Doncaster
Clinical Commissioning Group
Moving forward, getting better
Five year commissioning strategy:
2014/15 - 2018/19
Contents
Journey started and destinations planned
4
1.Introduction
5
2.Our vision, mission and our values
6
3.Our five year system vision – three strategic ambitions
7
3.1Overview
7
3.2 Care out of Hospital
7
3.3 Care of the Frail
8
3.4 Co-ordinated Care
8
3.5 The five year vision – how it looks and how it feels
9
3.6Impact
14
3.7 Sustainability for future generations
16
3.8 Managing Risk
20
4.Partnerships and Engagement
20
4.1Partnerships
20
4.2Co-Commissioners
21
4.3Providers
21
4.4 Patients and Citizens
22
5.Making it happen
22
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Foreword
One year on from the launch of NHS Doncaster Clinical Commissioning Group (DCCG) and
the story of our new organisation is similar to a plane that has just taken off – a steep
angle of ascent followed by stabilisation and trimming as we set our flight path.
To keep the aviation analogy, we have all worked hard to get the ‘plane’ ready. It’s easy to
spot the pilot and co-pilot but a successful flight is dependent on a wider ground crew who
are sometimes less visible but key to making sure the destination is reached safely, on
time and on budget. We have brought together a strong team with more clinical depth than
the Doncaster NHS commissioning function has seen for many years.
Crucially, we are a clinically led organisation, which means GPs – most patients’ front
door to the NHS – are using their skills, experience and knowledge of the health needs of
Doncaster’s communities to set the route. But they are not working in isolation. We know
that reaching important destinations and achieving on-going success hinges on listening
to our patients – our passengers - and learning and acting on their experiences. Above all
we are committed to making continual quality improvements, ensuring that what we do is
always in the best interests of Doncaster people.
We have spent a lot of time planning our journey, talking to patients, public and partners
who all have seats on our plane as key stakeholders. This document is very much a
shared vision for a journey to a number of healthcare destinations. Cancer detection and
treatment, community services, unplanned care and children’s services are already plotted
on our map and other important healthcare services are on our radar.
Helping you keep well is our organisational strapline and fundamental to our vision and
journey. It underlines how effective healthcare delivery is a two-way partnership between
our CCG and our patients.
Looking back, we have travelled a long way since 1 April 2013. There is much more to do
and many more healthcare settings and services to visit. We know that, with financial and
other pressures impacting on the NHS, it won’t always be a smooth flight. But we intend to
minimise any turbulence by being open and transparent and keeping everyone informed at
every point. Our focus is on our final destination - and that’s to provide the best possible
quality health services within easy reach of Doncaster people.
Dr Nick Tupper
Clinical Chair
4
Chris Stainforth
Chief Officer
1. Introduction
The aim of this document is to communicate the five year strategic vision that we have
developed following consultation and engagement with local partners and patients.
It will also demonstrate how we plan to achieve our vision through outcome focussed
delivery plans.
The challenges facing the NHS and partner organisations in Doncaster are extensive.
Health and wellbeing is improving in Doncaster for both men and women but not as fast as
in some other areas.
In general, lifestyles in Doncaster are less healthy than in other areas of the country.
Doncaster has a higher death rate from conditions such as cancer, heart disease and
respiratory disease.
There are increasing numbers of older people in the borough, many live alone and require
help and support to maintain their independence. The number of people living with
dementia is also increasing.
In addition, there is a requirement for the NHS to save £30 billion from the overall NHS
budget in the next five years whilst ensuring high quality care for all, now and in the future.
The DCCG was formally established 1st April 2013 and, as a new organisation, we believe
it is necessary to consider the issues facing Doncaster from an evidence base and from a
partner and patient perspective.
We did this by:
• identifying and understanding need
• engaging with partners and patients
• setting three strategic ambitions
• developing six outcome focussed delivery plans
This document provides our response to the issues facing Doncaster as we move forward
over the next five years.
5
2. Our vision, mission and our values
Our vision sets the ambition for the organisation. Our mission statement is our statement
of purpose as an organisation. Our values drive the culture of the organisation and provide
an anchor for everyone in the organisation against which to test behaviour and delivery.
These were created and agreed as DCCG began to develop. They still stand strong today.
VISION
Work with others to invest in quality healthcare for Doncaster patients
MISSION
A high quality, accountable CCG, encouraging responsible partnership engagement
in a transparent climate of ongoing learning in order to create a patient–centred yet
financially astute and corporate approach to commissioning
VALUES
•The needs of patients are paramount
•DCCG will drive forward continuous improvement
•Relationships based on integrity and trust
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3. Our five year system vision – three
strategic ambitions
3.1 Overview
The focus for our five year strategic vision is to concentrate on three connecting service
areas which will be a catalyst for systematic transformational change. These are:
1.
Care out of
Hospital
2.
Care of the
Frail
3.
Co-ordinated
Care
It is the view of the DCCG Governing Body, having worked closely with partners and
patients, that delivering significant change in these areas through outcome focussed
delivery plans will ensure tangible and measurable service improvements for all Doncaster
patients.
3.2 Care out of Hospital
3.2.1 DCCG Care out of Hospital definition
Our definition of Care out of Hospital is the provision of patient centred care outside of a
hospital setting, either in the patients home or based around a primary care community
team.
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3.2.2 Why Care out of Hospital?
Evidence suggests that approximately 20 per cent of the population have a moderate
mental or physical long term condition. Five per cent of the population have multiple, often
complex, mental or physical long term conditions. The Government has also determined
that there will be a specific focus on those patients aged 75 and over and those with
complex needs.1
3.2.3 Our Goal
We believe that care provision should be holistic, co-ordinated and integrated with services
across partner agencies. The patient should be central to the commissioned care model to
support choice of treatment, improved patient experience, improved outcomes and a more
efficient service delivery model. Where possible, services should be provided outside
of an acute hospital setting and they should focus heavily on getting patients as fit and
healthy as possible to maintain their independence.
3.3 Care of the Frail
3.3.1 DCCG Care of the Frail definition
Our definition of care of the frail services is the provision of high quality co-ordinated care
that meets the needs of the patient based on integration, prevention, patient and carer
involvement and access to responsive services.
3.3.2 Why Care of the Frail?
Improving care of the frail services is critical for a number of reasons. Improvements in
healthcare technology and medicine have resulted in people living longer and longer. As
a result of increased life expectancy, patients can experience multiple medical conditions
and an increase in clinical complexity. Older people are also more susceptible to requiring
urgent and emergency care services.
3.3.3 Our Goal
Our goal is to commission co-ordinated services based on an integrated care model around
the individual patient. We believe that care of the frail services should be based on the
health and social care needs of patients. Services should be co-ordinated and delivered
as close to home as possible in a community setting but when required, services should
also be responsive to urgent and emergency need.
3.4 Co-ordinated Care
3.4.1 DCCG Co-ordinated Care definition
Our definition of Co-ordinated Care is the provision of integrated care across a whole
system that is responsive to patient needs, uses the latest technology to support
service delivery and develops enhanced access to data and information across partner
organisations
3.4.2 Why Co-ordinated Care?
One of the key roles of DCCG is to commission high quality co-ordinated care from a
number of healthcare providers for Doncaster registered patients. We need to ensure that
organisations are providing the right care in the right place at the right time. This requires
significant improvement in communication systems across multiple providers and partner
organisations. We are also aware that patients want to be involved in making positive
choices about their own healthcare and we want to make sure they have the opportunity to
do this.
1. http://www.england.nhs.uk/wp-content/uploads/2013/12/5yr-strat-plann-guid-wa.pdf
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3.4.3 Our Goal
We will use technology to drive forward improved communication between patients, carers
and partner organisations. Our aim is to use patient information to improve commissioning
decisions and use technology to improve integrated, personalised, co-ordinated care
across partner organisations.
3.5 The five year vision – how it looks and how it feels
The section sets out the DCCG vision for Care out of Hospital, Care of the Frail and Coordinated Care services in Doncaster in five years time.
It describes how services will look and feel to patients, carers and partners in Doncaster
when We have successfully delivered significant change in our three strategic ambition
areas.
3.5.1 Citizen participation and empowerment
•Patients will give real time feedback on their experience of services provided in
the community
•Patient feedback will directly influence the commissioning and provision of
services in Doncaster
• Patients will be an equal stakeholder in determining their care
•Patients will agree community care plans and these will be reviewed at every visit
and updated as appropriate and this will be discussed with the patient and their
carer
•Personal Health Budgets will be offered to patients who may benefit and
Continuing Healthcare patients will have been offered this service from October
2014
•All patients with a long term condition will have a personalised care plan and
electronic access to their GP health record
•Services will have been commissioned that take advantage of new technologies
and these will be supporting patients to maintain and manage their medical
condition
•Patients will help us to design a health system that is easy to navigate and
understand, both as a patient and NHS employee
•By March 2016, co-commissioners will have worked together to ensure that GP
and hospital data is linked so that commissioners can use the information to
develop high quality services and achieve improved outcomes. Services will also
use the NHS number to improve communication across services
•We will use social media at scale to support the development of commissioned
services, communicate directly with patients and partners and understand
patient experiences in real time.
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3.5.2 Primary care, provided at scale
•As much as possible, services will be provided at home or in a community setting
• Services will be available when required, not just during the week
• Care provision will be holistic and integrated with services from partner agencies
•Care provision will be co-ordinated and based around a primary care community
team
• GP practices will be supported to improve the quality of care for older people
•Patients will be central to the commissioned care model and this will improve
patient experience, improve outcomes and provide a more efficient service
delivery model
•Patients will access a wider range of services in the community and outside of
the more traditional hospital environment
•Urgent care services will access data uploaded from GP practices to ensure
information about medicines, allergies and adverse reactions is available to
improve emergency treatment
•Services will be provided by a range of organisations and providers will work in
collaboration to develop new innovative models of care and drive up quality
•The re-commissioned community nursing and end of life service model,
developed by member practices, will be supporting patients in their own home to
manage their medical condition and maintain independence.
3.5.3 Integrated care
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•Health and social care commissioners will be working collaboratively to ensure
that services are co-ordinated and integrated. An early focus will be to develop
intermediate care services, dementia care and community services
•Services will address the mental health as well as the physical needs of
individuals
•Services will be co-ordinated around the individual patient and will be available
as required
•Community based services will be delivered in an integrated way and they will be
responsive to individual patient need
•Service provision will be based on the health and social care needs of the
patient
•Services will be co-ordinated across health and social care and delivered as
close to home as possible.
3.5.4 Highest quality urgent and emergency care
•Community based urgent and emergency care services will have been recommissioned to ensure they meet the needs of Doncaster patients and are
in line with the five key areas of focus highlighted in the Urgent and Emergency
Care Review 2
•Services will be co-ordinated and delivered as close to home as possible in a
community setting but when required, services will also be responsive to urgent
and emergency need
•The provision of services over the winter period will continue to be managed
by partners across the Doncaster health and social care system through the
Unplanned Care Working Group
•Urgent and emergency care services will be provided based on patient need
which may result in some patients receiving specialist treatment in major
emergency centres.
3.5.5 Productivity of elective care
•Patient choice will continue to be supported and patients will be able to choose
from a range of providers to meet their planned care needs
•Service pathways will continue to be developed to make them as efficient as
possible. This will increase the quality of the service and also reduce the
number of hospital visits that patients need to make
•One stop services will be available where possible and we will positively
benchmark for DNA (did not attend) rate, new to follow up ratios, day case and
outpatient procedures
•Elements of the planned patient pathway will be provided in a community setting
where it is feasible to do so.
2. http://www.nhs.uk/NHSEngland/keogh-review/Documents/UECR.Ph1Report.FV.pdf
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3.5.6 Maintaining a focus on the essentials
We are committed to achieving high standards of patient care for the services we
commission. Commissioners have an important role in driving quality improvement and
gaining assurance around the quality of care delivered by the provider organisations from
whom they commission services. Much has been written around the failings in quality of
care and treatment in the NHS over the last few years, following the enquiry into the events
at Mid Staffordshire and Winterbourne View. We make the following commitments:
•We renew and reaffirm our personal and organisational commitment to the
values of the NHS as set out in its constitution
•We will work together for patients – patients come first in everything we do
•We value every person whether patients, their families or carers, or staff – as an
individual, treating them with dignity and respect
•We will earn the trust placed in us by insisting on quality and striving to get the
basics of quality of care, safety, effectiveness and patient experience right every
time
•We ensure that compassion is central to the care we commission and will
respond with humanity and kindness
•We strive to improve health and wellbeing and peoples experience of the NHS
•We will listen most carefully to those whose voices are weakest and find it
hardest to speak for themselves
•We will work together to minimise bureaucracy, enabling time to care and time to
lead, freeing up expertise of the NHS staff and values professionalism.
To do this we will engage, empower and hear patients and carers at all times. We will
foster whole-heartedly the growth and development of all staff, including their ability and
support to improve the processes and environment in which they work. We will embrace
transparency unequivocally and everywhere, in the service of accountability, trust and the
growth of knowledge. In response to the events at Mid Staffordshire and Winterbourne
View, we will develop a system devoted to continual learning and improvement of patient
care top to bottom and end to end.
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How we intend to achieve this:
•Recognise with clarity and courage the need for wide systemic change
•Abandon blame as a tool and trust the goodwill and good intentions of staff
•Reassert the primacy of working with patients and carers to achieve health care
goals
•Use quantitative targets with caution. Such goals do have an important role to
demonstrate progress, but should never displace the primary goal of better care.
•Recognise that transparency is essential and expect and insist on it.
•Ensure that responsibility for functions related to safety and improvement are
vested clearly and simply.
•Develop the skills to help learn, master and apply modern methods for quality
control, quality improvement and quality planning.
•Make sure everyone has pride and joy in their work in the Doncaster system.
The NHS is always evolving as treatments and techniques develop. We must build our
knowledge and skills to enable us to respond. Our relationships with the people we care for
have also changed; they are now partners in their care and we involve them in decisions
that affect them.
Looking forward, we will increasingly be called to advise people on how to look after
their physical and mental health, to support people who are experts in their own care.
England’s changing demographics will influence this. Society is getting older and its needs
are more complex. Older people are likely to use several services across health and social
care, and may rely on carers. As the biggest users of health and care, we need to work
together to ensure we meet the needs of older people, and treat them with dignity and
respect that they deserve. If we get it right for them we can also get it right for everyone,
including children and young people and other key groups.
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3.6 Impact
We have described earlier how the health system in Doncaster will look and feel in five
years time.
This section of our strategy demonstrates how patient outcomes in Doncaster were
prioritised and how the ambitious quantifiable improvements that we strive to achieve were
identified.
As a discrete unit of planning, our ambition is to significantly improve outcomes for
Doncaster patients as a result of the work we do.
3.6.1 Identifying and understanding need
To determine local priorities, we used a range of data from:
•Patients
•Partners
•Joint Strategic Needs Assessment
•Commissioning for Value data packs
•Five NHS Outcome Framework domain benchmarking data against ONS cluster
3.6.2 Identified priorities
By understanding the views of patients and partners and combining this with the data
available, the DCCG Governing Body was able to make informed decisions regarding local
priorities in order to improve outcomes. The six priorities chosen are:
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•Cancer
•Children’s Services
•Continuing Healthcare
•Dementia
•Mental Health
•Unplanned Care and Long Term Conditions
3.6.3 Our Delivery Plans
Using that information also enabled the our clinician/manager partnership model to
develop a set of quantifiable, outcome focussed delivery plans. These were developed
in partnership with member practices and agreed by the DCCG Governing Body.
Our ambition is to make a significant contribution to the five NHS Outcome Framework
domains and improve outcomes in Doncaster based on local priorities.
Out aspirations are demonstrated in the following table:
Ambition Area
Metric
Proposed Attainment in
2018/19
Securing additional years
of life for the people of
England with treatable
mental and physical
health conditions
Potential years of life lost
from conditions amenable
to healthcare
3.2 per cent improvement
2014/15, with statistically
significant reduction year
on year to 2018/19
Improving the health
related quality of life of
the 15+ million people
with one or more long
term condition, including
mental health conditions
Health related quality of
life for people with long
term conditions
Year on year improvement
in the score to bring
Doncaster in line with
historic Yorkshire and
Humber Strategic Health
Authority
Reducing the amount
of time people spend
avoidably in hospital
through better and
more integrated care in
the community outside
hospital
Composite avoidable
emergency admissions
indicator
Zero growth during
2014/15, thereby reducing
the current trend for year
on year increase. By
2018/19 the number of
emergency admissions
will have reduced from
2014/15 level
Increasing the number of
people having a positive
experience of hospital
care
Patient experience of
hospital care
Maintenance of current
benchmarked position –
fewer negative responses
than average for NHS
England South Yorkshire
and Bassetlaw Area Team
and England
Increase the number
of people with mental
and physical health
conditions having a
positive experience of
care outside hospital, in
general practice and the
community
Composite indicator
comprised of GP services
and GP out of hours
Improve current
benchmarked position- to
fewer negative responses
than NHS England South
Yorkshire and Bassetlaw
Area Team and England
(already fewer negative
responses than England)
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Our delivery plans demonstrate the outcomes we aspire to achieve, the indicators that
will demonstrate the pathway to delivery and agreed actions to support success.
A full set of delivery plans are available from DCCG.
All delivery plans are encapsulated within the our Plan on a Page, Appendix 1
Appendix 2 demonstrates how our Strategic Plan was developed to contribute to the
delivery of NHS England aspirations and local priorities. It demonstrates connectivity
between:
•Five NHS Outcome Framework Domains
•Seven NHS Linked Measurable Ambitions
• Three DCCG Strategic Ambitions
• Six DCCG Delivery Plans
3.7 Sustainability for future generations
To ensure that the NHS system in Doncaster continues to be sustainable and is flexible
enough to deliver the ambitions of this strategy, a number of resource issues must be
considered and managed.
3.7.1 Organisational Development
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•We will ensure that we provide the people in our organisation with access to
development opportunities in order to support them in their commissioning roles
•We will ensure that we have effective commissioning systems and processes in
place that will help us to deliver on our vision and mission statement
•Charles O’Reilly (Leaders in Difficult Times, 2009) suggests that leaders should
consider themselves to be “signal generators” who are under constant scrutiny
and therefore through our words and actions we will lead the local health
economy towards the destination described in this strategy
•We are a new organisation and as such we will continue to develop our
leadership ethos and culture, conducting our activities in a manner that is both
professional and ethical
•We will continue to work with partners to ensure maximum value from joint
resources within sound risk management frameworks
•As a membership organisation, clinical engagement is critical to our success,
and we will maintain effective systems to enable and promote this engagement
•Our staff are our greatest asset, and we will ensure excellent support
methodologies in order to enhance staff satisfaction within the workplace and
their roles.
3.7.2 Partnerships
•We will work with co-commissioners to ensure opportunities for service
integration and efficiencies are realised
•We welcome the opportunity to work with provider organisations to support
the development of a health and social care community approach to workforce
development
•We will engage with partners to ensure our commissioning plans are
complementary across the Health and Wellbeing Board footprint
•We will support providers to respond to the developing market of the NHS
•We will continue to work collaboratively with other CCGs and co-commissioners to
ensure that services delivered across a wider geography are commissioned and
delivered cohesively and consistently
3.7.3 DCCG Financial Framework
•Our 2014/15 to 2018/19 financial plan builds on the solid financial plan
initiated by DCCG in 2013/14 which forecasts full delivery of financial savings,
efficiency measures and other targets
•We received notification of our baseline programme allocation for 2014/15
totalling £414.8m, inclusive of growth at 2.14 per cent and for 2015/16
£421.8m, inclusive of growth at 1.7 per cent
•Our expenditure plans for 2014/15 assumes a balanced financial position and
includes:
nA 1 per cent surplus totalling £4.3m
nAn efficiency programme totalling £4.5m
nA recurrent investment of £5m which reflects 1.2 per cent of the our
recurrent allocation
nA contingency of 0.5 per cent totalling £2.1m
nA 2.5 per cent non recurrent headroom totalling £10.4m
•For 2015/16 we assume a balanced financial position including:
nA 1 per cent surplus totalling £4.4m
nAn efficiency programme totalling £4.0m
nA recurrent investment of £9.4m which reflects 2.2 per cent of our recurrent
allocation
nA contingency of 0.5 per cent totalling £2.2m
nA 1 per cent non recurrent headroom totalling £4.2m
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•It is likely the NHS will face a funding gap between projected health spending and
NHS resource of around £30bn between 2013/14 and 2020/21. To support
these challenges we will:
n
Generate sufficient QIPP savings to offset the demographic growth in demand
for services year on year, technological development and medical advances
and health cost inflation. Over the planning period from 2014/15 to
2018/19 the we anticipate making £20.5m in savings to reinvest back in
health care services
n
Strengthen our underlying financial position by committing funding non
recurrently where possible to pump prime new services that will lead to
overall reduced costs, accelerated efficiencies or increased productivity.
•Any investment we make will be linked back to one of our delivery plans or
transformational programmes. The recurrent funding identified for investment
for 2014/15 is £5m and for 2015/16 and £9.4m and along with non recurrent
investment will support the transition of local services and prepare for the
introduction of the Better Care Fund.
•Our running costs allowance has been calculated at £24.73 per head of
population reducing to an indicative allowance of £22.07 in 2015/16. The
allocation will fund both our own running costs and the recharge for the support
services provided by the West & South Yorkshire and Bassetlaw Commissioning
Support Unit. We have a statutory responsibility to ensure we do not exceed
our running cost allowance and if current spending patterns are maintained it is
anticipated we will meet this reduced target in 2015/16.
•The delivery of an efficiency programme is key to providing the finances required
to drive investment forward, and failure to deliver the programme is one of the
major risks we face which would result in the need to curtail the investment
programme. The plan currently requires the need to identify and deliver £4.5m of
efficiency savings in 2014/15, and £4.0m in 2015/16 and is predicated on the
achievement of the recurrent savings required in 2013/14.
•We are aware of the risks and drivers that could affect the financial performance
and have assessed the potential impacts and have a strategy in place to deal
with them should the need arise. The following issues could influence the delivery
of this plan:
n
Growth in acute sector cannot be contained
n
Levels of required disinvestments cannot be delivered
n
Growth in high cost case numbers (e.g. Continuing Care) above that
projected.
n
Unanticipated growth in registered population.
n
In-year cost pressures exceed planning assumptions and cannot be managed
down to affordable levels.
n
Impact of unpredictable costs, such as the impact of new technologies
cannot be afforded within current assumptions.
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•Where there is downside risk this will be mitigated by utilisation of the
contingency reserve, a reprioritisation and re-profiling of investments, identifying
and delivering additional efficiency opportunities and the planned surplus. Upside
risk will allow us to bring forward schemes planned for future years or invest in
further initiatives, which benefit the health of the population of Doncaster.
3.7.4 Demand Assumptions
•We will reduce unplanned care demand significantly by effectively commissioning:
A community based urgent care service model
n
n
A new children’s community service
n
Improved unplanned care support services for cancer patients
n
A patient centred community nursing service, including enhanced end of life
care
n
A revised urgent, secondary care and primary care mental health service
model
n
Doncaster becoming a Dementia Friendly Community driven forward by joint
commissioning arrangements
n
A co-ordinated and integrated intermediate care service offer
•By the end of this strategy term, we will have worked with providers to improve
planned care productivity in Doncaster by 20 per cent. This will be achieved by:
•Increasing day case and outpatient procedure rates and ensuring that
the ratio of new to follow up outpatient appointments are in line with best
practice
•Developing one stop services where appropriate
•Improving the productivity of estate and facilities within hospital sites and in
the community
•Negotiation of local tariffs
•Embracing technology improvements
•Developing patient choice on treatment further
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3.8 Managing Risk
We are aware that the management of resource issues identified above is critical to
support the sustainability of NHS services in Doncaster moving forward.
To ensure these issues are being considered and managed effectively, the DCCG Governing
Body assesses the level of risk and ensures plans are put in place to mitigate those risks.
The Governing Body Assurance Framework is our main tool in managing strategic risks
to the achievement of our organisational objectives, and is underpinned by robust risk
registers held by each team in the organisation.
We have a proactive approach aiming to identify, assess, evaluate, record and review risks,
so as to reduce the likelihood of them causing harm to patients or staff or loss to DCCG
and to reduce the impact of such harm or losses should they occur. The Governing Body
recognises that risk management is an essential element of good management practice
and to be most effective needs to become part of the our culture. The Governing Body
is, therefore, committed to ensuring that risk management forms an integral part of its
philosophy, practices and business planning processes.
4. Partnerships and Engagement
4.1 Partnerships
DCCG is part of a wider partnership in Doncaster. To achieve ambitious transformational
change, partners must work collectively to focus available organisational resources
effectively and efficiently.
The Health and Wellbeing Board in Doncaster is responsible for bringing together
key partners to ensure organisational plans and priorities are aligned to support
transformational change and efficient use of resources.
The Health and Wellbeing Board is supportive of our strategy.
We will continue to actively support the ambitions of the Health and Wellbeing Board and
we will ensure that there is partnership involvement and engagement in the development of
our strategies moving forward.
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4.2 Co-Commissioners
Our three strategic ambitions for services in Doncaster cannot be commissioned in
isolation. Co-commissioning organisations have a significant role in helping us to
achieve our future vision.
We will work with NHS England South Yorkshire and Bassetlaw Area Team to:
•Strengthen local clinical leadership and ownership of plans to transform primary
care services
•We will work with co-commissioners to learn from the development of locally based
outcome focussed improvement methodologies to establish a matrix approach to
commissioning improved outcomes for long term conditions
•Support the development of more integrated arrangements for providing primary
care and community health services
•Ensure continuous strategic fit of CCG and Area Team respective priorities as they
evolve
•Ensure that resources are allocated appropriately between primary care,
community health services and hospital services to deliver the health needs of the
population based on commissioning responsibilities
We will work with Local Authority colleagues to:
•Maximise the opportunities presented by the Better Care Fund
•Establish a system of transparency, participation and collaboration
•Develop and establish new commissioning and provider models of delivery to
ensure services are patient centred and delivered in an integrated way
•Ensure that collective resources are used effectively and efficiently to improve
services for patients
•Work collectively, in partnership to drive forward transformational change at pace
•Ensure continuous strategic fit of Doncaster Council and DCCG priorities as they
develop
4.3 Providers
We will work with provider colleagues to:
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•Maintain high quality, effective and viable local services for Doncaster patients
•Respond to the NHS market environment
•Realise the ambitions we set out in this strategy in a planned and thoughtful way
•Support the development of integrated service models to improve patient experience and outcomes
4.4 Patients and Citizens
We will work with patients and citizens in Doncaster to:
•Engage with the public and actively seek the views of patients, carers and the
wider community
•Ensure effective feedback mechanisms are in place
•Develop a long term, inclusive and enduring relationship forged through sustained
effort and commitment
•Ensure that key themes emerging from our engagement activity have a direct
influence on the services we commissioned
•Have in place effective mechanisms so that patients and carers are involved
in planning, managing and making decisions about their care and can also be
involved in the commissioning processes itself
•Develop our membership model further
5. Making it happen
This strategy sets the strategic direction for the organisation and highlights the
ambitions of our organisation from 2014/15 to 2018/19.
The key drivers for turning our strategy into reality will be strong leadership by our
Governing Body and achievement of the six outcome based delivery Plans and our
operational and financial plans which cover a two year rolling timeframe.
The plans will be delivered through three key mechanisms:
•In partnership across Doncaster – making the most of joined up resources
•Internal resources within DCCG - organisational and personal objectives will be set
to support delivery
•Working with providers - establishing contracts to deliver our ambitions
We will be held to account for delivery through embedded governance arrangements in
place within Doncaster:
•Through our monthly public Governing Body meeting
•By the National Assurance Framework process implemented by NHS England and
the South Yorkshire and Bassetlaw Area Team
•Through the Doncaster Health and Wellbeing Board
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The needs of patients are paramount. We will drive forward continuous improvement, Relationships based on integrity and trust
Patient centred care outside of a hospital setting, either in the patients home or based around a primary care community team
High quality co-ordinated care that meets the needs of the patient based on integration, prevention, patient and carer involvement and access to responsive services
Our Values
Care out of Hospital
Care of the Elderly
Sustainability
Success
indicators
Improved care for children and
young people with suspected
autism
Excellent levels of patient
satisfaction with their care
Increase in the number of
patients accessing cancer
treatment
Improve one or two GP
attendances prior to referral
Increase in non palliative
treatment by March 2016
Improve earliest staging at
diagnosis by March 2016
Maintain national waiting
times
Increase the % of Personal
Health Budgets compared to
home care packages,
Reduce the average cost per
case,
Paediatric consultant led general
development assessments for
patients
90% of medical assessments to
be completed within six weeks of
request for medical
We will improve on patient/
Carers Quality of life indicator
scores whilst in service
Increase in referrals using agreed l
criteria to Access/Crisis Services and
DNA rates will be reduced
Better awareness of mental illness
Pregnant women who have a preexisting or newly developed mental
illness will access the perinatal MH
pathway
Personality disorder patients will be
placed on the PD pathway and will
access services locally
There will be a reduced number of
people with mental illness attending
A&E with self-harm
Acute mental health readmissions will
be reduced
People with eating disorders will access
the ED Pathway (local if appropriate)
Improved response rate of Patient
Reported Experience Measures
Timely and appropriate access to
mental health services
Improved experience of mental health
care
Increased community awareness of
mental health and reduced stigma
We will improve the physical health of
people with mental health
Patients will have sustained recovery
and mental wellbeing
Mental Health
Organisational Development, Partnerships, Financial Framework, Demand, Risk Management
Reduction in emergency
admissions for epilepsy
Increase the % of home care
compared to care home
packages
People with dementia will
have fewer episodes of crisis
and Carers of people with
dementia will have fewer
crises of emergency respite
increase the number of people
diagnosed with dementia from
2013/14 outturn
Quarterly review of % of Fast
Tracks over 90 days
Detailed understanding of
patient flow at all levels
Total spend against budget is
fully understood and reported
Increase the number of
people diagnosed early in
dementia against 2013/14
outturn
The Doncaster community will
have increased awareness of
dementia and there will be a
reduction in stigma
People with dementia and
their carers will be supported
to live well
More people will receive a
diagnosis and that diagnosis
will be made earlier
Less hospital admissions
and re-admissions against
2013/14 outturn and if
admitted will have a shorter
length of stay
Reduced national
benchmarking ranking
Evidence that the CHC
Framework/National
Guidance is met
Reduction in acute outpatient
tariff activity
Reduction in emergency
admissions for diabetes
Reduction on the % increase
in emergency admissions for
asthma
A care co-ordinator to be
allocated to each patient autism
A multi-disciplinary assessment
for all patients - autism
Inpatient survey improvement
Increase in treatment via two
week wait referrals
From February 2015, 18 weeks
for 95% of patients – autism
Commission appropriate care
packages
Improve one year survival
(acorn mean)
Reduced emergency
admissions
Develop personalised
healthcare
Commission appropriate care
packages
Commission appropriate care
packages
Ensure appropriate access
to CHC
Continuing Healthcare Dementia
Mortality rate < 200 (acorn
mean)
More people living beyond
cancer
Improve community health care
for children and young people
Extending the quality of life for
patients living with cancer
Improving
Outcomes
Children
Cancer
Our Priorities
No ambulance delays over
30 minutes at Emergency
Department
Reduction in re-admission rates
2012/13 outturn
Reduction in A&E attendance
against 2012/13 outturn
Reduction in conversion rate of
ED attendances to admissions
from 2012/13 baseline in
2014/15
Achievement of 95% A&E four
hour access target
Reduction in emergency
admissions for ACSC against
outturn in 2014/15
Reduction in Emergency hospital
admissions against outturn in
2014/15
Patients have unplanned care
delivered in the most clinically
appropriate place
Improved patient experience of
unplanned care in Doncaster
Patients with long term
conditions feel supported to
self-manage
Patients with long term
conditions maintain their health
and wellbeing and reduce the
number of exacerbations of their
condition
Develop services needed to
deliver efficient unplanned care
Unplanned Care
Co-ordinated CareIntegrated care across a whole system that is responsive to patient needs, uses the latest technology to support service delivery and develops enhanced access to data and
information across partner organisations
Work with others to invest in quality healthcare for Doncaster patients
Our Vision
Our MissionA high quality and accountable Clinical Commissioning Group, encouraging responsible partnership engagement in a transparent climate of ongoing learning in order to create a
patient-centred yet financially astute and corporate approach to commissioning
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Treating and caring
for people in a safe
environment and
protecting them from
avoidable harm
Ensuring that people
have a positive
experience of care
Reducing the amount of
time people spend avoidably
in hospital through better
and more integrated care in
the community, outside of
hospital.
Helping people
recover from
episodes of ill health
or following injury
Making significant progress
towards eliminating
avoidable deaths in our
hospitals caused by
problems in care.
Increasing the number of
people with mental and
physical health conditions
having a positive experience
of care outside hospital, in
general practice and in the
community
Increasing the number of
people with mental and
physical health conditions
having a positive experience
of hospital care
Increasing the proportion
of older people living
independently at home
following discharge from
hospital
Improving the health related
quality of life of the 15
million+ people with one or
more long-term condition,
including mental health
conditions
Enhancing quality of
life for people with
long term conditions
ambitions NHS E 7 measureable
Securing additional years of
life for the people of England
with treatable mental and
physical health conditions
Preventing
people from dying
prematurely
Framework
NHS E Outcomes
Outcome improvement plan
Doncaster
Clinical Commissioning Group
Cancer Children’s Co-ordinated Care
Care of the Frail
Care out of Hospital
Co-ordinated Care
Care of the Frail
Care out of Hospital
Care of the Frail
Care out of Hospital
Care of the Frail
Care out of Hospital
Care of the Frail
Care out of Hospital
Excellent levels of
patient satisfaction
with their care
More people living
beyond cancer
Extending the quality
of life for patients
living with cancer
Improve 1 year
survival
Mortality rate < 200
(acorn mean)
Improve community
health care for children
and young people
Commission
appropriate care
packages
Improve community
health care for children
and young people
Commission
appropriate care
packages
Develop personalised
healthcare
Commission
appropriate care
packages
Ensure appropriate
access to CHC
Healthcare
Community Improved care for
children and young
people with suspected
autism
Improve community
health care for children
and young people
ambitions
DCCG Strategic People of all ages
have unplanned care
delivered in the most
clinically appropriate
place
Improved patient
experience of
unplanned care in
Doncaster
Patients with long
term conditions feel
supported to selfmanage their own
condition
Patients with long
term conditions
maintain their health
and wellbeing and
reduce the number of
exacerbations of their
condition
Develop services
needed to deliver
efficient unplanned
care
Unplanned Care People will have
timely and appropriate
access to mental
health services
People will have a
better experience of
mental health care
The Doncaster
community will have an
increased awareness
of mental health
and there will be a
reduction in stigma
We will improve the
physical health of
people with mental
health
People with mental
health problems
will have sustained
recovery and mental
wellbeing
Mental Health The Doncaster
community will have
increased awareness
of dementia and there
will be a reduction in
stigma
People with dementia
and their carers will be
supported to live well
More people will
receive a diagnosis
and that diagnosis will
be made earlier
Dementia
Doncaster
Clinical Commissioning Group