Welcome to ourAnnual General Meeting

WelcomePhilip LewerChair

Housekeeping

• Fire Procedure

• Mobile Phones

• Toilets

• Photographer, videographer and animator

• Wi-Fi

Welcome to our AGM

Huge thank you for joining us…

• Opportunity to meet our providers - Quiz

• Today’s agenda:

• Overview of achievements and progress in 2013/14

• The CCG’s finances in 2014/15

• Looking ahead – plans for the future (responding to you)

• GP members

• Mini AGM for children and young people - dragon’s den’ style

• Open question and answer session

Introductions

Dr Andy Harris, Clinical Chief Officer

Mark Bradley, Chief Finance Officer

Matt Ward, Chief Operating Officer

Dr Alistair Walling, GP Executive Director

Dr Andy Harris Clinical Chief Officer

Review of the year 2014-2015

Our Organisation

NHS Leeds South and East Clinical Commissioning Group (CCG) was created in April 2013 and is a membership organisation made up of all the 43 GP surgeries in South and East Leeds.

Our job is to understand what the local people who live in the area need from health services and to plan, monitor and pay for them.

There are three CCG’s in Leeds. Each of the three CCG’s lead on different services and we manage the following:

• Children and maternity services• Community health services• Continuing health care services (children and adults)• Safeguarding (children and adults)• Joint commissioning with social care services (Better Care Fund and the Transformation Programme – also known locally as “Inspiring Change.”)

Our Organisation

Leeds South and East

Annual Report 2014/15

• Annual Report 2014/15 gives balanced and fair view of progress

and performance, including:

• Progress against strategic aims

• Working with others

• Being a good employer

• Achievements within challenging financial environment

• Assured by NHS England

Strategic Aims

The Landscape

• Leeds city wide Joint Health and Wellbeing Strategy

• City Wide Five Year Strategy for Health

• Our Two Year Operational Plan -Local commissioning AND city wide:

• Children’s and Maternity Services

• Community health services

• Continuing Healthcare

• Safeguarding

• Joint commissioning with social care (including Better Care

Fund)

Highlights of the past year

Potential Years of Life Lost (PYLL) from causes considered amenable to healthcare

- Meeting our goal to reduce mortality (death) rates in South and East Leeds. - Latest data revealed an 8.5% reduction in deaths from

conditions which can be improved by health care. - Promoting the benefits of lung and bowel cancer screening- Enhanced alcohol support service and smoking cessation clinics.

Reduction in Acute Admissions/Non elective admissions- To be provided by Thu AM

Highlights of the past year

Maternity Services Review- A new strategy for maternity services - Focus on how best to support women’s emotional and

mental health and providing personalised care.

Children’s and Young People’s Emotional Health- Review of emotional health services - 11 recommendations -to transform services and

improve access and experience - Including joining up support between schools and

health providers, having a single point of referral into services and providing online support for young people.

End of Life Care

- Review of end of life care with new strategy to ensure that everyone has a dignified end of life experience that closely meets their needs.

Highlights of the past year

Seven Day Services- Community services seven days a week - Expanding key community services to cover seven days in order that patients do not

have to stay in hospital when they could be cared for at home or in the community. The services include:

• The Early Discharge Assessment Team• Community Discharge Facilitation Team• End of Life Care Home Facilitator• Community Bed Management Team• Leeds Community Equipment Service.

House of Care - self management- Supporting people to manage their own health effectively,

especially when they have long term conditions- Relieve pressure on the NHS and support wellbeing. - Patients have a full care plan, managed by a small number of

clinicians so to ensure their care is seamless and meets needs

As well as planning and funding local services in South and East Leeds, we have a key role to play in monitoring the National NHS standards and ensuring they are met in our area. Standards for patients have improved during the year in a number of areas as a result of our work and that of other NHS organisations.

These areas are:

• Waiting times for outpatient appointments in gastroenterology• Waiting times for diagnostic tests• Waiting times for urgent appointments for patients referred with breast symptoms• Waiting times for A&E

NHS Standards

Annual Governance Statement

Governance statement – stewardship of the organisation

The system of internal control has been developing and strengthening throughout our first year.

The Head of Internal Audit Opinion states the CCG can take "significant assurance“ from its system of internal control.

Sets out continuous improvement with development of new approach to governance with creation of Quality Committee; Finance, Activity & Performance; and Audit and Governance Committees from April 2014.

External audit reviewed and confirmed Governance Statement reflects the CCGs operations and risk management arrangements.

Annual Accounts 2014/15Mark Bradley Chief Finance Officer

Key Financial Indicators & Financial Duties

Indicator / Duty Performance

CCG AllocationThe CCG achieved a surplus of £10,869k, £83k greater than the planned level of £10,786

Cash LimitThe CCG operated within its maximum cash drawdown allowance

Better payment Practice Code The CCG Achieved this target

The CCG received two allocations, one of £353.2m for the purchase of healthcare and £6.2m for Running Costs in South & East Leeds.

£7m of Historic surplus from the PCT effectively rolls forward each year - no CCG was allowed to use these in 14/15 without permission from NHS England

The CCG proactively increased its surplus by £3.9m (Inc. CHC Risk Pool) in 14/15 with the intention of drawing this down in 15/16.

CCG has received £3.5m non recurrent funds in 15/16 to invest in dual running and efficiency programmes

How did we spend our money?

Annual Accounts 2014/15

KPMG act as the External Auditors of the CCG.

They concluded:

• Unqualified opinion of the CCGs 2014/15 financial statements• No matters arising from Use of Resources review meaning CCG has

adequate arrangements in place to secure economy, efficiency and effectiveness in its Use of Resources

• Unqualified Group Audit Assurance Certificate to the National Audit Office regarding Whole of Government Accounting with no exceptions

• Accounting policies, estimates and financial statements been used and prepared in line with Department of Health Manual for Accounts

• KPMG commented on the high quality working papers provided by the finance team which enabled the audit to progress smoothly

Wider Financial Performance

• Foundation Trusts ended the year with a net deficit of £349m, £339m worse than plan

• NHS Trusts ended the year with a net deficit of £485m, £77m worse than plan

• FTs have told Monitor that 2015/16 is likely to be even tougher financially

Strategic Financial Context

• Financial Challenge is significant across the Health Sector

• Impact of further reduction in Local Authority cuts will have an impact on health

• Wider pressures on providers will have an impact on commissioners

Strategic Outlook

• CCG has £3.5m additional non recurrent funds in year due to its financial stewardship

• Forecasting to deliver our financial targets in 15/16 and provide additional funds targeting our strategic aims around prevention whilst supporting additional funds for winter resilience

• Strategically the focus is on developing New Models of Care

Local Commissioning Plans - Film

The CCG Two-Year Operational Plan 2015/16Matt Ward Chief Operating Officer

Our Plans for 2015/16

• We want to make sure that people in our area are able to live long and healthy lives, both now and in the future, and our plans set out how we will do that

• Our Plan has been developed with help from…

Partners in health & social

care

Patients

Members of the public

Public Health Leeds

NHS Five Year

Forward View

Our 43 GP

member practices

NHS Planning Guidance

Our staff

Our Plan on a Page

How we will spend the money

• Total budget of £370m

“To improve the health of the whole population and reduce inequalities in our communities”

• Social Prescribing – the service will assess and link people with social, emotional or practical needs to a range of non-clinical

• Leeds Forward - enhanced alcohol treatment sessions in the community,

• Smoking cessation –piloting new services whilst also promoting current quit schemes that support people to stop smoking

• Promote the NHS Health-check – encouraging people between 40 – 74 take their free NHS Health-check test

• Third Sector Grant Scheme – working with Leeds Community Foundation, the purpose of the scheme is to support the development of projects led by local community and voluntary sector groups

Health improvement through local commissioning

Achieving a balance between good physical and mental health

• Increasing Access to Psychological Therapies (IAPT) – in 2015/16 we will be part of a citywide review on how our community mental health services are provided in Leeds from next year

• Dementia care in Leeds – from October 2015, there will be four Memory Support Workers in South and East Leeds, working with our Neighborhood Teams and GP practices in supporting newly diagnosed patients

Quality and Innovation

• Leeds Institute for Quality Healthcare – sharing ideas to find better ways to deliver care and reduce variations in outcomes for patients

• Medicines Optimisation – our Pharmacist medicines review service will review patients medicines across a range of clinical areas and needs

Providing care closer to home

• With an ageing population, living with multiple long-term conditions, care closer to home will support people to stay healthy and live independently for longer

• In 2015/16, one of the ways we will be providing care closer to home is through the House of Care Model - putting patients with long term conditions at the centre of their care

Developing services for children and young people• Five Year Maternity Strategy – launched on 30 June 2015, the

strategy was developed based on the experiences of services in Leeds of women and their families

Priorities for 2015/16 include:• Personalisation• Perinatal mental health support • Support for women with learning disabilities

• Best Start Zone in South and East Leeds –support to families, linking them to local services that will ensure every child in South and East Leeds has the best start in life

Building sustainable Urgent and Emergency care in Leeds

We need to ensure that urgent and emergency care services are well prepared to be able to cope with an increase in demand during peak times of the year

• Planning for winter – extra appointments, marketing campaigns keeping people well and out of a&e

• First Aid Training for Parents – to support parents to increase confidence in caring for, and making the right decisions, for their children

Member EngagementDr Alistair WallingAssociate Director of Primary CareGP – Ashfield Medical Centre

Our Members

The CCG is a member organisation. GPs are a fundamental part of commissioning!

Why is it important that we are involved?

As GPs, we have a unique insight into the needs of our patients

As GPs, we often have a career long relationship with our community

• Our patients

• Our workload

• Our future

How do we get involved?

Engaging Our Members

New Ideas

Clinical Lead surgeries

Video blogs

Animation

‘ScribbleLive’ comment

forumFace to face

Bi-weekly members e-bulletin and

email

Extranet

Our Primary Care Schemes -14/15

• 14/15 Practice Engagement Scheme • Utilising structured and nationally recognised

approaches to management of patients with one long term condition

• Peer review to share best practice around cancer care

• Integrated working with neighbourhood team • Winter Scheme - balancing unplanned admissions with

increased capacity in Primary Care• Bowel Screening - Primary Care Influence with non-

participants• Enhanced Care Homes Provision – extended to meet

the needs of those in care home with Nursing Provision

Member input - Enabling Long Term Condition Management

• 42 Practices signed up to implement House of Care

• 24 (58%) practices implemented in advance of start date of 1st April 2015

• Key LTCs are Diabetes and COPD

Member input – Enabling Incident Reporting

Pressure Faced by Primary Care in LSE

3784 Monthy variation (95%)

Annualized Diff. to Trend

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• Over the past four years the number of completed appointments offered LSE practices has increased by 6.3% year-on-year

• This represents a 5.1% per year increase about demographic growth• The proportion of consultations led by GPs has remained relatively constant

at around 50% of all consultations

Member input - Enabling Understanding of Primary Care Workforce in LSE

41% of LSE GPs are 45-55 years

of age

67% of Practice Managers are 45-

55 years of age

56% of Practice Nurses are 45-55

years of age

Supporting Primary Care Development to secure a stable Resilient Primary Care For Our Population

•Establishment of South & East Leeds General Practice Group

• Comprising 27 Leeds South and East Practices

• Covering Population Footprint of 215,767

New Models of Working Team in LSE CCG

Working with:

• Establishment of support Practices to achieve statutory safe and effective practice and clinical environments

• Infrastructure/Capital Grant Bids

Supporting Primary Care Development to secure a stable Resilient Primary Care For Our Population

Practice Nursing Professional

Development and Nurse Leadership

Programme

Scope of Co-Commissioning

April 2015 To be Determined

Level 1 Greater CCG

involvement in NHS England decision-

making

CCGs and AT collaboration.

No new governance arrangements required.

No formal approval process.

Level 2Joint decision-making by NHS England and

CCGs

Joint responsibilities with AT

New Governance- legislative reform order to develop joint committees- needs CCG constitution change

Level 3CCGs taking on delegated responsibilities from NHS

England

CCGs assume full responsibility for primary care commissioning

Liability remains with NHSE

CCGs assurance to manage conflicts of interest

Primary Care Quality Improvement Scheme

Quality Pre Requisites:

Level 1: Continuation of 14/15

Level 2:

Level 3: Collaboration between practices

Systematic approach

COPD

House of Care

Cancer Peer

Review

Integration with NTs

Care Homes

House of Care for minimum of 3 LTCs

Systematic approach to minimum of 3 LTCs

Member and Nurse meetings

Currently Under RedevelopmentUsing Principles of

Collaborative Working and Innovation for Local Need

All aspects of level one

Datix Workforce tool/

Leeds Care Record

Yellow cardEPACCS

Leeds South and East CCG

Children’s and Young People’s AGM - The feedback

Q&A Session