service

Scheme Objective An emergency admissions and re-admissions avoidance scheme. GPs refer qualified patients on the COPD long term conditions register for pulmonary rehab services. The provider contract allowed for 900 patients.

Target Cost Reduction 2014-15 £97,000 Target Activity Reduction 2014-15 40 spells Variance from plan tbc Overall RAG Status A Date QIPP Live from October-12 Current Development Stage Live QIPP Lead (Non Clinical - CCG/ Local Authority)

Delia O'Rourke QIPP Lead (Clinical) Sally Armstrong & Dr Vijay Tailor

Highlights - Referrals in to the PRS scheme are running at 450 pa, against a contract target of 920 for 2014-15. Despite full funding continuing - GPs are not referring the quantity of patients expected as per business case, even though COPD patients exceed 3,500 as per QOF data. - CCG options re continuation of contract and or changes to the service to be discussed with provider on 20th Aug.

Key actions completed - Trust have put forward a marketing plan to increase referrals, which has been reviewed and agreed with CCG. - EHT-ICO have reported progress against plan. But impact is relatively low. - Mid term service review meeting planned for 20th Aug - invitation sent to ICO, awaiting confirmation of attendance.

Milestones achieved - PR service contacted by DOR to request a meeting to follow up on progress regarding action plan- date sent to EHT - Network Relationship Managers practice engagement continues - Practice level feedback shared with ICO by NRMs and ICO asked to respond / advise CCG on actions taken

Key actions next month - Hold contract meeting to review activity and marketing plan. - If no response issue a contract query in respect of referrals and patients completing the programme. - NRMs visiting practices with poor referral rates to PRS and collating feedback on the service

Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation Likelihood (1 to 5) Impact (1 to 5) Total Score EHT-ICO marketing programme to increase new referrals will not reach referrals target

5 5 25 The QIPP target has been set on the basis of achieving only half of the activity in the original business case. Contract monitoring and implementation of marketing plan. NRM visits to low referring practices to encourage usage of PRS Contract levers available or decommissioning of the service and recommissioning.

EH-ICO do no not put forward new proposal as part of the planned service review

3 3 9 The exiting contract and targets will be applied. Option to be discussed in August of utilising service capacity or an element of the service budget for new purposes e.g. O2 assessments.


Current Planned Date

RAG Comment

On-going service provision In progress Referrals marketing programme completed 07-May-14 07-May-14 Will not be achieved Awaiting for update on marketing plan at 20th Aug meeting. NRM visist to

practices Service review completed 07-Jul-14 20-Aug-14 At risk of delay Date and time frame for service review meeting set with agenda.

Awaiting ICO conformation of attendance


Progress report – Planned care scheme – RFS Name of the QIPP Scheme Referral Facilitation Service (HP referrals &

IGD) Type Planned Care Report Date: 16 July 2014

Scheme Objective An outpatients new and follow-up avoidance and diversion scheme. The RFS triages GP referrals for 8 conditions including 1.Cardiology, 2. Dermatology, 3. Gastroenterology, 4. Gynaecology ,5. Uro-renal (Nephrology & Urology) ,6. Paediatrics, 7.Orthopaedics, 8. ENT. The RFS is being expanded in 2014-15 to also triage consultant: consultant referrals and internal referrals.

Target Cost Reduction 2014-15 £570,000

Target Activity Reduction 2014-15 1,969 News; 2,238 Follow-ups Variance from plan

Overall RAG Status G

Date QIPP Live from October-14 Current Development Stage Design

QIPP Lead (Non Clinical - CCG/ Local Authority) Beryl Bevan QIPP Lead (Clinical) Dr Alex Fragonyannis

Highlights Orgaining the two workshops to discuss Internally Generated Demand protocols is proviiong very hard to schedule.

Key actions completed - Signing of EHT Heads of Terms, which includes an agreement for the parties to establish a "prior approval process " for all GP referrals to go via RFS. - Discussion on Internally Generated Demand at Execs with Bill Lynn. - Discussion on Internally Generated Demand at Execs with Bill Lynn.

Milestones achieved - None during reporting month.

Key actions next month - Hold two workshops on IGD: 1) consultant referrals from A&E, 2) all other referrals. - Progress RFS prior approval process design with EHT

Risks Risk Rating [Total Score = Likelihood X Impact]

Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score

Non co-operation and delayed agreement by provider 3 4 12 Contract management via PCE.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment

IGD workshops, and IGD protocol preparation - Completion 30-Jun-14 30-Jun-14 In progress these haven't started yet

Process definition for all GP referrals to go through RFS 30-Jun-14 30-Jun-14 In progress again not happening yet

CQG to approve IGD protocols and RFS processes 28-Jul-14 28-Jul-14 Planned, not at risk don't know that this has been done?

Start of C2C and IGR Validation 01-Aug-14 01-Aug-14 Planned, not at risk earliest would be October

Start of the prior approval process with EHT 01-Oct-14 01-Oct-14 Planned, not at risk earliest would be October


Progress report – Unplanned care scheme – GP Service for Nursing Homes

Name of the QIPP Scheme GP Service for Nursing Homes Type Unplanned Care Report Date Scheme Objective This commissioned service provides an enhanced primary care service for the 1,100 nursing home residents in Ealing. The contract with the

provider stipulates that: - It provides a service 8am to 8pm, 7 days a week - Provides a timely response to both routine and urgent calls - GPs spend a specified number of hours in homes per week - Provide medicines management which will ensure that residents have a regular review of their medication to make sure that it is appropriate to meet their specific needs.

Target Cost Reduction 2014-15 £1,053,000 Target Activity Reduction 2014-15 355 spells Variance from plan tbc Overall RAG Status G Date QIPP Live from September-13 Current Development Stage Live QIPP Lead (Non Clinical - CCG/ Local Authority) Charles Wheatcroft/ Sue Pascoe QIPP Lead (Clinical) Dr Mohammed Alzarrad Highlights '- Patients transferred to date are 855. 282 patients remain to be transferred. 4 nursing homes are resisting any transfers

- Provider did not achieve the Mobilisation Plan according to the contract. Patient choice was the main cause. Resistance to transfer by nursing homes has also been an issue

Key actions completed - Patients transferred to date are 855. Milestones achieved - Service mobilisation period is completed, though it did not achieve the objective of transferring all patients from all homes

- Continue to actively work / communicate with the nursing homes that have not transferred any patients across to the service. Relatives mtg with largest home now diaried for 23/07/14

Key actions next month - Negotiate contractual changes to reflect that fact that mobilisation did not achieve the target of 1,100 patients transferred. - Resolve IG issues, so that provider can receive SUS data, and allow triangulation between primary care and secondary care patient records.

Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score The QIPP financial goals will not be met because only 855 nursing home residents have transferred to the new service, and not the target 1,100

5 2 10 Volume based element of provider fee will reduce the re-provision cost. CCG has commenced a negotiation to reduce the Foundation Payment

Milestone Planned Date (1 April 14 b/line)


Service mobilisation completed 01-Nov-13 01-Nov-13 Completed Service mobilisation extension completed 03-Mar-14 30-Jun-14 In progress Annual stocktake meeting scheduled for September 2014 On-going service provision 31-Mar-15 31-Mar-15 Planned, not at risk


Progress report – Planned care scheme – CVD Anticoagulation

Scheme Objective An Outpatient follow-up reduction scheme that seeks to transfer stable anti-coagulation patients for on-going Warfarin dosage and treatment closer to home and with a range of primary care providers.

Target Cost Reduction 2014-15 £308,000 Target Activity Reduction 2014-15 2,200 Follow-up attendances Variance from plan Overall RAG Status G Date QIPP Live from March-12 Current Development Stage Design QIPP Lead (Non Clinical - CCG/ LA Delia O'Rourke QIPP Lead (Clinical) Dr Alex Fragonyannis

Highlights QIPP is based on both a reduced tariff of £22, reduced from £77 per follow-up attendance, and achieve the discharge of stable patients as per business case. Discharge of patients from EHT to GP care has resumed.

Key actions completed Contract query has been raised with EHT, which Trust has replied to. Follow up letter to EHT requesting more information sent and a meeting planned for 8th August

Milestones achieved Date for meeting with trust agreed to discuss discharges and service thresholds Key actions next month NRM to continue to visit practices and encourage transfer of ptnts monitored at EHT or referred to EHT to attend community management.

For agreement regarding threshold for patients to be seen in secondary care at meeting in August To agree process by which EHT assures the CCG that only eligible patients are attending Hospital clinics.


Likelihood (1 to 5) Impact (1 to 5) Total Score EHT fall behind their target to discharge patients.

5 4 20 Contract query notice has been served in relation to service deliverables. Subject to activity plan analysis by EHT, several mitigations under review, including non-payment of excess activity.

QIPP will not be achieved because, stable patients will not be discharged

3 1 3 QIPP target will be exceed by the impact of the tariff change only NRM targeting practices using EHT for patients who could be managed in community

EHT failing to agree reduction in tarrif 3 5 15 Ongoing negotiation of lower tarrif at director level

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment On-going service provision 2013-14 01-Jan-14 01-Jan-14 In progress Introduction of Nurse led tariff for follow ups

01-Apr-14 01-Apr-14 At risk of delay Trust are disputing the application of lower tariff - Contract still unsigned

Contract query - activity management plan letter & Trust reply

05-May-14 05-May-14 Completed

Contract query - rectification action plan 02-Jun-14 13-Jun-14 At risk of delay meeting planned for 8th August Amended service - Start of on-going provision

02-Jun-14 02-Jun-14 At risk of delay


Progress report – Planned care scheme – Diabetes Pathway Roll-out

Name of the QIPP Scheme Diabetes Type Planned Care Scheme Objective An outpatient new and Outpatient follow reduction scheme that provides community based clinics in multiple locations for stable Type 2 diabetes patients. The CCG's

overall diabetes services provide expanded capacity given the high prevalence of the condition amongst the Ealing population. In 2014-15, all new GP referrals are to be triaged subject to a "super six" set of clinical criteria and then navigated to acute or community services as the condition dictates.

Target Cost Reduction 2014-15 £371,000 Target Activity Reduction 2014-15 158 News & 2,747 Follow-ups Variance from plan Overall RAG Status A Date QIPP Live from April-11 Current Development Stage Design QIPP Lead (Non Clinical - CCG/ Local Authority) Frances Horne QIPP Lead (Clinical) Dr Raj Chandok Highlight - Community service is establised and providing services.

- In contract negotiations, it became clear that the business case estimates for stable type II patients that can be discharged from acute has been over estimated. This means that only half of the QIPP target can be achieved. Target cost reduction figures will need to be reviewed.

Key actions completed - Agreement reach with EHT-ICO over the Activity Plan for 2014-15 at 6,000 attendances. - Agreement that only referrals of patients with the "super eight" clinical conditions will accepted into the acute setting

Milestones achieved - None in reporting period Key actions next month - Sixth clinic is due to open on 16th July

- Review and verify the Trust's demand and capacity plan for Diabetes. - Begin process to introduce triage of the "super eight" conditions by RFS.


Likelihood (1 to 5) Impact (1 to 5) Total Score Trusts do not discharge all stable patients as per the QIPP specification

3 5 15 Use of contract levers to address issues with Trusts. DICE consultants are now in contact with trusts to discuss

Referrals are not going through RFS 4 4 16 Referral pathway agreed. Referral Template being developed.



On-going service provision (5 clinics) 01-Jan-14 01-Jan-14 Completed On-going service provision (6 clinics) 01-Apr-14 16-Jul-14 Planned, not at risk Planned start date of 16th July agreed Implementation Completed - RFS Triage of GP referrals 07-Jul-14 01-Sep-14 At risk of delay Process has not yet been finalised Planning Complete - Follow up discharges at IHT 01-Sep-14 01-Sep-14 Planned, not at risk Meeting has been arranged between consultants at EHT and IHT

Planning Complete - Follow up discharges at NWLHT, THHT 27-Oct-14 27-Oct-14 Planned, not at risk Meetings with trust are being arranged

Month / Year April May June July August September October November December January February March YTD Annual

GP referred first out patient attendances - 2014/2015 38 44 82 492

GP referred first out patient attendances - 2013/2014 37 52 89 534

GP referred first out patient attendances - Change2013/2014-

2014/20151 (8) (7) (42)

GP referred follow up out patient attendances - 2014/2015 527 520 1,047 6,282

GP referred follow up out patient attendances - 2013/2014 560 596 1,156 6,936

GP referred follow up out patient attendances - Change 2012/2013-

2013/2014(33) (76) (109) (654)

(80)

(60)

(40)

(20)

0

20

April May June July August September October November December January February March

2. Diabetes Pathway Roll-out

GP referred first out patient attendances - Change2013/2014-2014/2015 GP referred follow up out patient attendances - Change 2012/2013-2013/2014

(7)(109)

(100)

(50)

0

50

100

YTD


Progress report – Planned care scheme – MSK Pathway Development Name of the QIPP Scheme MSK Pathway Type Planned Care

Scheme Objective An outpatient new , outpatient follow-up and radiology test reduction (MRIs) scheme that provides expanded "interface" and physiotherapy services in the Community. Patients are triaged by the RFS and then either seen at the Interface clinics or sent direct to Physiotherapy. The Interface clinics provided community based treatment, and only refer those in most need of surgery or specialist care to consultant lead clinics in the acute sector.

Target Cost Reduction 2014-15 £1,281,000 Variance from plan Analyses has shown GP initiated first referrals to neurology decreased from 2179 to 1333, while referrals to rheumatology and T/0 were barely affected. In total a benefit of £385,000 was achieved.

Target Activity Reduction 2014-15 2952 News, 4876 Follow-ups, & Direct access MRIs

Variance from plan Activity up to March is showing 5,641 firsts and 688,700 follow ups. There has been a decrease in activity but not to the extent that was expected. MRIS have decreased by 519 since October 2013 when the pathway began, from 2331 scans in 2012-13 to 1812 in 2013-14.

Overall RAG Status A Date QIPP Live from September-13 Current Development Stage Live QIPP Lead (Non Clinical - CCG/ LA Anjum Fareed QIPP Lead (Clinical) Dr Robert McLaren Highlights Referrals for physio have increased in May to 983 against a monthly target of 939. However this is still within the 5% planned range. The first to follow upo ratio for May was 1:1.2.

MSK Interface services received 549 referrals against a monthly target of 644. The first to follow up ratio for Interface is 1:1.14. The referral rate for MSK interface has consistently been below projected levels since project inception. Initial analyses shows that MRI reductions to Inhealth have been greater than planned at 500 fewer MRIs, in fact 519 has been achieved. This figure takes into account the QIPP target applicable since October 2013 when the pathway began. The proposal submitted by EICO has been analysed and shows decreased benefit in terms of unit costs which have risen considerably, EICO appear to have exceeded the point at which economies of scale can be maximised unless a further investment in infrastructure is made. There are many other issues including: inaccuracies in calculation, ECCG requirements for first and follow up activity and total activity volumes have not been adhered to. In the meantime there are now approximately 1848 people waiting up to be seen.

Key actions completed EICO have been invited to amend their proposal in the light of concerns raised. ECCG is now conducting an options apprasal on availability and cost of spot purchase activity from other providers in the market, to include both NHS and non NHS providers. This is now complete and will be submitted to the seniof executive team on 23rd July.

Milestones achieved The recent proposal submitted by EICO has warranted a fresh review of value/benefits of the new pathway and has also enables some benchmarks to be applied in the sector. There has been a greater interaction/sharing of ideas options within th market and as part of the CHHWE review.

Key actions next month This will be pending depending on the outcome of the Executive Committee's decision on proposals. Also informed by the 23rd July meeting this years contract with EICO still has to be concluded. Further investigation is also required to determine appropriate first to follow up ratios for rheumatology, neurology and T/O as these appear to be very high at present.


Likelihood (1 to 5) Impact (1 to 5) Total Score EHT-ICO costs for expanded service will not be acceptable

3 3 9 Options appraisal is being undertaken by the executive committee.

Expanded capacity of staffing and venues will not be in place by summer and waiting lists will increase

4 4 16 Agreement of final contracted activity figures will be reached and signed off as soon as possible. Provider may need assisteance to secure space at Hanwell. Also close monitoring of DNA;s and service cancellations will be required to ensure slot utilisation is maximised.

Scope and implement phase 4 4 4 16 Data audits to detremine and scope extent of plans for phase 4 has been agreed by the MSK Strategy Group and letters to acute providers requesting access to data for audits has been sent. Current option appraisals will create delays/distract in implementation of phase 4.

Milestone Planned Date (1/4/14 B/line) Current Planned Date RAG Comment On-going service provision Phase III 01-Jan-14 01-Jan-14 In progress Resolution of IAP issue 06-May-14 30-May-14 Will not be achieved Trust have promised proposal, but CCG not yet seen costs Start of expanded capacity service 02-Jun-14 01-Jul-14 Will not be achieved expanded capacity commissioned through for this financial year will not be actioned

until EICO sign the contract, this has not yet been signed. Recruitment and consolidation is likely to take much longer than expected. Expanded capacity commissioned at the start of pathway has just been completed in May 2014.

Complete plans and commission pathway tariff

04-Aug-14 04-Sep-14 Will not be achieved Current proposals impact on pathway tariff which are nor acceptable to ECCG. This is under review.

Start of service, with pathway tariff 04-Aug-14 01-Dec-14 At risk of delay Complete Phase IV (Rheumatology and Pain) definition

06-Oct-14 06-Oct-14 At risk of delay As above

Implementation of Phase IV services 06-Oct-14 01-Dec-14 Will not be achieved As above.


Progress report – Planned care scheme – MSK Pathway Development

£0

£10,000

£20,000

£30,000

£40,000

£50,000

£60,000

£70,000

£80,000

£90,000

0

50

100

150

200

250

July 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14

MRI Activity MRI Cost

July 13 Aug 13 Sep 13 Oct 13 Nov 13 Dec 13 Jan 14 Feb 14 Mar 14 Apr 14 Total

Sum of Episode 226 183 144 132 103 94 72 78 78 72 1,182

Sum of Value (£) £77,704 £80,733 £71,905 £70,966 £42,037 £29,482 £34,774 £30,758 £28,934 £25,131 £492,424

MRI Cost against MRI Activity


Progress report – Planned care scheme – Gynaecology Name of the QIPP Scheme Gynaecology Type Planned Care Report Date: 16/07/2014

Scheme Objective An outpatient new and follow-up reduction scheme. GP referrals re triaged by the RFS, and only qualified referrals are sent to the acute sector. The scheme is also focussed on changing the pathway for a number of conditions which historically have been treated in acute in follow-up clinics, but which should normally be performed in primary care.

Target Cost Reduction 2014-15 £261,000 (£200,000 costs) Target Activity Reduction 2014-15 1339 News, 1442 Follow-ups

& 565 OPPROC Variance from plan

Overall RAG Status G Date QIPP Live from 01/08/2013 Current Development Stage Delivery QIPP Lead (Non Clinical - CCG/ Local Authority) Zoe Richards QIPP Lead (Clinical) Dr Serena Foo and Sally Armstrong Highlight - Data shows some reductions in GP referrals due to RFS action.

- Imperial have implemented changes to the delivery and charging for certain Gynae procedures. - Draft LES out on extranet. There are still financial risks as unit price not agreed - Poor engagement with EHT re future options - Data analysis to revise figures and potential to remove activity

Key actions completed - LES Ring pessary in place. Unit costs outstanding. ' - H&F procurement ongoing Ealing to consider if we could replicate. ' - Data review re multiple firsts ongoing. ' - Exec report rescheduled at CCG request to 23rd July.

Milestones achieved - LES Ring pessary in place. Unit costs outstanding. ' - H&F procurement ongoing Ealing to consider if we could replicate. Visit arranged ' - Data review re multiple firsts and actual condition specific analysis ongoing . - letter drafted for CASH/PH awaiting comment from clinical leads 5.6.14 - email sent to EHT re future collaboration 5.6.14. resent 26/6.14 and 15.7.14 ' - Exec report rescheduled at CCG request to 23rd July.

Key actions next month - Speak with RFS to establish if we can improve clarity of referral through to uro/gynae clinics by consultant specialist? - liaise with EHT re potential options re model and coding - review H&F model as potential Ealing way forward


Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score Ring pessary community contract has increased unit cost

3 5 15 CW has highlighted with lead. ECCG can decline to pay and negotiate local cost

Ring pessary community contract reduces momentum to encourage replacement removal in primary care

3 2 6 ECCG can continue with local plans. Mtg on 4.6.14 allowed for scoping of local model to support re identified condition. CDM and clinical lead capacity required. H&F procurement may offer a model.

CASH specification- move to exclude gynaecology activity. Cost and capacity risk

4 3 12 Communication with PH. On-going dialogue. Monitoring to manage risk. Consideration of local financial arrangement. Ongoing

Lack of interface with Imperial- reduced impact on coding/bundle payments

4 2 8 This is being managed collaboratively.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment Update report to Exec for decisions on how to proceed 09-Jul-14 23-Jul-14 In progress Exec date rescheduled


Progress report – Planned care scheme – Dermatology Name of the QIPP Scheme Dermatology Type Planned Care

Scheme Objective An outpatient new, outpatient follow-up and procedures reductions scheme which provides for consultant lead tele-dermascopy and tele-dermatology diagnostic services based in the community. Following the completion of a competitive tender, the service is scheduled to start in 2Q 2014-15.

Target Cost Reduction 2014-15 £1,412,000 Target Activity Reduction 2014-15 2558 News, 5935 Follow-ups,

and 5,265 OPPROC Variance from plan 2013-14 Out-turn for all dermatology first outpatient referrals (excluding

procedures) was 5444. An average of 453 referrals a month are expected if 100% of the pathway is diverted. At present 50% of the pathway is being diverted, at best we would expect to achieve at least 80% of pathway diversion as the project becomes embedded.

Overall RAG Status G Date QIPP Live from June-14 Current Development Stage Delivery QIPP Lead (Non Clinical - CCG/ Local Authority) Anjum Fareed QIPP Lead (Clinical) Dr Alex Fragonyannis

Highlights The project has been mobilised and is active. Constructive feedback has been received from a patient and GPs. Activity within the first two weeks was 102 referrals which is below the maximum expected volume in the business case. However, the business case had put forward a pathway diversion scenario ranging from 80% to 50%. A reasonable diversion rate can be agreed as referrals settle into the service. KPIs are being met. A fourth site is to be announced as soon as activity volumes increase. Concordia is yet to be resolve issues around the use of Choose and Book and the provision of directly bookable slots. Concordia are also experiencing some signalling problems from site which affects ability to log onto their own systems through own portable devices.

Key actions completed Service has been mobilised. Data is being reported, although there are still some internal CCG counting issues to be resolved which will improve once directly bookable slots are available. Support has been offered to Concordia from the CSU IT team.

Milestones achieved Mobilisation took place within the expected time. Key milestones going forward will include:1. Consolidation of performance reporting against KPIs (the first report is expected week beginning 14th July) by September 2014, 2. Ensuring the full scope of referrals for diversion is explored so that an appropriate target is agreed by September 2014. 3. Ensuring a fourth site opens as planned in September 2014. 4.Agree a programme of inspections over sites with ECCG Governance leads 5. To hand over the contract to small contracts team to manage this contract by October 2014. 6. To finalise and consolidate the clinical inclusion and exclusion criteria based on learning since June 2014.

Key actions next month The issue making directly bookable slots available to GPs and RFS on Choose and Book needs to be resolved very soon. Activity counting needs to be reconciled internally. A programme of unannounced and announced inspections should be planned to ensure appropriate mobilisation has taken place. Advice to be sought from Governance lead on how to conduct this. The inclusions and exclusions criteria also needs to be reviewed to take learning within the first month into account, the provider has advised if a patient has more than 3 moles they should be referred directly into secondary care by GP/RFS as the risk of cancer is higher. However, this would also reduce the pathway diversion into the service.


Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score Activity volumes to be monitored closely as low volumes may impact on service viability

2 3 6 Referrals data is under review.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment Tele-dermatology ITT evaluation and preferred bidder

06-Mar-14 06-Mar-14 Completed

Tele-dermatology contract drafting and evaluation 09-Apr-14 09-Apr-14 Completed

Tele-dermatology service mobilisation 01-May-14 In progress On-going service provision 09-Aug-14 Planned, not at risk


Progress report – Planned care scheme – Paediatrics

Name of the QIPP Scheme Paediatric Pathways Type Paediatrics Scheme Objective To provide appropriate clinical care within community setting improving patient experience and providing value for money

Target Cost Reduction 2014-15 £100,000 Target Activity Reduction 2014-15 Yet to be specified Variance from plan 0 Overall RAG Status G Date QIPP Live from 1.4.14 Current Development Stage Benefit realisation QIPP Lead (Non Clinical - CCG/ Local Authority) Zoe Richards QIPP Lead (Clinical) Vijay Tailor, sally Armstrong Key actions completed PPL audit completed and analysis undertaken. PACU review undertaken. EAS report received. Ongoing data analysis re

frequent flyers and conditions being undertaken. Initial plan of service re-design scoped. Milestones achieved PPL audited started and completed Key actions next month Executive report rescheduled for September 14. Draft report with project plan required for 23rd July. Workshop with acute

providers to be scheduled for July/Aug 14. On-going analysis of data re identified conditions and frequent flyers. Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation Likelihood (1 to 5) Impact (1 to 5) Total Score PPL audit may not provide sufficiently robust report

2 3 6 Further data analysis undertaken

CCG may not agree funding required to pilot model

3 3 9 costing currently being undertaken

Consultant engagement may be limited 2 5 10 workshop being undertaken. Comms strategy being developed and pre-work has been done.

GP engagement may be limited 3 5 15 Comms strategy being developed. Clear message about it being everyones business. Network level. Choose enthusiastic practices.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment PPL audit initiated 1.4.14 1.4.14 Complete PPL audit completed 10.5.14 1.6.14 Complete Business case scoped 1.6.14 23.7.14 A Developed by meetings to identify clear plan. CCG agree business case and direction of travel 1.7.14 September A Delayed at clinical lead request to ensure fully

worked up model rather than update report


Progress report – Planned care scheme – Prescribing Name of the QIPP Scheme Prescribing Type Medicine Management

Scheme Objective A primary care prescribing cost reduction scheme based upon analysis and evidence based advice to GP Practices. The Medicine Management Team has undertaken a detailed review of the areas of prescribing that do not conform to best practice and/or guidelines. An evaluation of the opportunity to influence and reduce prescribing in these specific drug categories has identified a total opportunity equivalent to the budget figure.

Target Cost Reduction 2014-15 £1,451,000 Variance from plan June 2014 forecast prescribing figures will not be available until mid-August 2014, however monthly actual spend will be available. April 2014 actual spend will be available in mid-June 2014.

Target Activity Reduction 2014-15 Overall RAG Status G Date QIPP Live from 01/04/2014 Current Development Stage Delivery QIPP Lead (Non Clinical - CCG/ Local Authority) Bal Hamphal QIPP Lead (Clinical) Arjun Dhillon Key actions completed Prescribing budgets allocated on a practice level.

Practice QIPP targets identified for each practice. The Invest to Save Scheme (increasing capacity in the MMT) started on 1st April. Practice pharmacists working in GP practices to implement the QIPP areas. The MMT have undertaken prescribing updates at the ICP MDG meetings (all 7 Health Net works have been completed).

Milestones achieved

Key actions next month The MMT Pharmaceutical Advisers will be undertaking practice visits to discuss the prescribing QIPP areas and the Prescribing Incentive Scheme.

Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation Likelihood (1 to 5) Impact (1 to 5) Total Score Individual practices do not engage with the QIPP programme 1 5 5 Work with prescribing lead / CCG GPs / Health Networks to get

engagement. Patients do not wish to have their medicines changed 3 5 15 Clear communication required with patients as regards the

changes. Provide written communication to facilitate this change e.g. leaflets, letters. Community Pharmacists to support changes.

Ealing CCG Commissioning Incentive Scheme - Prescribing is part of the CCG Commissioning Incentive Scheme which has not been agreed by NHS E - likely

2 3 6 The MMT are discussing the draft PIS 14/15 with practices

Cost pressures of drug price increases could affect the QIPP savings

4 5 20 Anticipate drug cost increases and the impact on the prescribing budget - report

Introduction of new drugs on the market, e.g. dabigatran, NICE approved drugs, newer diabetes drugs.

3 3 9 Ensure that these drugs are considered as cost pressures to the delegated budget. Consider options for off-setting the increases.

Community Pharmacists - engagement with community pharmacists

3 2 6 Communicate prescribing initiatives with community pharmacists to improve engagement.

Pathway redesign or actions in other workstreams or Shifting Settings of Care that cause prescribing cost pressures due to a shift of services from secondary to primary care

4 5 20 Ensure impact on prescribing budgets is identified and budgeted for when all new service developments are planned and implemented.

Inadequate resources to deliver programme affecting pace and breadth of delivery.

2 5 10



Number of GP practice prescribing visits completed 01-Jun-14 Planned, not at risk Monthly Invest to Save Reports Planned, not at risk Script Switch Profile under review Planned, not at risk Practice based pharmacists have started to work in practices to support medicines initiatives according to the work plan

Planned, not at risk

Regular monthly reporting of monthly figures Planned, not at risk


Progress report – Mental Health scheme – Mental Health Continuing Care Name of the QIPP Scheme Mental Health Continuing Care Type Mental Health

Scheme Objective To review responsible commissioner with LBE for all S117 patients who are currently fully NHS funded

Target Cost Reduction 2014-15 £650,000 Variance from plan £180000

Target Activity Reduction 2014-15 6 cases no longer being fully NHS funded

Variance from plan £110000


Date QIPP Live from 01/04/2014 Current Development Stage Delivery

QIPP Lead (Non Clinical - CCG/ Local Authority) Nicola Bradley QIPP Lead (Clinical) Dr Mohammed Alzharrad

Key actions completed Appointed named social worker (LBE), 2 x MH nurse assessors and Placement Manager (Ealing CCG)in place to review all cases ( 40 and 7 now outstanding ). Fortnightly Joint Mental Health Panel established bwteen CCG and LBE with co-charing by WLMHT Service Manager and Ealing CCG Head of Continuing Care and Complex Placements. Joint assessments taking place with Social Services to determine health needs and then health and social care funding responsibilities taken through Panel . Ealing CCG mental health update monthly meetings scheduled and in place to review QIPP and cases. Ealing MH CHC cases reviews being undertaken (7 outstanding)

Milestones achieved £470K savings achieved to date (10 July 2014)

Key actions next month Continue to present cases that have been jointly reviewed to Panel and agre LBE to take over funding responsibility for those cases not eligble for NHS funding . To also agree step down plans for those patients in assessment and treatment beds when appropriate. Projected forecast for further aprox £244k savings to be achieved by March 2015.


Mitigation


Delay by social services accepting funding responsibility

3 3 9 Ealing CCG Head of Continuing Care escalating to MD Kathyrn Magson for discussions to take place with LBE Director of Social Sevices

Cancellation of Joint Panels 4 5 20 LBE recruiting a senior officer who will take be responsibility for joint chairing Panel . Currently WLMHT joint chair and they have had staffing/resource issues

Social Services refusing to undertake assessments for those patients placed out of Borough = 6 cases

3 3 9 Escalate to Kathryn Magson for discussion to take place with LBE Director of Social Services


Joint Continuing Care and Social Services Panel 01-Apr-14 01-Apr-14 Complete

Review of all cases 31-Mar-15 31-May-15 A


QIPP Savings achieved in 2014–15 for Continuing Care

Patient No Cost of Placement

per week Date Placement

Ended Date Current

Placement Started Cost of Current

Placement Cost Savings per

week RAG

Rating Status QIPP Savings

achieved tp date

Asessement and

Treatment

1 £ 3,115.00 21/05/2014 21/05/2014 £ 2,135.00 £ 980.00 Step down to locked rehab. Nicola Bradley agreed placement at Cygnet Lewisham 9.5.14

£ 44,100.00

2 £ 1,526.00 11/06/2014 N/A £ - £ 1,526.00

Discussed at the Joint Panel on 16/01/14, not eligible for full funding. Issues around his immigration status have delayed him being discharged from Hospital. Patient was discharged from his placement to the custody of UK Border Agency on 11/06/14.

£ 64,092.00

3 £ 2,450.00 13/05/2014 N/A £ - £ 2,450.00 Discussed at the Joint Panel on 05/12/14, not eligible for funding. Transferred to and funded by Ealing Social Services from 13.5.14 who have sourced placement St Martin's of Tours

£ 112,700.00

TOTAL £ 220,892.00

Patient Initials

Cost of Placement per week

Date Placement Ended

Date Current Placement Started

Cost of Current Placement

Cost Savings per week

RAG Rating

Status QIPP Savings achieved tp date

Continuing Care

4 £ 535.00 08/05/2014 N/A £ 110.89 £ 424.11

Discussed at the Joint Panel on 10/04/2014 is no longer eligible for full funding but for Funded Nursing Care. 8/5/2104 panel agreed to be handed over from health to social services

£ 19,509.06

5 £348.00 N/A N/A £110.89 £237.11

Discussed at the Joint Panel on 19/06/14. Case was jointly funded (50/50) by Ealing CCG and LBE Social Services at £348 each per week. Now eligible for FNC only as of 19/06/14.

£ 9,484.40

6 £ 297.00 08/05/2014 N/A £ - £ 297.00 Disucssed at the Jont Panel on 08/05/2014 . No longer eligible for joint funding or FNC

£ 13,662.00

7 £ 915.54 27/03/2014 N/A £ 110.89 £ 804.65 Social Services took over funding as agreed at the Joint Panel on 27/03/14. Eligible for Funded Nursing Care

£ 41,037.15

8 £ 1,420.44 08/06/2014 08/06/2014 £ 110.89 £ 1,309.55 Social Services took over funding on 08/06/2014 as agreed at the Joint Panel on 27/03/14. Eligible for Funded Nursing Care

£ 55,001.10

£ 138,693.71

Patient Initials

Cost of Placement per week

Date Placement Ended

Date Current Placement Started

Cost of Current Placement

Cost Savings per week

RAG Rating

Status QUIPP Savings achieved tp date

Deceased Patients

9 £ 822.50 04/05/2014 N/A £ - £ 822.50 Patient passed away on 04/05/2014 £38,657.50

10 £ 1,400.00 22/03/2014 N/A £ - £ 1,400.00 Patient passed away on 22/03/2014 £71,400.00

£ 110,057.50

Total £ 469,643.21


Progress report – Shifting Settings of Care– Mental Health Name of the QIPP Scheme Shifting Settings of Care Type Mental Health

Scheme Objective A reduction in the number of patients in the care of the Mental Health Trust, based on a thorough clinical review of the needs of various categories of patients. The scheme is focussed on transferring these patients back in to the care of primary care, combined with additional support services to help these patient avoid the need for re-admission to the Mental Heath Trust.


Target Activity Reduction 2014-15 430 patients to be transferred Variance from plan 29patients below target at end May


Date QIPP Live from 01/04/2014 Current Development Stage Live

QIPP Lead (Non Clinical - CCG/ Local Authority) Sue Pascoe QIPP Lead (Clinical) Serena Foo

Key actions completed 1) Fortnightily monitoring meetings established and commenced with WLMHT 2) 46 GP practices signed up to scheme at end June 3) Cumulative total of 30 patients discharged at end of June set against activity target of target of 76 patients - new (rising) trajectory agreed with WLMHT 4) Additional cost of depot injections - CCG confirmed that this will be covered centrally . 5) CCG provided written confirmation of funding for PCMHWs through to 31/3/15

Milestones achieved 1) 50% (46) GP practices signed up to scheme as at 30th June 2) Agreed activity plan assumptions and expected number and trajectory of patientsto be discharged into primary care

Key actions next month 1) Continue to work with primary care to ensure 70% (55) GP practices to be signed up to scheme by 30th Sept 2014 2)Further detail being sought form WLMHT re Operational Plan for delivery 3) Finalise funding agreement with MIND for welfare benefits and peer support work 4) WLMHT to finalise recruitment of vacant PCMHW 5) Ascertain feasibility of PCMHWs being based at Percivale House


Likelihood (1 to 5) Impact (1 to 5) Total Score Further slippage on delivery of targets 3 4 12 Agree new (rising) trajecctory with WLMHT

Requested actual activity plan for shift broken down per practice. This will enable better monitoring of progress and more targeted intervention to bring back on target as appropriate

Insufficient GP practices sign up to scheme 2 3 6 Clinical commissioning lead, NRMS, PCMHWs continuing to work with primary care newtork leads to encourage sign up. Adopting co-ordinated approach targeting practices and networks where considered to be most potential gain. GP Champions established.


40% GP practices signed up to scheme 01-Apr-14 01-Apr-14 Completed Agreed activity plan assumptions, number & trajectory of patients to be transferred

01-Apr-14 01-Apr-14 Completed

50% GP practices signed up to scheme 30-Jun-14 30-Jun-14 Completed 70% GP practices to be signed up to scheme 30-Sep-14 30-Sep-14 G Achievement of transfer target of 155 patients to PMHCWs

30-Sep-14 30-Sep-14 At risk of delay work being done with the Trust to identify reasons for the delay in the transfer of 71 patients pending discharge.

Achievement of transfer target of 233 patients to PMHCWs

31-Dec-14 31-Dec-14 At risk of delay

Achievement of transfer target of 311 patients to PMHCWs

31-Mar-14 31-Mar-14 At risk of delay


Progress report – Mental Health: Productivity Name of the QIPP Scheme Mental Health: Productivity; Recovery

Houses; Ward closure & bed reconfiguration

Type Mental Health

Scheme Objective A reduction in the costs of commissioning Mental Health services based on two distinct strategies. A) Efficiency savings informed by benchmarking of the activity and costs of comparable services and modelling future provision B) Implementation of recovery house services.


Target Activity Reduction 2014-15 Variance from plan

Overall RAG Status A

Date QIPP Live from 1st April 2014 Current Development Stage

QIPP Lead (Non Clinical - CCG/ Local Authority) Leanda Richardson QIPP Lead (Clinical) Serena Foo

Key actions completed 1) Independent demand and capacity analysis commissioned and work commenced. 2) baseline data collected and reviewed 3) Model built, reviewed and refined via several workshop sessions and meetings

Milestones achieved

Key actions next month 1) Finalise model and organise handover to commissioners 2) Test planning scenarios using model


Mitigation


Demand and capacity model not delivered on time 3 3 9 Regular meetings taking place with PPL to review progress

In year efficiencies not delivered 3 3 9 50:50 risk share agreement in place with Trust for failure to deliver

Re-design initiatives and modelling tool fail to support long term efficiency agenda

3 5 15 Work taking place within NWL Mental Health Programme Board to achieve step change in service re-design work alongside local discussions about re-design initiatives more specific to Ealing. Modelling tool to support impact assessment of initiatives.

0


Commission independent analysis of existing and predicted pattern of provision

30-Jun-14 Completed

Establish planning model bringing together activity, capacity and spend

30-Jun-14 18-Jul-14 A

Develop and implement immediate changes 30-Sep-14 30-Sep-14 G

Use model to scope out longer term plans for inclusion in 2015/16 commissioning intentions

30-Sep-14 30-Sep-14 G

Develop and implement medium term pathway reviews 31-Mar-15 31-Mar-15 G


BCF Projects Summary July 2014 Project Name

Lead Go live date RAG Highlights Next Steps

Dementia Adenike Tilleray

01/04/2014 A - Commitment made to extend 2013/14 programme and train all front line primary care staff - Operational group completed review of care pathway and developed associated action plan to support admission avoidance - External support commissioned to establish demand and capacity model - good progress made - Local survey undertaken on primary care practice including assessment of dementia diagnosis rates pending receipt of QoF figures - Contract for enhanced primary care support for nursing homes established - further requirements being identified through this and operational group's review of care pathway - Led procurement of enhanced domiciliary care service as part of WLA initiative - Established CQUIN with ICO - Commissioners actively engaged in care co-ordination and navigation work

- Start to develop more specific training plan for primary care - Report of care pathway review to be considered by strategic leads / dementia programme board - Demand and capacity model to be completed and handed over to commissioners to take forward scenario planning - Support mobilisation of enhanced domiciliary care service - Review first quarter CQUIN reports

GP Network development & PMCF

Adenike Tilleray

0 G GP Network Development Secured agreement across general practice within Ealing to establish a single GP provider federation Definition of vision and design principles for federation and associated networks complete Establishment of federation governance arrangements and steering group Request for Quotes issued for legal and accounting support PMCF Initial engagement session completed with all general practitioner Baseline assessment underway (survey) High level plans developed Establishment of PMCF governance arrangements in progress

Further support development of Ealing GP federation Define and agree governance arrangements for PMCF Commence service design and implementation planning

Programme Management

Adenike Tilleray

01/06/2014 A BCF submitted in April. Programme Plan & PIDs in place. PI and Highlight reporting cycle in place, align to CCG PMO. Communication requirements scoped. Resources being agreed for projects. DCLG bid submitted. Governance review timetable proposed via Cabinet

HWB and Scrutiny Reports. Resubmit BCF Plan with financial model. Scope Care Bill programme Plan. Schedule/preparation for Awayday. Support complete Integrated Care Benchmarking Exercise


BCF Projects Summary July 2014 Project Name

Lead Go live date RAG Highlights Next Steps

Urgent Care Adenike Tilleray

Varies with each project.

A - ICE Review completed - First meeting of DTOC working Group held on 26/6/14 Action Agreed - EHT to reinstate daily DTOC list to be circulated to all organisations, including CCG. WLMHT to also complete daily DTOC list for under and over 65yrs. - GP OOHrs - Competitive dialogue completed. - Community Rehabilitation Beds - ITT documents released.

- OPRAC Review - Complete Phase 1

Health & Social

Adenike Tilleray

01/04/2014 G The care coordination / navigation prototyping exercise is being planned: the steering group has been agreed and defined and has started operating under agreed ToRs. The locality has been defined, clinical leads have been identified and the patient group agreed on. A recruitment mechanism and JD have been agreed on for the care coordinators. Key objectives of the prototyping exercise have been agreed on, and timescales mapped out. Alongside this, work has started to define self-management support needs and possible actions.

Establish role for care navigators, and recruitment mechanism for the prototyping exercise. Collect more detailed data about patient group and start defining the named patient group that will participate in the prototyping. Establish joint care teams - define roles, identify staff, gain agreement from providers and define working methods / tools. Complete Integrated Care Benchmarking Exercise

Third sector commissioning

Adenike Tilleray

01/04/2014 A - Resource identified and agreed for commissioning lead. Recruitment commencing - Initial meetings taken place with Corporate Grants lead and ECN chair to discuss alignment of Councils grants process and integration agenda - Some early consideration given to grant priorities - Commenced analysis of Ealing's carer population and spend. - Voluntary sector providers and commissioners active participants in co-design workshops for care navigation and co-ordination and dementia service re-design - Carers Partnership Board briefed

- Complete recruitment of commissioning lead - Agree framework for and set up third sector working group - Strategic review of resources available and grants/commissioning timetable - Complete carers population and spend analysis including drawing on NWL toolkit as appropriate - On-going involvement of voluntary sector providers and commissioners in co-design work 6) On-going discussion about grants priorities


BCF Project - Dementia July 2014 Name of the QIPP Scheme DEMENTIA Type PROJECT WTIHIN COMMISSIONING DEVELOPMENT WORKSTREAM

LEAD LEANDA RICHARDSON Scheme Objective Develop an integrated health and social care Dementia economy with joint responsibility shared between the CCG and LA.

Specific areas for improvement for people with dementia and their carers: Be supported to enjoy good quality of life and feel part of their local community, remaining in their own homes for as long as possible High quality residential care available where required; Access to high quality services, regardless of age, ethnicity, socioeconomic status or any other factor, so that hospital admission only occurs where there is a clear requirement.

Target Cost Reduction 2014-15 Not specified Variance from plan N/A Target Activity Reduction 2014-15 Not specified although contributes to overall BCF

targets Variance from plan N/A

Overall RAG Status A Date PROJECT Live from 01/04/2014 Current Development Stage Live QIPP Lead (Non Clinical - CCG/ Local Authority) Leanda Richardson QIPP Lead (Clinical) Serena Foo

Key actions completed 1) Commitment made to extend 2013/14 programme and train all front line primary care staff 2) Operational group completed review of care pathway and developed associated action plan to support admission avoidance 3) External support commissioned to establish demand and capacity model - good progress made 4) Local survey undertaken on primary care practice including assessment of dementia diagnosis rates pending receipt of QoF figures5) Contract for enhanced primary care support for nursing homes established - further requirements being identified through this and operational group's review of care pathway 6) Led procurement of enhanced domiciliary care service as part of WLA initiative 7) Established CQUIN with ICO 8) Commissioners actively engaged in care co-ordination and navigation work 9) Public health investment in dementia awareness work enabled dementia friends information sessions and support for people of working age dementia and their carers

Milestones achieved Key actions next month 1) Start to develop more specific training plan for primary care 2) Report of care pathway review to be considered by strategic leads / dementia programme board 3)

Demand and capacity model to be completed and handed over to commissioners to take forward scenario planning 4) Receive and take stock of QoF dementia diagnosis figures for 2013/14 and identify further action required for 2014/15 5) support mobilisation of enhanced domiciliary care service 6) Review first quarter CQUIN reports6) Ongoing involvement in care co-ordination and navigation work 7) commence production on service information for people with dementia and their carers


Likelihood (1 to 5) Impact (1 to 5) Total Score 0 Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment

Primary care training and support May-14 A Detailed training programme to be agreed eg delivery through MDGs using 'Barbara's story'

Treatment and assessment pathway review (Development of a shared pathway understanding amongst stakeholders)

May-14 A Operational group's review to be considered by strategic leads / dementia programme

board

Demand and capacity modelling (informing shared complex ward)

Jun-14 A Model to be completed and handed over to commissioners to take forward scenario

planning Review imaging & memory assessment service capacity

Jul-14 R Receive and take stock of QoF dementia diagnosis figures and identify further action

required Review initiative against DH toolkit and good practice examples

Jul-14 R Receive and take stock of QoF dementia diagnosis figures and identify further action

required Enhance primary care to meet need in the community ahead of A&E

Sep-14 A Follow up action arising from operational group's review of care pathway

Commissioning of specialist domiciliary care service Sep-14 A Support mobilisation of WLA's enhanced domiciliary care service

ICO evidence review on increased referrals Mar-15 A Review first quarter CQUIN reports Better coordinated care planning (ICE, community nursing, primary care)

Mar-15 A Ongoing involvement in care co-ordination and navigation work

Voluntary sector care navigation Mar-15 A Ongoing involvement in care co-ordination and navigation work Shared complex health and Dementia ward Mar-15 R To be reviewed with Hounslow and H&F commissioners Dementia awareness work May-15 G

Dementia CQUIN - Training for community Nursing Staff & Better care planning for dementia patients

Sep-15 A Review first quarter CQUIN reports

Increasing high quality care home beds Dec-15 R Unable to establish more dementia beds via PFI

Enhanced primary care provision to nursing homes Dec-15 G Ongoing monitoring of Argyle Road contract

Training to promote dignity in care Dec-15 A Ongoing training on dignity in care with care homes


BCF Project – GP Network Development & PMFC July 2014


BCF Project – Programme Management July 2014


BCF Project – Urgent Care July 2014


BCF Project – Health & Social July 2014


BCF Project – Third Sector Commissioning July 2014


Procurement Progress Summary July 2014 Procurement Value of the

Procurement Led By RAG

Status Highlights Key decisions in Committees

GP Out of Hours

Approx. £5m, based on a 2 years + 1 + 1 extensions

Ealing CCG A - Procurement being undertaken in partnership with Hounslow CCG. - Four companies have been short listed for the ITT stage . - Competitive Dialogue process now completed and bidders have submitted their outline proposals to the questions proposed to them at the end of the Competitive Dialogue process these questions are now being assessed by the Steering Group. - Draft ITT Questions will be issued the end of this week 11 July 2014. - Sign off on the specification and the contract this week, 25 July 2014. -Extension to the contract granted to the end of November pursuing this with the CSU to have the conversation with the provider.

- Sign off on schedule 5 of the contract IMT. - Issue of the ITT documentation middle/end July 2014 Timescales have changed slightly therefore a cover note needs to go to F&P re extension of current contract.

Rehabilitation beds

Approx. £8m, based on a 2 Years + 2 extension

Ealing CCG A - ITT was re-issued on 30 July - Dialogue was achieved with 4/5 Bidders - 4 Bidders remain interested in the procurement - Request made to EHT to provide TUPE information - Project timetable revised to reflect decision to re-issue ITT - Successful dialogue meeting was held with the 4th potential bidder - Request made to ICO to extend Jasmine Ward contract to align with revised procurement timetable

− Evaluate submitted Tenders - Select preferred − Approval to award contract by 7 August

RFS Current service costs approx. £600k pa. Final value of the procurement yet to be determined.

Ealing CCG G - 4 bidders have been short listed to proceed to ITT stage. - ITT is being is finalised. - There is some slippages in the timeline. The importance of timing for this procurement is relatively low, and some resourced have been diverted to other procurements to the detriment of RFS.

- Complete ITT documentation, and issue; - Agree updated timelines

Pathology £34.3m Total Contract Value , based on a 5 years + 2 extension contract

Ealing CCG G - ITT submissions evaluated - Preferred Provider selected – currently in Standstill Period. - Governing Body has approved the preferred bidder - Alcatel period completed - Procurement process is proceeding according to original plan fixed in December 2013. No slippages foreseen. - Initial meetings with THH to discuss mobilisation have taken place - Work in progress to complete contract signature

- Agree and sign the service contract with THH - Formal acceptance of associated final business case, that confirms the financial case to go to Exec and Governing Body.

Cardiology Approx. £2.2m pa for Cardiology community services, plus approx. £0.5m for Cardiology Rehabilitation

Ealing CCG A - The Business Case - High level financial case was agreed at the F&P meeting on 25th June - Procurement to commence Q3 of 2014/15. Procurement plan under revision. - Finance Lead appointed - Benchmark Data file for NWL CCGs extracted - Reconciled SLAM & SUS data for ECCG

- Advertise Prior Information Notice (PIN) event Complete presentations for the PIN event Revised project timetable for a new baseline to be agreed by Steering group - ECCG cardiology OP & InP benchmarked against NWL CCGs

Wheelchair Services

TBA CWHHE wide R - The Business Case - High level financial case was agreed at the F&P meeting on 25th June - Procurement to commence Q3 of 2014/15. Procurement plan under revision. - Finance Lead appointed - Benchmark Data file for NWL CCGs extracted - Reconciled SLAM & SUS data for ECCG

Completed the PQQ evaluation. Awaiting financial checks. Address the project management issue. Project Manager(Richard Nicholson) appointed commenced 4 June 2014. -Financial and Commercials yet to be decided. - Agree revised procurement timescales and new procurement project management arrangements - 14/7/14

Diagnostic Services

TBA CWHHE wide G - CSU responsible for procurement - Part B process. - Supplier Event held 25th March - PQQ deadline Tuesday 6th May (12 noon). PQQs received from 7 bidders bidding to deliver services for 1 or more CCGs [4 Bidders for Ealing] - Jonathan Davies coordinating finalisation of specification. New timescales to be circulated by JD w/c 12 May 2014 - Moderation meetings to take place - Specification and ITT to be dispatched end of June 2014 Specification issued on 4th July slightly later than planned due to additional financial diligence required. Project is on track as this is within tolerances

0


GP Out of Hours Procurement Highlights July 2014 Name of the Procurement GP Out of Hours Led by Ealing CCG

Report Date 09-Jul-14 Value of the Procurement Approx. £5m, based on a 2 years + 1 + 1 extensions Overall Procurement RAG Status A Present Provider Harmoni Date of expiry of present contract 30-Sep-14 Procurement Team CCG CDM: Sarah Blair

Clinical lead: Shanker Vijayadeva Project Mgr.: Sarah Blair Procurement: Lead Graham Sowter

Highlights - Procurement being undertaken in partnership with Hounslow CCG. - Four companies have short listed for the ITT stage . - Competitive Dialogue process now completed and bidders have submitted their outline proposals to the questions proposed to them at the end of the Competitive Dialogue process these questions are now being assessed by the Steering Group. - Draft ITT Questions will be issued the end of this week 11 July 2014. - Sign off on the specification and the contract this week, 25 July 2014. -Extension to the contract granted to the end of November pursuing this with the CSU to have the conversation with the provider.

Key decisions -Final draft of the Service specification to be presented to Ealing Exe on the 16 July 2014 - ITT documentation will be issued the middle/end of July.

Key Activities in next month. - Sign off on schdule 5 of the contract IMT. - Issue of the ITT documentation middle/end July 2014 Timescales have changed slightly therefore a cover note needs to go to F&P re extension of current contract.


Mitigation


The service specification may not meet all requirements and miss important priorities

1 4 4 The specification is being drafted and a version will be completed by Friday this week to hand to potential providers involved in the CD Process

Potential conflicts of interests 2 4 8 Close scrutiny for CCG. Paper to Investment Committee.

Loss of bidders, due to non-qualification at PQQ 1 1 1 4 bidders taken forward to Competitive Dialogue process

Procurement may not complete before current contract term

3 3 9 Extend current contract with existing provider. Decision has been made by Steering Committee to extend.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment PQQ Issue 21-Mar-14 Complete Bidder event 09-Apr-14 Complete PQQ Closing Date 24-Apr-14 G PQQ evaluation perform, two bidder queries PQQ Evaluation Complete 09-May-14 G Invitation to Dialogue 10-Jun-14 G Competitive Dialogue process now completed. ITT will

be issued and bidders will have 3 weeks to submit their bid.

Competitive dialogue complete 07-Jul-14 G ITT issue 01-May-14 25-Jul-14 A ITT Closing date 02-Jun-14 15-Aug-14 A Complete ITT Evaluation 16-Jun-14 25-Aug-14 A Contract Award 28-Jun-14 15-Sep-14 A Contract Execution 28-Jul-14 31/09/14 A Service commencement 01-Oct-14 05-Nov-14 A Commencement dépends on Bidder responses


Rehabilitation Beds Procurement Highlights July 2014 REHABILITATION BEDS Led by Ealing CCG REHABILITATION BEDS

Report date 10-Jul-14

Value of the Procurement Approx. £8m, based on a 2 Years + 2 extension

Overall Procurement RAG Status A Present Provider Ealing Hospital Trust -ICO Date of expiry of present contract 31st May 2014; extended to 31st August 2014 Procurement Team CCG CDM: Ebun Eno-Amooquaye

Clinical lead: Mohammad Alzarrad Project Mgr.: Ebun Eno-Amooquaye Procurement: Graham Sowter

CSU Procurement Lead CSU Procurement Lead: George Rana

Highlights - ITT was re-issued on 30 July - Dialogue was achieved with 4/5 Bidders - 4 Bidders remain interested in the procurement - Request made to EHT to provide TUPE information - Project timetable revised to reflect decision to re-issue ITT - Successful dialogue meeting was held with the 4th potential bidder - Request made to ICO to extend Jasmine Ward contract to align with revised procurement timetable

Key decisions ‒Steering group agreed 2x15 beds unit service model. This was approved at Exec meeting −Steering group agreed a block contract model for the service with a price envelpe ranging from £1.2m (lower) - £1.5m (higher). - Steering group agreed to state in the ITTT document that "TUPE was likely to apply to the contract" - Steering group agreed contract duration of 3 years +1 +1

Key actions in next month − Evaluate submitted Tenders - Select preferred − Approval to award contrct by 7 August


Likelihood (1 to 5) Impact (1 to 5) Total Score If TUPE implications are of significant material change this may necessitate a re-procurement process.

3 3 9 Obtain advice from Capsticks, and engage EHT on why they queried TUPE.

Original Bidders may loose interest in the procurement and may not submit Tenders

2 3 6 Dialogue process, prior to tender re-issue

Existing provider contract may need to be extended, due to timeline implications of ITT re-issue.

5 3 15 Extend the current provider agreement

Bidders may not submit tenders because the revised cost model for the ITT may not be cost effective for their business models.

2 2 4 dialogue process will be used to define financial parameters for the service

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment PQQ Issue 21-Feb-14 Completed Bidder event 28-Feb-14 Completed PQQ Closing Date 14-Mar-14 Completed PQQ Evaluation Complete 28-Mar-14 Completed ITT issue 04-Apr-14 30-Jun-14 Completed Re-issue of ITT following dialogue with 4/5 of the Bidders ITT Closing date 02-May-14 25-Jul-14 Complete ITT Evaluation 31-May-14 06-Aug-14 Site visits complete 04-Jun-14 tbc Contract Award 12-Jun-14 07-Aug-14 Contract Execution 06-Jul-14 19-Aug-14 Service commencement 29-Sep-14 15-Sep-14


RFS Procurement Highlights July 2014 Name of the Procurement Referral Facilitation Services (RFS) Led by Ealing CCG

Report date 09-Jul-14 Value of the Procurement Current service costs approx. £600k pa. Final value of the procurement yet to be determined. Overall Procurement RAG Status G Present Provider Ealing CCG employed staff Date of expiry of present

contract N/A

Procurement Team Management Lead: Sarah Blair Clinical lead: Alex Fragonyannis Project Mgr.: Sarah Blair Procurement: Graham Sowter

CSU Procurement Lead CSU Procurement Lead: N/A

Highlights - 4 bidders have been short listed to proceed to ITT stage. - ITT is being is finalised. - There is some slippages in the timeline. The importance of timing for this procurement is relatively low, and some resourced have been diverted to other procurements to the detriment of RFS.

Key decisions - Investment Committee to review and approve the process being followed, to verify conflict of interest issues are being appropriately managed - Confirmation of the PQQ result, and decision on the bidders to be invited to go forward to ITT stage. - Specification presented to Exe on 11 June 2014, and was agreed. - Project requires Financial resource

Key actions in next month - Complete ITT documentation, and issue; - Agree updated timelines


Mitigation


1. Possibility that RFS team would have to make two office moves: 1. to Perceval House; 2. to success bidder

1 3 3 1. A decision has been made that only one move will be allowed; OLS office occupancy will be extended

2. The volumes of referrals handled by the RFS is uncertain due planned increases resulting from consultant: consultant / IGR referrals changes and all GP referrals coming thru the RFS

3 1 3 2. Suitable language is to be included in the ITT, notify bidders of the likely changes Discussions with the Trust's, particularly EHT have commenced on by IGR and prior approval processes

3. Independent GP evaluator not yet identified 0 0 0 Risk fully mitigated. All evaluators identified.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment PQQ Issue 17-Mar-14 Complete Bidder event 25-Mar-14 Complete PQQ Closing Date 21-Apr-14 Complete PQQ Evaluation Complete 28-Apr-14 Complete PQQ now complete ITT issue 12-May-14 25-Jul-14 A ITT Closing date 16-Jun-14 29-Aug-14 A Complete ITT Evaluation 23-Jun-14 15-Sep-14 A Site visits complete N/A N/A A Contract Award 07-Jul-14 30-Sep-14 A Contract Execution 21-Jul-14 24-Nov-14 A Service commencement 06-Oct-14 01-Dec-14 A


Pathology Procurement Highlights July 2014 Name of the Procurement Pathology: Led by Ealing CCG

Report Date 14-July-14

Value of the Procurement £34.3m Total Contract Value , based on a 5 years + 2 extension contract

Overall Procurement RAG Status G

Present Provider TDL Date of expiry of present contract 30-Sep-14

Procurement Team CCG CDM: Frances Horne Clinical lead: Arjun Dhillon Project Mgr.: Frances Horne Pathology Specialist: Richard Dolby Procurement: Graham Sowter

CSU Procurement Lead CSU Procurement Lead: N/A

Highlights - ITT submissions evaluated - Preferred Provide selected – currently in Standstill Period. - Governing Body has approved the preferred bidder - Alcatel period completed - Procurement process is proceeding according to original plan fixed in December 2013. No slippages foreseen. - Initial meetings with THH to discuss mobilisation have taken place - Work in progress to complete contract signature

Key decisions - Agreement to sign contract

Key actions in next month - Agree and sign the service contract with THH - Formal acceptance of associated final business case, that confirms the financial case to go to Exec and Governing Body.


Mitigation


No material risks identified 0 0 0


PQQ Issue 02-Dec-13 Complete Bidder event 16-Dec-13 Complete

PQQ Closing Date 06-Jan-14 Complete PQQ Evaluation Complete 27-Jan-14 Complete ITT issue 17-Feb-14 Complete ITT Closing date 14-Apr-14 14-Apr-14 Complete Complete ITT Evaluation 02-May-14 02-May-14 Complete All on schedule Site visits complete N/A N/A Contract Award 12-May-14 12-May-14 Complete Contract Execution 30-Jun-14 30-Jun-14 G Service commencement 06-Oct-14 01-Oct-14 G


Cardiology Procurement Highlights July 2014 Name of the Procurement CARDIOLOGY Led by Ealing CCG

Report Date 10-Jul-14 Value of the Procurement Approx. £2.2m pa for Cardiology community services, plus approx. £0.5m for Cardiology Rehabilitation Overall Procurement RAG Status A Present Provider No existing provider. Procurement objective is to

introduce community services for cardiology, and reducing the need for acute care

Date of expiry of present contract

N/A

CCG Procurement Lead CCG CDM: Ebun Eno-Amooquaye Clinical lead: Alex Fragonyannis Project Mgr.: Ebun Eno-Amooquaye Procurement: Graham Sowter

CSU Procurement Lead N/A

Highlights - The Business Case - High level financial case was agreed at the F&P meeting on 25th June - Procurement to commence Q3 of 2014/15. Procurement plan under revison. - Finance Lead appointed - Benchmark Data file for NWL CCGs extracted - Reconclided SLAM & SUS data for ECCG

Key decisions -F&P have approved the start of procurement. '-The Steering group agreed on 9 July to re-schedule the PIN event from 16 July to 13 August. '-The Steering Group agreed on 9 July to include the wider market and local providers in the development of the service specification through the Clinical Reference group. This will minimise the risk of challenge from potential providers and ensure a wider professional consensus on the clinical aspect of the service specification. '-The Steering Group agreed on 9 July to set-up the Clinical Reference group in the first week of September. '-The Steering group agreed on 9 July to revise the procurement timetable and milestone dates to reflect the new PIN event date and the new set-up date for the Clinical Reference group

Key actions - Advertise Prior Information Notice (PIN) event Complete presentations for the PIN event Revised project timetable for a new baseline to be agreed by Steering group - ECCG cardiology OP & InP benchmarked against NWL CCGs


Likelihood (1 to 5) Impact (1 to 5) Total Score 1. Cardiology procurement is a high profile and major service change project, and continues to attract significant stakeholder interest.

3 4 12 Service change has been reviewed at both Overview and Scrutiny, and at H&WBB. Patient/Public engagement remains key.

2. It is possible that the Business case revision will be less convincing that earlier iterations. RISK CLOSED

1 1 1 Assumptions to be subject of careful review.

3. If EHT are unsuccessful in the Bid to provide the new community cardiology service, then the de-commissioning of 80% of current outpatient cardiology activity may significantly threaten the viability of the cardiology department at EHT and may threaten cardiology support to other specialties in the hospital.

3 3 9 Mitigated under SaHF programme

4. Set-up of Clinical Reference group may be delayed, if there is insufficient interest from suitable clinical experts from the PIN event

2 3 6 Steering group to continue to gather group of clinical experts to step in



Bidder event (PIN) 13-Aug-14 13-Aug-14 G Project baseline plan under revision. New baseline to be approved by the steering group by 23 July. PQQ Issue tbc tbc G

PQQ Closing Date tbc tbc G PQQ Evaluation Complete tbc tbc G ITT issue tbc tbc G ITT Closing date tbc tbc G Complete ITT Evaluation tbc tbc G Site visits complete tbc tbc G Contract Award tbc tbc G Contract Execution tbc tbc G

Service commencement tbc tbc G


Diagnostic Services Procurement Highlights July 2014 Name of the Procurement DIAGNOSTIC SERVICES Led by CWHHE: Collaborative procurement with all 6 NWL CCGs (was originally just

CWHHE – now includes BHH)

Report Date 09-Jul-14

Value of the Procurement TBA Overall Procurement RAG Status G Present Provider InHealth Date of expiry of present

contract 31 March 2015

CCG Procurement Lead CCG: Beryl Bevan Programme Manager (Central London): Cynthia Abankwa, CSU Project Manager: Jonathan Davies

CSU Procurement Lead CSU Procurement Lead: Jennifer Rhoden

Highlights - CSU responsible for procurement - Part B process. - Supplier Event held 25th March - PQQ deadline Tuesday 6th May (12 noon). PQQs received from 7 bidders bidding to deliver services for 1 or more CCGs [4 Bidders for Ealing] - Jonathan Davies coordinating finalisation of specification. New timescales to be circulated by JD w/c 12 May 2014 - Moderation meetings to take place - Specification and ITT to be dispatched end of June 2014 Specification issued on 4th July slightly later than planned due to additional financial diligence required. Project is on track as this is within tolerances

Key decisions Key actions Risks Risk Rating [Total Score = Likelihood X Impact]

Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score Schedule slippages, impacting the end day of current provider contract

0

Milestone Planned Date Revised Planned Date RAG Comment PQQ Issue 28-Mar-14 Complete Bidder event 25-Mar-14 Complete PQQ Closing Date 06-May-14 Complete Some time allowance made in the plan to accommodate

evaluation taking longer than expected due to clinician commitments. Project is on track

PQQ Evaluation Complete 28-May-14 03-Jun-14 G ITT issue 30-Jun-14 G ITT Closing date 03-Sep-14 G Complete ITT Evaluation (Steering Group endire preferred bidder

03-Oct-14 G

Site visits complete N/A G Contract Award 15-Oct-14 G Contract Execution N/A G Service commencement 03-Nov-14 G


Wheelchair Procurement Highlights July 2014 Name of the Procurement WHEELCHAIRS Led by CWHHE: Collaborative procurement across all 8 NWL CCGs plus Barnet Report Date 11-Jul-14

Value of the Procurement TBA Overall Procurement RAG Status R Present Provider EHT-ICO Date of expiry of present

contract 31st March 2015

CCG Procurement Lead CCG CSM: Usha Prema CSU for Hounslow CCG: Mary Crawford [left 24 April 2014] New Project Mgr:Richard Nicholson

CSU Procurement Lead - The CSU are responsible for both the overall Project Management and the procurement support - CSU Procurement Lead: Jennifer Rhoden

Highlights - This is a Pan-NWL procurement (Part A) for 9 CCGs, including Barnet. New service to start April 2015 - CSU responsible for procurement - Supplier Event held 2nd April - PQQ deadline is 9th April, Moderation Meeting held 13 May 2014. PQQ Financial analysis to be completed. - Service specification still to be finalised (possible dispatch of ITT Mid July) – Sub Grp commenced - meeting was held 11 April 2014 to review current and example specifications. Next meeting 28 May 2014. Final spec to be completed by mid June. - ITT Financial Model currently being worked on – 4/5 options currently under review by CCGs -New Project Manager (Richard Nicholson) started 2 June - Each CCG holding Local User Engagement - Ealing held on 29 April 2014. Two user representatives identified for Evaluation. - Financial Modelling on Contract - lead identified by CSU Ladan Tehrani - Email sent to bidders via the portal (2 June) apologising for delay in ITT being dispatched -Financial Modelling Options workshop held 1/7/14 -Steering Grp - 14/7/14 - to review procurement timelines and procurement management in light of several delays and issues

Key decisions PQQ Financial review still to be undertaken. Steering Group met 12th June 2014; Key actions Completed the PQQ evaluation. Awaiting financial checks.

Address the project management issue. Project Manager(Richard Nicholson) appointed commenced 4 June 2014. -Financial and Commercials yet to be decided. - Agree revised procurement timescales and new procurement project management arrangements - 14/7/14


Likelihood (1 to 5) Impact (1 to 5) Total Score Lack of Project Management support 0 CSU (Daniel Tagg) have escalated the issue within CSU. The procurement timeline is vulnerable to major delay, and will bot be completed by 31st March 2015

0 Ealing CCG is not clear how this major risk will be resolved

Governance and key decision making processes between 9 CCGs unclear

0

Milestone Planned Date Revised Planned Date RAG Comment PQQ Issue 10-Mar-14 Complete Bidder event 02-Apr-14 Complete PQQ Closing Date 09-Apr-14 Complete Resources are not in place to carry out this procurement. PQQ Evaluation Complete 30-Apr-14 31-May-14 A Subject to Financial Analysis ITT issue 26-May-14 end Jly tbc R date yet to be agreed. ITT Closing date 27-Jun-14 new dates tbc R Complete ITT Evaluation 30-Sep-14 new dates tbc R

Site visits complete 31-Aug-14 new dates tbc R Contract Award 30-Nov-14 R Contract Execution 31-Jan-15 R Service commencement 01-Apr-15 R


Project Name Lead Go live date RAG Highlights Next Steps Community Transport

Alex Matthews

G Demand, eligibility criteria, and the process for delivering the service are in discussion with the Exec and once agreed will inform the service specification for the pilot and the PID for the project to deliver the pilot.

- Reach agreement on the key decisions outlined above - Finalise service specification and CCG to negotiate with transport provider ECT - Finalise PID for how the project will be delivered and how the pilot will be evaluated

Community Services Review

Elizabeth Youard

G Phase 0 complete. Governance and steering arrangements in place with phase 1 advisers to Steering Group appointed June. Baker Tilly appointed phase 1 adviser 25/06/14 through careful selection discussion after competition. Phase 1 analysis and benchmarking due to complete mid August - 2 weeks' slippage being accommodated. Evidence and stakeholder engagement being mobilised. Provider engagement approach integrated. Brent CCG following consistent methodology & sharing tools. Phase 2 adult care pathways due to complete 1 September. Steering Group options for phase 2 content and approach under discussion. Phase 3 option appraisal due to complete 30 September

Confirmation and implementation of stakeholder engagement for confirmation of phase 1 quantitative and qualitative survey. Use of MDGs. Dialogue with stakeholders to focus on multidisciplinary integrated perspective on care pathway development over 5-10 years Integration of CCG Steering Group approach into EHT ICO risk management framework

Best Start- better care for under 5s

Maggie Wilson

Oct-15 A Stakeholder event held June 2014; parent engagement has taken place; service model agreed

Report to CCG executive 23 July; meetings of core group and of project management group

Children’s and Families Act

Maggie Wilson

01/09/2015 G Consultation with parents has been happening; local offer being written; EHC processes close to agreement; CWHHE working to recruit to designated health role

Report to CCG on 9 July – re EHC decision making process and general update; finishing text for local offer; consultation with young people and parents

Other Major Projects Progress Summary July 2014


Community Patient Transport July 2014 Name of the Project Community Patient Transport Led by Ealing CCG Report Date: Report Date 09-Jul-14 Purpose of the project Ealing CCG is seeking to accelerate the development of a community transport service which will enable patients to attend its widening range of primary care and out of

hospital services. This has been identified as a strategic need for the CCG based on patient feedback discussed with the Transport Advisory Group. Importantly the development of the new service will be complimentary (and not additional) to the Shaping a Healthier Future programme. The CCG covers an area with a population of over 340,000 people making it one of the largest in London. Over the past two years it has prioritised the implementation of its ‘Out of Hospital Strategies’ (firstly Better Care Closer to Home and more recently Ealing CCG Out of Hospital Delivery Strategy). The CCG has identified patient transport to primary and community care services as a key driver for ensuring that out of hospital care can deliver the expected benefits to patients. It is recognised that patient transport to acute services has always been, funded and supported by commissioners, this needs to be replicated for primary and community care.

Project scope In support of this the CCG has identified three strands of activity as follows: - An exercise to quantify the approximate level of demand for community transport services that can be used to inform a service specification; - A service specification which will allow the CCG to initiate a pilot to test the new service and verify the assumptions made around demand; and - An evaluation of the pilot, to inform a final service specification and support the procurement of a full borough-wide service for the start of the next financial year.

Inter-dependencies No specific interdependencies Overall RAG Status G Present Provider ECT Date of expiry of present contract Not yet contracted

Project Lead Jill Downey Project Team Kathryn Magson, Sue Pascoe, Jill Downey, Alex Matthews (PA) and Zoe Przyjemski (PA)

Highlights Demand, eligibility criteria, and the process for delivering the service are in discussion with the Exec and once agreed will inform the service specification for the pilot and the PID for the project to deliver the pilot.

Key decisions 1. Commission the pilot with ECT to support an initial demand of 10 return journeys per day across Ealing for Anti-coagulation and Diabetes clinics, including regular review points to increase demand to up to a maximum of 60 return journeys per day, so that avoided home visits and other appointment types can be brought into scope. 2. Run the pilot over a 6 month period to fully test the community patient transport service for different appointment types and for different levels of demand. 3. Tighten-up eligibility for the service by allocating each GP practice a set number of community patient transport journeys (that they are able to refer their patients to over a given time period) and restricting referrals from GP practices once that number of journeys has been reached.

Key Activities in next month (incl updates at various Committees)

- Reach agreement on the key decisions outlined above - Finalise service specification and CCG to negotiate with transport provider ECT - Finalise PID for how the project will be delivered and how the pilot will be evaluated


Mitigation

Likelihood (1 to 5) Impact (1 to 5) Total Score Demand exceeds scope of pilot 3 2 6 Monitor pilot and cap demand with GP practicews

individually GP practices do not flex appointment booking and scheduling to accommodate service

3 2 6 Include measures in the service spec to require GP practices to meet targets and provide flexibility and use performance data to address issues with GP practices where necessary

Patients complain if the pilot service is withdrawn before the full service is implemented

2 2 4 Consider the need for service continuity between pilot and implementation of full service


Commence delivery of pilot by mid-August

15-Aug-14 15-Aug-14 A Subject to agreement from the exec and the negotiation of the service spec between the CCG and ECT


Community Provider Reviews July 2014 Name of the Project Community Provider Review Led by Ealing CCG Report Date:


Purpose of the project To assist ECCG with its strategic commissioning, generating options for the future provision of community services

Project scope EHT ICO portfolio of services for adults and children Inter-dependencies Alignment and strategic fit with whole systems and BCF agenda including ICE review Overall RAG Status G Present Provider EHT ICO - Ealing Directorate Date of expiry of present contract 31-Mar-15

Project Lead CRO CCG Chair, SRO CCG MD Project Team ECCG Steering Group, PM Elizabeth Youard Highlights Phase 0 complete. Governance and steering arrangements in place with phase 1 advisers to Steering Group appointed June.

Baker Tilly appointed phase 1 adviser 25/06/14 through careful selection discussion after competition. Phase 1 analysis and benchmarking due to complete mid August - 2 weeks' slippage being accommodated. Evidence and stakeholder engagement being mobilised. Provider engagement approach integrated. Brent CCG following consistent methodology & sharing tools. Phase 2 adult care pathways due to complete 1 September. Steering Group options for phase 2 content and approach under discussion. Phase 3 option appraisal due to complete 30 September

Key decisions Selection of adviser for phase 1. Selection of phase 2 approach - under development Approval of completion at end of phases 1 to 3; Options appraisal September 2014


Confirmation and implementation of stakeholder engagement for confirmation of phase 1 quantitative and qualitative survey. Use of MDGs. Dialogue with stakeholders to focus on multidisciplinary integrated perspective on care pathway development over 5-10 years Integration of CCG Steering Group approach into EHT ICO risk management framework

Risks Risk Rating [Total Score = Likelihood X Impact] Mitigation Likelihood (1 to 5) Impact (1 to 5) Total Score Overall review is ambitious in the timescale and with supporting resources available

3 3 9 Negotiation process with appointed review adviser and oversight of project plan through project leads

Lack of engagement or supporting information from existing provider

2 3 6 Integration of EHT ICO proposed risk management framework into approach, and briefing of providers Engagement of project leads into EHT ICO proposed contract review meetings

Loss of project team or adviser team capacity during project

1 5 5 Project capacity and systems sufficiently resilient for contingency and transitional arrangements

Options appraisal does not meet CCG requirements for recommendations for CCG commissioning intentions

2 5 10 Negotiation process with appointed review adviser and oversight of project plan through project leads. Steering Group closely sighted.

Milestone Planned Date (1 April 14 Baseline) Current Planned Date RAG Comment Project reporting arrangements established 14-May-14 Complete Steering group and meetings established 30-Apr-14 Complete ITT for project adviser circulated 19-May-14 Complete 2 bids received 30/05/2014 Adviser appointed and mobilised 19-Jun-14 Complete Appointed for phase 1 25/6/2014 after interview and

adjudication Analysis and benchmarking phase 1 concludes 30-Jul-14 15-Aug-14 G Deferral into phase 2 period being accommodated

Adult services and care pathways phase 2 ends 01-Sep-14 A Steering Group choice of phase 2 approach tbc

Accept phase 2 findings & possible options with recs 01-Sep-14 A

Phase 3 development and testing of short-, medium- and long- term options with actions

30-Sep-14 G

Delivery of options appraisal and recommendations to Steering Group for sign off

30-Sep-14 G

Accepted phase 3 options appraisal and recommendations

30-Sep-14 G


Best Start – Better care for under 5’s July 2014 Name of the Project Best Start- better care for under 5s Led by Ealing CCG Report Date:


Purpose of the project TO COMMISSION AND PROVIDE AN INTEGRATED SERVICE AS PART OF THE EARLY INTERVENTION STRATEGY

Project scope LBE and CCG to commission from Oct 2015 an integrated service comprising healthy child programme, specialist child health and family support services

Inter-dependencies The transfer of health visitor and family nurse partnership commissioning from NHD E to LAs in 2015; the current issues relating to shortage of health visitors which impacts on primary care

Overall RAG Status A

Present Provider LBE and the ICO Date of expiry of present contract

Project Lead Maggie Wilson Project Team

Highlights Stakeholder event held June 2014; parent engagement has taken place; service model agreed

Key decisions CCG executive in July to agree commissioning approach and healthcare input into service


Report to CCG executive 23 July; meetings of core group and of project management group



Recruitment of health visitors; uncertainty over funding to transfer from NHSE to LBE and the formula to be used to determine this transfer of funds

4 4 16


Report to CCG executive 23-Jul-14 23-Jul-14 Planned, not at risk

Report to LBE cabinet 01-Sep-14 01-Sep-14 Planned, not at risk

July/August – meetings with NHS E re current issues in Ealing and re transfer of responsibilities

01-Jul-14 01-Jul-14 Planned, not at risk

Identifying office bases and agreeing management model

01-Oct-14 01-Oct-14 Planned, not at risk

NHSE to transfer health visiting service funding to LBE

01-Oct-15 01-Oct-15 Planned, not at risk

Integrated service begins 01-Oct-15 01-Oct-15 Planned, not at risk


SEN and Disability/ Children and Families Act July 2014 Name of the Project SEN and disability/Children and Families Act

implementation Led by Ealing CCG Report Date:


Purpose of the project To ensure that key partners in Ealing are ready for implementation in Sept 2014

Project scope To agree process for EHC plans; to publish local offer; to set up systems for direct payments; CCGs to appoint to medical/clinical role; parents to be consulted; to undertake needs analysis; to enter into revised agreement between LBE and CCG TO jointly commission services

Inter-dependencies Funding by CCG of specialist health care services; offer of health services via a direct payment


Present Provider LBE; ICO; Schools; independent and third sector; colleges Date of expiry of present contract

Project Lead CCG project lead - Maggie Wilson Project Team

Highlights Consultation with parents has been happening; local offer being written; EHC processes close to agreement; CWHHE working to recruit to designated health role

Key decisions


Report to CCG on 9 July – re EHC decision making process and general update; finishing text for local offer; consultation with young people and parents


Mitigation


Key elements not in place by Sept – eg designated medical post

3 3 9

Insufficient resources for specialist health to enable delivery of requirements of EHC process and to meet population growth

3 3 9


Regular meetings of project board and sub groups

regular meetings regular meetings Planned, not at risk

Publication on LBE website of Local offer

01-Sep-14 01-Sep-14 Planned, not at risk

EHC process goes live 01-Sep-14 01-Sep-14 Planned, not at risk


APPENDIX


Procurements are monitored via Steering Committee that operate under mandate granted by Finance and Performance Committee. In addition, North West London CSU provides Procurement advisory service on a monthly basis for some of the procurements, which is monitored by the CCG. New schemes are subject to development through defined stages and approvals through Executive Management and Innovation Committee and Finance and Performance Committees and CWHHE Investment Committee.

Governance and PMO structure to track progress and benefits

Ealing CCG Finance and Performance Committee (Monthly)

ECCG

Deputy

MD

ECCG

Managing

Director

ECCG

Finance

Lead

CWHHE

Accountable

Officer and

CFO

ECCG

Business

Manager

Joint

Management

Team

Meeting

(BCF)

Deputy MD/

Business

Manager

Commissioning

Development

Managers

Procurement

and other

Project

managers

Clinical

Leads

BCF

PMO

Lead

QIPP

Workstream

A

QIPP

Workstream

B

BCF

Workstream

C

BCF

Workstream

D

Procurement

Workstream

E

ECCG Monthly PMO Meeting

Monthly Review Meeting

ECCG Service Change Delivery workstreams

Ealing CCG Governing Board

CWHHE Collaborative Committees

1. Programme wide meetings

2. Scheme level 121 meetings

LBE F

e

e

d

b

a

c

k

Deputy MD (Programme Director)

Business Manager (Programme Manager)

PMO Project Support Officer

PMO Analyst

Programme Management Office

ECCG PMO

For BCF

ECCG

and LBE

to

manage

jointly


Summary of 2014-15 QIPP Programme

Scheme Type Scheme Code Scheme Name Gross

Saving

(£000)

Investment

(£000k)

Net

Savings

(£000)

Risk Rating

(% Deliverable)

Net Rated

Savings

(£000)

Unplanned Care 07W-1415-001 Intermediate Care Service (ICE) £750 £0 £750 100% £750

Unplanned Care 07W-1415-002 U&USC Pathway: Ambulatory Care £0 £0 £0 0% £0

Unplanned Care 07W-1415-003 U&USC Pathway: Frail Elderly £0 £0 £0 0% £0

Unplanned Care 07W-1415-004 GP Service for Nursing Homes £1,053 £477 £576 81% £466

Unplanned Care 07W-1415-005 Pulmonary rehabilitation £97 £0 £97 50% £49

Unplanned Care 07W-1415-006 Falls Pathway £0 £0 £0 0% £0

Planned Care 07W-1415-007 Referral Facilitation Service (RFS) £570 £285 £285 57% £162

Planned Care 07W-1415-008

CVD Anticoagulation Schemes £308 £72 £236 40% £94

Planned Care 07W-1415-009 MSK Pathway £1,281 £387 £894 100% £894


Diabetes £371 £324 £47 100% £47

Planned Care 07W-1415-011 Cardiology £547 £497 £50 30% £15


Gynaecology £461 £200 £261 39% £101

Planned Care 07W-1415-013 Dermatology £1,412 £452 £960 88% £848

Planned Care 07W-1415-014 Ophthalmology TBD TBD TBD TBD TBD

Paediatrics 07W-1415-015 Paediatric Pathways £100 £0 £100 100% £100

Paediatrics 07W-1415-016 Connecting Care for Children £0 £0 £0 0% £0

Mental Health 07W-1415-017 Mental Health CC £650 £0 £650 100% £650

Mental Health 07W-1415-018 Shifting Settings of Care (Mental Health) £500 £0 £500 67% £333

Mental Health 07W-1415-019

Mental Health: Productivity; Recovery

Houses; Ward closure & bed

reconfiguration

£400 £0 £400 47% £188

Medicines Management 07W-1415-020

Prescribing £1,451 £200 £1,251 79% £993

Medicines Management 07W-1415-021 Acute High Cost Drugs Risk Share £100 £0 £100 100% £100

Financial Management 07W-1415-022

NCA Validations £75 £0 £75 75% £56

Efficiency and Productivity 07W-1415-023 Emergency Admissions Reduction £1,125 £0 £1,125 50% £563

Efficiency and Productivity 07W-1415-024

Productive Community Services Efficiency

2014-15

£368 £0 £368 50% £184

Efficiency and Productivity 07W-1415-025 Old Productivity and Efficiency Metrics TBD TBD TBD TBD TBD

Diagnostics 07W-1415-026

Diagnostics: Pathlology £100 £0 £100 100% £100

Diagnostics 07W-1415-027 Diagnostics Cloud £0 £0 £0 0% £0

Diagnostics 07W-1415-028

Pathology Services Re-procurement £344 Saving shown

net

£344 78% £267

Totals (roll forward of 2014-15 QIPP

schemes)

£12,063 £2,894 £9,169 £6,960

Net QIPP Target £9,169

2014-15 QIPP Summary Plan


Programme Risks and Mitigation

Risk types Risk description Mitigation

Procurement outcome • Managing the Procurement timetable slippage; • Bidder proposed prices being equal to or less than market

based assumptions • Risk of challenge delays contract awards

• Ensuring procurement projects had sufficient skilled resources; Team is being re-organised to set a dedicated procurement team.

• Specific procurement advice in place to mitigate risks as much as possible

Delivery by provider • Managing acute providers to reduce acute inpatient or outpatient activity, according to commissioned Activity Plan

• Sustainable recurrent transformation

• QIPP contracting terms for 2014-15including activity caps for certain schemes where provider performs both acute and community service.

• Provider performance management and joint Clinical Steering Groups.

Delivery integration • Dependency on EHT reducing acute activity, whilst delivery community service. Trust needs to work in an integrated way across providers.

• Integrated approach to contracting intentions with EHT across community and acute. Imperial performance bond will assist.

• QIPP contracting terms for 2014-15including activity caps for certain schemes where provider performs both acute and community service.

GP referrals • Encouraging GP to refer patients into QIPP community service: Managing provider (EHT) to market the service to attract referrals

• Encouraging GPs to reduce referrals, sign up to Local Enhanced Service agreements, or reduce spend with primary care arena

• Use of specialists to supplement GP resources • Use of Commissioning Incentive scheme. • Use of Network Relationship managers; Sufficient

resources to engage

Scheme design in progress

• Proposed QIPP schemes, where activity and cost reduction estimates may not be accurate.

• Business case is not completed, and implementation decision not yet made.

• Uncertainty over procurement timing

• Sufficient resources to design the schemes in detail, and in timely way

• 2015-16 ideas session to be held in June

Scheme effectiveness assumption

• Uncertainty that the scheme will have the outcome predicted.

• Reviews to investigate outcome gaps • PMO structure • Risk stratified position around delivery

Measurement: Double counting:

• Some patient care activities are the focus of more than one QIPP scheme.

• QIPP OOH dashboard report has been designed to only count a patient record once.


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