Initial Outline Commissioning Intentions 2014/15 - Ipswich and East

IpswichandEastSuffolkCCG Commissioning Intentions. 1

Date: 30 September

Rushbrook House Paper Mill Lane

Bramford Ipswich Suffolk

IP8 4DE

Tel: 01473 770000

Fax: 01473 770201 Website: www.Suffolk.nhs.uk

Dear Initial Outline Commissioning Intentions 2014/15 This letter outlines the commissioning intentions of Ipswich and East Suffolk Clinical Commissioning Group (CCG) for the commissioning of health services for 2014/15. These intentions have been developed by GP Commissioners through a number of clinical workstreams which will be leading the development and implementation of these intentions in 2014-15. The letter is intended to signal the start of the contracting process and is designed to:

outline the CCGs strategic direction (Appendix 1 references the CCG 5 year clinical strategy in detail)

give advance warning of changes, opportunities and threats to allow providers to plan ahead.

The next two years will be financially challenging for Ipswich and East Suffolk CCG and it is likely that substantial efficiencies will need to be made particularly in 2015/16. 2014/15 will therefore be a year where radical pathway redesigns are considered and difficult decisions are made about services which could result in decommissioning in some areas

1. Strategic Initiatives Ipswich and East Suffolk CCG (I&ESCCG) overarching aims are to:

work effectively with patients, carers, communities, clinicians and partners

improve the health and wellbeing of the people of Suffolk

help individuals to take responsibility for their health

ensure high quality health services for all who need them

give patients and their carers easy access to joined up services

maintain financial balance.

Specifically the CCGs priorities are to:

improve health and educational attainment for children and young people

improve outcomes for patients with diabetes to above national average

Improve care for frail elderly individuals


improve access to mental health services

allow patients to die with dignity and compassion, and choose their place of death

improve the health of those most in need

ensure high quality local services wherever possible

promote self-care.

The CCG wants to ensure that the system of commissioned healthcare delivers high quality services and good clinical outcomes for patients. It is vital that services are commissioned in a sustainable way to safeguard clinical quality. The CCG wants to ensure there is equality of outcome for different patient groups, and that this is achieved through effective engagement with member practices, providers, patients and carers and other stakeholders.

Clinical Strategy and Priorities I&ESCCG has organised its workload and its commissioning intentions into programme groups known as workstreams. The priorities have been agreed by the Clinical Executive supported by a 5-year clinical strategy (referenced in Appendix 1). The clinical priorities of each programme are referenced in Appendices 2. The strategy and these priorities were formerly approved by the Governing Body on the 24th September 2013.

Health Ambitions In partnership with Public Health and Suffolk County Council, the programme aims to improve population health by focussing on prevention to limit the onset, or reduce complications of conditions such as diabetes, cardiovascular disease, other long term conditions and some cancers which are associated with lifestyle. It aims to provide an evidence based approach to deliver health improvement and reduce health inequalities by decreasing the gap in life expectancy and adding life to years. The intentions listed below are areas to be developed or extended in 2014/15

Improve access to Alcohol and Substance Misuse Treatment Services

Improve access to Psychological Therapies for those within alcohol and substance misuse treatment services increasing their chances of achieving recovery and improving their quality of life

A review of the obesity pathway and weight management treatment services. Ensuring all patients flow through a tiered programme of care to improve the quality of interventions for those requiring bariatric care.

Primary Care In 2014/15 for Primary Care there will be incentives provided through the Quality and Outcomes Framework (QoF) and the Quality and Productivity Indicators which will encourage the uptake of services and pathways for the following areas:

Advice letter listing

Clinical Thresholds

Osteo Arthritic Hip Pathway

Admission Prevention Services

Dementia Assessment Tool ACE 3

an Integrated Diabetes Service

A&E Improvement Plan – review patients to reduce attendances. The CCG has responsibility for some Local Enhanced Service (LES) contracts inherited from the former Primary Care Trust (PCT). These are:

minor injury

depo-neuropletics


phlebotomy

wound care

Gonadorelin analogues. These contracts related to GMS practices only and will be transferred to a standard NHS contract to ensure continuity of services to patients. The CCG has revised the Multi-disciplinary Team contract this year to ensure alignment with the NHS England Risk Profiling Directed Enhanced Service. This will be reviewed and evaluated prior to 31st March 2014 to determine suitability for continuation. Near patient testing and DVTs arrangements will also be reviewed within the same timeframe to determine suitability for continuation. The new additional care home services contract which begins on 1st October 2013 will be reviewed in March 2014. Monitoring of the Minor Surgery LES has been delegated to the CCG by NHS England until 31st March 2014. Future plans for this service will be advised by NHS England and communicated once known.

Information Sharing and IT Strategy Healthcare can be delivered more efficiently and seamlessly for patients when shared electronic health records are deployed widely across care settings, and this is the best way to provide integrated care, particularly for the most complex or vulnerable patients. We will progress our Information Sharing initiatives in line with our patient safety and care quality objectives, and focus on integrated care records accordingly.

Workforce Planning The CCG will work to ensure that providers have an appropriate, capable and sustainable workforce with cohesive system-wide clinical leadership. The commissioning of local services will need a workforce fit for purpose, as we change the shape of services and where necessary move them closer to patients’ homes. Our local workforce will need to be highly flexible to respond to changes in how we deliver healthcare. As services across health and social care become more aligned and are delivered in more flexible ways in the community, providers and commissioners must work together and, as appropriate towards easing the transfer of staff between different employers and ensure they can minimise cost and maximise efficiencies where the workforce overlaps. The CCG will commission services that are appropriately skilled and competent in providing high quality and safe services for patients.

2. Quality, Innovation Productivity and Prevention (QIPP) QIPP remains one of Ipswich and East Suffolk CCG’s key priorities for 2014/15. The programmes in Appendix 2 are the summary of the current plans of the CGG to ensure delivery of QIPP which will be continued into 14/15. There is also a continuing need for new ideas that will help to sustain the financial health of the Suffolk health economy whilst maintaining or improving quality. Providers with ideas relating to changes in commissioning that will help fulfil this agenda are invited to share their ideas with Ipswich and East Suffolk CCG.

3. Market reviews


Ipswich and East Suffolk CCG has embarked on a number of significant service redesign programmes since its inception in April 2013. The result is a number of key service procurements. In addition there will be some market testing and review for the feasibility of new service options. For Social Marketing the CCG wants to ensure that providers and suppliers are aware of the changing economic pressures, the opportunities available to them and will seek to promote innovative solutions. Services for procurement include:

Service Likely tender start Service Implementation Date

Ophthalmology Triage Underway April 2014

High cost drugs: management support

Winter 2013/14 April 2014

Dermatology Underway – market testing June 2014

Out of Hours Winter 2013/14 April 2015

111 Winter 2013/14 April 2015

Urgent Care Integration Winter 2013/14 April 2015

Musculoskeletal Services , including Physiotherapy

Spring 2014 Early 2015

Stroke early supported discharge

Early 2014 Late 2014

Community Services October 2014 October 2015

Cardiology Intermediate Community based services

November 2013 May/June 2014

There are further services with market review planned and/or specifications in development, these include:

Child Adult Mental Health Services (CAMHS) – strategy completed

Learning Disability Services

Community respiratory services

Myalgic Encephalomyelitis and Chronic Fatigue Syndrome

Pain Services

Gastroenterology – Faecal Calprotectin

Dementia – Memory Assessment Service

In relation to pathology services:

Subject to Office of Fair Trading ruling I&ESCCG will commission most of its pathology services from Transforming Pathology Partnerships a joint venture of local acute trusts.

Any residual pathology to be commissioned from local providers will be commissioned at 2013/14 tariff plus or minus standard NHS inflation net of efficiency.

I&SCCG expect providers to continue to provide the same range of services as available in 2013/14.

4. Activity levels For acute contracts the CCG will:

Continue to support the national PbR structure but move to local tariff options were appropriate and permitted

Review day case procedures expected to be done as OP procedures and specify commissioning levels

Require compliance with national guidance over recording of day cases versus outpatient procedures


Require compliance with 2014/15 payment by results guidance and national data definitions.

Develop pathways for outpatient services to achieve maximum efficiency and quality of care, e.g. one-stop clinics, multidisciplinary clinic, parallel clinics and triage to most appropriate clinics

Review maternity pathways to ensure compliance with PbR rules and no duplication of payments

Identify potential services eligible for Best Practice tariffs and agree plans/timetable for introduction (must have adequate supporting information)

Review of tariffs for urgent and emergency care which may require local tariffs to be developed and agreed (including, but not limited to, short stay emergency paediatric admissions)

We will work with providers to explore opportunities for incentives for managing internally generated demand.

5. Lead Commissioning Arrangements The CCG anticipates working closely with West Suffolk CCG in particular to ensure a coherent approach to commissioning is maintained. Ipswich and East Suffolk CCG intends to continue with the lead commissioning arrangements agreed in 2013/14. As with current multilateral contracts there may be variations to the schedules within those contracts to reflect the differing priorities of each group and a separation of the budget elements to each CCG. In most cases the CCG will seek to enter into associate agreements with other CCGs outside of Suffolk where other CCGs geographically host the service in question. The CCG is a member of the Suffolk Commissioner’s Group. This forum works collectively to deliver a joined up approach to commissioning Suffolk services for delivery of elements of the joint Health and Wellbeing Strategy and other areas of agreed joint working as appropriate. The Group will work in 2014/15 to agree plans to deliver the joint strategic aims where cross organisational commissioning is required and to deliver system leadership in the optimum use of resources to deliver the best overall outcomes for Suffolk residents. This approach allows strategic alignment with Suffolk County Council (SCC) in particular Section 256 for reablement. The CCG is also a member of the Suffolk Leaders Partnership (SLP) which exists to provide system leadership for delivery of elements of the joint Health and Wellbeing Strategy. The SLP will be a key system enabler to drive the delivery of programmes for 2014/15.

6. Other national and local initiatives The CCG will implement the National Operating Framework requirements when issued by NHS England. The Operating Plan identifies what CCGs must deliver on a number of key outcomes, including commissioning for local need, demonstrating clear alignment with national requirements and to provide evidence that major strategic change programmes will be delivered. The Operating Plan is underpinned by the national allocations and provides a clear framework for the negotiation of all provider contracts.

7. Performance Data / information For all contracts we intend the following:

Continued on-going compliance with the reporting requirements of UNIFY 2 and SUS, which includes compliance with the required format, schedules for delivery of data and


definitions as set out in the Information Centre Guidance and All Information Standards Notices (ISNs), where applicable to the service being provided.

Where the provider is part of a multi provider pathway then the provider will be expected to proactively participate in the development of integrated information flows that are consistent, complete and timely and compliant with all mandatory data items.

Any accountable provider who sub contracts out to other providers should provide evidence and assurance to the CCG that their contracts and schedules with the sub contracted provider are consistent with their contract with the CCG, so that all providers can be held accountable on the same basis.

Proactive participation in the provision of daily information to support the system wide urgent care dashboard.

We will be reviewing data flows over the next 6 months due to the implementation of the Health and Social Care Act and the changes it brings to the way patient confidential data (PCD) is handled by commissioners. Historically providers sent some PCD directly to commissioners, due to the Information Governance (IG) changes patient identifiers have been removed from these flows. In 2014/15 we expect all local data flows with PCD data added back in to be flowing via the Data Service for Commissioners Regional Office (DSCRO) who we are procuring services from. We would hope that providers would work with us on this in the lead up to the new financial year as this will make the invoicing process easier in 2014/15.

We will be expecting trusts to submit all corrections to data via SUS so that SUS becomes the definitive source of data together with any amendments being submitted as Net change (as opposed to bulk)

We will be expecting trusts to be submitting data to SUS in the latest version of CDS as advised by any ISN.

We will require providers to work with ourselves and the DSCRO on various areas including but not limited to: Data quality, data standardisation, data flows, data access, invoice validation.

In 2014/15 some agreed challenges will come directly from the DSCRO to providers. There will also be challenges raised by commissioners and practices.

For any new community contract the CCG intend the following:

Completion, as a minimum, of the community Information dataset and on-going development to ensure that the provider is able to submit the Community Information dataset to SUS and as an interim measure will be able to submit it locally to the CCG

Where statutory reporting is required to UNIFY2, Choose & Book, Omnibus, Open Exeter and other statutory reporting fora then the Provider should ensure that they are N3 compliant.

Compliance with ISN 0149- where completion of NHS Numbers is a mandatory requirement

7. Quality

In the first Commissioning Intentions letter following the publication of ‘The Francis Report’, it would be inappropriate not to make reference to this important work, the recommendations of which have been embraced by the Clinical Commissioning Group from its development of a direct email address to enable communication from GPs on Commissioned Services to the


development work undertaken on the structure of visits by the Clinical Commissioning Group to services, in reviewing quality and patient safety. We note here our intention to implement the recommendations of the over-arching report by the National Advisory Group on the Safety of Patients in England, A Promise to Learn – a Commitment to Act, Improving the Safety of Patients in England. This approach supports that Patients and their carers should be present, powerful and involved at all levels of healthcare organisations from wards to the boards of trusts.

8. Notice Periods and Contract Renewals Ipswich and East Suffolk CCG will apply reasonable notice periods in line with contractual requirements where significant change is anticipated. The CCGs has in the region of 200 health service contracts. Each of these has an expiry date and the CCGs’ constitutions and the emerging changes to procurement law mean all renewals should be scrutinised by the CCGs in order to make decisions about whether contracts are to be decommissioned, tendered or extended. In 2014/15 a number of key contracts will require renewal. Many of the contracts are Suffolk wide. Should the CCG decide on a different direction of travel there will need to be a mutually agreeable solution or whether there will be a divergence and contracts split.

9. Public Involvement

Ipswich and East Suffolk CCG is committed to involving the public and patients throughout the commissioning cycle; in developing our plans, setting our priorities, service re-design and in monitoring the quality of our services through feedback. The CCG will work with patients, the public and providers to close any gaps between the expectation of quality and perception of quality of service received. The CCG is also focused on targeting health inequalities and improving the health of those most in need. The CCG expects its providers to continue to fulfill their obligations in these respects too.

2014/15 presents an opportunity for clinical focus on delivery. The national allocation and local financial assumptions will provide an important context for delivery in 2014/15. There are more than 30 major projects already identified for next year, and we anticipate that further plans will need to be developed to manage the financial duties of the CCG. These plans demonstrate how we will respond to health needs, local clinical priorities and the national priorities for the NHS outlined by the National Commissioning Board. Ipswich and East Suffolk CCG looks forward to working with you in realising the changes to be made for the challenges ahead.

Yours sincerely

Julian Herbert Dr Mark Shenton Chief Officer Chairman


Appendix 1

Agenda Item No.

5

Reference No. From: Part 1 Part 2 GOVERNING BODY REPORT: CCG’s Five Year Clinical Strategy 1. Purpose This paper updates Governing Body Members on progress with the development of the CCG’s five year clinical strategy and sets out the timeline for key strategic commissioning decisions that the Governing Body will need to make, in relation to provider contracts that are due to expire in 2015/16. The clinical strategy provides the strategic context for the CCG’s 2014/15 commissioning intentions, which are considered under a separate agenda item. 2. Background CCG Commissioning Strategy and Clinical Priorities By way of context we have a population of 385,000 in Ipswich and East Suffolk; we have rural idyll and rural isolation, market towns and urban deprivation. We have forty one GP practices, community hospitals, a large DGH, and many other buildings giving health and social care its infrastructure. We have a culturally diverse population, 8,000 people with dementia increasing to 12,000 by 2021 and we are soon to become the second oldest county in the country. 22% of children live in poverty and 50% are not school ready. There is a five and half year life expectancy gap in men between those least deprived and those most deprived. Demographic changes in the population with the projected increases in the elderly, combined with the current financial challenges could create the perfect setting for radically transforming our services.


The CCGs five year Clinical Strategy was agreed in 2012 and is reflected in the CCGs eight clinical priorities:

1. To ensure high quality local services 2. To improve the health of those most in need 3. To improve access to mental health 4. To promote self-care 5. To improve health and educational attainment for children and young people 6. To improve outcomes for patients with diabetes to above national averages 7. To improve care for frail elderly individuals 8. To allow patients to die with dignity and compassion and in their place of

choosing The CCG has agreed key values (PATIENTS) underpinning everything that we do:

1. Patients first 2. Action orientated 3. Team work 4. Integration for improved results 5. Equality of opportunity 6. Never overdrawn 7. Timeliness 8. Safe, sustainable services

Health and Well Being Board The new NHS and Social Care landscape is complex, it is an attempt to wrap the commissioning and provider functions of the health and social care system around our population with the people at its centre. It requires the coordinated effort of many "bodies", "trusts", "groups", "executives" and it requires the inputs and understanding of politicians, managers, clinicians, regulators, social workers, voluntary organisations, carers and, ultimately, our public and patients for us to be able to deliver the vision of "long and healthy lives for the people of Ipswich and East Suffolk" - all of us doing our best to deliver against agreed, shared objectives. These county wide objectives, shared by this and Suffolk's other CCGs are set out by the Health and Wellbeing Board and are summarised below. They have been taken from the Joint Strategic Needs Assessment created by Public Health and lay out the strategy for health and wellbeing of the population of Suffolk.

1. Every child in Suffolk has the best start in life 2. Suffolk residents have access to a healthy environment and take responsibility

for their own health and wellbeing 3. Older people in Suffolk have a good quality of life 4. People in Suffolk have the opportunity to improve their mental health and

wellbeing The Health and Wellbeing board is a statutory body but it has no funds of its own, other than to provide programme office functions and has no Accountable Officer. Its constituents hold both the funds and accountability through their own statutory organisations and the membership includes health, social care, councillors, and the police, children's services, Health Watch Suffolk and the voluntary sector. It is chaired by an appointee of the county council. Having set the strategy, it helps coordinate and hold to account those that commission health and social care, as well as those that


commission services that impact on the wider determinants of health, such as housing, education, law and order. 3. Key Points Over the summer, Clinical Executive and Governing Body members have been working on how to deliver the clinical strategy and have identified five key enablers:

1. Single Urgent Care System including Mental Health. The CCG Chair and Chief Redesign Officer are leading the development of an integrated care strategy, through the Ipswich and East Suffolk Integrated Care Network. A CCG Clinical Executive workshop on 17th September 2013 will begin to firm up the CCGs commissioning approach to this agenda and consider alignment with commissioning partners, including West Suffolk CCG and Suffolk County Council. During October 2013 we will work with commissioning partners to align our commissioning strategies and discuss system integration with Providers through the Integrated Care Network. The November 2013 Governing Body will agree the approach to the Out Of Hours/111/Serco (Suffolk Community HealthCare) contracts which are due to end on 31/3/2015 and 30/09/2015 respectively in the context of the five year clinical strategy and the commissioning of a single urgent care system. The Integrated Care model most frequently commented on is the American "Kaiser Permanente” with Clinicians leading healthcare commissioning and provision. We believe that we can model an Integrated Care Organisation (ICO) with the commissioning and provider structures, and infrastructure that we currently have, without having to create a single organisation. We need to commission outcomes not processes and use our significant resources, to align incentives in our systems, to allow multiple providers to work in an interdependent way, to deliver those outcomes. We believe in strengthening our foundations to achieve this by commissioning a continuing programme of clinical leadership development across our system and having a relentless focus on continuing quality improvement.

2. Mobilising Primary Care Resources. The Chief Operating Officer is working

closely with Primary Care Colleagues to develop a local primary care strategy, within the context of the national and area team strategies for primary care.

3. Mobilising Clinical Leadership to ensure clinically led commissioning and

delivery of Health and Well Being Board priorities. The CCG Chair is leading the development of a programme with local clinicians, to ensure that clinicians are at the forefront of the local healthcare system. This approach includes the development of clinical networks across Ipswich and East Suffolk, which recognises that commissioners need to engage with a broad spectrum of clinicians to develop high quality clinical services. Effective networks will need the broader approach and expertise from all quarters necessary to get the best outcomes. These are not the networks of deciding best practice; they are the networks that will deliver best practice... providers, commissioners of health and social care and patients doing their best for themselves and their network. Networks will span primary, community and secondary health care, voluntary organisations and social care wherever possible. The CCG will move its focus onto the outcomes it wants for its population and share the responsibility for the finance and the outcomes to its networks. These delivery networks will need to have broader ranges of service within them and clearly have much more responsibility attached to them than the current "best practice" networks we are


historically used. Such networks will have a much more positive direct influence over the standards of care for our population.

4. Mobilising System-Wide Partnerships to ensure effective, integrated

system-wide delivery of Health and Well Being Board priorities The Accountable Officer is leading a programme of work with system partners including the establishment of a System Leaders Partnership Board and Suffolk Commissioners Group, to align the commissioning and delivery strategies across the Health and Social Care system. This work involves statutory and voluntary providers, Health Watch Suffolk, Suffolk County Council, West Suffolk CCG and Great Yarmouth and Waveney CCG.

5. Workforce Development including recruitment strategies for hard to

recruit specialisms, including Consultants and GPs. The CCG, through the Accountable Officer, is a member of the Local Education and Training Board in East Anglia, which is leading work on workforce development across the area. The CCG is ensuring that local priorities are captured within the overall priorities of the LETB, given the difficulty in recruiting to some key areas. In addition the CCG is developing recruitment and retention strategies with local providers in particular specialities e.g. Interface Geriatrics.

4. Public Engagement The CCG will engage with patients and the public through the Voluntary Sector, Health Watch Suffolk and other, formal consultation processes where appropriate. 5. Recommendations In summary, the CCG wants to move away from the current commissioner provider relationship with its silo contracts and excessive competitive behaviour that stifle creative energy. It wants a system that is in better equilibrium with itself, one that recognises the value of, clinicians working with patients, extended stakeholders and good management and one that is about quality not quantity, service not size and patients not process. The Governing Body is asked to note:

1. the work to date in developing the five year clinical strategy, including the key enablers and the work by elected GPs and Chief Officers, to progress this work

2. that the Governing Body will be asked to make some strategic commissioning

decisions, in November, to progress delivery of the strategy, using the strategic opportunity that arises in relation to a number of provider contracts that are due to expire in 2015/16.

Author: Dr Mark Shenton/Dr Imran Qureshi/Sandy Hogg


Appendix 2

HWB Priority

1.Every child in Suffolk has the best start in life

2.Suffolk residents have access to a healthy environment and take responsibility for their own health and wellbeing

3.Older people in Suffolk have a good quality of life

4.People in Suffolk have the opportunity to improve their mental health and wellbeing

CCG Clinical Priorities

1.To ensure high quality local services

2.To improve the health of those most in need

3.To improve access to mental health

4.To promote self care

5.To improve health and educational attainment for children and young people

6.To improve outcomes for patients with diabetes to above national averages

7.To improve care for frail elderly individuals

8.To allow patients to die with dignity and compassion and in their place of choosing

Complexity

MP - Major Project

CT - Commissioning Task

DC - Decommissioning


Commissioning Intentions

Integrated Care - Dr McKee / Sandy Hogg / Clare Banyard

Introduction to overarching aims of the

workstream

The Integrated Care Programme supports the Joint Health and Wellbeing Strategy for Suffolk, particularly Outcome 3: Older people in Suffolk Have a good quality of life and cuts across all the CCG clinical priorities. The programme will be delivered as part of a system wide approach to reducing urgent care demand in partnership with stakeholders through the Integrated Care Network.

Key Initiatives

Ensure that health and social care services are integrated at the point of delivery

Ensure provision of proactive care for the frail elderly and those with long term conditions, giving these patients greater control of their care and promoting independence (self-care)

Supports the four emerging principles for urgent and emergency care in England to deliver a system that: 1. Provides consistently high quality and safe care, across all seven days of the week; 2. Is simple and guides good choices by patients and clinicians; 3. Provides the right care in the right place, by those with the right skills the first time; 4. Is efficient in the delivery of care and services



Area HWB Priority

CCG Clinical

Priorities

Commissioning Intention Linked to existing charter QIPP, Invest, Efficiency

Priority Complexity

IC 2, 3 & 4 7 (not self care)

Manage growth in Accident and Emergency (A&E) activity to ensure sufficient A&E capacity for injuries and emergencies that require A&E services. Consideration given to the development of an Urgent Care Centre (single access portal), integrated with primary care, secondary care, mental health and community health and social care services.

No Q, I, E High MP

IC 3 7 (not CYP)

Develop a fully integrated system wide falls and fragility fractures prevention service as recommended using the Glasgow model (Level 1-4) with a main focus of level 1 and 2 service provision underpinned by an updated JSNA.

Yes Q, I, E High MP

IC 3 & 4 All To evaluate the Winter Plans for 2013/14 and develop plans for Winter 2014/15 to support: patients being treated in the right place; flexibility in the system; 7 day working/availability 7 days per week; quick mobilisation across the system; working as a system prior to the point of crisis; collaborative working across system particularly with the voluntary sector and primary care; improving system-wide communication.

Yes (transformation of urgent and emergency care system)

Q, I, E High MP

IC & EOL

2, 3 & 4 7 (not CYP)

Continue development and integration of admission avoidance schemes to ensure that at times of urgent need, when clinically correct, patients are supported in the community and keep patients at home. Improving health and well being and helping to keep people independent and active. Services to be assessed through a Single Point of Access (Care Coordination Centre)

Yes Q, I, E High CT & DC



Area HWB

Priority

CCG Clinical

Priorities Commissioning Intention Linked to existing charter

QIPP, Invest, Efficiency

Priority Complexity

IC & CYP & MH

All All Renewal of NHS 111, OOHs and Serco Contracts during 2015 - consideration as to how these services are provided in the future.

No Q, I, E High MP & DC

IC & CYP & MH

All All A single pooled budget for health and social care services to work more closely together in local areas, based on a plan agreed between the NHS and local authorities - Integrated Transformation Fund (ITF). There will be a need to a two year plans for 2014/15 and 2015/16 which must be in place by March 2014.

No Q, I E Medium MP

All All All Improve 7 day access/working; the overall length of stay and integrated care discharge planning within the acute & community setting. Explore commissioning episodes/packages of care and develop alternatives with the Voluntary Sector for longer term rehabilitation/reablement.

No Q, I, E Medium CT

IC & EOL & CYP & MH

2, 3 & 4 All To work with the voluntary sector and carers in developing integrated pathways to support admission avoidance and early supported discharge. Utilising self care models (shared decision making that supports the optimisations of health for the individual and therefore reduce unplanned demand on the system affecting both health and care). Routine consideration of the use of telecare, telehealth and assisted technology that will increase effectiveness of the workforce or through improved self-management.

Yes Q, I, E Medium CT & DC



Area HWB

Priority

CCG Clinical



Priority Complexity

IC 3 7 (not CYP)

Improved access and efficiencies to system wide reablement services including step up, step down and step across beds/domiciliary care.


IC & MH &CYP

4 All Improve psychological support services for patients with Long Term Conditions.


IC & EOL

3 7 (not CYP)

Continue to commission and integrate an enhanced service with primary care to support patients residing in nursing and residential care homes to improve quality of care; support education and training and reduce urgent care activity. Consideration to extend and integrate this service to Private Retirement Schemes and very sheltered housing. To develop Patient Group Directive specifically for anti-biotic therapy with nursing homes.

Yes Q, I, E Medium CT

IC 3 7 (not CYP)

Continue to roll out Integrated Geriatrics Service to provide a 7 day service and support community hospitals; care homes; admission prevention and early supported discharge through system wide leadership and education.

Yes Q, E Medium CT

IC n/a Diabetes The CCG intends to commission, if not in place by March 2014, a single Integrated Diabetes Service with (1) stringent standards for advising on or treating patients with the greatest need and (2) a structured programme of support to general practice.

Yes (Diabetes) Q, E Medium CT



Area HWB

Priority

CCG Clinical



Priority Complexity

IC n/a People in most need, high quality local services,

The CCG intends to commission an Early Support Discharge service for patients who are admitted to hospital with Stroke.


IC n/a People in most need, high quality local services,

The CCG intends to commission hyper-acute stroke services from both West Suffolk and Ipswich Hospitals following a trial period in 2013/14.


IC & MH

2 & 4 7 (not EOL)

Consider how to improve the delivery of a range of services to people that abuse alcohol and substances that results in a more effective coordinated approach and reduced impact on the acute service.

No Q, I, E Low CT

IC n/a All It will be a requirement that all providers of the Integrated Care Network work to maximise the interoperability of IT systems to optimise the delivery of safe care across the health and social care system. To include robust monitoring processes to evaluate success of admission prevention and early supported discharge programmes.

No Q, E CT



Area HWB

Priority

CCG Clinical



Priority Complexity

All All All Social Marketing & Market Development to ensure that providers and suppliers are aware of the changing pressures, the opportunities available to them and seeks to promote innovative solutions.

No Q, E CT


Medicines Management - Dr Blades, Dr Egan, Dr Solway, Lois Taylor

Introduction to overarching aims of the workstream

To improve the quality and consistency of prescribing for all our patients and continue to generate cost effective prescribing strategies. To ensure we continue to strengthen and develop our relationships with key providers. To ensure patients are put first when developing new

treatment pathways or reviewing current ones.

Key Initiatives

To transform shared care into a safe, comprehensive system that works for patient and clinicians

To ensure all providers adhere to our joint formulary resulting in consistency across all interfaces for our patients.

To ensure primary care are adequately supported to safely initiate and/or continue complex medicines in primary care where this improves the patient pathway.



Area HWB

Priority

CCG Clinical



Priority Complexity

MM 7 Shared care and traffic light adherence - ensure that our providers are aware of the traffic light document and adhere to shared care. Providers will be expected to provide GPs with shared care agreements and ask if they would be willing to participate in shared care. Providers must work with us to streamline and improve the current shared care system. Aim for all shared care agreements to be electronically sent to GPs.

No QIPP, safety High MP (but manageable)

MM 7,8 Formulary Adherence - to ensure our providers adhere to any joint formularies.

No QIPP High MP (but manageable)

MM 2 2,8 Blood Glucose Meters - All providers will be expected to adhere to our guidance on blood glucose meters once finalised.

No QIPP High

MP (but manageable)

MM 7 Local agreements in primary care - we will look to invest to ensure the safe introduction of medicines where appropriate in primary care. We also seek to ensure primary care are supported to provide shared care. Current shared care arrangements will be reviewed with the possible expansion of local agreements to ensure primary care can safely deliver prescribing and monitoring of drugs that have previously been managed by secondary care where this improves the patient experience.

No QIPP, I Medium

MP (but manageable)

PC/MM

2,3 3,6,7 To review current remit of community clinics regarding the administration of medicines and look at possible expansion of service provided to include the administration of rheumatology injections such as zolendronate etc. Or look at possibility of commissioning a community rheumatology nurse to administer injectables to patients in their own homes. This overlaps with planned care priorities.

No QIPP Medium CT



MH & LH - Dr Hague / Sandy Hogg / Carolyn Tester


One of the CCG’s eight clinical priorities is to improve access to mental health services The CCG’s ambition for mental health services is that: • Provision for mental health services will be open and accessible to all people who need it, regardless of their age, diagnosis and severity of their mental health condition(s) and include those marginalised from society. • Mental health services should be integrated. No mental health service user should need to be returned to their GP for onward referral for another mental health service. Moreover, patients who have been identified with mental health needs in a traditionally non-mental health setting should likewise receive timely and high quality care. Many of the commissioning intentions below have been developed and will be delivered in partnership with West Suffolk CCG and Suffolk County Council where issues are county wide.

Key Initiatives

Improve the clinical input provided to meet the mental health needs of patients with physical illnesses

Achieve integrated delivery of post dementia diagnosis dementia services with commissioning partners

Develop integrated pathways for learning disability services that maximise progression, deliver services closer to home and remove barriers between service providers

Ensure that the NSFT service strategy is meeting needs in areas highlighted by service users, clinicians and needs assessments

Ensure that people of all ages have access to earlier assessment and diagnosis for autism and ASD and are supported to access the services that they need



Area HWB

Priority

CCG Clinical



Priority Complexity

MH 4 5 Embedding the new psychiatric liaison service (being established in 13/14 from CQUIN), to improve the clinical input provided to meet the mental health needs of patients with physical illness. Includes collating evidence about the impact of the service and developing plans for 2015 onwards.

Yes Q,I,E High MP

MH 3 and 4 5 Working with commissioning partners to remodel and jointly commission post diagnosis dementia services and continue to ensure that the memory service meets local needs.

Yes I High MP

LD 4 5 Working with partners to remodel learning disabilities services to deliver integrated pathways that promote progression and independence for people of all ages, delivering services closer to home removing barriers between services and providers

Yes Q,I,E High MP

MH 4 5 Reviewing in depth effectiveness of specific NSFT services in the following key areas: o meeting the needs of people with a dual diagnosis and working with primary substance misuse services o providing a response in a crisis o provision of a pathway for people with a Personality Disorder o rehab pathways

NSFT REDESIGN (in draft) Q,E

High CT



Area HWB

Priority

CCG Clinical



Priority Complexity

MH 4 5 Ensure that high quality care packages that provide access to high quality evidence based treatment are defined for people in each mental health PbR cluster by working with commissioning partners across Norfolk and Suffolk to ensure care packages meet local needs within the available financial envelope

MH08 - MH PBR E Medium CT

MH 4 5 Define the future scope and arrangements for joint commissioning of mental health services which maximise recovery by agreeing with partners how current mental health pooled fund arrangements are taken forward

POOLED FUND Q,E Medium CT

MH 4 5 Reduce levels of suicide by increasing understanding of suicide risk in primary care through training

No Q Medium CT

MH 1 & 4 5 To work with colleagues in public health to support development of drug and alcohol services and ensure they work in partnership with primary care and mental health

No Q Medium CT



CYP&M - Dr McCullagh / Sandy Hogg / Carolyn Tester


One of the CCG’s eight clinical priorities is to improve health and educational attainment for children and young people Safeguarding and promoting the welfare of children – and in particular protecting them from significant harm depends on effective joint working between agencies and professionals that have different roles and expertise. Individual children, especially some of the most vulnerable children and those at greatest risk of suffering harm and social exclusion, will need co-ordinated help from health, education, early years, children’s social care, the voluntary sector and other agencies. Many of the commissioning intentions below have been developed and will be delivered in partnership with West Suffolk CCG and Suffolk County Council where issues are county wide

Key Initiatives

Improve mental health services for children and young people

Ensure children starting school are well prepared to participate and learn through promotion of good early parenting and child development

Ensure that people of all ages have access to earlier assessment and diagnosis for autism and ASD and are supported to access the services that they need

Improve the quality of service available to meet the physical and mental health needs of looked after children (LAC)

Develop a true single point of access to all children's and young people's health and social care services



Area HWB Priority

CCG Clinical

Priorities


Priority Complexity

CYP 4 4 • Working with commissioning partners to develop integrated CAMHS pathways for children, young people and families to address gaps in current provision, includes; • Access to evidence based support for children with conduct disorders and their parents and carers and ensuring that services delivered by local partners respond to NICE guidance relating to conduct disorders. • Strengthen investment into Tier 2 capacity, predominantly around Primary Mental Health Workers

Yes I High MP

CYP 4 4 Improve the quality of service available to meet the physical and mental health needs of looked after children (LAC) and meet national LAC guidelines by implementing the recommendations of the local LAC Health review together with partners. This will include significant work around joint commissioning arrangements / frameworks and a significant project to improve Information Sharing across the organisations

LAC I High MP

CYP 1 and 4 4 Developing a joint action plan with partners to coordinate multiple services to maximise preparation for school to ensure children are well prepared to participate and learn through promotion of good early parenting and child development. Includes: family nurse partnership, health visiting, breastfeeding, speech and language development, health child programme and children centres

No Q High MP



Area HWB Priority

CCG Clinical

Priorities


Priority Complexity

MAT 4 Review options to strengthen the adult pathway to ensure appropriate perinatal and post natal mental health support is available by working with providers to develop plans to implement commissioning guidance for perinatal mental health services (expected Autumn 2013)

No Q,I High CT

MAT 4 Review, in collaboration with partners, recommendations from the maternity needs assessment being produced in autumn 2013 by developing an action plan to take forward improvements recommended.

No E High CT

CYP 1 4 Ensure that commissioned services comply with requirements in the Children and Family Bill 2013 and the Special Educational Needs and/or Disability (SEND) reform programme by reviewing contractual arrangements to ensure compliance

No Q Medium CT

CYP 1 4 Ensure children and young people have consistent access to evidence based Speech and Language Therapy (SALT) services by reviewing options for improving capacity and quality of SALT provision with commissioning partners

No Q,I Medium CT

CYP 1 4 Reviewing contractual arrangements to ensure commissioned services contribute to the Suffolk Family Focus which takes forward the national Troubled Family Initiative

No Q Medium CT

CYP 1 4 Explore the scope for setting up a paediatric telephone advice line for primary care by reviewing the options with partners

No E Medium CT



Area HWB

Priority

CCG Clinical



Priority Complexity

CYP 1 4 I&ESCCG will to work with IHT colleagues to ensure correct coding around emergency paediatric admissions, specifically focusing on patient admissions where discharge is under 4 hours

YEs E Medium CT

Planned Care - Dr Bethell / Sandy Hogg / Nerinda Evans


To transform elective care, via a system wide approach, to ensure improved patient experience and outcomes with appropriate levels of access to services that deliver high quality, responsive and proactive care. Professionals from primary, community and secondary care will work together within Clinical Networks, across traditional health boundaries, to improve the entirety of the clinical pathway and manage patient care as locally as possible.

Key Initiatives

Outpatient transformation- including ALL

Formation of Clinical Networks to support elective pathway development

To ensure maximum compliance with clinical thresholds policies



Area HWB

Priority

CCG Clinical



Complexity (MP, CT,

DC) Priority

PC 7 Network development: to work with clinical leads at IHT on transformation of elective care at strategic level.

Yes Q,E High CT

PC 7 Outpatient transformation - to commission outpatient services with a customer focus for a good patient experience, ensuring waiting times are reduced and patients are offered a choice of appointments with the aim of reducing DNAs.

Yes Q, E High MP

PC 7 Ophthalmology - Commission and implement a referral refinement and triage service.

Yes Q, E High MP/CT - Procurement

PC 7, 1 Ophthalmology - Implement a variety of community based pathways including a community based minor oculoplastics service

Yes Q, E Medium MP/CT - Procurement

PC 7, 8 Musculoskeletal - Direct access MRI pilot - consider options for commissioning direct access to diagnostics for MRI to knee, shoulder and spine. Commission patient education and self care programmes for patients with prolonged problems.

Yes Q,E Medium CT

PC 7,8 Musculoskeletal - OA Hip and Knee - Consider options for the commissioning of a service to ensure all patients receive structured advice and information on their condition and treatment. More integrated physiotherapy service.

Yes Q,E High CT

PC 7,8 Musculoskeletal- Spinal pathway- embed pathways guidance to ensure patients benefit from more structured conservative management prior to referral for surgery.

Yes Q, E Low CT



Area HWB

Priority

CCG Clinical



Complexity (MP, CT,

DC) Priority

PC 7 Cardiology- Commission a community intermediate cardiology service to manage the assessment, care and treatment of patients in a community setting. Develop pathways for heart failure, chest pain and heart murmurs. Review provision of echocardiography.

Yes Q, E High MP/CT - procurement

PC 6 Clinical Thresholds - policy procedure embedded into practice with no patients by passing the process.

Yes Q, E High CT

PC 7 7 Day Diagnostics - to work with clinical services to develop and deliver capacity for seven day working

Yes Q, E , I MP

PC 7, 8 Gastroenterology - continue the implementation of inflammatory disease business case and pathway supported by Nurse Specialist resource and using the faecal calprotectin screening test.

Yes Q,E High MP/ CT

PC 7, 8 Neurology - develop improved community service for patients with Multiple Sclerosis, Parkinsons and Epilepsy working with the Specialist Nurses and Consultants

New Q, E , I Medium MP

PC 7 Gastro enterology - developments of pathways for non- alcoholic steatohepatitis, direct access endoscopy, alcoholic liver disease, coeliac disease.

Yes Q, E Medium MP

PC 7, 8 Urology - develop pathways for the management of continence / catheter management, lower urinary tract symptoms, community monitoring of stable prostate cancer, loin pain (renal colic).

New Q, E Medium DC then MP



Area HWB

Priority

CCG Clinical



Complexity (MP, CT,

DC) Priority

PC 7, 8 Rheumatology - develop pathways of care for new onset inflammatory arthropathies, osteoporosis, gout, PMR and shared care for monitoring DMARDs.

New Q, E Medium MP

PC 7, 8 Pain Management - establish an integrated community based pain management service.

New Q, E, I Medium MP

PC 8 Self care - aligns with schemes above and integrated care.

Cancer / EOL - Dr Holloway & Dr Kaiser / Sandy Hogg / Nerinda Evans


To improve cancer outcomes by ensuring cancers are diagnosed promptly, services are compliant with relevant Improving Outcomes Guidance and care is delivered in the most appropriate setting. To develop and provide the best possible services for palliative and end of life care patients, allowing them to be cared for in a place of their choice facilitated by advance care planning.

Key Initiatives

Reduce the number of emergency cancer admissions, by ensuring patients are diagnosed early and pathways are in place to ensure they are able to access oncology advice in a timely manner.

Meet the survivorship needs of cancer patients as they live with and beyond cancer.

Advance care planning for patients at the end of their lives and co-ordination of their end of life care, use of the Suffolk End of Life Pathway.



Area HWB

Priority

CCG Clinical



Complexity (MP, CT,

DC) Priority

CAN 7, 8 Transforming community cancer services - continuously review the learning from the on-going community cancer nurse pilot sites and consider options for commissioning the model beyond the life of the pilot.

Yes Q, I High CT

CAN 7, 8 Level 3 psychology services will be piloted using funding from Macmillan Cancer Support and will form part of Transforming Community Cancer Services.

Yes Q Medium CT

CAN 7, 8 Consider and implement new models for follow up care for cancer patients, based on risk stratification, that address the survivorship needs of cancer patients and ensure access to a supported self management programme and provision of an end of treatment care plan following holistic needs assessment.

Yes Q, E High MP

CAN 7 Continue to commission an acute oncology service to ensure that cancer emergency admissions and cancer bed days are reduced and that one hour door to needle time is achieved for neutropenic sepsis patients.

Yes Q, E Medium CT

CAN 7 Earlier diagnosis of cancer will be supported by revising existing cancer 2ww pathways (upper and lower GI, symptomatic breast) and the development of new referral pathways for suspicious lymph nodes, unexplained weight loss.

Yes Q, E Low CT

CAN 7 All commissioned cancer services will be compliant with the relevant Improving Outcomes Guidance for Cancer, with compliance measured via the cancer peer review process.

Yes Q High CT



Area HWB

Priority

CCG Clinical



Complexity (MP, CT,

DC) Priority

EOL 5 Will continue to commission timely, co-ordinated and consistent palliative and end of life care, including signposting to bereavement services as per the agreed Suffolk End of Life Pathway. Opportunities for providers of end of life care to work together in an integrated approach in the delivery of the pathway will be explored.

Yes Q, E Medium CT

EOL 5 Patients at the end of their lives will be identified and offered advance care planning supported by the yellow folder.

Yes Q, E High CT

EOL 5 Do Not Attempt CPR information will be communicated between care settings using the East of England Form, with the original form staying with the patient at all times.

Yes Q, E High CT

EOL 5 The CCG will work alongside individual providers to develop and implement end of life care plans for each patient backed up by condition specific good practice guidance.

Yes Q Medium CT

EOL 5 End of Life Care will be provided by staff competent in the delivery of end of life care, who have received appropriate training and education in the use of end of life care tools.

Yes Q, E High MP

EOL 5 The Electronic Palliative Care Co-ordination System will be further rolled out to additional providers of end of life care to ensure information regarding end of life care is shared between providers, with the aim of ensuring patients achieve their preferred place of care and emergency admissions at the end of life are avoided where appropriate.

Yes Q, E High MP


HWB Priority

1.Every child in Suffolk has the best start in life

2.Suffolk residents have access to a healthy environment and take responsibility for their own health and wellbeing

3.Older people in Suffolk have a good quality of life

4.People in Suffolk have the opportunity to improve their mental health and wellbeing

CCG Clinical Priorities

1.To ensure high quality local services

2.To improve the health of those most in need

3.To improve access to mental health

4.To promote self care

5.To improve health and educational attainment for children and young people

6.To improve outcomes for patients with diabetes to above national averages

7.To improve care for frail elderly individuals

8.To allow patients to die with dignity and compassion and in their place of choosing

Complexity

MP - Major Project

CT - Commissioning Task

DC - Decommissioning

Documents

Initial Outline Commissioning Intentions 2014/15 - Ipswich and East