Agenda Heading / Standing Items – for information
Enclosure / R 141/11
Date of Meeting / 27th October 2011
Title of report / QIPP Update
Recommendation / The BCCC members are asked to NOTE the contents of this report and support the delivery of the QIPP agenda within Bexley.
Executive summary
This report provides an update on QIPP within the Care Trust showing the 11/12 schemes, 12/13 schemes and headline schemes across South East London. The current position regarding delivery and ongoing monitoring is also included within this report. Attached at the end of this report are the slides from South East London QIPP presentation showing the Commissioning Plan for 2012/13 to 2014/15 for information.
Key points to note are as follows:
1. The start point for QIPP schemes was audited by Cluster and Price Waterhouse Coopers (PWC) and in most cases risk rated low.
2. It has become apparent that insufficient activity has been decommissioned during contract negotiations. Dartford and South London Healthcare Trust (SLHT) contracts are still unsigned.
3. Monitoring of only four of the QIPP schemes are the responsibility of the BSU. The rest relate to acute schemes and will be monitored by cluster.
4. It has been agreed with cluster that the planned QIPP will not be changed any further.
5. The initial £4.6m QIPP Gap has now been closed at the end of month 6. The Q1 stocktake meeting agreed to improve the RAG rating to amber, which should be green at the next stocktake meeting.
6. There is a forecast adverse variance of £1,078k against planned QIPP of £10,203k for 2011/12.
7. New schemes and potential 12/13 Schemes are currently being worked up as part of planning and the Commissioning Strategy Plan.
Organisational implications
Financial / There is a risk that Bexley Care Trust will not meet the 2011/12 control total or breakeven if QIPP is not achieved.
Equality and Diversity / This is considered in all QIPP schemes.
Risk (governance and/or clinical) / N/A
Patient impact / This is considered in all QIPP schemes.
NHS constitution / N/A
Which objective does this paper support? / Insert Tick (ü)
Improve choice and access to integrated health services for Bexley patients / ü
Reduce the level of health inequalities across Bexley
Improve care for patients with long term conditions & increase the range of services offered within the community / ü
Improving the health & wellbeing for people in Bexley / ü
Maximizing the opportunities of joint working (APoH, JSNA, Wellness agenda etc)
Using our resources in the most efficient & effective manner (organisational & financial) / ü
Report Author / Michael Boyce – Assistant Director of Finance & Business
Date / 13th October 2011
Contact Details / 0208 298 6078
Executive sponsor / Theresa Osborne – Chief Finance Officer
Bexley Care Trust
QIPP Update
1. Introduction
This paper provides an update on Bexley Care Trust’s 2011/12 Quality, Innovation, Productivity and Prevention (QIPP) Schemes.
The QIPP agenda identified where organisations can release resource whilst improving services through quality, redesign or greater efficiency.
Over the next 5 years the NHS has been tasked with finding efficiency savings of £20bn in order that this money can be reinvested in frontline services in both primary and secondary care. All acute and community providers have been asked to deliver plans that identify where these savings can be made and assess if they can be delivered. These plans are being monitored by Strategic Health Authorities (SHAs) and at a sector level via the five Clusters in London. Each PCT/Care Trust was given the target of financial stability over the next 5 years and was required to identify what QIPP schemes were needed to make this happen.
The delivery of the QIPP programme of work within Bexley is key to reaching financial balance in 2011/12. A team has been identified to carry forward the schemes which includes active General Practitioner (GP) members. The schemes are monitored on a regular basis and reported to the Strategic QIPP group, Clinical Cabinet and the Cluster team. This has included the development of practice budgetary and case management systems via MEDE (a web based reporting tool) and the development of peer and practice review processes for referrals, prescribing, frequent fliers and ambulatory sensitive conditions.
2. Current QIPP Schemes
The summary table on the next page shows the current schemes included in the 2011/12 FIMs plan. These schemes total non risk assessed savings of c£7.3m. Of these schemes, the BSU is responsible for monitoring and reporting on four of the nine schemes to the non risk value of £2.5m. The cluster is responsible for the remaining five schemes. It has been agreed with the cluster Director of Commissioning, Susannah Masters, that a pragmatic approach should now be taken to the planned values for these schemes and that they should not be changed. The cluster should now be reporting against each, but no detailed reporting has been seen to date.
These schemes must be delivered to achieve the 2011/12 financial control total and breakeven. Due to acute over-performance to date, the Care Trust is already reporting failure to meet its control total for 2011/12.
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
Prescribing and PEARS are both under-performing against the QIPP targets for the first six months. However, for PEARS this is marginal. The prescribing over-performance is reflected in the Prescription Pricing Authority (PPA) reports and reported in the monthly position. The value of over-performance is covered by the prescribing reserve held. However, the Long term conditions/ non elective QIPP scheme is overperforming by £508k at month 6.
Despite seeing no details of acute QIPP, Cluster are now reporting under-performance of £946k against the acute schemes at month 6, with a forecast outturn under-performance of £1,936k.
The QIPP return for the Care Trust submitted as part of the month 6 FIMs is shown over the page.
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
3. Unidentified QIPP
The unidentified QIPP following arbitration was c£4.6m. At the end of month 6 this gap has now been closed with the help of GPs re-prioritising investments and scrutinising budgets. This is an excellent achievement.
Details are provided below.
The unidentified QIPP Gap was the GPs’ priority and any gap resulting from underperformance of acute QIPP schemes will need to be closed by Cluster, although GPs will assist in addressing this issue wherever possible.
4. Potential New 11/12 QIPP Schemes
In order to ensure the QIPP target is met in 11/12 additional schemes are continually sought. The identification forms part of the Practice visits currently taking place and are discussed at the Operational QIPP meetings.
The table below shows the potential new schemes currently listed within the QIPP programme. These are currently being reviewed to evaluate whether any savings will be realised in the current financial year (this could be reducing cost as opposed to budget). However, considering the time of year, it is likely that most viable schemes will have effect from 2012/13 onwards.
5. Summary of Sections 2, 3 & 4
The table below summarises the headline information from the previous three sections by showing:
1. The value of the non risk adjusted planned QIPP schemes, shown in column 1 of the table on page 4, “Savings in 11/12”
2. The subsequent risk adjusted value of the schemes shown in the final column of the table on page 4, “Total”
3. The current forecast performance of the schemes shown in column 2 of the table on page 6 “Forecast outturn”.
4. Finally, the note on potential new schemes for 11/12 is derived from the table above.
The table shows a current forecast shortfall of £1,078k, which has been reported to NHS London and the Department of Health as part of month 6 reporting. The potential new schemes total c£600k which is not enough to close this latest gap, even if the schemes are implemented and delivered on time. Work is currently underway with Cluster to establish a way forward, as the shortfall is a result of underperformance on acute QIPP.
6. Potential New 2012/13 QIPP Schemes
There are several potential QIPP schemes which have been identified for implementation in 2012/13. These are set out in the tables over the page and have been sent to Cluster to inform commissioning intentions for 2012/13. It is imperative that these schemes are worked up fully to ensure that they are implemented in time to deliver full year savings in 2012/13. Cluster colleagues with acute responsibility and expertise need to start working with GPs to scope acute savings and KPIs to ensure savings are appropriately negotiated as part of the 2012/13 SLA negotiations.
BSU staff with local responsibility also need to be working closely with GPs and the operational QIPP group to identify additional QIPP schemes for 2012/13 as a matter of priority.
The table below is a high level summary of the tables shown on pages (10,11 &12 ). The table shows the value of the non risk adjusted planned QIPP schemes for 2012/13 of £12,610k and the subsequent risk adjusted value of £10,388k. It must be noted that these schemes are currently being worked through and are dependent on the following:
1. Full delivery of 11/12 schemes
2. New schemes being fully worked up in order to deliver on time
3. KPIs being negotiated as part of the 2012/13 SLA negotiations.
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
A partnership of Primary Care Trusts in Bromley, Greenwich, Lambeth, Lewisham, Southwark and Bexley Care Trust
Chair: Caroline Hewitt Chief Executive: Andrew Kenworthy
1
7. Collaborative Working
In addition to working with GPs, the Local Authority and the Cluster, BSU staff are meeting with Bromley and Greenwich colleagues to explore areas that can be developed across the three boroughs. This approach to working will facilitate the decommissioning of services within the acute sector.
The table below shows the headline areas for QIPP initiatives across South East London Business Support Units.
8. Roles & Responsibility
QIPP delivery and headline individual responsibilities are summarised below. Clare Ross & Michael Boyce will continue to oversee and give direction linking in with Beth Hill regarding the Commissioning Strategy Plan (CSP). Theresa Osborne will continue to sign off final reporting for stock take meetings and monthly financial returns.
Paul Jenkins
1. Specialist acute advisor to GP’s, linking to Cluster to improve accountability, understanding and reporting.
Nigel Gausden
1. Lead on completing the cluster highlight report template for all 37 schemes included in the CSP.
2. Continue giving support for Elmstead (Neuro Rehab).
3. Cover teleconference meeting as per table below and e-mail updates to Michael, Clare & Beth.
4. Update monthly QIPP spreadsheet for 11/12 & 12/13
Kathy Bell
1. Pull together monthly highlight reports for Cluster reporting and produce overall summary table. Table reported at Operational & Strategic QIPP meetings & sent to Cluster when requested.
2. Coordinate completion of Strategic & Operational QIPP agendas and circulate to group.
3. Arrange monthly Strategic & Operational QIPP meetings.
4. Take notes of action points at Strategic & Operational QIPP meetings write up and circulate.
5. Provide appropriate admin support to QIPP team.
6. Coordinate practice visits and completion of the Practice visit action log.
Darren Blake
1. Mede QIPP dashboard monthly report.
2. Lead for BXPL16, LTC/Non elective QIPP.
3. Attend Strategic & Operational QIPP.
4. Practices monthly report.
Cluster Strategy Meetings
Attendance is split between Nigel, Clare R, Michael & Beth, as per table below. Teleconferences are on Wednesdays and the meetings are on Tuesdays.
Date / Time / Style / Location/Dial in number28 September / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
4 October / 2-4 (Nigel G) / Meeting / Lower Marsh, Room 204
12 October / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
18 October / 1-3 (Clare R) / Meeting / Lower Marsh, Room 407
26 October / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
1 November / 9-11 (Michael B) / Meeting / Lower Marsh, Room 407
9 November / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
15 November / 1-3 (Beth H) / Meeting / Lower Marsh, Room 407
23 November / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
29 November / 3-5 (Michael B) / Meeting / Lower Marsh, Room 407
7 December / 9-10 (Nigel G) / Teleconference / 0844 473 73 73
PIN - 327155
13 December / 10-12 (Clare R) / Meeting / Lower Marsh, Room 204
This is not an exhaustive list of all QIPP roles, it just captures what is happening now so we are in a position to monitor going forward.
9. Recommendation
The BCCC members are asked to NOTE the contents of this report and support the delivery of the QIPP agenda within Bexley.