Commissioning headlines: 2016/17

Published: March 2016

1.1. Introduction

South Tyneside Clinical Commissioning Group (CCG)publishes it commissioning headlines (formerly known as commissioning intentions)annually in advance of the year ahead, taking into account the requirements of the NHS annual planning framework, available here[1].

The document is used as a means to indicate to local providers, the wider health economy and local citizens what and how the CCGintends to commission health care services during the upcomingfinancial year. Our plans will be drawn up in association with partners and communities and will take into account the priorities outlined in the JSNA and the refreshed Joint Health and Well Being Strategy.

2.Sustainable Transformation Plan 2016/17 - 2020/21

As required by this year's planning framework, we will be designing with neighbouring CCGs, partners and stakeholders our five year Sustainable Transformation Plan (STP) by 30th June 2016. We will be developing this across a layered footprint as set out below:

South Tyneside level / South Tyneside and Sunderland level / Northumberland, Tyne and Wear level
We will be focusing mainly on our “out of hospital” vision and strategy (an amalgam of our strategic plan for integration across health and social care and the South Tyneside general practice strategy). / We will work with Sunderland CCG, South Tyneside and City Hospitals Sunderland Foundation Trustsaround acute collaboration to ensure high quality, sustainable hospital services / We will maximize “do once” opportunities with our neighbours, including Urgent and Emergency Care Vanguard and the Transformation Programme for people with Learning Disabilities.

3.Financial headlines

CCG allocations[2] were issued early January giving three-year firm allocations and indicative for a further two years.

NHS England has focused on place-based allocations, incorporating CCG commissioning, Primary Care Medical and Specialised Commissioning with the intention to drive allocations at a place-based level to within +/- 5% of target allocation.

Nationally, growth funding has been allocated differentially to CCGs according to their Distance from Target (DfT) allocation. Whilst the pace of change moves the CCG closer to target it does allow for a small amount of growth funding over the five years as shown in the table below. However, there were a number of unexpected pre-commitments within the growth allocation.

Further, in previous years, the CCG has benefitted from efficiency on the national tariff for hospital services, but for 2016/17 the national tariff for hospital services has an inflationary uplift of 1.1% that must be funded from the growth; this is approximately £2m.

In summary, this means that for South Tyneside there is effectively no growth allocation

4.Quality and patient safety

The NHS Constitution clearly articulates patients’ rights to high quality care, defined as clinical effectiveness, patient safety and excellent patient experience. CCGs have responsibility to ensure continual improvement in the quality of local NHS services for everyone.

A quality service is one that recognises the individual needs and circumstances of the patient and ensures services are accessible, appropriate and effective for all and that workplaces support and empower the staff to deliver high quality care.

Quality is at the centre of our vision and values and we are dedicated to ensuring that the services we commission on behalf of the people of South Tyneside are of the highest quality and delivered with respect and compassion.

The CCG introduced a Quality Strategy (2014-2017), refreshed in November 2015, this strategy communicates our vision, key drivers and ambitions for quality and it explains how we will deliver the vision, our commitment to continuous improvement of quality outcomes and the development of robust quality assurance mechanisms to provide assurance to our Governing Body on standards of quality and patient safety in commissioned services.It will be operationalised in part via a commitment to carry out a quality impact assessment on all reform initiatives prior to their initiation. However, recognising that quality is an ongoing process there is a further commitment to ensure impact is monitored throughout the implementation process.

Our challenge as commissioners is to create a culture of continuous quality improvement, based on openness, transparency and candour, within our own organisation and across our local healthcare system. We believe that ensuring the delivery of compassionate, high quality care that is focused on outcomes can only be achieved by establishing a shared understanding of quality and a joint commitment to keep it at the centre of everything we do. We will therefore put quality at the centre of all our discussions with our providers. The CCG will align incentives and ensure it utilises all contractual levers to maximise the impact on quality improvement and innovation.

The CCG will additionally work with general practices around improving quality of end of life care services and the optimisation of medicines management.

5.Safeguarding

Safeguarding adults, children, and young people is ‘Everyone’s Business’ and it is the fundamental right of individuals to be protected from harm. We will continue to work with commissioned services to ensure they fulfil their statutory responsibilities and compliance with legislation and guidance to prevent risk of harm, and protect adults and children from abuse and neglect.

The safeguarding agenda continues to evolve and the CCG key priorities include:

  • Implementation of the new statutory arrangements for adults - The Care Act 2014 (implemented April 2015)
  • Further work to ensure compliance with The Children Act 1989/2004 and The Mental Capacity Act 2005
  • As a member of the Local Safeguarding Children Board (LSCB) and Safeguarding Adults Board (SAB), continue to work towards effective multiagency working, including the development of positive learning culture, to ensure that adults and children in South Tyneside are safeguarded from abuse and neglect.
  • Work towards reducing the number of children in need of protection by strengthening the early help offer to children and families.
  • Continue to work towards ensuring Looked After Children are receiving timely health assessments in order to meet their health needs.

We will continue to work with partner agencies to strive to meet the challenges of the internet / social media, child sexual exploitation (CSE), female genital mutilation (FGM), honour-based violence (HBV), Prevent (counter terrorism strategy) and domestic abuse (DA).

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4. Plan on a page

You can find our more about our work programmes in the Appendix to this document

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List of Appendices

Appendix 1 -Our work programmes in more detail

a)NHS Right Care (CVD, respiratory, cancer, frailty, end of life)

b)Health Pathways

c)LD Transformation

d)Mental Health

e)Urgent Care

f)Helping people to stay well and cared for in their homes

g)Primary Care

Appendix 2 - A contractual perspective

Appendix 3 - Procurements

a) NHS RightCare Programme

In this programme, CCGs compare their spend and outcome data against ‘equivalent’ CCGsnationally (based on population and demographics). This allows the identification of variation in terms of spend and outcomes which cannot be explained by a difference in population needs, thus enabling focus to be directed towards those areas of greatest improvement opportunity.

Through the NHS Right Care Programme, our focus in 2016/17 will be to work collaboratively with partners, stakeholders and patients to understand and transformthe following pathways:

  • Cancer
  • Respiratory
  • Cardiovascular disease

Frailty and end of life care programmes of work will continue and will cut across these work programmes.

The 2016 commissioning for value pack (linked with the NHS Right Care programme) for South Tyneside can be viewed here[3]

We are also exploring a potential focus for 17/18, using NHS Right Care analytics, around Gastro-Intestinal and MSK pathways too.

b) HealthPathways

We will use the HealthPathways toolkit as a transformation vehicle in 2016/17. This is being adopted as part of our work with the New Zealand Canterbury Health System. Clinicians from primary and acute care, as well as professionals and partners, will be engaged in the review and redesign of optimal patient pathways and this work is now in a detailed planning phase ready to launch in early 2016/17.

HealthPathways is underpinned by a web-based information portal that supports clinicians to plan patient care through primary, community and secondary health care systems and acts as a 'care map', enabling all members of a health care team (regardless of setting) to have a standardised approach to an individual’s care.

We will also be working with partners to develop Alliance ways of working during the year. We will use learning from the internationally recognised success of the NZ Canterbury Health System, its alliancing frameworks being founded on strong clinical leadership from across the system, consensus decision-making, and a patient-centric and whole of system approach.

c)Learning Disability Transformation

South Tyneside is facing a number of challenges with the provision of services for residents with learning disabilities. The local pressures are reflective of the national challenges faced by CCGs across the country:

  • Drive to reduce the reliance on hospital provision
  • Increasing demand
  • Disjointed planned care services
  • Care not provided close to home
  • Patients not always fully involved in decision making

Within 16/17 we will focus on the integration of learning disabilities services supported via a pooled budget to ensure a seamless planned pathway of care, which is integrated within and across organisations. This objective will be delivered through a programme of initiatives:

  • Pool health and Social Care budget
  • Develop joint key principles
  • Integrated Community services
  • Develop integrated care pathways across Learning Disability services
  • Support to providers in reducing the reliance on inpatient beds.

d)Mental Health

The Planning Guidance for 16/17 – 20/21 references the NHS Mandate requirements for Mental Health and highlights that Commissioners must continue to increase investment in mental health services each year at a level which at least matches their overall expenditure increase. In addition where CCGS collaborate with Specialised commissioning to improve efficiency they will be eligible for a share of the benefits.

South Tyneside CCG will focus upon achieving two new mental health standards for 16/17:

  • More than 50% of people experiencing a first episode of psychosis will commence treatment with a NICE approved care package within 2 weeks of referral
  • 75% of people with common mental health conditions referred to IAPT (Improved Access to Psychological Therapies) will be treated within 6 weeks and 95% within 18 weeks.

There will be a continued focus on meeting the dementia diagnosis rate of at least two-thirds of the estimated number of people with dementia. An affordable implementation plan will be developed to meet the Prime Ministers challenge for 2020 to improve post-diagnosis, treatment and support.

Implement transformation plan for children and young people’s mental health which will improve prevention and early intervention activity. Working towards the children and young people’s improving access to IAPT programme for 2018 as part of delivering national coverage.

e) Urgent Care

We will continue to develop the Urgent Care hub arrangements in terms of there being one accessible, single front door for urgent care needs in the borough. We will also continue to develop our Pharmacy First Scheme to ensure people with minor ailments can access appropriate services very locally which meet their needs.

The CCG will initiate and complete a procurement for a new Out of Hours GP service. In addition we will work with our providers to develop further integration and community pathways to support patients in the community and reduce the need for admissions.

As part of the Urgent and Emergency Care Vanguard, we will continue to work regionally and locally around programmes of work which aim to reduce unwarranted variation and improve the quality, safety and equity of urgent and emergency care provision by bringing together SRGs and stakeholders to radically transform the system at scale and pace which could not be delivered by a single SRG alone.

Through the work of our system resilience group (SRG) we will work together in South Tyneside to ensure that our whole health and care system works in the best possible way that it can, and that systems - from primary care, through to hospital discharge and community services- function to their maximum to avoid unnecessary hospital admissions and re-admissions. In particular we will work together cohesively at peak times such as Easter and throughout winter, to appropriately plan for and implement escalated ways of workingin order to ensure the whole system continues to flow. It is through this work that the SRG will have oversight of work to recover and A&E 4-hour standard and to maintain it, as well as to ensure that the numbers of Delayed Transfers of Care are reduced.

f) Helping people to stay well and cared for in their homes

Through these we will aim to ensure people are able to access the right services in the right place at the right time, as well as developing services in the community and in primary care which will help people to stay well at home, and in turn reduce emergency admissions to hospital. Examples of schemes include:

  • Care homes scheme - aligns our GP practices with care homes to provide more consistent and proactive care to these vulnerable individuals. Every care home in the borough has an aligned practice. We will continue to develop this model during 2016/17. We will be looking at the development of a frailty workstream during 2016/17 which will include care homes as well as a wider client group.
  • Integrated health and social care community teams - community nursing teams and adult social work teams working in a new way, in smaller delivery teams which are aligned to general practice, to provide more focused and consistent levels of care to patients and service users.

Features include teams being co located and every patient on the caseload having a named care co-ordinator; a care navigator works closely with the team to promote the important role played by our third sector providers, signposting patients and client to servicesand generally raising awareness of the third sector as a key asset. Roll out of the model will have been completed during Spring 2016.

  • Integration Pioneer - We have been awarded Integration Pioneer status due to our joint commitment to increase self-care, with the aims of improving the health and wellbeing of our local population and reducing demand on statutory services. Our mechanisms for achieving this are engaging staff across all health and social care partners to encourage self-care and self-management of health conditions, and working with our local third sector to maximise the support available in the community.

g)Primary Care

The majority of patient contacts take place in general practice so it is critical to consider the contribution of general practice in our overall system wide plans. The CCG is currently working with GPs in the borough to plan the future shape of primary care in line with the themes set out in the Government's document the Five Year Forward View[4]. In developing the role of general practice the following developments are planned for 2016/17:

  • Developing a clear sense of the shape of general practice in South Tyneside and its place in the five year Sustainability and Transformation Plan including the development of our Primary care strategy with a likely focus on access and reducing variation.
  • To commission services in a more strategically consistent and holistic way, rather than in fragments (as is the current commissioned model, e.g. numerous Local Enhanced Services)
  • We will continue to work with NHS England around the GP IT agenda, including information sharing across our Local Digital Roadmap using the NHS number as the common identifier.
  • Through co-commissioning, at level 2, we will work with NHS England to develop a quality dashboard for general practice, for assurance and analytical purposes, and to help us identify and address unwarranted variation.

We are working with Practices to understand how Primary Care can best operate as part of the overall system in order to contribute to a reduction in none elective admissions through schemes such as:

  • Winter weekend Primary care
  • Alignment with care homes
  • Integrated Health and Social care teams based around the GP registered list. Fully rolled out by March 2016 and further developed during 2016/17.
  • Our local primary care incentive scheme, the ‘Better Outcomes Scheme’. This focuses on 4 key clinical workstream areas and aims to support the delivery of robust and consistent primary care to enable people to be cared for proactively in the community.

Having implemented the “Think Pharmacy First” Scheme in 2015, we will continue to monitor uptake and service user feedback, to understand how readily able people are to access the right services, in the right place, at the right time.

Appendix 2 - A contractual perspective

National tariff and planned activity profiles

Where possible, detailed financial and activity schedules outlining the impact of commissioning intentions and reflecting modelled activity requirements will be issued in association with this document. Proposed activity volumes will be costed using the available PbR tariff and the relevant tariff groupers and algorithms. Where appropriate, activity assumptions will be adjusted to reflect changes to populations and age/sex profiles. In addition, any known impacts of clinical guidance which may affect activity profiles will also be taken into account. The basis on which activity assumptions have been modelled will be shared with our providers for discussion and agreement as part of the contract negotiations.