Appendix 1

Islington CCG Commissioning Intentions for 2017/18 and 2018/19 – background paper and summary of commissioning intentions

1. Synopsis

This paper provides an overview of the financial and operational guidance published by NHS

England and NHS Improvement that sets out a series of actions designed to support the NHS to

achieve financial sustainability and improve operational performance in 2016/17 and deliver

operating plans, and supporting contracts with providers, for 2017/18 and 2018/19.

The guidance launches a two-year NHS planning and contracting round for 2017/18-2018/19, to be

completed by 23 December 2016 that will flow from local Sustainability and Transformation Plans.

The paper sets out further information on the approach to delivering two-year contracts by the 23

December 2016 deadline.

The guidance sets out 2015/16 performance ratings for CCGs in which Islington CCG has been

rated as “good”.

The paper also provides an overview of the first cut of our commissioning intentions for 2017/18 and

2018/19 with those intentions framed within:

Local priorities to deliver the health and improvement priorities agreed through the Health and Wellbeing Board and informed by the Joint Strategic Needs Assessment;

The Five Year Forward View published by NHS England in 2014;

The response of London CCGs to the recommendations published in the “Better Health for London” report commissioned by the London Health Commission;

Collaboration priorities for North Central London CCGs identified through joint work across the CCGs, with Local Authority partners and local providers in early 2015/16.

2. Strengthening Financial Performance and Accountability in 2016/17 On 21 July 2016 NHS England (NHSE) and NHS Improvement (NHSI) published guidance for 2016/17 that set out the agreed legal responsibilities of individual NHS bodies to live within the funding Parliament has decided should be available to the NHS this year. Specifically, it confirms action to dramatically cut the annual trust deficit, and sharpen the direct accountability of trusts and CCGs to live within the public resources made available in 2016/17. The plan includes:

Allocating an extra £1.8 billion to trusts to cut combined provider deficits to around £250 million in 2016/17, and that in aggregate the provider position commences 2017/18 in run-rate balance;

Replacing national fines with trust-specific incentives linked to agreed provider specific performance improvement trajectories to deliver waiting time standards for A&E and elective care;

Agreeing 'financial control totals' with individual trusts and CCGs, which represent the minimum level of financial performance, against which their boards, governing bodies and chief executives must deliver in 2016/17, and for which they will be held directly accountable;

Introducing new intervention regimes of special measures which will be applied to both trusts and CCGs who are not meeting their financial commitments;

Setting new controls to cap the cost of interim managers and to fast track savings from back office, pathology and temporary staffing;

Publishing the 2015/16 performance ratings for CCGs;

Launching a two-year NHS planning and contracting round for 2017/18-2018/19, to be completed by 23 December 2016, and linked to agreed sustainability and transformation plans.

2.1. CCG Ratings

The report sets out a summarised overview of CCG ratings in 2015/16, with Islington CCG has been

rated as “good”. Ratings for North Central London CCGs are summarised in the table below:

CCG

ratings for

2015/16

Overall Well-led Delegated

Functions

Finance Performance Planning

Islington Good Good Good Good Good Good

Camden Good Good Good Good Requires

Improvement

Good

Haringey Requires

Improvement

Good Good Requires

Improvement

Requires

Improvement

Good

Barnet Requires

Improvement

Requires

Improvement

Good Requires

Improvement

Requires

Improvement

Requires

Improvement

Enfield Inadequate Requires

Improvement

Good Inadequate Requires

Improvement

Requires

Improvement

To note from 2015/16 ratings:

In London only Islington and City and Hackney CCGs received a good rating across all categories;

Camden and Haringey “requires improvement” rating for performance stems from performance at UCLH for cancer, diagnostics, and referral-to-treatment and North Middlesex (A&E) respectively;

Enfield overall rating based on their financial position.

For 2016/17 onwards, NHS England is introducing a new approach to CCG ratings. CCGs will be rated in 29 areas, underpinned by 60 indicators, all made available to patients for the first time on the myNHS website. The new areas include six clinical priorities matching those set out in the NHS Five Year Forward View, which will be assessed annually by independent expert panels. These are cancer, dementia, diabetes, learning disabilities, maternity and mental health. 2.2. Sustainability and Transformation Fund for 2016/17 Access to the 2016/17 £1.8bn Sustainability Fund will depend on providers meeting agreed control totals and spending limits as well as their individually agreed performance trajectories for key waiting standards in A&E, Referral to Treatment (RTT) and cancer. The Fund is therefore designed to support providers to reach financial balance whilst improving performance and productivity. Access to the Fund provisionally allocated to providers will be unlocked as they meet their financial control totals. The vast majority of providers have now agreed these control totals. At each quarter, 70% of allocated funding will be released upon achievement of the financial control total, with a further 30% released where a provider also meets its agreed trajectories for delivery of operational standards. This funding also assumes full and effective participation in the STP process by each provider in receipt of an award.

To support delivery of operations standards A&E Improvement Plans and RTT Recovery Plans are being developed by NHSE and NHSI. The 2016/17 A&E Improvement Plan requires all systems to implement five mandated initiatives to improve performance:

Introduce primary and ambulatory care screening in A&E;

Increase the proportion of NHS 111 calls handled by clinicians;

Implement the Ambulance Response Programme;

Implement SAFER and other measures to improve in-hospital flow; and

Implement best practice on hospital discharges to reduce Delayed Transfers of Care (Discharge to Assess, Trusted Assessor etc.).

As a consequence the Islington System Resilience Groups (SRGs) will be re-formed into a Local A&E Delivery Board to focus only on urgent and emergency care rather than RTT and cancer standards as well. RTT Improvement Plans focus on a review of the contract levers in the national NHS contract, a number of pilot projects on transforming elective services, particularly outpatients, and enhancements to the Electronic Referral Service, demand management with CCGs producing referral management plans where Operating Plan referral assumptions are exceeded, and production of formal outsourcing plan to divert activity to other providers where providers are adrift of their performance trajectory. The table below summarises the financial contribution to NCL providers from the Sustainability and Transformation Fund (STF) in 2016/17 and the risks of receipt to that funding from operational performance:

Planned surplus/ -

deficit £000

STF Support

£000

A&E RTT Cancer 62-days

Diagnostics

Whittington -6,400 6,500 Red Green Green Green

UCLH -11,000 14,700 Red Green Red Red

Royal Free 15,500 18,300 Amber Amber Amber Green

North Middlesex 14,100 9,800 Amber Green Red Green

Moorfields 2,632 1,100 Green Green Green Green

Great Ormond Street 2,241 2,400 N/A N/A N/A N/A

RNOH -7,372 1,000 N/A Amber Amber Red

Total Acute 9,701 53,800

Camden & Islington Foundation Trust (C&IFT)

1,700 800 N/A N/A N/A N/A

Barnet, Enfield and Haringey Mental Health Trust (BEHMHT)

-12,500 1,160 N/A N/A N/A N/A

Central and Northwest London Mental Health Foundation Trust (CNWL)

-1,030 2,770 N/A N/A N/A N/A

Central London Community Healthcare NHS Trust (CLCH)

4,820 2,220 N/A N/A N/A N/A

Total 2,691 60,750

Trust planned surplus/deficits are shown after applying the STF support (Whittington Health have a planned deficit of £6.4m after receipt of £6.5m from STF monies).

In 2016/17 North Central London (NCL) providers are working to a collective surplus of £2.7m after receipt of support from STF monies of £60.8m, leaving a deficit before receipt of STF monies of £58.1m. Both Whittington Health and UCLH are recording deficits after receipt of STF monies. (*) All providers within NCL have agreed control totals for 2016/17 in order to receive STF monies with the exception of Barnet, Enfield and Haringey Mental Health Trust (BEHMHT). The rating of provider operational performance in the table above is categorised as follows:

Green: NHS Constitution Standard waiting times are being delivered;

Amber: NHS Constitution standard waiting times are not being delivered but performance is improving towards the standard in line with plans;

Red: Both the waiting time standard and improvement trajectory are being missed. For Islington CCG the main areas of performance risk accrue from:

A&E performance for the Whittington health and care system, with an escalation meeting with NHSE being planned as performance is falling behind the trajectory agreed for the release of sustainability and transformation funds this year. An updated recovery plan has been submitted and performance against the standard has improved in August and September. The Trust is achieving waiting time standards for cancer (62-days), referral-to-treatment and diagnostics;

UCLH cancer performance with delivery of the 62-day cancer waiting time standards not expected until September 2016, and diagnostics with delivery of the six-week waiting time standard not expected until July 2016.

2.3. Operating Plans for 2017/18 and 2018/19 Following submission of final STP Delivery Plans in October each STP footprint will need to agree two-year operational plans and contracts with providers that will underpin delivery in 2017/18 and 2018/19 by 23 December 2016. To support this planning guidance was published on 22 September 2016. Two-year operational plans and contracts will be based on the STP that in turn sets out how individual organisations will play their part in delivering their locally agreed STP objectives, including sustainable financial balance across the health economy. Operating plans for 2017/18 and 2018/19 will therefore focus on collaborative actions across local health economies supported where appropriate by system control totals. Initial NHS England guidance indicates that:

There will need to be a change in the behavioural dynamics of planning /contracting towards a more collaborative process;

This will be underpinned by simplifies approaches to contracting and flexibility in implementing strategies;

Partnership working will be incentivised by a number of funding streams available at an STP level;

Local health economies with robust STPs could adopt system control totals for finance, providing opportunities for the transparent sharing of risk.

Operating Plans for 2017 to 2019, and the supporting contracts with providers, will need to address:

The clinical case for change set out in the STP including a significant reduction in health inequalities;

The significant financial gap across the health and care economy;

Variable service quality across providers across both primary and secondary care;

Workforce recruitment and retention;

Delivery of NHS Constitution waiting time standards for A&E, Cancer, and referral-to treatment, as well as the new mental health access standards for psychological therapies and early intervention in psychosis.

2.4. Local response Work is underway locally to prepare for the requirements set out in the recent guidance for:

Settlement of the 2016/17 contract position with providers to provide a platform for negotiating and agreeing contracts for 2017/18 and 2018/19;

Plans to deliver contracts for 2017/18 and 2018/19 by 23 December 2016. This is supported by development of a commissioning strategy as an enabler for the NCL Sustainability and Transformation Plan.

2.4.1. Settlement of 2016/17 position CCGs will seek to agree year-end settlements with providers for 2016/17 in order to:

Close the gap on baseline financial assumptions for 2016/17 in the NCL Sustainability and Transformation Plan that accrues from over performance on acute contracts that puts at risk the opening baseline assumptions of the NCL Sustainability and Transformation Plan (STP);

Provide a baseline position for the negotiation of contracts for 2017/18 and 2018/19 by the end of December 2016.

2.4.2. Contracts for 2017/18 and 2018/19 Work is underway to prepare for delivery of contracts for the next two years including consideration of contract form that will best deliver strategic objectives and investment in prevention, primary care, and community services.

The experience on contracts to date in 2016/17 indicates that in the longer-term system incentives

need to be re-aligned to support delivery of NCL STP:

Payment-by-results (PbR) in 2016/17 causes an opportunity cost of investment in primary care and prevention;

PbR does not incentivise investment in prevention and primary care and is inflationary (drives up cost);

Contracts for 2017/18 need to set a road-map for realigning incentives and commissioning models to support STP objectives. This presents an opportunity and challenge for both commissioners and providers.

Consideration of contract form, as part of the road-map for realigning incentives and commissioning models to support STP objectives, includes the value based commissioning approach and experience from elsewhere (Vanguards) and in particular a minimum income guarantee approach used in places such as Bolton. The minimum income guarantee approach includes:

An income guarantee contract (with no financial consequences for CQUIN or penalties);

A system pool for urgent care risk;

Access to a local fund for provider performance and local priorities;

Access to transformation fund through the STP. Within the minimum income guarantee the following arrangements apply:

An activity reduction incentive for services where there are opportunities to reduce activity shift activity into different settings or delivery models. Payment is based on a level of income which is protected against activity reduction with the intention to create conditions in which there are opportunities to reduce activity where it is clinically and economically appropriate to do so. This could be used for outpatients, electives and daycases, diagnostics, and direct access;

A cost reduction incentive for services where there is potential cost reduction opportunities, in particular for pass through costs. This allows providers to retain the benefits of cost reductions for an agreed period for areas where there are potential cost reduction opportunities. This would

include estates costs and pass through payments for high-cost drugs. A risk-share arrangement could apply here to share the benefits of cost reductions;

Fixed income - payment is fixed for areas where activity and costs are relatively controllable or stable and can be prioritised within available resources. This could include community services, telephone clinics, readmissions, maternity, devices, and CQUIN;

A cost risk-share. Here the minimum level of income is guaranteed and in the event of activity being above plan the system takes joint responsibility, as a single place, to develop action plans. If activity remains over plan additional funding over the minimum income guarantee will be agreed to support additional costs.

Analysis is underway by North East London Commissioning Support Unit (NELCSU) to see if this approach is applicable within North Central London, against the outcomes to:

Realign systems incentives and get off payment-by-results (PbR) contracts;

Enable targeting of investment in prevention, primary care and out-of-hospital services;

Deliver better services and outcomes for patients;

Address historical activity trends. The table below summarises this approach to provider contracts:

North Central London proposed contract arrangement for 2017/18 and 2018/19

Activity Reduction Incentive Cost Reduction Incentive Fixed Income Cost Risk Share

Payment based on a level of

income which is protected

against activity reduction. This is

intended to create conditions in

which there are opportunities to

reduce activity where clinically

and economically appropriate

Payment based income

flowed in 2015/16. If costs

reduce then the Trust will

retain any benefit for an

agreed period. In the event

that costs rise, the CCG will

be liable. This is intended to

put rewards into the system

for reducing costs in this

area

Payment level is fixed

The minimum level of payment

is guaranteed. In the event of

activity above plan the system

as a single place will take joint

responsibility and develop

action plans. Additional funding

over the minimum income

guarantee will be agreed

between CCG and Trust to

support additional costs.

For services where there are

opportunities to reduce activity,

shift activity into different

settings or delivery modes.

For services where there

are potential cost reduction

opportunities.

For services where

activity and costs are

relatively controlled or

not volatile and can be

priorities within

available resources

Services

Day Case/Elective Pass through excluded

drugs Community Services Critical Care

Outpatients Estates Telephone Clinics A&E Diagnostics Unbundled Readmissions Non Elective Secondary care therapies Excluded devices Direct Access Best practice tariff Acute block

CAMHS

CQUIN Integration Maternity Pathway

Initial conversations on the contract approach for 2017/18 and 2018/19 have been undertaken with Whittington Health.

2.4.3. Planning timetable The table below sets out a draft planning timetable from NHS England to support the delivery of two-year contracts by 23 December 2016.

Programme Area

Services (Free Text)

Commissioning Intention Theme /

Objective Commissioning Intention (Free Text) Timescale Proposed Outcome measure (Free Text)

Integrated Care

Community Nursing

Quality Improvement Building on existing joint work between Islington and Haringey, we will review the Community Nursing offer (including specialist nursing) and pilot the Buurtzorg model within the next 12 months. Based on this work we will confirm an improved model for Islington and Haringey Community nursing, building service capacity and improving quality, for delivery from 1 October 2017 at the latest.

12 months Increased time at home

Integrated Care

Integrated Discharge Service

Transformation Implementation of an Integrated Discharge Function. The changes in practice facilitated by introducing this improved discharge function will bring together acute discharge with community based provision to better facilitate hospital flow, with a focus on discharge to assess as a way of working. Collaborative working across organisations will aim to deliver this in full by July 2017 at the latest.

9 months Increased time at home Increased independence

Integrated Care

Single Point of Access (Integrated Network Co-ordination)

Productivity To explore options around developing the Integrated Network Co-ordination service into a professional facing single point of contact. To make a decision on this proposal within 6 months, 1 April 2017.

6 months Increased professional satisfaction Increased response to referrals

Primary Care Locally commissioned Service for Sexual health-to promote and support STI testing in primary care.

Re-commissioning A locally commissioned service (LCS) is currently in place for sexual health, supporting and promoting STI testing in primary care. Public health are currently reviewing models and may wish update the specification for 2017/18.

6 months Activity is currently monitored and measured via the following read codes, • HIV positive: 43C3 • Hepatitis B surface antigen positive: 43B4 • Hepatitis C viral RNA PCR positive: 4JQD • Chlamydia test positive: 43U8 • Gonorrhoea positive: 4JQA • Syphilis titre test positive: 4382 Additional a yearly audit need sto be completed and returned

Primary Care Locally commissioned Service for Sexual health-to promote take of Long acting reversible contraception in primary care. These services includes the provision, fitting, checking, monitoring and removal of intrauterine contraceptive devices, and the fitting and removal of contraceptive implants

Re-commissioning There is currently a Locally commissioned Service (LCS) for Sexual health-to promote taking of Long acting reversible contraception in primary care. These services includes the provision, fitting, checking, monitoring and removal of intrauterine contraceptive devices, and the fitting and removal of contraceptive implants. Public health are currently reviewing models and may wish update the specification for 2017/18.

6 months Practitioners are monitored through quarterly submissions to the CCG on number of fittings reviews and removals per fitter, plus completion of an annual audit. Additional a yearly audit need sto be completed and returned

Primary Care Locally commissioned service - The service can be provided to Female clients aged 13 to 24 (inclusive), requesting Emergency Hormonal Contraception (EHC)

Re-commissioning There is currently a Locally commissioned service (LCS) to provide Female clients aged 13 to 24 (inclusive), with Emergency Hormonal Contraception (EHC) when requested. Public health are currently reviewing models and may wish to update the specification for 2017/18.

6 months All consultations and precribing are entered on to webstar. LBI monitors activity through this data base. Reduction in teenage preganacies and abortions monitor through public health data and abortion data.

Community Abortion of pregnancy

QIPP Providers will be contracted from April 2017 for 3 years under an any qualified provider contract

6 months Increase in early medical abortion. Reduced activity within acute setting (NELLIE), reduced finanical spend.

Mental Health

Islington Work and Well Being Partnership

Audit / Review Review the Work and Well Being Partnership to ensure alignment to Prevention offer

9 months

Mental Health

Primary Care Mental Health Service

Audit / Review Review the Primary Care Mental Health Service and associated QIPP savings

9 months Being agreed at business investment meetings currently for 16/17

Mental Health

Developing Commissioning Approaches to Support Population Based Healthcare

Productivity Agreement with C&IFT as to how the implementation of MH Tariff will support delivery of new integrated models of care including health and employment , the rehabalitation and recovery accommodation pathway, and primary care mental health

18 months Agreement on the implementation the mental health tariff

Mental Health

Review the Community Eating Disorder Service with Childrens and NHS England Eating Disorder Commissioners to inform commissioning intentions for 2017-18

STP A review of the Community Eating Disorder Service with Childrens and NHS England Eating Disorder Commissioners will take place to inform commissioning intentions for 2017-18. Part of the NCL STP

18 months to be determined

Mental Health

Develop a 5 borough NCL Crisis Pathway Plan as part of the STP for NCL

STP Review Crisis Pathway across NCL and develop a transformation plan as part of STP

Phased plan

to be determined

Mental Health

Integrated Practice Unit for Psychosis and Physical Health Care

Audit / Review monitor the implementation of the Integrated Practice Unit for Psychosis and Physical Health Care and review the alignment of commissioning approaches for relevant services falling outside the IPU e.g. our primary care approach and the LBI/C&I S75 arrangement

Other Agreed in contact for 16/17

Mental Health

Secondary Care Mental health Services

Audit / Review Review impact of wait list clearance in 2016-17 to inform robust understanding of activity underpinned by robust performance and quality management by CSU

Other Reduction in waiting lists, both numbers and length of wait

Mental Health

Residential Rehabilitation Pathways

STP Complete a value based commissioning exercise for Residential Rehabilitation Pathways (supported by NHS IQ: Leading Transformational Change programme), to support commissioning intentions for 2017-18.

Other

Mental Health

Business Innovations

Audit / Review Implement the recommendations from our review of value produced by investments (recurrent and non-recurrent) from 2013-14,15 & 16 .

Other

Mental Health

Trust activity and capacity planning

Audit / Review develop our approach to capacity and activity planning for the C&I contract. Specifically we will be working to strengthen links between activity, need and the contract, and ensuring clear links between activity planning to investment and service developments

Other

Mental Health

Improve Access to Psychological Therapies

Increase resourses within the service in order to continue to deliver a high quality IAPT service, increasing capacity within primary care, and reducing need for secondary care services.

9 months Increase capacity within primary care (and maintain increased access levels to IAPT at 17%); To meet the local demand in a timely manner and deliver high-quality care; Reduced number of referrals to secondary care mental health services; Support people to move off benefits and into employment.

Integrated Care

Rapid Response - Enhanced Virtual Ward

Wellbeing Partnership

Our Wellbeing Partnership: To review rapid response services across Islington and Haringey in order to develop a common offer, facilitating the reduction of non-elective emergency admissions.

12 months Increased care provided closer to home

Learning Disabilities

Islington Learning Disability Partnership

Audit / Review To review the integrated multi-disciplinary ILDP, in line with changing demographic, strategic and financial contexts

12 months ILDP will have a clear service specification, which will include how it will address the needs of the LD population with specialist community services and support mainstream services to make reasoanble adjustments. Specific outcome measures and KPIs will be developed as part of this.

Diagnostics Neuro-developmental disorders service

Productivity To improve the capacity of the NND service to meet the needs of people with Autism & ADHD in Camden & Islington

Phased plan

People in Camden and Islington will be able to receive a timely diagnosis of Autism or ADHD and access to treatment for those diagnosed with ADHD. Specific outcome measures and KPIs will be developed as part of this.

Community Wheelchair Service

Productivity To improve the capacity of the service to ensure disabled people in Cameden & Islington can access the right wheelchair quickly and that this is properly maintained and repaired

12 months Disabled people in Camden & Islington will be able to access the right wheelchair quickly, including quick access to maintenance and repair. Specific outcome measures and KPIs will be developed as part of this.

Learning Disabilities

All Transformation To ensure people with learning disabilities or autism who also have mental health conditions or behaviours viewed as challenging receive equal access to high quality, appropriate and timely interventions across the healthcare system to enable community living and prevent or reduce the need for hospital admissions

Phased plan

People with learning disabilities or autism who also have mental health conditions or behaviours viewed as challenging will be able to receive the support they need in community services and specialist inpatient admissions will be rare and short-term.

Learning Disabilities

All Quality Improvement To ensure people with learning disabilities, particularly those with additional complex health needs, receive equal access to high quality, appropriate and timely interventions across the healthcare system to identify and treat health conditions, improving well-being and preventing premature deaths

Phased plan

People with learning disabilities, particularly those with additional complex health needs, receive equal access to high quality, appropriate and timely interventions across the healthcare system to identify and

treat health conditions, improving well-being and preventing premature deaths

Medicines Management

Acute care Productivity To increase cost effectiveness of high cost drugs

12 months Gain/Risk share scheme in line with London Procurement Programme recommendations for 17/18

Medicines Management

Ophthalmology Productivity To increase cost effective delivery of ophthalmic high cost drugs

12 months Reduction in price from £289 to £171 plus MFF

Medicines Management

All Productivity To reduce National Tariff excluded drug cost charges to acquisition cost only.

12 months Reduction in additional drug costs

Medicines Management

All Productivity To reduce unwarranged variation in productivity and performance in acute trusts in line with the Carter review: https://www.nhsproviders.org/media/1746/otdb-lord-carter-report.pdf

12 months Increase in prescribing pharmacists as a proportion of total hospital pharmacists and other measures (see Acute MM document)

Medicines Management

Primary Care of older people

Quality Improvement To commission a Domiciliary Medicines Use Review Locally Commissioned Service from community pharmacists

12 months Reductions in hospital admissions and adverse drug reactions and improved medicines adherence as evidenced by similar scheme in operation in Croydon CCG

Planned Care

Ophthalmology acute service

Re-commissioning Commissioners would like to agree that either the Royal Free, or the Whittington repatriate the ophthalmology service that is currently jointly delivered by both hospitals. We would wish to maintain the locations that the service is currently delivered in however, for admin and patient safety reasons - 1 provider should lead the service.

6 months Improved administrative delivery of the service

Planned Care

Obesity Services New Service To commission a Tier 3 Obesity Service for Islington residents in line NHS England guidance.

6 months A decrease in the numbers access tier 4 (surgical) services in the acute setting. The service is currently not provided and therefore, people who require intervention for their obesity are not receiving the required service.

Planned Care

CKD acute service

Re-commissioning To commission a community element to the RFH CKD service including triage and nurse led clinics.

6 months A decrease in the numbers being seen in the community CKD service

Planned Care

Neurology acute service

Quality Improvement To commission for agreed neurology clinical pathways and recommendations from the London Strategic Clinical Network for Neuroscience

12 months A decrease in neurology spend as Camden and Islington are an outlier.

Planned Care

Pathology Quality Improvement In order to improve detection of chronic liver disease, we would like the asparate aminotransferase test (AST) to be included in a normal panel of blood tests at no additional charge.

6 months Commissioned as a result of the NALFD pilot to improve detection of NALFD.

Planned Care

Pathology Quality Improvement In order to improve detection of chronic liver disease, we would like the analysis of GP requested ELF tests to be commissioned from the North Middlsex pathology department.

6 months Commissioned as a result of the NALFD pilot to improve detection of NALFD.

Planned Care

MSK community, MSK acute, Rheumatology, Orthopeadics (surgery), Pain services, diagnostics

Wellbeing Partnership

To commission a new model of care for MSK services, across community and secondary care.

12 months Improved patient pathways across the whole of MSK services in order to improve outcomes, improve care and reduce overall spend.

Planned Care

Moorfields A&E, acute ophthalmology services

Re-commissioning To commission a minor eye conditions service, delivered in the community by optometrists that will impact on the number of minor eye conditions seen in the acute setting.

Other From Apr 17, to see a reduction in A&E and outpatient activity for minor eye conditions that can be seen in the community service which will go live in December 2016.

Planned Care

Acute ophthalmology services

Re-commissioning To commission a minor eye conditions service, delivered in the community by optometrists that will impact on the number of minor eye conditions seen in the acute setting.

Other From Apr 17, to see a reduction in A&E and outpatient activity for minor eye conditions that can be seen in the community service which will go live in December 2016.

Children and young People

Hospital at Home Activity Change (place / type / coding)

Whittington Health and UCLH to refer eligible Transitional Care Babies into the Hospital at Home Service and to work with commissioners to further extend scope of service

6 months Increased activity in H@H. Proms.

Children and young People

Personal Health Budgets (continuing care, palliative care and further service to be identified)

Quality Improvement Whittington Health to work with commissioners to role out personal health budgets to children and young people.

18 months 40-80 children and young people to be in reciept of a personal health budget by 2020

Children and young People

Transition (children and young people services)

Quality Improvement Providers to implement the NICE quality standards for transition to adult services.

12 months NICE transition guidance implemented across all services

Children and young People

Asthma standards (children and young people services)

Quality Improvement Providers to implement asthma standards (Healthy London Partnership)

12 months Asthma standards implemented

Children and young People

London Paediatric acute care standards (children and young people acute services)

Quality Improvement Providers to implment London Paediatric acute care standards (Healthy London Partnership 2016)

12 months London Paediatric acute care standards implemented

Children and young People

London Paediatric critical care standards (children and young people acute services)

Quality Improvement Where appropriate levels apply, providers to implement London Paediatric critical care standards levels 1 and 2 (Healthy London Partnership 2016)

12 months Where appropriate levels apply, providers to implement London Paediatric critical care standards levels 1 and 2

Children and young People

Delivery of SEND Services to deliver local offer and statutory requirements within EHCP

Quality Improvement To ensure professionals provide timely information to inform statutory EHCP processes and deliver robust local offer services

Other All EHCPs to have been informed by appropariate clinical advice / assessment where required weithin the required timeframe.

Children and young People

Implementation of recommendations set out in Review of ASD Assessment and Diagnostic services

Quality Improvement To address excessive waiting times within ASD Pathway

6 months Waiting Time

Community CNWL- Elipse service, St Johns & elizabeth hospice, Marie Curie hospice and St Joseph's hospice

Re-commissioning Commissioned Last Years of Life (LYoL) services will be reviewed in 2016 with a view to recommission services that are effective and performing well and decommissioning services that no longer meet the CCG's strategic objectives .

18 months The contract will include requirements to measure quality impact through seeking service user feedback and other KPIs linked to the quality will be confirmed with provider once in place.

Older People Intermediate Care

Transformation The intermediate care system will be redesigned in collaboration with Haringey and existing providers in order to improve outcomes for patients and services users. We will take a whole system approach which will result in de-commissioning services which are not meeting our needs reconfiguring existing services ro deliver improvements for all.

Phased plan

These will be developed via a collaborative commissioning approach over the development of a new Intermediate Care service

Older People Dementia Audit / Review The whole system review of Dementia will: 1. Set out the current baseline of provision 2. Benchmark the current provision against national standards and consider other models 3. Identify any potential gaps and areas where we excel 4. Advise on opportunities for improvement to increase the value offered for people with dementia in Islington. 5. Will help set clear priorities and outcomes for Dementia services in Islington

6 months Any proposed outcomes will be developed through the review

Primary Care Opiate prescribing

To provide opiate substitute prescribing in a primary care setting

Locally Commissioned Service to continue. Monitor the Locally Commissioned service this year.

12 months Outcome: Increase in patient's achieveing patient goals as described in patient care plan.

Primary Care Primary Care Alcohol and Drugs Service

Psychosocial interventions for substance misuse in partnership with GP prescribing.

Service to continue in 2016/17. Subcontracted by Camden and Islington Foundation Trust in order to facilitate integrated working with Practice Based Mental Health. Review integration process

12 months • Minimised harm to service users, their families, their carers and the wider community. • Increased numbers of people accessing drug and alcohol treatment services. • Increased numbers of people recovering from drug and alcohol misuse – including increased numbers of people becoming abstinent from their problem substances. • Increased understanding of alcohol and drug

misuse and treatment options and other support available to people with alcohol and/or drug misuse problems in Islington amongst Islington residents.

Public Health Alcohol Liaison To identify and engage patients whose hospital admission/attendance is alcohol related and work with them to prevent or reduce further admissions.

Service to continue in 2016/17. Review service model in year.

12 months • Reduce alcohol consumption in patients given a brief intervention • Reduce repeat attendances to A&E (within 30 days of previous attendance) including those with concomitant mental health needs • Reduce the number of alcohol-related admissions and re-admissions • Shorten the length of stay for hospital admissions • Improve access to alcohol treatment • Increased use of alternative primary care and community services • Improved skill base of existing Mental Health A&E Hospital Liaison to address the needs of people with alcohol problems and mental health issues • Improved skill based within the acute sector workforce through training in identification and brief advice and management of acute alcohol withdrawal • Improvement in mental and physical health wellbeing • Prevention of alcohol

related deaths and illness • A reduction in bed days associated with managing acute alcohol withdrawal • A reduction in alcohol fuelled violence and aggression against hospital staff.

Primary Care Productivity Digitisation of records to free up space in practices

Phased plan

Better utilisation of building. In some practices there will be an increase in clinical space that can be used to see patients

Primary Care Productivity Implementation of e-consultation Phased plan

Additional primary care capacity

Primary Care Walk in Centre Systems Resilience Remodel the Walk in Centre to improve access Other Additional primary care capacity for Islington residents

Primary Care Direct booking into general practice from IUC service

Transformation To develop an incentive for general practice to enable the IUC to be able to make direct bookings into general practice appointments

12 months Improved access for patients to primary care

Primary Care Improve access to primary care during core hours as part of commitment within SCF to deliver care 8am-8pm

Activity Change (place / type / coding)

To agree a baseline capacity for primary care core services

12 months Improved access for patients to primary care

Primary Care Commission LCS portfolio on a population basis through the Federation of general practices

Transformation To commission the LCS portfolio through the GP Federation in order to secure full population coverage. The LCS portfolio will be realigned against the SCF - co-ordinated, proactive and accessible care

Other 100% of patients eligible for services are offered

Primary Care Interpretation services

Re-commissioning To commission interpretation service from London framework on expiry of current contract

12 months Patients have access to interpretation services

Primary Care Build team around the practice

Transformation To commission new roles within primary care to support the development of capacity

6 months Improved access for patients to primary care and irproved outcomes for the workforce

Urgent and Emergency Care

Commission NCL wide ESD for stroke

Transformation To commission NCL wide ESD for stroke to improve pathway from HASU and ASU

Other Reduced LOS at ASU, better outcomes from ESD for patients