stroud & berkeley vale locality development plan …€¦ · care act 2012, replacing...

Stroud & Berkeley Vale Locality Development Plan of 16

STROUD & BERKELEY VALE LOCALITY DEVELOPMENT PLAN

2013-15

1 PURPOSE

1.1 This Locality Development Plan has been produced to describe the specific health needs for the population of Stroud & Berkeley Vale, and sets out how the Locality Executive Group will lead work to address these needs over the next two years.

2 BACKGROUND

2.1 Gloucestershire Clinical Commissioning Group (CCG) was formally constituted in April 2013 as a requirement of the Health and Social Care Act 2012, replacing Gloucestershire Primary Care Trust (PCT) as the organisation responsible for the local NHS. A central aim of creating the CCG is to ensure a clinical focus on the commissioning of healthcare services for the county’s population.

2.2 The county of Gloucestershire covers a diverse range of populations,

from the very deprived to the very affluent, from people living in very rural areas to people living in one of two large urban areas where there are a significant number of immigrant populations. This leads to a countywide population with very different health and social care needs, spread over a large geographic area. In recognition of the need to understand and represent these differences, the CCG has formed seven Localities; one of these is for the Stroud & Berkeley Vale area. In each Locality lead GPs work alongside key partners to help determine how best to meet the needs of its population, informing the wider work of the CCG; this is known as the Locality Executive Group.

2.3 Two major strategies have recently been produced by the CCG (and its

predecessor PCT), working with Gloucestershire County Council. The first is the Health and Wellbeing Strategy (‘Fit for the Future’), which sets out the priorities for improving health and outcomes of the population of Gloucestershire over the next twenty years, focusing on supporting preventative measures and self-care. The priorities within this Strategy during 2013/14 are:


Reducing obesity;

Reducing the harm caused by alcohol;

Improving mental health;

Improving health and wellbeing into older age;

Tackling health inequalities. 2.4 The second major strategy, as the NHS response to the Health and

Wellbeing Strategy, is ‘Your Health, Your Care’, which sets out the vision for health and social care services and community support in Gloucestershire for the next five years.

2.5 This Locality Development Plan must be seen in the context of these

two important strategy documents – we do not intend to replicate them. The CCG has also produced an Annual Operating Plan for 2013/14, which sets out its work programme for the coming year. This Locality Development Plan therefore fits within this wider context as follows:

Delivery of the actions contained within these plans will be measured in a number of ways, including against the NHS Outcomes Framework.

2.6 Producing this Locality Development Plan - To identify the health

needs of the population of Stroud & Berkeley Vale the Locality Executive Group has identified three main sources of information:

Public Health Intelligence (through the Joint Strategic Needs Assessment);

Activity and financial data on the use of services, highlighting those areas where the Locality is significantly over or below ‘expected’ levels;

‘On the ground’ intelligence – i.e. conversations with local colleagues who are working directly with patients to understand their views about need.

Health and Wellbeing Strategy

Your Health Your Care

CCG Annual Operating Plan

Locality Development

Plans


2.7 The Locality Executive Group has worked closely with key stakeholders to ensure they have the opportunity to fully contribute to identifying the health and social care needs of the local population, prioritising actions, and providing ideas for how these needs could be addressed, including:

Local GP Practices and their staff;

Gloucestershire Care Services;

Gloucestershire Hospitals NHS Foundation Trust;

Gloucestershire County Council and Stroud District Council;

Local voluntary organisations;

Local MPs/councilors;

Patients and their representatives.

In future, the Locality Executive Group will seek to work with others, including library services, Turning Point, Food Bank, financial advice agencies, churches/faith groups, and schools/colleges.

3 KEY ACHIEVEMENTS TO DATE 3.1 Whilst the CCG was only formally constituted recently, the Localities

have been working in shadow form for much of 2012/13. Key achievements of the Stroud & Berkeley Vale Locality during this time are as follows:

Participation in the Living Well Programme;

Commissioning of factsforlife (education of primary school children), iVitae (community development work), Kitchen Challenge (cooking with vulnerable adults), Art Therapy at St Luke’s GP Practice, and new equipment trials with GP Practices;

Practice Manager Time Management training;

The Locality Executive Group visited each Practice, including discussions on prescribing, referrals and general updates;

Worked hard to engage beyond health service colleagues, for example with patients, voluntary organisations and the public health team. Also, starting to work together with the Stroud and Berkeley Vale Health and Wellbeing Partnership through quarterly meetings and joint planning around health and wellbeing priorities.

4 LOCAL SERVICE PROVISION 4.1 The Stroud & Berkeley Vale Locality is comprised of Stonehouse,

Nailsworth, Frampton-on-Severn, Wotton-under-Edge, Painswick, Dursley, Stroud, Berkeley, Minchinhampton and Cam – the total area covers around 113,000 people. There are 20 GP Practices in the Locality.


4.2 In addition to the main acute hospitals in Gloucester and Cheltenham and the GP Practice sites, local NHS health services are also delivered from:

Stroud General Hospital;

The Vale Community Hospital;

Hospitals in Bristol, including Emersons Green Treatment Centre, particularly those people living on the South Gloucestershire border in Wotton-Under-Edge;

Weavers Croft Mental Health Unit.

We recognise too the growing number of residents in local Care Homes and the need to meet their increasingly complex needs.

5 WHAT ARE THE ISSUES WE FACE? 5.1 The NHS and Local Authority in Gloucestershire produce a Joint

Strategic Needs Assessment (JSNA) – this brings together the latest information on the health and wellbeing of people in the county, and its localities, including factors which influence health and wellbeing such as income, employment, environment and housing. The JSNA also highlights population changes over the coming 20 years. 5.1.1 The most significant issue facing the population of Stroud and

Berkeley Vale is shown in the graph below (the population projection from 2010 to 2035), which highlights a considerable % increase in the proportion of people aged 65 and over. However, there is expected to be a reduction in the number of infants and those aged 5 to 19.


5.1.2 As well as showing the geographical area covered by the Locality, the map below shows the levels of deprivation. There are clear pockets of deprivation in Cam West, Stonehouse, Dursley, Slade (Stroud), Central (Stroud), Caincross and

Minchinhampton.

5.1.3 Overall the health population of the Locality varies most significantly from the Gloucestershire/national picture as follows:

• Health & life expectancy of people in the Locality is generally

better than Gloucestershire and England averages; • Over the last 10 years, all cause death rates have fallen.

Early deaths from cancer, heart disease and stroke have fallen and are better than Gloucestershire and England averages;

• Life expectancy is 5.1 years lower for men in the most deprived areas of the Locality than in the least deprived areas.

5.1.4 The JSNA highlights the following issues to be addressed for the

Stroud and Berkeley Vale Locality:

• CHD mortality; • Cancer incidence (including breast) • A&E admissions (overall and for intentional self-harm,

fractured neck of femur, diabetes, cancer, asthma); • Early identification: NHS Health Checks, diabetes and

dementia registers; • Obesity – variation in obesity levels across the Locality and

high levels of overweight (but not obese) children.


5.2 In addition to the JSNA intelligence, the CCG information team has reviewed activity and finance data from commissioned services to assess where there are significant variances from expected levels; this has highlighted areas for further consideration.

5.3 As well as the information provided through the JSNA and CCG activity

data, we want to strengthen this with understanding the views of people working alongside our patients in the community/’on the ground’, so we have also worked with our local colleagues (see section 2.7 above) to better understand the needs of our population, and priorities for improvement.

5.4 Nationally, the government is seeking to ensure services offered by the

NHS and Local Authorities are as ‘joined-up’ as possible, and so will be investing heavily in integrated health and social care over the coming five years. We have already worked closely in Stroud and Berkeley Vale with our colleagues at Stroud District Council, and will work to strength this relationship further. The Stroud District Council’s priorities are as follows:

Adopt the Gloucestershire Health and Well Being Strategy by June 2013;

Support and expand the ‘Living Well’ programme;

Expand social prescribing initiatives, including those focused on people with learning disabilities (e.g. Future Clean project) and people with mental health needs (e.g. the partnership between JobCentrePlus, Public Health, Wiggly Worm Ltd and the Council);

Expand existing health initiatives – GP leisure prescriptions and Healthy Homes loans scheme;

Deliver health related packages in support of Families First programme;

Deliver £65m social housing investment programme over 5 years, focused on fuel poverty measures, improved housing conditions (decent homes) and provision of new homes;

Deliver ‘jobs and growth’ agenda to provide more employment and investment in the District - positive impact on lifestyle options;

Environmental health interventions that protect the community from public health hazards;

Healthy Eating and Health Workplace Award for local businesses. 5.5 Critically, we face an unprecedented financial challenge over the

coming years, at the same time as increased demand for our services, within the context of a fast-ageing population. At present around 17 % of the population are aged 65 and over; this is expected to grow to 30% over the next 20 years. We will therefore need to provide services that are simple to access, integrated and cost-effective.

5.6 This Plan therefore incorporates all the intelligence we have gathered

into a comprehensive statement of local health needs/issues, shown below in section 7.


6 THE FINANCIAL PICTURE 6.1 In 2013/14, the scope of CCG commissioning budgets has changed

from the former PCT scope of budgets in 2012/13. Former PCT resources, particularly Specialised Services Commissioning, have transferred to new Commissioning Organisations in the NHS organisational structure (CCG’s, NHS England and Local Authorities). The scope of GP Practice and Locality budgets devolved in 2012/13 was Acute commissioning, Community Services and Practice Prescribing.

6.2 The 2012/13 Stroud and Berkeley Vale Locality allocated share of

the Gloucestershire PCT budgets, devolved to Localities, was 18.77%. Stroud and Berkeley Vale’s spend on services for the year was 18.80% of this Budget. This amounted to an overspend of £220k.

6.3 For the financial year 2013/14, the Locality has an 18.81% share of

resources based on the national fair shares toolkit. Gloucestershire CCG budgets are devolved to the Locality using this share of resources. The final budget figure is not available at the time of writing.


7 LOCAL HEALTH NEEDS

NEED/ISSUE SOURCE ACTION LEVEL*

IDEAS/OPTIONS ** WORK ALREADY UNDERWAY?

Emergency Admissions – Overall

High numbers of emergency admissions in a few GP Practices; and

Significant variations in expenditure between GP Practices on emergency admissions

Public Health/ JSNA and CCG Information

LOCALITY Practice Information Support Officers to introduce ‘risk register’ for review at Practice meetings

Personalised Management Plans for ‘at risk’ patients, and Advanced Care Planning

Ensure Adastra special notes regularly updated

Implementation of Risk Stratification

Support further improvement of Integrated Community Teams

Discussion through Quality Premium meetings

Use of Protected Learning Time GP education sessions

Older People/Dementia Rising numbers of emergency admissions of older people, including those with dementia

CCG Information and Local Intelligence

CCG Use of Living Well Programme

Work with Care Homes and their residents

Ensure earlier diagnosis and provision of support services

Improve support to carers

Improve take-up of Medicines Use Reviews for older people

Key workers/care coordinators for vulnerable older people

Greater use of befriending and night-sitting services

GP involvement in hospital discharge planning

Dementia Friendly Communities work

Carers projects

Dementia Local Enhanced Service

‘At risk’ register, systematically reviewed


Smoking High prevalence of smoking in adults in some areas, including pregnant women

Public Health/ JSNA

CCG Gloucestershire Stop Smoking Service to strengthen links with Midwifery Services to support pregnant smokers to quit

Build on recommendations from the Smoking in Pregnancy Social Marketing Project

Better understand why specific target groups tend not to use preventative services locally

Targeted effort and support to deprived populations

Explore earlier engagement in ‘Stop before the op’

Gloucestershire Stop Smoking Service prioritises supporting pregnant smokers, people with mental health issues and people from areas/groups experiencing deprivation

GP Practices, pharmacies and dental practices offer support to quit through Local Enhanced Services arrangements

Obesity High levels of child obesity in some neighbourhoods, particularly deprived areas. This is a key preventable risk factor for principle causes of ill-health and disability (CVD, cancer, respiratory disease, depression, dementia)

Local (and national) intelligence

CCG Develop best practice guidance for Practices, possibly enhanced with related training in brief interventions and signposting (e.g. ‘Making Every Contact Count’)

Health improvement interventions in schools

Allotments in areas of high deprivation

Promotion of physical activity on referral and weight management support

At school initiatives, e.g. ‘walk to school’ scheme

Green gym

Review existing services for which uptake or outcomes are poor and consider new approaches

Weight management on referral – to be offered across the Locality as part of the Quality Premium

‘Gloucestershire Healthy Living and Learning’ requires participating schools to deliver healthy weight interventions

Physical activity on referral scheme and Health Walks delivered across Locality

Locality-led weight management innovation (e.g. ‘Take-away’, ‘iVitae’, ‘On Target’ – to be piloted in 2013/14)

Specialised weight management service for


morbidly obese adults with co-morbidity

Mental Health Poor access to Child and Young People Emotional Wellbeing Service (i.e. acceptance of patients into the Service)

Local Intelligence

CCG Children’s ‘Improving Access to Psychological Therapies’ pilot to be expanded to ensure access for all Practices

Support delivery of the CYPEWS Plan

Plan already in place to improve access times to CYPEWS

Self Harm High level of emergency admissions due to self-harm, mainly in young women

Public Health/ JSNA

LOCALITY Map out all local support services for those at risk and already self-harming, and share with referrers/other professionals

Monitor the expansion of ‘Lets Talk’ and ensure optimum utilisation

Work closely with local A&E departments and their psychiatric liaison teams to support frequent pro-active case management of frequent attenders

Review of current self-harm services to ensure compliance with NICE guidance

Self Harm Helpline

Work underway to understand self harm admissions

Suicide High rates of suicide

Public Health/ JSNA

LOCALITY Learn from local and national suicide audits and action plans and consider training, Protected Learning Time for GPs and local action plans

Request review of mental health crisis services and lower level support services

Review actions from the Gloucestershire Suicide Prevention Strategy

Engage with Practices

Pro-active work with National Car Parks (RE: Stroud multi-storey car park)

Pro-active work with Network Rail

Gloucestershire suicide audit underway


Coronary Heart Disease High premature mortality – CHD (in outlying areas)

Public Health/ JSNA

CCG AND LOCALITY

Promotion of healthy lifestyles – smoking, physical inactivity, poor diet, excess alcohol all contribute to premature mortality for CHD

Focus work on communities with high incidence/prevalence

Work with local statutory and community groups to share messages and data, and develop joined-up support, through the Stroud Health and Wellbeing partnership

Gloucestershire Stop Smoking Service

NHS Health Checks delivered in all but one Practice across the Locality

Health improvement programmes at Locality level, in liaison with District Council and other partners

Weight management and physical activity support (as above)

Respiratory Need to ensure good support is provided for people with COPD and young asthmatics

Local Intelligence

CCG AND LOCALITY

Develop best practice guidance for Practices, possibly enhanced with related training

Use of preventative services, including smoking cessation and exercise on referral/healthy lifestyles services

Part of Quality Premium

Trauma and Orthopaedics

Relatively high expenditure on Trauma and Orthopaedics, particularly in several Practices; and

Relatively high numbers of emergency admissions for fractured Neck of Femur

Public Health/ JSNA and CCG Information

LOCALITY Ensure best use is being made of alternatives to referring into consultant-led services, e.g. interface services, therapy services

Falls and Bone Health Services, including:

Falls Pathway (Map of Medicine)

GCS Bone Health Service

GHNHSFT Falls Clinical Specialist Service

Community Exercise Pathway

Sexual Health Lack of local access to sexual health services

Local Intelligence

LOCALITY Liaise with Public Health Commissioning Lead to understand if sufficient demand to create local access

Variety of Sexual Health services available in the Locality


NHS Health Checks Need to improve take-up of NHS Health Checks in deprived areas, targeting people at risk

Public Health/ JSNA

LOCALITY Work with local voluntary and community groups to promote

Work with Public Health Commissioning Lead to understand reasons why some Practices have been successful and roll-out these methods

NHS Health Check scheme, including outreach to communities

Tackling Isolation and Loneliness Need to contribute to addressing inequalities in partnership with Stroud District Council, including tackling isolation and loneliness

Public Health/ JSNA

LOCALITY Good ideas local and nationally we can use

Use of Living Well Programme

Practices can signpost to befriending schemes and community support

Stroud & District Health and Wellbeing Partnership – addressing inequalities funding

Village agents

GCS Older People’s health improvement delivery initiatives

Carers Relatively high numbers of carers, according to census data

Local Intelligence

CCG Priority is to identify carers, then undertake a needs assessment so that they can then be signposted to resources and support

Work to encourage carers to use available advice and information and emotional wellbeing support services

Carers Strategy under development;

?a GP Direct Enhanced Service;

Work by Carers Gloucestershire

Care in the Community Need to make better use of local community services and hospitals/outpatients (including the Vale), for example for leg ulcers and continence

Local Intelligence

LOCALITY Undertake review of local service provision/patient pathways for those suffering with leg ulcers and continence issues

Living Well Further development of the Living Well Programme – consider focus on deprived areas

Local Intelligence

CCG Take the principles and learning and share with Practices’ and the new Integrated Community Teams

Some work on this through Police and Crime Plan


Transport Transport for patients and their visitors to hospitals: both public transport and NHS-funded transport

Local Intelligence

CCG Supporting implementation of the new Patient Transport Service

Ensure referrers have access to all information about local voluntary car schemes

Encourage development of local voluntary car schemes


7.1 * We will not be working alone in addressing the needs of our population. As can be seen in the YHYC strategy, there are many actions that are already underway and are planned at a countywide level by the CCG that will help. The identified needs and issues will be addressed at a number of levels, and the amount of input required of the Locality Executive Group will vary accordingly:

LEVEL LOCALITY INPUT

CCG/Countywide

Provide lead person(s), where relevant

Locality

Lead the identified workstream

A group of two or more Practices

Support as required

Individual Practice

Support as required

7.2 ** At the time of writing, these are the list of ideas/options generated by

local clinicians and managers for how the need/issue could be addressed. It is vital to note though that not decisions have yet been made, they are not exhaustive and further work is now required to agree a long list of options, assess them and determine the preferred commissioning intentions.

7.3 Crucially, for patients living in any part of Gloucestershire their health

issues are often closely linked to other ‘social’ factors, such as employment, education, and housing. Therefore, we are committed to working in partnership with the Local Authority and third sector partners to both find and implement solutions. The Stroud Health and Wellbeing Partnership provides a focus for planning and implementation and a ‘Health Inequalities’ grant enables local organisations to innovate and implement health improvement interventions in areas of unmet need.

8 LOCALITY WORK PROGRAMME FOR 2013/14 8.1 We have set out a range of local health needs/issues in section 7 above.

With our CCG, GP Practice and other colleagues, we will work hard to address these. Recognising though that we need to prioritise our work as a Locality, we have summarised what we aim to achieve in 2013/14 in the programme below:


PRIORITY ACTION AREA

PROPOSED SCHEME LEAD LEG GP

LEAD MANAGER (CCG OR OTHER AGENCY)

EXPECTED OUTCOMES/IMPACT

SUPPORT/LINKS REQUIRED TO DEVELOP SCHEME

EXPECTED COMPLETION DATE

ALL AREAS Locality Guide/Directory of Services for Referrers, through CCG Live … all services, i.e. including voluntary groups

Increase likelihood that patients will be referred to the right service, first time around

MANY AREAS Health improvement interventions in schools

Preventing obesity and therefore related issues, such as diabetes and heart disease

TO BE COMPLETED AT NEXT LOCALITY EXECUTIVE GROUP MEETING ON 14 AUGUST


9 NEXT STEPS 9.1 Once this Plan has been approved by the CCG Governing Body, the

following will occur:

a) Through a comprehensive option appraisal process, determine how best to address each area of need included within the 2013/14 work programme, then work to formulate a detailed plan for how they will be delivered, including management resources required – ACTION BY LOCALITY EXECUTIVE GROUP WITH CCG COLLEAGUES

b) Develop common format finance and information briefings to support the implementation of this Plan and the Locality Work Programme – ACTION BY CCG FINANCE AND INFORMATION TEAMS

c) Agree a process for how progress on delivery of the work programmes (for all seven Localities) will be monitored and assured – ACTION BY CCG PROGRAMME MANAGEMENT OFFICE

d) Ensure this plan is reviewed at regular points and refined as

appropriate, at least every 12 months – ACTION BY LOCALITY EXECUTIVE GROUP

Jonathan Jeanes Project Manager, GCCG

On behalf of Stroud & Berkeley Vale Locality 22 July 2013

stroud & berkeley vale locality development plan …€¦ · care act 2012, replacing...

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