Developing Commissioning Intentions 2015-16

Developing Commissioning Intentions 2015-16

Council of Members September 2014

Janet Cree

12 August 2014

Developing Commissioning IntentionsHeadlines for this year

•Key points about developing the intentions this year –A move away from the ‘annual’ approach to intentions – we will

engage with staff and patients but will draw on the all the work we have done through the year

–Providers are the specific audience in the first instance - more ‘contracting intentions’ than ‘commissioning intentions’ – by September

–Two angles: what do we need to do this year to:• Progress the delivery of our ‘big ticket’ strategic plans?• Respond to local issues?

–A separate public facing document will be produced for the end of the year

‘Big ticket’ items

Service reconfiguration

Whole Systems Integrated Care

Primary Care Transformation

More health services available out of hospital, in settings closer to patients’ homes seven days a week.

Patients with complex needs receive high quality

multi-disciplinary care close to home, with a named GP

acting as care co-ordinator.

Patient

Urgent appointments

Care delivery teams and time for care plans

Community hubs

Convenient appointments

Continuity appointments

Access via range of channels

GP as lead for patient care

Local Authority and Social Care

involvementInformation

systems and record sharing

Capitated budgets

More local diagnostic equipment

More specialised

hospital care

Acute reconfiguration

Less inappropriate

time in hospital

Assistive technology

Carer

Community support

FamilyPatient’s own GP practice

Supported to self manage

and held together by resilience

Groups of accountable

care providers

BCF

PMCF

Patients have access to General Practice services at

times, locations and via channels that suit them

seven days a week.

• Framework developed by Strategy & Transformation colleagues

• Allows us to consider the key planks of our strategy in turn and the actions needed to deliver

• For each one, we can look at:• What’s been achieved?• What’s needed next year?• Other enablers?

Patient

Assistive technology

Carer

Community support

Family Patient’s own GP practice

Supported to self manage and held together by resilience

Patient Empowerment

Enablers- Lay person group established for WSIC- Co-design and co-production-Care navigator service-HCCG Patient Reference Group-HCCG PPE work plan-Hounslow Prevention Strategy-Locality PPG groups-PM Challenge Fund-Personal Health Budgets-Care Planning -Personal Care Framework

Deliverables 2014/15- Whole systems integrated care toolkit-Implementation of DES and Out of Hospital contracts for care planning-Co-production of FBC for WSIC-Children and Families integral to planning for Children’s Act implementation-Diabetes Patient engagement-Patients involvement in planning health services-Review of care navigator service-Co-production of PMCF plans-Policy framework for personal health budgets

Deliverables 2015/16Development of locality PPG groupsPromoting the self care agenda100% of WSIC early adopter population have care plansOutcomes for PMCF delivered including e-prescription, improving access, extended hoursReview of Hounslow clinical networks – with established patient role in ToR and workplansExtension of self-management agenda to wider hard to reach groups through outreachPatient engagement in contract monitoring of PCF providers and personal health budgets including CHC

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Patient

Urgent appointments

Convenient appointments

Continuity appointments

Access via range of

channels

Patients have access to General Practice services at times,

locations and via channels that suit them seven days a week.


Deliverables 2014/15• Develop HCCG primary care strategy• Primary care workforce analysis• Commission out of hospital services at network

level• Locality networks established• Networks have agreed their delivery plan for

2014/15 (including OD requirements)• Initial business change in place in primary care

(e.g. online appointment booking / email consultations etc)

• Models of network service delivery agreed• Increase number of practices using systm1• Increase capacity and number of trainer /

facilitators for Systm1• GP Ooh service redesign and procurement for

Ealing• Heston options appraisal and OBC• EPS rollout and implementation

EnablersPrimary care strategyPM Challenge Fund • Locality / Network development• New legal entities• 7 day workingOut of Hospital contractsWorkforce including training and developmentEstatesIT Co-commissioning

Deliverables 2015/16• PMCF outcomes including - 7 day/ week

primary care services in operation at practices within networks; a range of consultation methods available to patients (telephone/email/Skype); primary care appointments tailored to patients needs (e.g. urgent, continuity and convenience appointment standards met)

• Community patient transport service in place• ChenMed(like) model of care implemented in

pathfinder locality• Commissioning HEI to meet primary care

workforce development needs• Workforce plan developed

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Patients with complex needs receive high quality multi-disciplinary care close to home, with a named GP


PatientCare delivery teams and

time for care plans

GP as lead for patient

care

Local Authority and Social Care involvement

Information systems and

record sharing

Capitated budgets


care providers

Deliverables 2014/15• Develop full implementation plans that inform

commissioning intentions• Trial new ways of working & OD• Provide linked dataset with local capitation values &

analysis• Create provider and commissioner dashboards• Agree NWL-frameworks for new commissioning and

provider vehicles• Provide costing tool for new models of care• integrated community recovery services• Joint homecare tenders• Community Recovery service (CRS) specification and

planning• PCF procurement and provider framework place and

enacted

EnablersBetter Care FundJoint governance arrangementsPooled budgetsPersonal Care frameworkLocality ODQIPPWorkforceWSIC enabling infrastructure OOH hubs (covered on next slide)

Deliverables 2015/16• New models of care in place• 7-day services in operation• Health and social care commissioners

holding multi-provider ‘accountable care partnerships’ to account for delivery of population health outcomes

• New payment model in operation• Issue contracts for accountable care

provider• Capitated budgets and pooled budgets and

governance arrangements in place between commissioners

• Full implementation of CRS• Review ICRS role, function and capacity• Care navigator provision following

evaluation

Whole Systems Integrated Care (1 of 2)

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Patients with complex needs receive high quality multi-disciplinary care close to home, with a named GP


PatientCare delivery teams and

time for care plans

GP as lead for patient

care

Local Authority and Social Care involvement

Information systems and

record sharing

Capitated budgets


care providers

Deliverables 2014/15OOH Hubs: • Heston Options Appraisal and LIFT Stage 1

EnablersBetter Care FundJoint governance arrangementsPooled budgetsIntegrated community recovery servicesJoint homecare tendersQIPPWorkforceWSIC enabling infrastructure (OOH hubs)

Deliverables 2015/16Hubs:• West Middlesex Hospital OBC• Stage 2 LIFT following any LIFT Stage 1

schemes (e.g. Heston)

Whole Systems Integrated Care (2 of 2)

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Service reconfigurations

More health services available out of hospital,

in settings closer to patients’ homes seven

days a week.

PatientCommunity

hubs


More specialised

hospital care

Acute reconfigur

ation

Less inappropriate time in hospital

Deliverables 2014/157-day services:• Complete baseline self-assessment against 10 clinical

standards for 7-day services (all acute Trusts with partners)

• Agree priorities and sequence for implementation of standards across the non-elective pathway/develop action plan

• Achieve priority standards for 14/15 (including as per 7- day CQUINs)

• Integrated mental health emergency pathway in place• Children's – strategy, pathfinder hub, Paediatric

assessment unit specified, SEN local offer set out

Enablers7 day workingMental health transformationDiagnostic CloudChildren's StrategyLocal Hospital Business CasesMajor Hospital Business CasesOut of Hospital StrategiesClinical standardsQIPP

Deliverables 2015/167-day services:• Achieve agreed priority 7-day clinical

standards for 15/16, including those included within the national acute contracts

• Implement Diabetes, AEC, diagnostic contracts

• Sustain reduction in OP activity with non face to face and one stop clinic

• mental health and wellbeing strategy

Service Reconfigurations (1 of 4)

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Service Reconfigurations (2 of 4)Deliverables 2014/15• Diabetes – respecified and procurement completedChildren's• strategy, pathfinder hub, Paediatric assessment unit specified,

SEN local offer set outUrgent Care• AEC specified & implemented at WMUH from 1/10/14• GP OOH respecified and procured• 111 reprocurement plans developedCommunity Heart Failure• Review model and deliveryCommunity Transport • Specify service requirements and plans for deliveryMental Health• IAPT – increased capacity, improved access• IAPT – new contract robust monitoring of performance• Primary Care Plus established ensuring patients do not stay

with secondary services longer than necessary• Dementia Adviser Scheme LD• Reduce out of area hospital placements in line with

Winterbourne View Recommendations• Appropriate pathways developed to ensure all local responses

& options are considered prior to placing people out of area.• Transition – appropriate pathways from children’s services to

adult for people Diagnostics• GP direct Access contract respecified and procuredCancer• Chemo closer to home pilot – evaluate and roll out 15/16 as

appropriate

Deliverables 2015/16• Consolidation and evaluation of AEC care model initiated in

14/15 at WMUH• Out Patient Antimicrobial Therapy (OPAT) service at WMUH• Anti-coagulation clinics at WMUH respecified• Homecare Shared care• MSK service review (recommission / decommission) in light

of CWHHE outcomes• Community Gynaecology service / pathways review & plans• Community ENT service / pathways review & plans• E-referral functionality / utilisation and interface with RFS• Sleep studies – community / secondary care pathway

improvement• Minor Surgery – local minor surgery plus service• Care pathway for continence patients to facilitate transfer of

care and activity out of WMUH and into the community and how to

Learning difficulties / Mental health interface• Improving funding decision process and timelines• Review forensic LD service need• Review the LD assessment and treatment service

requirements and access compliance• Joint( with LBH) process for agreeing funding for patients

transitioning from NHSE• Commission an LD, Asperger’s and autism needs assessment • Review Asperger’s and Autism service requirements in line

with the needs assessment outcomesSpecialist Palliative Care • Establish a Macmillan GP role in the CCG and define how this

will integrate with the specialist teams across secondary, community and primary care.

• Consider role for a consultant working with the acute trust to support EOLC for both cancer and non-cancer patients.

• Review the palliative care nursing and social worker resourceCancer• Macmillan GP with focus on screening / early diagnosis

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Deliverables 2015/16 continued• diabetes

• Continue to collaborate with NWL diabetes network, which will develop NWL clinical & prescribing guidelines and support the diabetes Out of Hospital contract;

• Review diabetes paediatric and transition care pathway at local providers; • Support co-commissioning with NHS England for Retinal screening across London;• Improve access to the Diabetes MDT Foot care clinic at WMUH;• Review adult and antenatal diabetes service provisions at local providers

• Mental Health• Expanding and developing the primary care MH service (PC plus) • To include peer support worker, social worker, clinician to support physical health care in the hard to reach groups (eg non-

registered, rough sleepers, hard to engage registered patients), facilitator for carers, care navigators /dementia CPN Develop and implement new model of care for recovery and improved physical HC and incorporate as part of the early adopter WSI for LTMHC

• Commission a primary care consultant psychiatrist and manager across all three WLMHT CCGs in line with business case • Recovery model within the community - see model that emerges from WSI LTMHC • Urgent care - timely urgent assessment, extension of 'in hours' working, more outreach assessment in crisis, roll out of the

templates for communication along the pathway of care between primary and secondary care, development of a MH SPA

• IAPT • expansion to accept self-referral, more complex cases, carers, LTC• Increase use of groups and use of IT media eg Big White Wall for live therapy. to achieve 15% access and 50% recovery and reduction of waiting list to be within KPI• development of CYPIAPT

• Dementia • Improve diagnostic pathway and timelines eg timely MRI• Increase number of primary care dementia nurses to 1 per locality• Commission locality community dementia CPN• increase post-diagnostic support including Information packs for patient & carers • Carers training post diagnosis to include details of personal budgets• Dementia aware Care navigators within the locality

• CAMHS • Evaluate impact and effectiveness of LD CAMHS • Improved out of hours services and responses to crisis

– CCGs collaborative function• Review of local Tier 2 and Tier 3 CAMHS pathway• Review of LAC CAMHS• Improved engagement and commissioning work with

NHSE to ensure good pathways into and out of tier 4 – CCGs collaborative function

• Ensure effective implementation of CAMHS IAPT project in Hounslow.

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Service reconfigurations

More health services available out of hospital,

in settings closer to patients’ homes seven

days a week.

PatientCommunity

hubs


More specialised

hospital care

Acute reconfigur

ation

Less inappropriate time in hospital

Deliverables 2014/15Local Hospital and Major Hospital BusinessCases:• Approved Implementation Business Case (by DH

and HMT)• Approved Outline Business Cases for Major and

Local Hospitals (by CCGs and Trust Boards• CMH A&E and HH Emergency Unit transitionedMaternity:• Agreement on decision to proceed with

implementation of maternity contingency planning (proposal for activity from Ealing Hospital Trust to five receiving trusts in NWL)

Enablers7 day workingMental health transformationLocal Hospital Business CasesMajor Hospital Business CasesOut of Hospital StrategiesMaternity contingency planningClinical standardsQIPP

Deliverables 2015/16Local Hospital and Major Hospital BusinessCases:• Approved Outline Business Cases for Major and

Local Hospitals (by NTDA, DH and HMT)• FBCs developed


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Public Health {1 of 3}Deliverables 2014/15Strategic• Produce a Public Health Commissioning

Strategy outlining LBH’s approach to PH service provision over the next 4 years

• Explore with the CCG the feasibility of commissioning a diabetes prevention programme which could include i) awareness raising with community groups at high-risk ii) pre-diabetes programme for high-risk individuals iii) review current lifestyle interventions for those with diagnosed diabetes

• Explore with the CCG the feasibility of commissioning a TB prevention programme which would include latent TB testing for high-risk communities.

• Produce robust multi-partner action plans to underpin delivery against Health and Wellbeing Strategy priorities and in particular lead on the following:-

Childhood obesity Children’s oral health Smoking cessation NHS Health Checks programme

Deliverables 2014/15 continuedStrategic• Work with NHS England, Children’s services and

other partners to agree arrangements for the transfer of the Health Visiting service to the Council in October 2015.

Procurement• Joint procurement of new school nursing service

with Harrow and Barnet• Funding provided to Housing Department for

procurement of Winter Warmth programme for vulnerable adults

Service improvement• Work with GP localities and the CCG to ensure that

all PH commissioned services have standardised clinical templates to ensure smoother data flows between GPs and PH.

• Work with the local adult substance misuse service to explore the feasibility of improving /re-designing the existing clinical information system.

• Work with CCG and local GPs to improve cost—effectiveness of NHS Health Checks programme by improving advice and onward referrals to interventions for high-risk patients.

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Deliverables 2015/16

Contingent on further internal discussion at the Council and wider discussions with the CCG the following are draft new intentions for 2015/16Children and young people• The smooth transfer of the Health Visitor service and the Family Nurse Partnership programme form NHS

England to the Council• Strengthen the focus of the new School Nursing Service on prevention. This will include negotiating with the

LCSB to agree a more efficient process for the SN team to positively contribute to child protection cases • Delivering interventions against the agreed Health and Wellbeing Strategy action plans for children’s oral health

and obesity including:- Increased investment in physical activity infrastructure (parks and schools) in the more deprived parts of

the borough A new weight management programme for children and families linked to the National Childhood

Measurement programme Working with Children’s services and the CCG to strengthen the Early Years settings and Healthy Schools

offer which will include engaging with GP localities, community and voluntary groups. Exploring the feasibility of commissioning dental outreach programmes for schools in the more deprived

parts of the borough.• Improve our offer on reducing teenage pregnancy - including reviewing our community outreach intervention • Review our offer around empowering young people to make more informed decisions around drugs, alcohol,

tobacco and their sexual health.

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Public Health {2 of 3}

Deliverables 2015/16

Adults• Commission a new one-stop healthy lifestyle service with strong links to the existing NHS Health Checks

programme• Following on from the Adults Prevention Strategy (Autumn 14), working with Adult Social Services and the CCG

we will review and recommission our primary prevention services for older people e.g. befriending service, falls prevention, older peoples volunteers

• Working in collaboration with the CCG we will commission a new diabetes prevention programme• Working in collaboration with the CCG we will commission a new TB prevention programme• Following on from the production of a new Alcohol Strategy in early 2015 we will improve our offer on the

prevention of alcohol misuse• Reconstitute a multi-partner DAAT board to strengthen partnership working to tackle substance misuse• Review our HIV prevention offer including

Evaluate the introduction of GP testing of new registrations (introduced 2014) Evaluate local HIV community prevention projects

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Public Health {3 of 3}

What are our key local issues?What are the specific quality/performance issues we want to address next year?

•WLMHT•HRCH•WMUH•Imperial•ASPH•ChelWest•Nursing & residential •Primary care•Other?

What are our key local issues?What are the gaps in service/local pathway priorities we want to address?

These are ideas suggested so far. Is there anything missing? How should we decide what the priorities are for next year?

• Community Transport

• Specialist Palliative care

• MSK

• End of Life Care

• TB

• Heart failure

• Community ENT

• Community Gynaecology service / pathways

• Care pathway for continence

• Consolidation and evaluation of AEC care model initiated in 14/15 at WMUH

• OP antimicrobial service at WMUH

• Anti-coagulation clinics at WMUH

• Homecare Shared care

• Children – hubs, PAU, SEN local offer

• Sleep studies – community / secondary care pathway

• Minor Surgery – local minor surgery plus service

The TimetableMONTH

Activity When / where

AUGUST

Development of draft high level Commissioning Intentions

Patient and Stakeholder event 5th August

Collation of areas identified in year

Clinical lead and commissioning manager feedback

Council of member 22nd August

Clinical Board

SEPTEMBER

Consult, discuss and refine commissioning intentions

Draft Commissioning Intentions to be Presented for discussion to :

Intentions refined and redrafted

CWHHE template reviewed and populated

Joint Commissioning Board 2nd sept

Health and Wellbeing Board 3rd Sept

Governing Body 9th September

Clinical Board 23rd September

Practice Locality meetings

Practice Patient Groups

CONTRACT INTENTION LETTERS SENT TO PROVIDERS

OCTOBER

Finalise commissioning intentions

Focussed feedback on key areas

Refined intentions as latest draft presented for discussion and agreement to:

Commissioning Intentions Documents finalised

Joint Commissioning Board 7th October

Governing Body seminar 14th October

Council of members 29th October

Practice Locality meetings

NOVEMBER

Share with patients and providers, contract drafting, initiate contract negotiations

Final Sign-off Joint Commissioning Board 5th Nov

Governing Body 11th Nov

Health and Wellbeing Board 19th Nov

What do Members need to do?• Review the Draft Intentions• Schedule discussion at locality meetings• Share at Patient Groups• Feedback on current draft – identify omissions

/ enhance content / plans by 1st October 2014 to [email protected]

mailto:[email protected]