‘the right healthcare, for you, with you, near you’ wiltshire clinical commissioning group...

‘The right healthcare, for you, with you, near you’

Wiltshire Clinical Commissioning Group

Stakeholder Event


Welcome

Dr Peter JenkinsChair


Agenda• National Financial Picture• The Task for Commissioners• New Models of Care• The Local Financial Picture• The Local Solutions• Question time with the panel• Refreshments• We need your help!• Lunch


Deborah Fielding,Accountable Officer


• Biggest financial squeeze in its history• Budget ring-fenced but frozen at 2010 levels plus

1.7% growth• Social Care and Public Health funding in local

authorities squeezed• 30 billion required to keep pace with growth by

2020• £2.2 billion to come from efficiencies• 8 billion to come from treasury

National Financial Picture


How do we achieve these efficiencies without effecting

quality of care?


1. More systematic and proactive management of chronic disease - improve health outcomes, reduce inappropriate use of hospital and impact on health inequalities2. The empowerment of patients3. Better integrated models of care4. Population based approach to commissioning

Commissioners need to drive the following


1. More systematic and proactive management of chronic disease

1. Primary Care Based2. Multidisciplinary Teams wrapped around patients3. Early systematic identification4. Patient led care plans based on outcomes


2. The empowerment of patientsSupport for Self Management;• Patient and carer education programmes• Meds management advice and support• Support for diet and exercise• Use of telecare and telehealth• Psychological interventions• Telephone based health coaching• Pain management• Access to records


3. Better Integrated models of care

Five Year Forward View – New Models of Care

1. Multi-Speciality Community Provider (MCP) with population based (placed based) commissioning at its heart centred around General Practice. (Horizontal Integration)

2. Primary and acute Systems (PACS) Managed by Acute Sector includes primary care (Vertical Integration)


The Case for Outcome Based Commissioning

Funding can be linked to activity (inputs), or achievement of targets (outputs). However, it can also be linked to outcomes for individuals and groups.

The ultimate aim is to reward impact, but impact is usually the result of the work of many agencies – better quality of life may be influenced by health care, finance, education, environment etc.

Inputs/activity Outputs/targets OutcomesNumber of patients treated for hypertension

Mean blood pressure achieved

Number of strokes prevented


Multi-year capitated contractsPlace the individual centre stage with a comprehensive anticipatory care plan. Providers must have;1. The ability to coordinate the care of

individuals along pathways and across settings

2. The ability for population health management (can incentivize primary prevention)


The Financial Outlook for the Wiltshire Health Economy

Simon TrueloveChief Finance Officer


• Wiltshire CCG receives £540m for commissioning healthcare services for the population of Wiltshire.

• Does not include core contract for primary care, public health, specialist services and army personnel health.

How much funding does WCCG receive


• Set to overspend by £2.4m or 0.5% of its funding.

• We have to produce a Financial Recovery Plan (FRP) to improve the CCG’s position by

£4.8m

The CCG’s Financial Position for 15/16


What does the health system look like

SFT £6m deficitGWH £14m deficitRUH £1m deficitAWP breakeven


How much money will we get in 2016/17

We are assuming a 1.7% growth on the 15/16 Baseline

£9.7m


Impact of Growth £11.7m

Impact of Inflation and National Insurance

increases £18.7m

What could our expenditure look like if we do not change


Income stopping, known cost

pressures – (£6.8m)

Re-create mandated 1.5%

uncommitted reserves (£8.3m)

What could our expenditure look like if we do not change


Efficiency will be set at 4%

£17.7m

What Efficiency will we require from our Providers


£m

Total Funding to Wiltshire CCG 2016-17 (560)

Existing Expenditure & Reserves 568Anticipated Growth for 2016/17 12Inflation and National Insurance increases 18Provider Efficiency (17)Total Expected Expenditure and Reserves 583

Recurrent Savings to be Found 23

What does this add up to for 2016/17


This is before Provider Overspends

• Providers will have to deal with

£18m of efficiency savings• Deal with Underlying deficits• Manage new costs in 2016/17


What is the Financial Gap

• The financial gap across the whole of the health economy

could be in excess of £40m.– CCG Savings Requirement £23m– Provider Efficiency Requirement £18m– Historical Provider Deficits £???


What are we going to do?• We cannot afford the levels of health

intervention that we currently provide – we need a local debate on what should we stop / reduce

• We have to ensure the sustainability of the 3 acute hospitals through better efficiency and reducing the number of patients entering the acute system

• We can only do this by working together across the health system


Debbie FieldingAccountable Officer


The Local Solution

Out of Hospital Care

Emergency Dept.

Admitted care/discharge

Wiltshire CCG

Co-commissione

rs

GP community

Providers

Our 2016/17 plan needs to address underlying system pressures. Our strategy has already set the direction of travel for the system

System pressures can only be resolved through agreed integrated action across the whole care system

Our plan will need to demonstrate financial balance and progress in implementing our strategy, which can be achieved through commissioning less acute activity and shifting care into out of hospital settings


Our four key themes for 2016/17

Managing down demand in both

elective and emergency care

Restricting growth and investment

Changes to funding arrangements

Internal cost reduction within the CCG and its

support services

Our 2016/17 planning will be grouped around four key themes

We have formulated a structured programme to work with partners across the health system to:

• Develop plans that are aligned and with agreed outcomes

• Get buy in at an operational level

• Create joint delivery teams so we can actively support and contribute to implementation of more complex change projects

The plans to manage down demand and restrict growth/investment will require difficult decisions and not be straightforward to agree with our system partners

We will also need to make the right use of contractual levers to facilitate action acroiss the health system

These themes will be managed at CCG level and are likely to require a lower level of external engagement. They will release a much lower level of cashable savings than the other two themes identified

These will be the two key themes around which we will engage with Co-commissioners, our GP members and Providers. They should also release the greatest level of cashable savings to help us achieve our financial plans


• Estates - exploit opportunities emerging from the One Wiltshire devolution proposal

• Workforce - progress with integrated workforce planning and improved leverage in Local Education Training Board (LETB)

• Acute Care – managing acute care bed capacity for the system• Out of Hospital Care – a new provider of integrated community

services to form the platform for further integration• Seven Day Working - continued support with developments such as

Urgent Care Centres – particularly in Devizes• Prevention and Early Diagnosis - develop closer working

relationships with Wiltshire Council and the One Wiltshire devolution agenda

Supporting our future


Please wait for the microphone

before asking your question


Refreshment Break15 minutes


We need your help!


Table top sessionRed Table – PrescribingYellow Table – Sharing People’s InformationLight Blue Table – Winter PlanningOrange Table – Commissioning for ValueGreen Table – Crisis Management in Community Settings Dark Blue Table – Prevention/Self-Responsibility


Feedback from tables


Thank you for coming

‘the right healthcare, for you, with you, near you’ wiltshire clinical commissioning group...

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