Report to the Sutton
Clinical Commissioning Governing Body
Date of Meeting: Wednesday, 3rd April 2013
Agenda No: 5.1 Attachment: 03
Title of Document:
The 201314 Operating Plan
/ Purpose of Report:For approval
Report Author: Geoff Price, CFO / Susan Roostan, Director of Commissioning and Planning / Lead Directors:
Jonathan Bates (SCCG COO)
Contact details: ;
Executive Summary: See below
Recommendation(s):The Clinical Commissioning Group Governing Body is requested to approve the 13/14 operating plan and associated documentation. The Board will continue to be updated and any changes of a material nature will be bought to the board for approval.
Committees which have previously discussed/agreed the report:
The CCG Finance Committee - 28 March 13; The Executive Committee - 20 March 13;
Financial Implications:
The CCG has a robust financial operating plan for 2013/14 and that recognises risks going forward.
Equality Impact Assessment:
Not applicable
Information Privacy Issues:
None
Communication Plan:
The CCG will be developing a CCG prospectus in April to publish to stakeholders in May. This will be developed and submitted to the board in May for approval.
Executive Summary:
The governing body is asked to approve the submission of Sutton CCG final version ‘plan on a page’, the self certification template as part of the submission, the trajectory for the diagnosis rate for people with dementia, 2013/14 & 2014/15, the local priorities for the CCG and activity data trajectories for 13/14. Attention is drawn to the self certification question and where the CCG has responded.
The 13/14 financial operating plan
An update on the 2013/14 financial plan was given at the last Board.
Since then the Chief Clinical Officer has met with NCB Finance leads (12 February 2013) to present the plan, answer questions and provided clarifications.
The final draft of the plan is due at the NCB on 05 April. A submission will be made on the 28th March by the CCG outlining various trajectories and the final version of the plan on a page. However there may be further changes as, in particular, acute contracts are finalised. Any such changes will be highlighted to the Governing body.
Attached are a range of documents being submitted including the salient parts of the operating plan finance template reported to the NCB.
Detailed budgets are being prepared and are based on the operating plan.
For the finance element of this paper the governing body’s attention is drawn to two main areas.
· Continued work on QIPP has identified most of the QIPP savings requirement of £7.1 million. However, achievement of QIPP savings is subject to risk (which has been quantified). To mitigate against this risk it is important that the risk on schemes is reduced, the amount of savings from schemes is increased where possible, and that new schemes are developed on an ongoing basis. QIPP clinical leads are working with managers to achieve this, and the CCG has also secured support from PWC. The CCG is very keen to work collaboratively with its acute providers to align CCG QIPP schemes with provider cost saving schemes to support the alignment of commissioner and provider strategic objectives.
· Secondly the CCG is, at the time of writing, in negotiation with its main acute providers on 1314 contract agreements. This includes agreement on QIPP that will be included in contract. The outcome of these negotiations, as indicated above, could impact on the operating plan. A verbal update will be given at the Board meeting.
A SWL CCG risk share agreement has been reached which will help mitigate any unplanned downside events in year.
1. Background &Introduction
Sutton CCG is required to develop an operating plan for the financial year 2013 -2014.
In December 2012, the Department of Health published the guidance;
Everyone Counts: Planning for Patients 2013/2014 and Supporting Planning for 2013/14 Direct Commissioning.
These documents set out the CCG requirements in terms of planning for the coming year and set out the expectations of the commissioning board in terms of inclusions within the plans but also how the plans will be monitored going forward.
An initial operating plan submission was made to the Local Area Team of the National Commissioning Board on the 25th January 2013.
On 12th February the Chief Clinical Officer, Chief Finance officer and the Director of Commissioning and Planning met with the Local Area Team from the NHS Commissioning Board to respond to questions and queries regarding the first submission and to provide assurance to the team that the plans were being developed to support the CCG commissioning activity in 13/14.
2. Process to date
The NHS Commissioning Board set an initial submission date for Friday 25th January 2013. The submission was discussed at a meeting with Local Area Team on 12th February and further amendments have been made to take account of comments from the LAT and other stakeholders in the interim period.
The CCG has been receiving feedback from a range of stakeholders regarding the plan. The priorities set out in the plan on a page were discussed in detail at a stakeholder event on the 27th March. The event was attended by a wide range of CCG stakeholders including local MP’s, Provider Trust Chief Executives, patient group’s members, voluntary sector organisations, Local authority colleagues and CCG GP & practice colleagues. The priorities were seen by the stakeholder group as a positive statement of the intentions of the CCG for the coming year and that they were supported by the stakeholders.
The CCG is required to self certify against a number of areas:
· Do your plans ensure that the performance standards in the NHS constitution will be delivered throughout 13/14?
· Do your plans ensure that the performance commitments in the mandate will be delivered throughout 13/14?
· Have you assured provider CIP’s are deliverable without impacting on the quality and safety of patient care?
· Do you plan to manage HCAI’s so that your local population have a maximum number of C Difficile infections as set by your local CDi objective?
With the exception of the CIP certification the CCG has responded positively, to the self certification questions as per the attached sheet.
The CCG is continuing its discussions with its main provider; Epsom and St Helier NHS Trust (ESH), on how it can be assured that provider CIPs do not impact on the quality and safety of patient care. At this time ESH has not fully finalised its CIPs for 201314, however there is more detail being made available by the Trust.
Sutton CCG clinical leaders will be required to make their own assessment of cost improvements to be satisfied that services are safe for patients with no reduction in quality. To support this decision making the CCG will continue to assess the existing ESH process, and working through the Clinical Quality review Group which is chaired by the CCG Chief Clinical officer, ensuring they are robust. In making its decision, the CCG will also draw on the National Quality Board’s "how to" guides, and assess the potential impact on local and nationally accredited tools, such as the National Quality Dashboard, the NHS Safety Thermometer and any likely impact on staff and patient surveys, including the Friends and Family Test.
Attachments
· Plan on a page
An overview of the CCG priorities and plans for 2013/14
· Self Certification document including
A mandated submission to the NHSCB via UNIFY in response to specific questions and thus confirming the CCG intention to support delivery in a number of areas;
· Trajectory for dementia diagnosis
A trajectory for the CCG to deliver which identifies the diagnosis rate for people with dementia expressed as a percentage of the estimated prevalence;
· Local priorities
These are the three local priorities that have been developed in conjunction with the Executive Committee members and clinical leads. These local priorities will be agreed with the Commissioning Board, they are set out in the attachment, and the detail is listed below for the areas identified. The measures should focus on local issues and priorities, especially where outcomes are poor compared to others.
The local priorities linked to the quality premium for Sutton CCG are:
Increase childhood immunisation rates. Sutton has lower than average immunisation rates for children, and there are three workstreams proposed to improve uptake: Increased maternal record linkage, improved access via health visitor referral following recurring failure to take up practice invitations, and information management by improving numbers of children registered with a GP by 28 days old. Success will be measured by meeting 90% uptake across all immunisations for all 0-2 year olds.
Improved acceptance of ScriptSwitch messages to reduce prescribing costs in line with medicines management workstreams. Greatest financial gain will be in acceptance of messages for repeat prescriptions: 2012/13 acceptance rate for repeat prescriptions = 12.6%, 2013/14 target: 17% Number of messages may vary from year to year due to changes in pricing and best practice, so audit of 9 months’ prescribing data will be used to measure success against this indicator
Improved participation in CCG Patient Reference Group: over 70% of practices to be represented at the CCG's Patient Reference Group during 2013-14;
· Activity trajectories
The activity trajectories show the planned activity across a range of areas. The trajectories cover, First Finished Consultant Episodes in elective care and non elective care, first outpatient attendances and A&E attendances. The figures include demographic growth of 2.2% and a reduction based on proposed QIPP that will be delivered in 13/14;
· Financial template
An updated financial spreadsheet that takes account of the on-going contractual negotiations with the acute providers and the QIPP schemes planned for implementation in 13/14.
3. Recommendations
The Clinical Commissioning Group Governing Body is requested to approve the 13/14 operating plan and associated documentation. The Board will continue to be updated and any changes of a material nature will be bought to the board for approval.
Susan Roostan
Director Commissioning and Planning
Sutton CCG
Page 2 of 6
Page 2 of 6