Cannock Chase
Clinical Commissioning Group
Annual General
Meeting
Thursday 2nd July 2015
Welcome
Dr Johnny McMahon,
Chair of Cannock Chase CCG
2014-15
Annual Report &
Annual
Governance
Statement
Andrew Donald,
Chief Officer
Journey 13/14
Journey 15/16
Key Achievements for 2014/15 and Next Steps for 2015/16
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Finance
Quality and Safety
Operations
Urgent Care
Commissioning
Primary Care
Medicines Optimisation
Corporate & Governance
Finance Team - Key Achievements for 2014/15
1) Support for the delivery of the 2014/15 control total
2) Significantly improved monthly and year-end processes;
Finance “one team”
3) Annual accounts submitted with no major changes and
clean audit opinion
4) Development of a Medium Term Financial Recovery Plan
(MTFRP)
5) Support to the 15/16 planning and contracting round
Finance Team - Next Steps for 2015/16
1) Support the aim of delivering a balanced budget in 2015/16
2) Alignment of activity and finance data for 15/16 monitoring;
improved reporting
3) Preparations for 16/17 planning and contracting round and
development of QIPP opportunities
4) Build on solid foundations and enhance Finances role – not
just book-keeper but business adviser
5) Explore opportunities for personal and professional
development and also greater collaboration?
Quality & Safety Team - Key Achievements for 2014/15
1) Ensuring the safe transition of services from Mid Staffs Hospital to
Royal Wolverhampton & University Hospitals of North Midlands Trusts
2) Improving the quality and safety of care delivered in Nursing Homes
3) Developing new Quality Assurance (QA) tools for use by
commissioners – automated Quality Impact Assessment
4) Developing new QA tools for use by commissioners – bespoke quality
and safety dashboards
5) Supporting the quality frameworks for new models of commissioning
and services
Quality & Safety Team - Next Steps for 2015/16
1) Strengthening Associate Commissioner role to drive
through improvements in quality and safety
2) Consolidating gains from new Quality Assurance (QA)
systems developed for Nursing Homes, QIA enhancement,
provider benchmarking
3) Developing robust QA systems to reflect the new
commissioning models in the “Way Forward” NHS Strategy
and local initiatives eg Prime Provider approaches.
4) Addressing the underdevelopment of QA systems in
Primary Care through all commissioned contracts. Ensuring
this reflects the key priorities in the Primary Care Strategy.
Operations Team - Key Achievements for 2014/15
1) CC CCG achieved 100% delivery of the Quality, Innovation,
Productivity and Prevention (QIPP) programme in 2014/15
2) Successful QIPP Schemes, including MSK, Continuing
Healthcare and Calprotectin
3) We achieved nearly all of the NHS Constitution standards
(targets) for patients being treated in a timely manner
4) The A&E target to be seen and treated within four hours
at the County Hospital (formerly Stafford Hospital) is now
achieved regularly
5) Map of Medicine has been launched in all practices
Operations Team - Next Steps for 2015-16
• Development of Performance and QIPP monitoring
Framework
• Delivery of 18 weeks across main providers
• Cancer Standards – robust reporting, assurance and delivery
• Maintenance on NHS Constitutional Standards
• Delivery of QIPP
• Maintenance of A & E performance (County)
• Building improved working relationships with both Providers
and CCGs in relation to Contract Management, Performance,
QIPP, Transformation
Key Achievements for the Urgent Care Team in 2014/15
1. Procurement of the NHS 111 Service
2. On Call North in hours
3. Supported Cannock and Stafford with the design,
procurement and mobilisation of the new OOH service
4. Supporting commissioners with the unplanned care model
and patient flow for the County Hospital Health Economy
5. Assist boundary CCG’s in the management of Staffordshire
patients
Next Steps for the Urgent Care Team in 2015/16
1. Mobilisation of the new NHS 111 service
2. Supporting redesign of the Stoke and North Staffs CCG OOH
Service
3. Supporting Cannock and Stafford CCG with delivering their
unplanned care model
4. Implement National Direction for integrated OOH and 111
Commissioning Team - Key Achievements for 2014/15
1) Revised structure Nov 2014
2) Harmonised PoLCV – Pan Black County and South
Staffordshire
3) Statutory consultation - Operational Plan / Minor
Injuries Unit
4) Associate commissioning arrangement
5) QIPP Programme – development and delivery
6) Improved model of Urgent Care post Mid Staffs
7) Internal and external relationships across the CCGs and
CSU
Commissioning Team – Next Steps for 2014/15
1) QIPP = Need to do it all again and more…..
2) Delivery of the Operational Plan priorities
3) Cross CCG working arrangements and delivery
4) Extended work streams – quality and finance
5) Winter Planning
6) Planning and Commissioning Intentions focused on
providers rather than CCG’s
7) A more effective model of working – avoiding staff
fatigue
8) Creation of a small planning team for 2016/17
Our Financial Recovery Plans
Do you know how much we currently spend on activities of
limited clinical value; money we could choose to use differently
Opportunities to use resources differently (FYE)
£
Procedures of limited clinical value (PoLCV)
653k
Excess elective bed days
120k
Referral pathway management (GP referred first
outpatient)
267k
First to follow up ratio (Avoidable follow up outpatient
attendances)
1,241k
Day case procedures that could be delivered in an
outpatient setting
233k
Avoidable A&E attendances
145k
Avoidable A&E admissions
Excess non elective bed days (under construction)
1,440k
93k
Primary Care – Achievements for 2014/15
1) Development on new Primary Care Strategy
2) Innovation, Workforce, Education, including:
• national recognition for Flo telehealth, Map of Medicine, Protected Learning
Time and successful bid to Prime Minister’s Challenge Fund
3) Information Management & Technology, including:
• 100% practices achieving patient online project and summary care record
requirements, all Stafford practices transferred to EMIS and development and
rollout of Stafford and Cannock intranets
4) Establishment of three Cannock Networks, including Patient and Public Reference
Groups in:
• Cannock, Rugeley and Great Wyrley, Cheslyn Hay and Norton Canes
5) Successful level 2 co-commissioning bid
Medicines Management – Achievements 2014/15
1) Electronic prescribing (EPS2) project – improved process for
patients and practices
•
13/26 practices live in Cannock Chase
2) £1.2 million prescribing QiPP delivered across both CCGs:
• Scriptswitch® - used in 40/41 practices across both CCGs
• Care home pharmacist medicines review (1603 patients
reviewed)
3) Domiciliary Medicines Use Review pilot – Rugeley
4) Medicines Waste Campaign: improved awareness for public
& healthcare professionals of >£1.5million of wasted medicines
across the two CCGs
ACHIEVEMENTS SO FAR…National and local targets
Target
2014/15
achievement
Dementia diagnosis rates
(% of expected cases)
67%
Stafford: 59%
Cannock: 66%
Flu immunisation uptake rates
75%
Stafford: 72.2%
Cannock: 71.1%
Reduction in antibiotic usage
Stafford:15.5%
Cannock:11.3%
Stafford: (14.5%)
Cannock: (9.4%)
Access to psychological therapy
(IAPT)
16%
Stafford: 16.23%
Cannock: 17%
Increase in NHS health checks
(Cannock only)
10%
Cannock (10.6%)
Improved hypertension prevalence
16%
Stafford: 15.8%
Cannock: 16.3%
Improved COPD prevalence
(Stafford only)
1.5%
Stafford: 1.49%
What are our priorities for 2015/16?
3. Co-Commissioning
2. Medicines
Optimisation
1. Quality
4. IM&T
5. Workforce
6. New operating Models
- Practices
- Networks
- Federations
Corporate Team - Key Achievements for 2014/15
1) Governing Body & Committee development
2) Development of the Board Assurance Framework (BAF)
3) Processes embedded for complaints handling, Conflicts of
interest, the Risk Register, Audit Tracker and BAF as well as
IG training & awareness raising
4) C&E – Production of the Annual Reports & development of
Network PPGs, Choose Well & Medicines Waste public
awareness campaigns, new website
5) Minor Injuries Unit Consultation
Corporate Team - Next Steps for 2015/16
1) C& E- New way of working, strategy with key priorities
aligned to Operational Plan and FRP. Ramp up engagement &
consultation on future plans.
2) Staff Training eg Mandatory, Easy (hard!), Risk
Management, IG & review of all policies, strategies.
3) HR & work force- improve systems and processes to make
it slicker
4) Governing Body development working with new chairs &
new members.
5) Corporate governance underpinning what we do.
Annual
Accounts
Paul Simpson,
Chief Finance Officer
How we spent the CCG’s money
Cannock Chase CCG
Summary Financial Statement as at 31st March 2015
Acute Contracts
Mental Health
Community Services
Total HCHS
Continuing Healthcare
Primary Care Services
Other Programme Services
Annual
Budget
£000's
87,847
13,942
15,095
116,884
Year to Date
Budget
Actual
Variance
£000's
£000's
£000's
87,847
91,215
3,367
13,942
13,420
(521)
15,095
16,641
1,546
116,884
121,276
4,392
15,414
24,808
1,231
15,414
24,808
1,231
15,638
24,968
1,245
224
160
14
Reserves
4,941
4,941
0
(4,941)
Corporate Running Costs
Corporate Non Running Costs
3,282
197
3,282
197
3,327
253
45
56
166,757
166,757
166,707
(50)
(158,183)
(158,183)
(158,183)
0
In Year Position (Surplus)/Deficit
8,574
8,574
8,524
(50)
Repayment of previous year deficit
9,599
9,599
9,599
0
18,173
18,173
18,123
(50)
CCG Total Expenditure
Revenue Resource Limit prior to repaying previous year
deficit
Cumulative Position (Surplus)/Deficit
Commentary on 2014/15
• Cannock Chase CCG delivered its deficit control total of £8.574m
(with a small “underspend”). This is a significant milestone in the
CCG’s recovery back to financial balance. (note however that the
cumulative deficit as at the end of 2014/15 was £18.2m)
• The CCG also received a “clean” audit opinion on its Annual
Statement of Accounts.
• The main financial variances in 14/15 were as follows:
– Activity over performance at RWT, Burton and other providers partially offset by under
performance at UHNM, resulting in a net over performance on acute services of £3,367k.
– Under performance at SSSFT contributed to a net under performance on mental health
services of £521k.
– Over performance at SSOTP contributed to a net over performance on community health
services of £1,546k.
– Overall position mitigated by use of contingency, QIPP reserves and commissioning reserves
of £4.9m.
Analysis of CCG Expenditure
Analysis of Total Expenditure
£000
Acute Contracts
Ambulance Services
Mental Health
Community Services
Continuing Healthcare
Primary Care Services
Other Programme Services
Corporate Costs
Further analysis
Analysis of Contracted Expenditure
£000
Mid Staffordshire
Hospitals
Burton Hospitals
Analysis of Acute Expenditure
£000
Mid Staffordshire
Hospitals
Burton Hospitals
Royal Wolverhampton
Hospital
University Hosp North
Staffordshire
Walsall Manor Hospital
(acute)
West Midlands
Ambulance
Rowley Hall
Royal Wolverhampton
Hospital
Staffordshire &
Shropshire Healthcare
Staffordshire & SOT
Partnership Trust
Other
Rowley Hall
University Hospitals of
Birmingham
University Hosp North
Staffordshire
Walsall Manor Hospital
(acute)
Other
Forward look – MTFRP
£m
Revenue Resource Limit
Recurrent
Non-Recurrent
Repayment of previous year deficit
Total
Income and Expenditure
Programs
Running Costs
Contingency
Total Costs
Reported surplus/ (deficit)
Repayment of previous year deficit
Reported in year (deficit)/
surplus
% surplus / (deficit)
Non recurring income
Non recurring expenditure
Recurrent surplus/ (deficit)
QiPP
% QIPP
FY 15/16
FY 16/17
FY 17/18
FY 18/19
FY 19/20
162.68
0.42
(18.17)
144.93
165.52
(24.55)
140.97
168.25
(22.90)
145.35
171.03
(17.65)
153.38
173.93
(8.76)
165.17
165.98
2.69
0.81
169.48
160.34
2.69
0.83
163.86
159.55
2.69
0.76
163.00
158.69
2.69
0.76
162.14
158.28
2.69
0.76
161.73
(24.55)
(22.90)
(17.65)
(8.76)
3.44
18.17
24.55
22.90
17.65
8.76
(6.38)
(3.92)%
(0.42)
0.81
(6.03)
4.28
2.63%
1.65
1.00%
0.83
2.49
8.16
4.93%
5.25
3.12%
0.76
6.04
4.80
2.85%
8.89
5.20%
0.76
9.70
4.94
2.89%
12.20
7.02%
0.76
13.03
4.00
2.30%
The Transforming Cancer & End of Life
Care Programme for Staffordshire and
Stoke-on-Trent
John M Sneddon, Non Executive Board Member
Joanne Coulson, Engagement Support Officer
What is the problem?
We have been told that there are serious issues with access,
outcomes and experiences in both cancer and end of life care.
The delivery of care, both for cancer and at end of life, is
becoming increasingly fragmented, families and carers are not
integrated and centered upon their needs and wishes.
We have patterns of inappropriate or unnecessary hospital
admissions particularly in the frail elderly. This is unsettling for
patients and families as well as expensive for the NHS.
What do we want to do?
Develop services along integrated care pathways focusing on
patient outcomes
This puts the needs and expectations of the patient family
and carers at the center of decision making about care
Move more care out of the hospital setting by increasing the
range and volume of services in the patient’s home and other
settings in the community.
How do we propose to do it?
Appoint two SERVICE INTEGRATORS to bring together and
manage all of the existing contracts.
The Service Integrator will be responsible for the day to day
management of the providers that deliver care.
The overall responsibility for the care delivered remains with
the NHS through its direct relationship with the service
integrator.
 The Service Integrator will be responsible for designing a
delivery model and a patient care pathway that will meet
the outcomes agreed with the NHS commissioners.
 Put simply we want to appoint a coordinator or
integrator who will manage contracts and design
pathways.
 We will do this by placing two 10 years contracts to allow
time for the culture of change to be embedded in
practice.
 Years 1 & 2 the Service Integrator will work
with commissioners, service providers AND
service users to design and plan the services
needed, building a ‘road map’ of where they
all want to go.
 The remaining eight years are to deliver a year
on year improvement in service to patients.
What input have patients had in this process?
 Devising the development of Programme Outcomes
Equal partners with the CCGs, NHS England and local
authorities in the evaluation of bidders for the contracts.
Selection of potential Bidders from this process.
Selection of Service Integrator.
Service Users and Implementation of the Contract
A major outcome of the programme is that it meets the needs of
patients, their families and carers in both Cancer & End Of Life
Care pathways.
Question to ponder for the future:
How can WE, as patients, family members and carers, work with
others to see this outcome is met?
How do WE work as equal partners with NHS commissioners,
the service integrator, and medical/social care providers to
monitor the delivery of the care and implement “real-time”
improvements in care.
Improving Patient
Access Project
Dr Murray Campbell & Clive Cropper
Prime Minister’s Challenge Fund
Wave 2
Cannock Practices
Network
IMPROVING PATIENT
ACCESS PROJECT
Why?
Opportunity to address concerns over 08:00 – 20:00,
especially in response to local issues, 7 day working

Mid Staffs effect : MIU, A&E - reduction in hours

Patient concern and demand

Precarious state of CCG finances

Local GP issues -
size of practices
capacity
uptake of extended hours DES
How?
Local manageable pilot to be developed.
Review -
CCG Primary Care Strategy
NHS 5 Year Plan
King’s Fund
BIDS from Phase 1
Patient views
£320,000
Key Requirements and Key
Objectives

Improved access to primary care
- extended hours
- release capacity in hours

Improved collaboration in participating
practices

Promote patient empowerment and selfmanagement/ self-help via education

Support the CCG in reducing MIU/A&E
attendances
Combined GP/Nurse
Practitioner Surgeries

Based in Cannock Hospital

MON-FRI 15:30 – 20:00

SAT-SUN 09:00 – 13:00
Overflow/extras – provides some booked appointments for
patients not able to access their own Practice on MON-FRI
08:00 – 18:30
Sessions
15:30- 20:00
15:30 – 17:30
17:30 – 20:00
15:30 – 18:00
18:00 – 20:00
15:30 – 17:00
17:00 – 18:30
18:30 – 20:00
Supplemented by EMIS functionalities
To allow self-help and self-empowerment to patients
Use of Available I.T

Nursing home pilot

Healthy Living Apps

Adolescents – obesity, self-harm
Release Capacity in Primary Care

Bid is not to address under capacity or poorly managed
appointment systems

45,000 – 50,000 patients included in the Project

1 patient/1000 patients requesting an urgent or late p.m.
appointment, therefore 40-50 appointments per day is
required to help meet this demand.

Freeing up Practice time for example for:

Frail Elderly
on average 15-20/1000 on admission avoidance register

Allow an annual full assessment review and 3-6 monthly
reviews

20-30 minute appointments

With MDT support

Sustainability and future funding
Public
Questions