Attach 5
Wandsworth CCG
Commissioning
Intentions
2016-2017
Foreword
This document sets out our commissioning intentions for the financial year 2016/2017,
demonstrating our response to the strategic vision described in the Five Year Forward View
and our local priorities as set out in the Wandsworth Joint Strategic Needs Assessment and
the Wandsworth Health & Wellbeing Strategy. https://democracy.wandsworth.gov.uk/documents
The document includes:






Our strategic priorities
The vision of our clinical leaders for eight Commissioning Programmes, progress to
date and key focus areas for the next 12 months
The role of the Localities and Clinical Reference Groups
Our approach to empowering and engaging with our patients
A summary of our Commissioning Intentions
A summary of the Commissioning Intentions of CCGs in SW London (as part of our
Collaborative Commissioning programme) where these are applicable.
Our work continues to be underpinned by our vision as encapsulated in the phrase ‘better
care and a healthier future for Wandsworth’ and the principles outlined below. We will
commission care in a way that it:





Patient focused
Outcomes driven
Principled
Collaborative
Progressive & Professional
Wandsworth CCG is formed from three localities Battersea, Wandle and West Wandsworth,
each with a clear understanding of the health and social care needs of their local population.
As a membership organisation we place local clinicians, who are truly able to understand
the needs of our patients, at the heart of our vision and decision making. We passionately
believe in real clinical leadership in all parts of the commissioning cycle – the priority setting,
the planning, contracting, performance management and review of commissioned services
are all undertaken under the leadership of the elected clinical leads. Collaborative working
is also fundamental to our approach and we strive for openness and transparency; working
with local people and partners so that our population has confidence in our commissioning
decisions.
The Wandsworth CCG Commissioning Programmes, which are defined under eight umbrella
headings, are supported by a series of clinically-led Clinical Reference Groups (CRGs)
http://www.wandsworthccg.nhs.uk/aboutus. CRGs are the vehicle by which clinical
2
leadership, patient voice and integrated working come together to focus on key service
areas and deliver service redesign that achieves real health improvements for patients.
We are ambitious about commissioning and transforming services to improve health
outcomes and the quality of care, personalising care and offering people more choice and
control of their care both in hospital and in the community. Over the past two years we
have made significant progress to improve the standards of care and outcomes for our
patients and we are committed to continue the transformation of services, addressing
inequalities and improving health outcomes for the people of Wandsworth.
Signed
Nicola Jones
Graham Mackenzie
(Chair)
(Chief Officer)
3
Table of Contents
Foreword
1. Background and context …………………………………………………………………………………… 5
2. Commissioning Intentions of Partner Organisations …………………………………………… 6
3. NHS Constitution & Assurance Standards …………………………………………………………… 6
4. Health Needs in Wandsworth …………………………………………………………………………….. 7
5. Ensuring Quality …………………………………………………………………………………………………. 8
6. Reducing Inequalities …………………………………………………………………………………………. 9
7. Engagement – Empowering the Patient & Public Voice ……………………………………… 10
8. Locality Commissioning Intentions …………………………………………………………………….. 12
8.1 Battersea…………………………………………………………………………………………………….. 13
8.2 West Wandsworth ……………………………………………………………………………………… 14
8.3 Wandle ………………………………………………………………………………………………………. 15
9. Commissioning Programmes……………………………………………………………………………..
16
9.1 Preventing Ill Health …………………………………………………………………………………..
18
9.2 Primary Care ………………………………………………………………………………………………. 20
9.3 Out of Hospital Services ……………………………………………………………………………… 23
9.4 Learning Disabilities ……………………………………………………………………………………
28
9.5 Children & Young People ……………………………………………………………………………
31
9.6 Older People ………………………………………………………………………………………………
35
9.7 Mental Health ……………………………………………………………………………………………
38
9.8 Urgent Care ……………………………………………………………………………………………….
41
10. Wandsworth CCG - Other services ……………………………………………………………………
44
11. Enabling Services ……………………………………………………………………………………………..
44
12. Appendices – Summary of WCCG and SWL Commissioning Intentions ………….
45
4
1. Background and Context
The purpose of these commissioning intentions is to provide an indication to current and
potential providers about how, working with our partners, we intend to shape the delivery
of health services for the population of Wandsworth. It is not intended to set out all of the
activities that we will be undertaking in this year but will;
•
Provide the context for proposed changes to our current commissioning plans.
•
List agreed commissioning intentions including changes that will improve the
quality of services and/or achieve improved value for money.
•
Signal to providers the areas where resources may be reducing or where new
services may be required.
Our commissioning intentions and strategic priorities have been developed in line with the
vision set out in the Five Year Forward View, with a clear emphasis on the transformation of
services. This means commissioning more prevention services and ensuring greater
integration with social care where it will generate a health benefit. It also means targeted
commissioning for particular groups of patients in order to reduce health inequalities.
Our strategic priorities are:
•
Doing core business well – delivering better care and a healthier future for
Wandsworth through our clinical leadership, robust commissioning processes and
excellent staff, focussed on delivering quality services and improved outcomes for
patients.
•
Transforming primary care – optimising impact and outcomes for patients through
delivery of excellent primary care to all people registered with a Wandsworth GP.
•
Commissioning prevention and social care services– where it will generate an
increased health benefit for our population.
•
Reducing health inequalities – the CCG will commission differentially to address
specific population need where it will reduce health inequalities.
5
2. Commissioning Intentions of Partner Organisations
We know the NHS faces challenges in the years ahead and that demand for services will
continue to rise. We have aligned our commissioning intentions with those of NHS England,
who are responsible for Primary Care and Specialised Services, the London Clinical Networks
specialist clinical teams, the NHS England (London Region) Transforming Care workstreams
and Wandsworth Borough Council, who are responsible for social care.
We are also working closely with other commissioners and stakeholders across South West
London (SWL) to design the right services to deliver sustainable high quality care for our
whole population. Our SWL Strategy will strengthen out of hospital care and improve
quality and equitable access to hospital services.
The South West London Collaborative Commissioning vision is that:




people in south west London can access the right health services when and where
they need them
care is delivered by a suitably trained and experienced workforce, in the most
appropriate setting, to deliver a positive experience for patients
services are patient-centred and integrated with social care, focus on health
promotion, and encourage people to take ownership of their health
services are high quality and affordable
This work is reflected in the South West London Commissioning Intentions
http://www.wandsworthccg.nhs.uk/aboutus/Ourwork we have helped to develop and
which are closely aligned with our own CCG intentions.
3. NHS Constitution and NHS Assurance Framework
Standards.
This year we have worked hard to maintain performance against a number of challenging
indicators, reflecting the impact of our strategic direction and continued focus on
performance improvement. However we recognise the financial challenges across the
provider environment and there are key areas where, as with CCGs across London, we are
struggling to achieve core NHS Constitutional Standards.
The commissioning intentions for each of our commissioning programmes have been
developed with a view to ensuring optimal performance against the NHS Constitution and
Assurance Framework measures and we are committed to redoubling our efforts, focusing
management capacity and resource, to ensure all key service standards are met.
6
4. Health Needs in Wandsworth
The Joint Strategic Needs Assessment (JSNA) http://www.wandsworth.gov.uk/jsna is ‘a
systematic method of reviewing the health and wellbeing of a population, leading to agreed
commissioning priorities that will improve health and wellbeing outcomes and reduce
inequalities’.
Key messages & challenges
The Wandsworth population demographic presents us with a particular set of challenges.
While the majority of the Wandsworth population is remarkably young and healthy, there
are significant areas of deprivation and our older population is more likely to have poor
health and live in deprivation than that of other areas of south west London.

There are approximately 2,800 deaths in Wandsworth a year and approximately
1,000 of these are of people under the age of 75. Within the borough there is a
strong correlation between rates of mortality under the age of 75 and deprivation in
Wandsworth.

The two most frequent underlying causes of death in the under 75’s are cancer and
circulatory disease with approximately 220 and 150 deaths respectively.

Wandsworth now has one of the widest gaps in life expectancy in London, for both
men and women.
6.8
years
lower

The overall prevalence of smoking, being overweight and lack of physical activity is
relatively low in Wandsworth at 16 per cent, 50 per cent and 23 per cent
respectively. However, rates are significantly higher in deprived parts of the borough.

As our population ages, we are seeing a significant increase in the number of people
with long-term conditions such as heart disease, diabetes and hypertension. The
resulting increase in demand, combined with rising expectations and increasing
costs, threatens both the financial stability and the sustainability of the NHS.

There are approximately 13,200 children aged 0-15 years living in income-deprived
families in the borough.
7

There are 48,500 people living with a common mental health condition, which is a
root cause of multiple issues across health, care and society.

Learning disabilities: a vulnerable group with a growing population, with longer life
expectancy and consequent increasing health and care implications.


Overweight and obesity: a national problem affecting 133,000 local people.
Physical inactivity: a national problem with 84,000 local people not sufficiently
active.

Smoking: 55,000 local people smoke, and this is a key cause of morbidity.

Looked After Children and care leavers continue to be affected; inequities later life.

Children with disabilities and special needs: a group of children with on-going care
and support needs.

Young carers: a vulnerable group with known inequities in later life.

Long term conditions: increasing number of people living with a long term condition,
including mental health and circulatory disease. Circulatory disease is the largest
contributor accounting for approximately 30 per cent of the life expectancy gap.

Care homes: an ageing population with complex needs using care homes, and a
necessity to provide equitable services.

Dementia: a known population of approximately 1000 adults, with increasing
prevalence and multiple implications for health and care services.

Identification and support for carers: a vulnerable group and potentially isolated
group with increasing numbers.

Social isolation (for older people): the extent of social isolation in Wandsworth is
unknown, but it does have known impacts on health and wellbeing
5. Ensuring Quality
The CCG’s priority is to commission services that offer quality for local people. This covers
three key dimensions:
8
Patient Safety - Commissioning high quality care which is safe prevents all avoidable
harm and risks to the individual’s safety; and having systems in place to protect
patients.
Clinical Effectiveness - Commissioning high quality care which is delivered according
to the best evidence as to what is clinically effective in improving an individual’s
health outcomes. Making sure care and treatments achieve their intended outcome.
Patient Experience - Commissioning high quality care which looks to give the
individual as positive an experience of receiving and recovering from the care as
possible, including being treated according to what the individual wants or needs,
and with compassion, dignity and respect. It’s about listening to the patient’s own
perception of their care.
We will continue to strive to secure positive health outcomes for local people and
continuously improve the quality of services.
6. Reducing Inequalities
We are committed to reducing inequalities to improve health outcomes for our patients and
this is a priority that runs throughout the areas of focus described within our commissioning
programmes. Examples of this are:

Primary Care
Primary Care transformation is critical to everything we want to achieve and at the
heart of this is the need to support General Practice to achieve the series of
specifications set out in the London Strategic Commissioning Framework for Primary
Care. Transforming Primary Care services will ensure consistent, high quality
primary care to all our residents.

Learning Disabilities - Building on the outcomes of the Learning Disability Review to
develop an improved service offer for Wandsworth-registered patients with learning
disabilities. This includes contractual requirements to comply with standards for
admission and discharge for people with learning disabilities, the implementation of
integrated education, health and care plans and the offer of Personal Health
Budgets.

Children & Young People - Working with partners, schools and parents to pilot a
new service model that will ensure equitable, accessible care and improved
outcomes for children and young people with special educational needs and
disability.

Preventing Ill Health - Working with our partners to develop targeted smoking
cessation services in key local communities to reduce health inequalities.
9

Older People - Developing a multi-disciplinary in-reach team to ensure residents in
nursing homes have access to equitable and high quality community services.
7. Engagement - Empowering the Patient and Public Voice
The CCG has a strong record of engaging patients and the public in the development of
services and active engagement with patients is a common thread through all of our
commissioning programmes.
Our aim is to ensure that PPI and the patient voice are at the centre of everything we do as
a CCG. This means that we systematically embed PPI and the patient voice at every stage of
the commissioning cycle as illustrated by the examples shown in the diagram below.
Building on best practice principles, the following diagram illustrates how PPI is a continuum
and is made up for four distinct levels and processes. We use these levels or different
approaches for PPI as indicators/standards for assessing PPI within each stage of the
10
commissioning cycle.
Inform
Involve &
Engage
Consult
Partnership
Informing is the first level of involvement and is a useful process to be clear, honest and
transparent about what we are doing and about any plans or service changes. It is a oneway process to enable us to tell our stakeholders about our work/service or any changes to
patients, carers and the public without involving them.
Consulting is a two-way process which enables us to ask people and obtain feedback about
their views; and gives us the ideal opportunity to build the patient voice/gain insights into
projects or service improvements or new models of care.
Involving is the logical extension of consulting which enables us to ensure that the patients
and the public are actively engaged in our programmes. This is a useful process to ensure
that we are taking patients, carers and public on the journey with us.
Partnership- This is when patients and the public are actively working with us to determine
the outcomes of our programmes or shape services
We continue to refine and enhance our approach to ensure that the patient voice is
embedded throughout the commissioning cycle, utilising a variety of processes from patient
representation at our Clinical Reference Groups, engagement events throughout the
Borough and user engagement in the redesign of services.
Engagement on Commissioning Intentions
The CCG intends to undertake a significant programme of engagement over the autumn and
winter of 2015/16 to help generate a discussion about the principles and priorities within
these commissioning intentions. This will be the basis of further development into the
CCG’s Operating Plan for 2016/17, setting out our funded programmes that will deliver
improved outcomes for patients, quality of services and improved patient and carer
experience.
Sian Job - Clinical Lead Patient & Public Involvement
11
8. Locality Commissioning Intentions
Locality Commissioning Groups operate at a geographical level, they have a
clear understanding of the health and social care needs of their local
population and can help reduce health inequalities and address health and
social care issues that may be specific to their communities. The map below
identifies the three localities and their constituent practices.
The Health & Wellbeing Strategy has identified Healthy Places as a key
enabler to addressing health inequalities and the CCG supports differential
commissioning where it will deliver a health benefit. Locality commissioning
groups, with their geographical focus, have identified the priorities for their
local populations.
12
8.1 Battersea
Battersea locality has a growing and diverse population. There are areas of high
deprivation and the locality has a strong inner-city profile; more so than the other
localities in Wandsworth. Our local Initiatives have been decided in collaboration with the
Battersea Patient Group, our Locality Management Team and Wandsworth Public Health
to focus on key priorities for the resident of Battersea.
Jonathan Chappell & Nicola Williams
Joint Locality Leads – Battersea
Battersea local priorities

Identifying Mental Health problems
Identifying mental health problems and delivery of stress management courses – 18
free courses available throughout the year to Battersea residents who are identified
by their GP as having mental health issues related to stress/anxiety.

Parenting
Roll out of successful parenting course to 4 locations across Battersea. These free
courses are delivered by the Neighbourhood Midwives and offered to Battersea
parents of new-borns identified by primary care. Courses are tailored to the specific
population needs (i.e. parents attending the course at the Doddington estate may
have different needs to those attending in the Northcote ward).

Sexual Health
Continuing to work with the Terence Higgins Trust, the METRO centre and the HIV
trainer to improve rates of HIV and chlamydia screening. Evaluation of last years
‘condoms, chlamydia and HIV’ project is on-going in conjunction with Public Health.

Patient Welfare Advice Service
Working with the Citizens Advice Bureau, Family Action and DASCAS to deliver a
telephone and face-to-face advice service.

Childhood Obesity
Working to identify children who may be overweight before they start school and
direct them and their families to appropriate support services
Nine Elms Vauxhall (NEV) Development
We have already seen a rise in the population of Battersea and it is estimated that over
27,000 new residents are due to arrive over the next 15 years. We are working closely with
Lambeth CCG, NHS England and South London Health Partners on the impact of NEV on the
healthcare infrastructure.
13
8.2 West Wandsworth
West Wandsworth Locality covers the areas of Roehampton and Putney and the practices
that lie within these areas. The West Wandsworth priorities build on the work and priority
areas previously identified, to improve the health and wellbeing of the population and
also support Wandsworth wide priorities. Our priorities have been identified through
consultation with West Wandsworth Management Team and Members, the Local
Authority, Public Health and our locality patient group to address some of the key health
issues affecting the residents of West Wandsworth.
Peter Ilves – West Wandsworth Locality Lead
West Wandsworth local priorities

Improvement of uptake in Breast Cancer screening in the locality
The Locality is working with practices and the South West London Screening Centre
to increase uptake of breast cancer screening locally.

Improvement in rates of childhood immunisations
The locality is currently working with practices to support them to achieve an
improvement in childhood immunisation rates in West Wandsworth.

Support uptake of Improving Access to Psychological Therapies (IAPT) services
Through presentations at Members Forums and the Locality Patient Consultative
Group and promotion within weekly bulletins, the Locality is continuing to improve
awareness of the IAPT service and encourage primary care to make appropriate
referrals.

Work with public health to deliver the public health strategy where it relates to
our Locality
A representative from Public Health sits on the locality Management Team and
Members Forum. This ensures we continue to work closely with Public Health and
contribute to the delivery of the public health strategy in locality initiatives.

Support practice patient groups and development of Locality patient group
The Locality will continue to support the work of the Patient Consultative Group. The
Locality will further develop and enhanced the programme of engagement with
wider stakeholders and hard to reach groups.

Men’s Health - Man MOTs in conjunction with Public Health
Improve engagement with men about preventative health services aiming to reduce
inequalities in health outcomes. This will further enable engagement with men who
may not normally engage as readily with NHS services whilst encouraging greater
referrals to Public Health lifestyle services.

NHS Health Checks
Supporting delivery to Roehampton practices to ensure equity of access across
locality
14
8.3 Wandle
Wandle is the largest of the three Wandsworth localities, with 22 member practices
serving the electoral wards of Bedford, Earlsfield, Fairfield, Graveney, Nightingale,
Southfields, Tooting and Wandsworth Common.
Whilst sharing many of the same health priorities as the rest of Wandsworth, we know
from our public health needs analysis that Wandle does have locality-specific issues that
could be addressed and this has shaped our chosen priorities.
Seth Rankin & Mike Lane
Joint Locality Leads -Wandle
Wandle local priorities

Citizens Advice Bureau
Delivery of the CAB service – Wandle have commissioned a dedicated Community
and Advice Referral Assistant. This enables all Wandle Practices to prescribe
community advice with onward referrals where appropriate for their patients.
Interventions are initially done by email and telephone with provision of space at
two Wandle Practices for patients to be seen face to face.

Childhood Obesity
Public Health analysis shows Wandle has high levels of Childhood Obesity. Practices
are taking part in a pilot where Nurses measure the children’s Body Mass Index
(BMI) when they attend for their pre-school immunisation booster. Training for
health care professionals on measuring BMI in children and how to discuss the issue
of child obesity in an effective, compassionate and motivating ways has been
provided.

HIV Clinical Indication Conditions
A pilot is taking place to determine whether active screening for clinical indicator
conditions is a more cost and clinically effective way of identifying people with
undiagnosed HIV infection in Wandle. Training will be carried out with Practice Staff
and EMIS searches will be carried out to identify the number of patients registered
and diagnosed with a clinical indicator condition. Where this is identified a prompt
will be placed on the system to recommend HIV testing at the patient’s next
attendance.
15
9. Commissioning Programmes
This year we have defined our commissioning programme under eight headings. This
enables us to describe our set of commissioning priorities in a way that is clear to our
patients, commissioning partners and providers. This way of working is also allowing us to
define clear outcomes for each programme and track our progress in delivering these.
We have agreed a joint commissioning programme with Wandsworth Borough Council in a
number of areas. The shared commissioning programmes are: preventing ill health,
learning disabilities, children, mental health and older people. These are areas where we
have a shared interest in delivering integrated care to people with long term or complex
health needs or working together to deliver preventative care to support the health and
wellbeing of our local population.
16
Attach 5
WCCG Commissioning Programmes Executive Summary
CCG/Local Authority Joint Programme
Preventing
Ill Health
Voluntary
Sector
Community
Empowerment
Carers
Prevention
Initiatives
Reducing
Inequalities
Learning
Disabilities
Complex
Disabilities
Adolescent
Transition
Access &
Equity
Winterbourne
View
Placements
Complex
Community
Placements
Children
Older
People
Reablement
Dementia
Complex
Disability
CAMHS
Care Homes
Frailty
Pathway
End of Life
Care
Intermediate
Care
Prevention
Initiatives
Community
Therapies
Acute
Paediatrics
Education,
Health and
Care Plans
CCG Programmes
Mental
Health
CMHT
Perinatal
Mental
Health
IAPT
Primary Care
Urgent Care
Primary Care
Quality
OOH/111
Primary Care
strategy
Primary Care
Delivery
Complex
Family
Therapies
Non Elective
Pathways
Admission
Avoidance
Trauma
Social Care
Out of
Hospital
Diabetes
COPD
CVD
MSK
Diagnostics
Cancer
Ophthalmology
Prevention
Initiatives
Acute
Inpatient
IT, Capital Planning, Estates & Medicines Management
Commissioning Levers & Financing
Stakeholder Engagement and Communications
Aligning with the South West London Collaborative Commissioning Strategy
Delivering the London Health Commission recommendations
These key
enablers
support all
Programmes
Attach 5
9.1 Commissioning Programme - Preventing Ill Health
Our Vision
The Five Year Forward View outlined a vision for a sustainable NHS placing a clear
emphasis on increasing the focus on prevention; moving from acute episodic care towards
prevention, self-care and integrated and well-co-ordinated care to cope with an aging
population and increased prevalence of chronic diseases.
Working with Wandsworth Council and our partners we are developing a joint programme
that:






Is informed by the development of the five year Joint Health and Well Being
Strategy for Wandsworth.
Directs resources to the patients with greatest need
Focuses on reducing lifestyle risks and their causes or by targeting high-risk groups.
Focuses on systematic primary prevention targeting areas of health inequalities.
Engages with patients who are not reached by mainstream services by working
with community and voluntary sector groups.
Empowers patients through our Self-Management Programme.
Focus in the last 12 months
•
•
•
•
•
•
We have been empowering patients to manage their care through the
Wandsworth Wellbeing Hub, a central point of access to information about third
sector services, self-management courses, Public Health ‘Lifestyle’ services and
access to psychological therapies in Wandsworth.
Implemented a new Stroke Information, Advice and Support Service.
Produced a guide to local dementia services, developed with extensive
engagement and in partnership with people with dementia and their carers and
families; this provides key contacts, information and support readily available
across Wandsworth.
Re-established the Expert Patient Programme; 10 courses delivered in 2014/15.
Rolled out the self-management Healthcare Professional (HCP) Training,
designed to train HCPs on self-management and the tools and services available
in Wandsworth.
Continued to develop the Care4Me website, allowing Wandsworth residents to
access self-help groups and established charities for advice on care and support.
•
Promoted Big White Wall, an innovative and accessible 24/7 mental health
support service.
•
Working with the Older People’s Network and various third sector organisations
to develop centres for Wellbeing, providing a range of locally determined
activities to promote good health, reduce social isolation and increase resilience.
Focus for the next 12 months








Further development of the Wandsworth Wellbeing Hub
Alongside commissioning for prevention and social care, developing differential
commissioning will be a key enabler to addressing health inequalities which remains
one of our strategic priorities.
Wandsworth CCG Patient Self-Management Courses, in particular targeting these at
specific patient groups and hard to reach communities.
Delivery of the joint Health & Well-being Strategy
Delivery of the joint Healthy Weight, Health Lives Strategy
Continued initiatives around smoking cessation services
Continue to work with the Older People’s network to identify two additional centres
for wellbeing.
We will explore with the local authority opportunities to develop joint service
specifications, particularly around services provided by communities and the
voluntary sector (third sector). This will both generate efficiencies and provide the
security of longer term contracts. Various initiatives with the third sector include an
evaluation programme to assess effectiveness, value for money, value to the
individual and the wider social value.
WCCG Commissioning Intentions for Preventing Ill Health
1. Commission prevention and social care services in an integrated way – where it
will generate an increased health benefit for our population.
2. The CCG will work through the commissioning programmes to commission
differentially; addressing specific population need where there is evidence it will
reduce health inequalities. This is a reflection of a key priority in the Joint Health
and Wellbeing Strategy.
19
9.2 Commissioning Programme - Primary Care
Our Vision
The NHS is unique because of its system of general practice. The practice provides a
medical “home” for the patient, underpinned by a life-long medical record. It has the
ability to deliver health services to the whole population and in doing so has the potential
to reduce health inequalities. General practice can deliver care closer to people’s homes,
through a continuous relationship with the same clinical team from birth through to the
end of life. Whilst Wandsworth has many examples of good General Practice, we know
that the service is variable and, in places, unable to cope with the pressures placed on it
today and into the future.
The CCG recognises that Primary Care transformation is critical to everything we want to
achieve and at the heart of this transformation is the need to support General Practice to
achieve a series of specifications set out in the London Strategic Commissioning
Framework for Primary Care. These specifications are structured around the three themes
of co-ordinated care, accessible care and pro-active care and delivery across London is
expected within the next five years.
The nature of these specifications, particularly those around accessible care (which
describe delivering services 8am – 8pm seven days per week), mean that the existing
model of General Practice in Wandsworth must change. It is therefore essential that the
CCG empowers and supports practices to work collaboratively with one another, in order
to achieve the requirements set out.
The NHS Five Year Forward View sets out a number of models of care which CCGs are
being encouraged to work towards in order to deliver more joined up and integrated out
of hospital services for patients. The Multi-Specialty Community Provider model (MCP)
sees groups of GP practices working together to deliver a wider range of services,
coordinating input from Community Services, hospital specialists and others where
needed, and eventually shifting the majority of ambulatory care to out-of-hospital
settings. In June 2015 the Wandsworth CCG Board agreed to work towards the
development of an MCP in the next three to five years, which will deliver significant
benefits for patients and act as a vehicle for achieving our ambitions for Primary Care
across the Borough.
Clinical Lead - Nicola Jones – Chair –Wandsworth CCG
Focus in the last 12 months
Our focus has been to monitor, review and develop the initiatives that were launched in
2014/15 with a particular focus on the development of equal levels of service across
20
General Practice, encouraging collaboration where appropriate, to ensure all patients across
Wandsworth have access to a range of high quality primary care services locally.
In addition we have improved links between primary care, social services and community
services, to ensure that patients are placed at the centre of out of hospital services and are
empowered and supported to remain healthy at home for as long as possible. Specific
initiatives have been:
1. Delivery of a series of enhanced services including diagnostics, extended opening
hours and our innovative planning all care together contract by General Practices
across the Borough
2. Enhancing the quality of primary care through our membership development
programme and the launch of a practice support team
3. Development of the primary care workforce through a programme of education,
improved communication and shared best practice
Focus for the next 12 months
London wide Strategic Commissioning Framework for Primary Care
• Commissioning services which support delivery of the three areas detailed in the
framework:
- Accessible care i.e. providing a personalised, responsive, timely and
accessible service;
- Coordinated care i.e. providing patient centred coordinated care for patients
with long term conditions or complex needs; and
- Proactive care i.e. supporting and improving the health and wellbeing of the
population, self-care, health literacy and keeping people healthy.
Multispecialty Community Provider (MCP)
• Begin development of an MCP model as referenced in the NHS Five Year Forward
View. The development of this model in Wandsworth will benefit patients through
increased integration of services and will enable us to deliver on a number of our
ambitions for transforming Primary Care across the Borough.
Enhanced Primary Care Services
• Commissioning Enhanced Primary Care services on a whole population basis;
ensuring that all Wandsworth patients have access to enhanced Primary Care
services locally.
Improving Quality in Primary Care
• Supporting practices in improving the quality of the services they provide through a
series of Borough wide and practice specific improvement schemes. These include
the use of the Quality Tracker and visits from the Practice Support Team to all
practices to identify and tackle areas for improvement.
21
Up-skilling of the Primary Care workforce
• To ensure they have the capacity and capability to manage more complex patients in
the community. Working with the local Community Education Provider Network
(CEPN) and Health Education South London (HESL) to develop and roll-out a
programme of training and education for Primary Care staff.
WCCG Commissioning Intentions for Primary Care
1. Ensure that all patients across the borough have access to the full range of enhanced
primary care services locally (including diagnostics, extended hours clinics and those
services which make up the Planning all Care Together contract) by commissioning
them via a single provider.
2. Increase collaborative working and sharing of best practice by commissioning a quality
contract for Primary Medical Services.
3. Improve care for our most vulnerable patients by stimulating engagement of practices,
community services and other partner organisations to ensure that care is fully joined
up and integrated. The CCG will take a decision in 2015/16 on the formal delegation of
responsibility for commissioning core Primary Care contracts (GMS and PMS) from
NHS England for 2016/17 and onwards.
4. In line with the Five Year Forward View and CCG Board strategy, continue to work with
the Wandsworth federation of GP practices to develop a Multi-Specialty Community
Provider (MCP) to deliver co-ordinated, integrated out of hospital care to the
Wandsworth - commencing with a service specification in anticipation of proceeding
to procurement in October 2016.
22
9.3 Commissioning Programme - Out of Hospital Services
Vision
The Out of Hospital commissioning programme encompasses a range of health provision
which strengthens care available in community settings or in a patient’s own home. The
effectiveness of these services is of particular importance to patients with long term
conditions and those older patients who are at high risk of falls or periods of ill health and
who are likely to end up in hospital if the right community based support is not available.
These services range from support for self-management and management of long term
conditions, to providing access to specialist and consultants in community settings. The
focus is on right care at the right time, making the best use of clinical teams in the
community and ensuring that hospital based care is provided only where that is most
appropriate for patient care. This programme is supported and delivered through a series
of clinically-led Clinical Reference Groups focusing on the redesign of key service areas to
deliver health improvements for patients.
Strengthening Out of Hospital care is a central element of the SWL strategy. When
community based services are effective and reliable we will have hospitals that are under
less pressure and better able to deliver the high quality planned and urgent care that we
all rely on and which can only be delivered in an acute setting.
The Five Year Forward View anticipates the development of a comprehensive Out of
Hospital Strategy which the CCG Board has agreed will be delivered in Wandsworth
through the Multi Specialty Community Provider (MCP) model.
CRG Leads:
Nicola Jones – Cardio-Vascular Disease (CVD); Seth Rankin - Diabetes ;
Anthony Cunliffe – Cancer; Kieron Earney – Chronic Obstructive Pulmonary
Disorder (COPD); Ayran Jogiya - Dementia
Focus in the last 12 months
Respiratory


Establishing a pilot in Battersea Locality using Lung Function Questionnaires as part
of the smoking cessation appointment to identify undiagnosed COPD.
Secured the recurrent funding for the Community Pulmonary Rehabilitation Service
- Clinics have been established in three Community locations
23
-




Waiting lists at St Georges have been reduced as a result of the service
Housebound patients have been able to access Pulmonary Rehab where they
may not have been able to access the service previously
We continue to offer training to Health Care Professionals to upskill staff on the
management of COPD and Asthma
Running a Respiratory Diploma Course to upskill professionals in Primary Care
(mainly GPS) as part of our pathway work to provide more Tier 2 support
Running Accredited Spirometry Course for Primary Care staff
Working with the Pharmacy Team to support an Asthma Care Audit in Primary Care
Stroke & Neuro Rehab
 Primary Care Pathway programme in development and the clinical leads have been
looking at how we can identify and manage stroke patients in primary care and these
associated pathways
 The Six Month Review Service continues to be provided by the Stroke Association
and numbers are increasing with 22 reviews taking place (Provider data) in Q1 of this
year.
 The Information, Advice and Support Service provided by the Stroke Association is
being well utilised with 67 beneficiaries of the service in Q1 and 28 referrals.
 Connect continue to provide support for people with Aphasia and are working with
the CRG group to develop a survey for health care professionals to look at
understanding the needs of people with communication difficulties when accessing
primary care services.
 Working with Thrive the Horticultural Charity to develop a programme of
rehab/exercise for people who have had a stroke.
Cancer
 Bowel screening and breast screening embedded within PACT to improve uptake.
 SWL practice nurse training delivered with four practice nurses trained from
Wandsworth
 Training delivered by Cancer Research UK for primary care practice staff across
Wandsworth: up to 40 members of staff
 Self-management to patents being delivered by Pauls cancer support Centre to run
a series of self-management coursework and 1:1 sessions for people with cancer
 Wandsworth Federation delivering cancer specific messages with identified cancer
leads
Focus for the next 12 months
Diabetes
 Implementation of redesigned diabetes tiered model
COPD
 In year development of integrated/tiered models for COPD
 Developing, commissioning and reviewing effecting high quality Asthma Services
24


Roll out of the COPD Missing Millions Programme
Continued provision of Community Pulmonary Rehabilitation Programme in
Wandsworth
Dementia
 In year development of integrated/tiered models for Dementia
CVD






To commission a high quality chronic heart failure pathway by ensuring that patients
receive the right treatment, at the right time by the right staff.
To develop a standardised CVD assessment template. This template will list all the
factors that a healthcare professional should consider when conducting a CVD
assessment. This template will ensure that there is a consistent approach to
assessing CVD risk across all Wandsworth GP practices
Design and implementation of new arrhythmia and anticoagulation pathways
ensuring that patients receive the right treatment, at the right time by the right staff.
(projects are currently under review by the CVD CRG but will include medicines
management i.e. NOACs v warfarin)
To develop clear prescribing and local guidelines for primary care to improve the
identification of individuals and families at very high risk of Familial
Hypercholesterolemia (FH).
To engage patients, carers and the public in service developments and the wider
implementation of the Cardiovascular Disease Outcomes Strategy
To reduce the incidence of stoke caused by atrial fibrillation (AF) through a range of
approaches
o Ensuring 80% of patients with non-valvular AF with a CHA2DS2-VASc stroke
risk score of 2 or above are prescribed oral anticoagulation medication,
taking bleeding risk into account. This is above the QOF threshold of 70%.
o Ensuring all patients with AF referred to an anticoagulation clinic should have
a referral-to-treatment time of no more than two weeks
o Promotion of opportunistic screening in patients over 65 years old through
pulse checks and/or portable affordable technologies.
o Offering patients on oral anticoagulant medication on-going support to
ensure medicine adherence.
Cancer
The Cancer CRG will continue to focus on prevention of disease, early diagnosis and patient
experience of treatment with an emphasis on patients’ choice and care provision in the
community during active treatment and recovery.
To deliver the above aspiration the Cancer CRG is committed to the following programmes:
Through contracts with GPs:
 Improving bowel screening
 Improving the holistic cancer care review
 Improving mammogram screening
25
Through the Out of Hospital programme:
•
Working with Paul’s Cancer Support Centre to deliver a physical activity
programme for patents with a five year diagnosis in partnership with Macmillan
•
Practice nurse training for cancer
•
Macmillan GP facilitator leading general practice engagement
•
Developing the role of practice leads through the federation of GP Practices
•
Paul’s Cancer Support Centre delivering specialised self-management
programmes
•
Raising awareness through campaigns, health and well-being events and
developing opportunities for patient feedback
•
Working with seldom heard communities such as people with learning disabilities
to improving awareness and screening uptake
•
Our aim is for all providers to deliver the pan London quality standards.
Chronic Kidney Disease (CKD)
 Wandsworth has fewer than predicted numbers of people on GP registers with CKD.
There is a national programme to roll out a case-finding approach and we will
promote involvement in this work.
Stroke & Neuro Rehabiliation
 Continued implementation of Community Information, advice and support services
for stroke patients
 Development of services that support the National Outcomes Framework
measurement of reporting an improvement in activity /lifestyle at six months post
stroke
 Implementation of programmes to increase exercise opportunities in the community
for people who have had a stroke
 Provision of a six month review services for people who have had a stroke
 Develop Primary Care pathways to support stroke identification and management in
primary care
 Development of the Neurological Conditions pathway including a review of current
needs, and service provision
Musculoskeletal Services
 Undertake a procurement for an all body parts muscoskeletal service to commence
in April 2016.
Podiatry
 Undertake a review of the current AQP Podiatry service.
Community Dermatology
 Review eligibility and activity flow of current service to inform future procurement
within the context of the Multispecialty Community Provider model.
26
WCCG Commissioning Intentions for Out of Hospital Services
1. In line with the Five Year Forward View and CCG Board strategy, continue to work
with the Wandsworth federation of GP practices to develop a Multi-Specialty
Community Provider (MCP) to deliver co-ordinated, integrated out of hospital care
to the Wandsworth population. This will include provision of specialist clinical
care to the older population, and those with chronic long term conditions (as per
the detailed plans), in community settings and aligned with primary care services.
2. Commissioning an integrated tiered pathway for ophthalmology. This will be a
proof of concept for evaluation with a view to wider role out of the model.
3. Working with NHSE and SWL commissioners to improve neuro-rehabilitation
pathways.
4. Commission a tiered model of diabetes care. It is proposed that the new model
will optimise the role of primary care through strengthening specialist nurse and
consultant support to support delivery of care plans. There will be a focus on
supporting self-management and an expectation that fewer patients will need to
access outpatient care in hospital clinics
5. Undertake a procurement for an all body parts Muscoskeletal service to commence
in April 2016.
SW London Collaborative Commissioning Programme Intentions
1. The CCGs will apply the agreed Adult Community Principles and Standards across
all services
2. CCGs will implement the Crisis Response Initiative (out of hours GP home visits)
27
9.4 Commissioning Programme - Learning Disabilities
People with learning disabilities are amongst the most vulnerable and socially excluded in
our society. Employment opportunities are limited; very few live in their own homes or
have choice over who cares for them. This leads to people with learning disabilities being
marginalised and excluded.
Building on the principles of Valuing People Now, we have developed a our Learning
Disability Programme; a collation of initiatives for children and adults with learning
disabilities that uses commissioning drivers to identify and deliver opportunities for short
and long term strategic improvement in learning disability services.
We want to improve the lives of people with a learning disability. We will do this utilising
our commissioning drivers to support people to be more independent, have healthier lives
and have more choice and control and most importantly by listening to our patients and
carers to tell us about what works for them.
Farooq Rafique - Clinical Lead
Focus in the last 12 months

Wandsworth CCG review of commissioned services for people with learning
disabilities with recommendations. The review will inform service redesign and
development in 2016/17.

Review of placements for people with learning disabilities, leading to better
contracts, more focus on patient outcomes and greater assurance on the standards
of care delivered to some of our most vulnerable patients.

Establishment of the Learning Disabilities Reference Group and appointment of
Clinical Lead for Learning Disabilities.

Local agreement on discharge planning arrangement for Winterbourne View and ex
NHS Campus patients under the national “Transforming Care” programme, leading
to 50% patients in hospital type accommodation being transferred to community
settings.

Agreement with Wandsworth Borough Council on the development and delivery of a
joint programme of initiatives in 2016/17 including provision of specialist community
services and transition between child and adulthood.
28
Focus for the next 12 months
Primary Care & Community Care
• Review of existing community learning disability services delivered by South West
London & St George’s Mental Health Team and St George’s University Hospitals NHS
Foundation Trust.
• Commission primary care services that will improve physical health of people with
learning disabilities to optimise impact and outcomes for patients through delivery
of excellent primary care to all people registered with a Wandsworth GP.
Winterbourne View
• Working in partnership with Wandsworth Borough Council to develop a strategy for
facilitating repatriation of patients in hospital type accommodation from inpatient
units outside the area, back to Wandsworth.
Personal Health Budgets
• Agreeing and implementing the core offer for Personal Health Budgets for people
with learning disability and challenging behaviour. The change will be implemented
through Commissioner, Provider and Service User consultation and by joint
agreement with stakeholders.
Supported Living Accommodation
• Working in partnership with Wandsworth Borough Council to review capacity within
supported living accommodation to respond to the needs of people with learning
disabilities.
Care co-ordination and case management
• Pilot delivery of case management and care co-ordination within locally agreed
definitions.
Integrated Community Learning Disability Health and Social Care Team
• Working in partnership with Wandsworth Borough Council to consider the benefits
of an integration community health and social care team.
•
A review of community learning disability services in line with local review and national
policies.
•
Training & Development
- Commission training programme to up skill mainstreams providers to
better respond to the needs of people with autism and/or people with
learning disability.
-
Ensure that all commissioned services have service specifications that
reflect the nature and cost of what they are delivering. To support
delivery of better care and a healthier future for Wandsworth through
29
our clinical leadership, robust commissioning processes and excellent
staff, focussed on delivering quality services and improved outcomes for
patients.
Inpatient facilities
 Improve inpatient facilities for people with Learning Disabilities and Autism. Given
the poor provider marketplace, and the increased focus on caring for people with LD
close to home and in intensively managed pathways, we would like to explore the
potential to significantly improve and increase the current offer for this patient
cohort. This may potentially be picked up wider than WCCG as both for SW London,
and across London, this is a significant issue.
WCCG Commissioning Intentions for Learning Disabilities
1. Implement the core offer for Personal Health Budgets for people with learning
disability and challenging behaviour.
2. Continue the work of the Transforming Care programme, ensuring that patients
are cared for in community settings where possible.
3. Develop a strategy for facilitating repatriation of patients in hospital type
accommodation from inpatient units outside the area to Wandsworth.
4. Joint programmes with Wandsworth Borough Council Directorate of Education and
Social Services
30
9.5 Commissioning Programme - Children & Young People
We are working with our partners in Wandsworth Borough Council and primary and
secondary care to develop care that is targeted towards those with the greatest need and
delivered across integrated pathways. To ensure equitable services for all young people
led by their needs and a flexible delivery model to improve outcomes and support and
empower children young people and their families to manage their care and lead longer,
healthier lives.
Tom Coffey - Clinical Lead
Focus in the last 12 months
Children’s Therapies in special Schools
• Service review and redesign in partnership with Wandsworth Borough Council
• Pilot – integrating therapy teams within the school’s management team and direct
commissioning
• Development of resource allocation model aligned to children’s health needs
• Practical training for parents and school staff to empower parents and staff to
support the children by increasing key skills and knowledge.
Children with Complex Needs
• Review of the resources and the pathway between the CCG and LA to improve
integration. This is a joint approach focusing on future commissioning arrangements
of the services for children with complex needs.
Children Looked After
• Review of the Health Needs of Children Looked After who are leaving care.
• Revised service specification.
CABIN
• Pilot to safely reduce very short stay admissions to hospital by the implementation
of a paediatric admission tool.
Child Mortality
• A multi-agency programme to reduce child deaths as a result of Asthma.
Service Specification review
• Haemoglobinopathies
• Therapies
• Continuing Care
• Paediatric Community
• Safeguarding Team
• Homeless and Refugee Services
• Looked After Children
31
Children’s Continuing Care
• Review of service, including assessment processes and resource allocation model
• Development of Personal Health Budgets offer for Children with Continuing
Healthcare funding
South West London Children’s Collaborative
5 year strategy for children services including the following areas:
• Child and Adolescent Mental Health Services (CAMHS)
• Under Five Year Olds
• Children with Disabilities
• Paediatric Admissions – Acute
Focus for the next 12 months
Children Looked After (LAC)
• LAC Pilot – to review the emotional well-being and drug/ alcohol needs of Looked
After Children. This pilot will be running in 15/16 and will inform commissioning in
16 /17.
• Changing the Looked After Children GP role
Children’s Therapies in Special Schools
• Full data provision of for the core specification
• Evaluation of pilot models and roll out of integrated service provision across all
Wandsworth Special Schools
• Implement resource allocation model across school base and implement for
mechanism for recharge for out of borough pupils.
Continuing Health Care (CHC) Nursing Review
• Revised service specification to reflect new assessment arrangements and revision of
existing block contract.
• Implementation of revised resource allocation model
• Roll out offer of Personal Health Budgets for Children with CHC
• Improved joint commissioning arrangements between the CCG and Local Authority.
CAMHS
• Government ‘Policy Future in Mind’- Feb 2015 - implementation of the CAMHS
Transformation Plan produced in line with the principles and guidelines within the
new legislation.
• Developing an adolescent transition service for CAMHS and Drug and Alcohol.
• Place to Be - Expansion of the Primary School Counselling Service, extending the
service to those schools in deprived areas in Wandsworth.
Children with Complex Needs
• Commission and deliver selected services differently from 2016/17 and a potentially
larger range of services from 2017/18.
32
Teenage Pregnancy & Sexual Health
• The CCG is a member of the commissioning partnership that is leading on the
implementation of FNP. The development of this initiative and the links with
perinatal service and the developing sexual health strategy may lead to differences
in how services are commissioned in future.
Child Obesity
• Development of an obesity clinical pathway.
Asthma
• Redesign of the community pathway to reduce A&E admissions for 0-5s.
Female Genital Mutilation
• This is an objective for the Clinical Reference Group work programme in 15/16 and is
part of the child protection plans for the LA and CCG.
WCCG Commissioning Intentions for Children & Young People
1. Special Educational Needs and Disability (SEND) – the CCG intends to recharge
responsible CCGs where health services are provided to children within
Wandsworth Special Schools who are registered with a GP outside of
Wandsworth.
2. SEND- the CCG intends to agree and implement from April 2016 a local tariff
based on the agreed matrix of needs assessment.
3. Roll out of integrated service model to all Wandsworth Special Schools.
4. Roll out of Personal Health Budgets offer for Children receiving CHC in
Wandsworth
5. Commission a CAMHS 18-25 service and ensure that all providers meet the
CAHMS London Quality Standards (Referrals to be available 24 hours a day, 7
days a week with a maximum response time of 30 minutes. Psychiatric
assessment to take place within 12 hours of call)
6. Commission a Paediatric asthma service based on London quality standards
(2015)
7. Commission a nurse led Children Looked After 5-11 review service
8. Implement local CAMHS Transformation Plans
9. CHC - Revised service specification to reflect new assessment arrangements and
33
revised funding moving from block to cost of package from April 2016
10. Commission South West London Child Sexual abuse - HUB .
11. Work with Wandsworth Borough Council to harmonise/integrate the
commissioning of care for children with complex needs
SW London Collaborative Commissioning Programme Intentions
1. Commission providers to the new London Asthma Standards for Children and
Young People.
2. By the end of 2016/17 every acute provider will meet the acute CAMHS LQS 21 –
single access for children and adolescent health (CAMHS) (or adult mental health
services with paediatric competencies for children over 12 years old). Referrals
to be available 24 hours a day, 7 days a week with a maximum response time of
30 minutes. Psychiatric assessment to take place within 12 hours of call.
3. Establish and pilot a Children’s Surgical Network across SWL which meets the
standards of the new London SCN Children’s Surgical Guidelines (2015)
4. Implementation of the new specification for maternity services
5. Meet the trajectory to achieve Obstetric Standards of the London Quality
Standards (LQS) by 2018/19 – provide a minimum of 144 hours of consultant
obstetric presence on acute labour wards by 1st April 2017
6. Meet the trajectory to achieve Settings of Care Standards of the LQS by 2018/19
– provide for 20% of births to be Midwifery-led setting of care by 1st April 2017
and 3% of births to be home-births by 1st April 2017
34
9.6 Commissioning Programme - Older People
Building on the strong foundations delivered through the redesigned community adult
health service (CAHS) we are working with partners to build systematic and proactive
management of chronic disease to deliver a pathway for patients over the age of 75 who
are identified by their GP as having complex needs which would be most appropriately
managed by a multi-disciplinary team.
In the proposed model a range of organisations will work together as a team around the
patient. This will include acute care, community services, the older people’s mental
health team, social care teams and the voluntary sector. Mental, physical and social care
needs will be managed in an integrated way at each stage of the pathway and will be
coordinated around the individual patient’s needs. Through this joined up working we
hope to keep more patients well and cared for in their own home and deliver the
outcomes that make a difference to older adults and their carers.
Seth Rankin and Andy Neil
Focus in the last 12 months
Community Adult Services
• Embedding the redesigned community adult health service (CAHS), delivering
complex case management, rapid response, specialist care, facilitated and supported
discharge from hospital and maximising independence for people with Long Term
Conditions.

Extending the Quickstart service to provide rapid access to homecare services to
prevent admissions for older people.

Improving support for patients and families to find the right nursing home

Reducing delayed discharges from hospital

Working with leaders from community services, St George’s University Foundation
Trust, mental health, social care and the voluntary sector to design an integrated
pathway of care for people over the age of 75 with complex health and care needs –
currently known as the Frailty Pathway

Working with care homes to support improved health outcomes for residents
Focus for the next 12 months
Over the next year our focus will be on making sure that the services we have redesigned
and commissioned are delivering the outcomes that matter to patients and carers, that
partner organisations have agreed ways of working together at a team around the patient
35
and that older people living in care homes have access to high quality effective health
services.
To achieve these objectives we will:







Improve the competency framework for Nursing and Residential homes in
Wandsworth
Review and redesign the non-clinical post dementia diagnostic support is driven by
the need to support the navigation of the dementia pathway.
Streamline referral routes and pathways via the Access and Coordination Hub to
receive Social care referrals from Primary Care.
Review of step up and step down beds and the Acute Avoidance Admission (AAA)
Pathway based at Queen Mary’s Hospital, including referral criteria, to patient
rehabilitation outcomes.
Develop a multi-disciplinary in-reach team to ensure residents in nursing homes
have access to equitable and high quality community health services
Implement a new integrated community service model for older adults with mental
health needs and those living with dementia.
Improve awareness and training to increase the timely diagnosis of dementia
Integrating acute and community pathways
 The CCG will test the Multi-Specialty Provider (MCP) model as the approach to
promote integrated primary care and community services.
 Deliver Planning All Care Together (PACT) >75 - to improve the care being delivered
to older people most in need integrated health and social care support.
 Provide improved access to home care services through joined up working with
social care, including rapid access to services where this is required.
 Facilitated & supported discharge from hospital, making sure that this support is
available 7 days a week for all patients who require it.
 Implementation of the full Dementia Clinical Nurse Specialist provision in 2016
 Ensure that end of life care co-coordination is available to all patients at end of life
and that these services work in an integrated with wider community teams.
WCCG Commissioning Intentions for Older People
1. Revised specifications for health and social care teams to deliver PACT >75s.
2. Shared outcomes and KPIs across organisations to embed integrated service
delivery for PACT>75 cohort.
3. Development of multi-provider CQUIN scheme.
36
4. Investment in new posts to support;
a. Equitable healthcare for care home residents
b. Additional community consultant capacity
c. Improved co-ordination of health and social care case management
d. Management capacity to oversee PACT>75 integrated delivery
5. Revised service thresholds and referral pathways to ensure care is delivered at the
right time in the right place.
37
9.7 Commissioning Programme - Mental Health
We know that mental ill health is the single largest cause of disability and one of the
greatest areas of health inequality. People with severe and prolonged mental illness
currently die on average 15 to 20 years earlier than the wider population.
Our priorities for improving the Mental Health in Wandsworth focus prevention, the
promotion of wellbeing and reducing inequality with our service users at the forefront of
these changes.
Tom Coffey - Clinical Lead
Focus in the last 12 months
The range of initiatives below has been the areas of focus for the Mental Health CRG over
the last 12 months. These continue to constitute the work programme and will continue to
develop.
Talking Therapies - counselling services
 A review of talking therapies leading to a procurement process for Improving Access
to Psychological Therapies (IAPT) and digital MH services. This will aim to ensure
that Wandsworth commissions an effective service which best meets the needs of
the local population and is able to sustain achievement of key targets for access,
recovery and waiting times.
Common mental health disorders in primary care
 A review of best practice for leading to ensuring that the procurement of talking
therapy services fits within the stepped model of care. This will also lead to the
consideration and further development of a Primary Care Liaison model in
collaboration with the Mental Health Trust.
Also:

Implementation of the Mental Health Joint Commissioning Action Plan.

Dual Diagnosis (Mental Health and Learning Disability) – implementation of the
review of provision.

Dual Diagnosis (substance misuse) – input into re-tendered Substance Misuse
contract.

Development of the Mental Health Tariff - further work on the national programme
with other SW London CCGs and the major provider, South West London and St
George’s NHS Trust (SWL&SGH)

Perinatal Services – implementation of proposals to re-shape services to deliver a
comprehensive service, no matter where women give birth
38

Development and mainstreaming of the Service User Network (SUN) project for
people with personality disorders

A work stream to ensure that Service User and Carer experience is at the centre of
service delivery and improvement

Service transformation – increased Home Treatment Team staffing, implementation
of a Street Triage scheme with Wandsworth police (to assess and support out at
night), Community Mental Health Teams (CMHT) and older adult’s services.
Focus for the next 12 months
Our priorities and areas of focus for Mental Health relate to Prevention and promotion of
Wellbeing
Black and Minority Ethnic (BME) inequalities within MH Services.
• Expansion of the Place 2 Be wellbeing service in primary schools
• Surviving to Thriving (community champions)
• Community Network of Family care
• Develop community links for secondary services and IAPT (re-modelling and
procurement outcomes)
• BME Carer Care Planning involvement
• Peer audits and discharge support
Talking therapies
• Re-modelling and procurement (IAPT service and digital MH services).
Primary Care optimum model
• Link to IAPT and to Community Mental Health Team (CMHT) re-configuration
Adult Attention Deficit Hyperactivity Disorder (ADHD)
• Undertake a local pilot for an Adult Attention Deficit Hyperactivity Disorder (ADHD)
service.
Also:
•
Re-model Community Mental Health Team services including considering the model
for Primary Care Liaison (2016/17)
•
Taking forward the outcomes of work undertaken by the Suicide prevention subgroup
•
Continue the transformation work to re-model Crisis and Home Treatment Team
services – links to Gateway review for Mental Health Trust modernisation plans
•
Early Intervention in Psychosis (EIP) – focus on outcomes against national targets
from 2016.
39
•
Continued emphasis on ensuring Service User and carer experience is at the heart of
service delivery and improvement
•
Initiation of a panel approach for out of area/specialist placements, to ensure
patients can be supported as close to home as possible, ensure value for money and
quality outcomes.
•
Crisis Care Concordat – implementation of Action Plan as part of MH CRG work
programme
•
Build on the outcomes of the review of adult rehabilitation pathways, working
closely with the SWL&SGH Trust and Wandsworth Borough Council to improve
pathways, outcomes and value for money of rehabilitation services.
Specialised and cross-cutting pathways



Implement a review of personality disorder services, that will deliver a sustainable
service for the medium term
Dual diagnosis – substance misuse care pathway
Perinatal service outcomes
WCCG Commissioning Intentions for Mental Health
1. Mental Health Tariff – continued work with cluster colleagues and SWLSTG to
develop an appropriate cluster wide tariff.
2. Talking therapies re-modelling and procurement (IAPT service and digital MH
services): new service to be in place for October 2016
3. Early Intervention in Psychosis – measuring outcomes against national targets from
2016.
4. Development of the Primary Care optimum model – link to IAPT and to Community
Mental Health Team (CMHT) re-configuration
5. Engagement with on-going SWL&STG estate modernisation plans and assurance of
the impact on residents for all services (with specific reference to plans to reduce
inpatient services at Queen Mary’s Hospital, Roehampton)
6. Build on the outcomes of the review of adult rehabilitation pathways, working
closely with the SWL&SGH Trust and Wandsworth Borough Council to improve
pathways, outcomes and value for money of rehabilitation services.
40
9.8 Commissioning Programme - Urgent Care
Throughout last winter we saw how increased pressure on urgent care services led to
poorer access and longer waits for patients. This caused problems of longer waits in A&E
departments and also had a knock on effect of patients having their planned surgery
cancelled often at short notice. This is not the experience that we want for patients in
Wandsworth and we are working hard in Wandsworth and with commissioners and
providers across SWL to find better ways to make use of the resources we have both in
and out of hospital.
There are a number of areas where we are focusing our commissioning programme to
improve access to urgent care and make sure our patients can get the support they need
in the right place and at the right time. These include:








Increasing urgent access to GPs for all patients, both in and out of core hours and
across each day of the week. Making sure that GPs are supported to work
together to provide equitable and timely access.
Increasing proactive ongoing care for patients with multiple long term conditions
or complex needs so that they are less likely to need urgent care. Where a patient
does require urgent care the aim is to have their care plan available to support
clinicians in making the right decision to manage the crisis.
Some patients, particularly those who are older and frail, need to have access to
rapid diagnostic tests during times of ill health or after a fall. At the moment some
of these patients have to be admitted to hospital while they wait for tests to be
carried out. This can be distressing and not in the patients best interest. For this
reason we aim to increase rapid access to diagnostics in the community, making
better use of resources at Queen Mary Hospital and St John’s Therapy centre and
ensuring that patient experience of using these services is high including the right
transport solutions and support from community teams. The aim is for patients to
spend less time waiting for tests and be admitted to hospital only when there is
clinical reason to do this.
We want to ensure that community teams have the right staff in place to respond
rapidly when their patients need help in a crisis and that health and care team,
along with voluntary sector services work together to provide a holistic response in
times of increased need.
We will ensure that national standard for urgent care centres are fully
implemented so that patients can be seen rapidly and by the right teams.
We will work with our acute and community teams to ensure that patients with
complex needs are supported to leave hospital in a timely way supported by the
right package of care delivered in their own home wherever possible.
We will work with colleagues across the SWL to move towards delivering urgent
care services which are consistent available and achieve effective outcomes for all
patients.
We will work with London Ambulance Service (LAS) to make sure that patients
only need to be taken to hospital when that is clinically appropriate and that
handover into community based services is consistent and effective.
41

We will work with SWL partners to re-procure a high quality a 111/Out of Hours
service by September 2016.
Tom Coffey – Clinical Lead (Urgent Care)
Angelique Edwards - Clinical Lead (111)
Focus in the last 12 months
System Resilience Group
•
•
•
The System Resilience Group (SRG) around St George’s Healthcare NHS Foundation
Trust has focused on improving performance and “whole systems” working,
redesigning pathways and developing better ways of delivering care to improve flow
through the hospital and support discharge.
Schemes to increase capacity across winter – in primary care, social services, mental
health services and community care, as well as in St George’s
Close working with our major provider on schemes to improve hospital flow and
increase capacity in order to improve performance against 4 hour standard.
Other supporting initiatives
•
•
•
•
•
•
•
•
•
•
An Urgent Care Centre (UCC) model review
Review capacity of Out of Hours (OoH) services, including UCC
Implementation of the Improving Primary Care Access contract with GPs
Ensuring quality and safety standards with Provider through 111& OoH Clinical
Quality Review Group (CQRG)
Planning All Care Together (PACT) Contract with GPs: OoH GP Patient Leaflet; Special
Patient Notes Referral form; Single Point of Contact (SPoC) Referral form.
CAHS redesign supporting SPoC through the locality structures: access and coordination hubs
NHS 111 and OOH procurement (with SPoC and UCC provision)
Review of Clapham Junction GP Led Health Centre contract with a view to extending
hours.
The development of Queen Mary’s Minor Injury Unit as an urgent care centre.
Winter pressures – additional capacity within primary care setting during the
autumn/winter period to ease pressure on General Practice and inappropriate
attendance at A&E.
Focus for the next 12 months
•
•
Delivering the additional acute capacity required to support flow through the urgent
care system
Reviewing and expanding the capacity available in primary care for patients
navigated from A&E to GPs
42
•
•
•
•
•
•
•
•
•
•
Continued development of the System Resilience Group (SRG) to enable a multiagency, strategic group who has oversight of the whole urgent care system and is
enable to enact transformational change over the next 12 months
Inform and support the urgent care network in delivering the aims of the SWL Five
Year Strategy
Deliver improvements in delayed transfers of care and inter hospital transfers
Deliver improvements in performance against the four hour wait time standard
Expanding out of hospital crisis response with a particular emphasis on a MultiDisciplinary Team response for patients with complex needs
Implementing SWL standards for Out of Hospital care
Implementing changes to pathways as agreed via the SRG transformation
programme
Reviewing UCC capacity during 15/16 with potential to vary contract if required
Provider engagement with the Urgent Care Network
Procurement of an integrated 111/OOH contract to support local urgent care
pathways in line with national guidance
WCCG Commissioning Intentions for Urgent and Emergency Care
1. Implementation of the SWL standards for crisis response
2. Procurement of an integrated 111/OOH contract to support local urgent
care pathways in line with national guidance
3. Working closely with St George’s University Hospital NHS Foundation Trust
on appropriate out-of-hospital urgent care, admission avoidance, hospital
flow and fast discharge arrangements, to deliver A&E wait time standards
on an on-going basis.
SW London Collaborative Commissioning Programme Intentions
1. Working with providers to meet the full range of London Quality Standards
by the end of 2016/17
2. Introduction of a new tariff for Ambulatory Emergency Care (AEC) across
SW London providers
3. Commissioners to undertake an Urgent and Emergency Care (UEC) services
designation process and contribute to the new SWL UEC Network
43
10. WCCG - Other services
Termination of Pregnancy
WCCG intends to recommission the above service under the London AQP arrangement from
April 2016.
11. Enabling Services
Information Technology
CCG Commissioning Intentions for Information Technology
1. Primary Care (GP Practices) - The CCG intends to undertake a procurement of IT
services through the NHSE Lead Provider Framework, to support Primary Care.
2. CCG IT – The CCG intends to procure IT support to the CCG offices through an OJEU
procurement
SW London Collaborative Commissioning Programme Intentions
1. Providers to reach Level 4 of the NHS e-Referral Service Maturity Model by the end
of 2016/17. This will be supported by CCG activities to promote ERS utilisation in
primary care
2. The co-development and introduction of a shared information governance model
between health and care providers in SWL, to support sharing of clinical
information between organisational boundaries in support of direct patient care
3. Providers to work with commissioners to agree incentives to make progressive
improvement in the timeliness, accuracy and completeness of data in patient
records in support of specific use cases agreed within the SWL IM&T Strategy
4. Providers to work with commissioners to agree a baseline and trajectory for
increasing the rate of Summary Care Record or GP records access in emergency
departments
Estates
We are working with colleagues across SWL to deliver a SWL local estate strategy that aligns
to local CCG commissioning intentions to extract maximum value from NHS resources and
reduce waste.
44
Focus in last 12 months
Mapping of estates costs at SWL acute trusts to 2025 to determine:
•
•
•
Maintenance backlog for each trust
cost of improvements necessary to reach 21st century standards
revenue implications of capital costs.
Priorities for next 12 months
•
•
•
•
Rationalise estate in south west London
Maximise use of facilities
Deliver value for money
Enhance patients’ experiences
12. Summary of WCCG and SWL Commissioning Intentions
Wandsworth CCG – Commissioning Intentions 2016/17 Summary
Programme
Preventing Ill Health
Commissioning Intentions
1. Commission prevention and social care services– where it will generate an
increased health benefit for our population.
2. The CCG will work through the commissioning programmes to commission
differentially; addressing specific population need where there is evidence it will
reduce health inequalities. This is a reflection of a key priority in the Joint Health
and Wellbeing Strategy.
Primary Care
1. Ensure that all patients across the borough have access to the full range of
enhanced primary care services locally (including diagnostics, extended hours clinics
and those services which make up the Planning all Care Together contract) by
commissioning them via a single provider.
2. Increase collaborative working and sharing of best practice by commissioning
a quality contract for Primary Medical Services.
3. Improve care for our most vulnerable patients by stimulating engagement of
practices, community services and other partner organisations to ensure that
care is fully joined up and integrated. The CCG will take a decision in 2015/16
on the formal delegation of responsibility for commissioning core Primary
Care contracts (GMS and PMS) from NHS England for 2016/17 and onwards.
4. Develop an MCP model for Wandsworth as referenced in the NHS Five Year
Forward View, commencing with a service specification in anticipation of
proceeding to procurement in October 2016.
Out of Hospital
Services
1. In line with the Five Year Forward View and CCG Board strategy, continue to
work with the Wandsworth federation of GP practices to develop a MultiSpecialty Community Provider (MCP) to deliver co-ordinated, integrated out
45
2.
3.
4.
5.
Learning Disabilities
1.
2.
3.
4.
Children & Young
People
of hospital care to the Wandsworth population. This will include provision of
specialist clinical care to the older population, and those with chronic long
term conditions, in community settings and aligned with primary care
services.
Commissioning an integrated tiered pathway for ophthalmology. This will be
a proof of concept for evaluation with a view to wider role out of the model.
Working with NHSE and SWL commissioners to improve neuro-rehabilitation
pathways.
Commission a tiered model of diabetes care. It is proposed that the new
model will optimise the role of primary care through strengthening specialist
nurse and consultant support to support delivery of care plans. There will be
a focus on supporting self-management and an expectation that fewer
patients will need to access outpatient care in hospital clinics
Undertake a procurement for an all body parts muscoskeletal service to
commence in April 2016.
Implement the core offer for Personal Health Budgets for people with
learning disability and challenging behaviour.
Continue the work of the Transforming Care programme, ensuring that
patients are cared for in community settings where possible.
Develop a strategy for facilitating repatriation of patients in hospital type
accommodation from inpatient units outside the area to Wandsworth.
Joint programmes with Wandsworth Borough Council Directorate of
Education and Social Services
1. Special Educational Needs and Disability (SEND) – the CCG intends to
recharge responsible CCGs where health services are provided to children
within Wandsworth Special Schools who are registered with a GP outside of
Wandsworth.
2. SEND- the CCG intends to agree and implement from April 2016 a local tariff
based on the agreed matrix of needs assessment.
3. Roll out of integrated service model to all Wandsworth Special Schools.
4. Roll out of Personal Health Budgets offer for Children receiving CHC in
Wandsworth
5. Commission a CAMHS 18-25 service and ensure that all providers meet the
CAHMS London Quality Standards (Referrals to be available 24 hours a day, 7
days a week with a maximum response time of 30 minutes. Psychiatric
assessment to take place within 12 hours of call)
6. Commission a Paediatric asthma service based on London quality standards
(2015)
7. Commission a nurse led Children Looked After 5-11 review service
8. Implement local CAMHS Transformation Plans
9. CHC - Revised service specification to reflect new assessment arrangements
and revised funding moving from block to cost of package from April 2016
10. Commission South West London Child Sexual abuse - HUB .
11. Work with Wandsworth Borough Council to harmonise/integrate the
commissioning of care for children with complex needs.
46
Older People
Mental Health
Urgent care
Enabling services ICT
1. Revised specifications for health and social care teams to deliver PACT >75s.
2. Shared outcomes and KPIs across organisations to embed integrated service
delivery for PACT>75 cohort.
3. Development of multi-provider CQUIN scheme.
4. Investment in new posts to support;
- Equitable healthcare for care home residents
- Additional community consultant capacity
- Improved co-ordination of health and social care case management
- Management capacity to oversee PACT>75 integrated delivery
5. Revised service thresholds and referral pathways to ensure care is delivered
at the right time in the right place.
1. MH Tariff – go live 15/16. Continued work with cluster colleagues and
SWLSTG to develop an appropriate cluster wide tariff.
2. Talking therapies re-modelling and procurement (IAPT service and digital MH
services): new service to be in place for October 2016
3. Early Intervention in Psychosis – measuring outcomes against national
targets from 2016.
4. Development of the Primary Care optimum model – link to IAPT and to
Community Mental Health Team (CMHT) re-configuration
5. Engagement with on-going SWL&STG estate modernisation plans and
assurance of the impact on residents for all services (with specific reference
to plans to reduce inpatient services at Queen Mary’s Hospital, Roehampton)
6. Build on the outcomes of the review of adult rehabilitation pathways,
working closely with the SWL&SGH Trust and Wandsworth Borough Council
to improve pathways, outcomes and value for money of rehabilitation
services.
1. Implementation of the SWL standards for crisis response.
2. Procurement of an integrated 111/OOH contract to support local urgent care
pathways in line with national guidance.
3. Working closely with St George’s University Hospital NHS Foundation Trust
on appropriate out-of-hospital urgent care, admission avoidance, hospital
flow and fast discharge arrangements, to deliver A&E wait time standards on
an on-going basis.
1. Primary Care (GP Practices) - The CCG intends to undertake a procurement of
IT services through the NHSE Lead Provider Framework, to support Primary
Care.
2. CCG IT – The CCG intends to procure IT support to the CCG offices through an
OJEU procurement.
47
South West London Collaborative Commissioning – Commissioning Intentions Summary
Work stream
Urgent and
Emergency Care
Cancer
Maternity Care
Children and Young
People
Integrated, Out of
Hospital and
Community Based
Care
IM&T and
interoperability
Commissioning Intentions
5. Commissioning intention 1: Acute providers to meet the full range of LQS by the end
of 2016/17 (sanctions to be considered)
6. Commissioning intention 2: Ambulatory Emergency Care(AEC) – introduction of
new tariff to support significant increases in AEC activity (trajectory of desired
increase to be agreed with providers)
7. Commissioning intention 3: Providers to comply with UEC services designation
process and contribute to the new SWL UEC Network
8. Delivery of the Transforming Cancer Services pan-London commissioning intentions
9. Implementation of the new specification for maternity services
10. Meet the trajectory to achieve Obstetric Standards of the LQS by 2018/19 – provide
a minimum of 130 hours of consultant obstetric presence on acute labour wards by
1st April 2017
11. Meet the trajectory to achieve Settings of Care Standards of the LQS by 2018/19 –
provide for 20% of births to be Midwifery-led setting of care by 1st April 2017 and
3% of births to be home-births by 1st April 2017
12. All providers will meet the new London Asthma Standards for Children and Young
People (2015)
13. By the end of 2016/17 every acute provider will meet the acute CAMHS LQS 21 –
single access for children and adolescent health (CAMHS) (or adult mental health
services with paediatric competencies for children over 12 years old). Referrals to be
available 24 hours a day, 7 days a week with a maximum response time of 30
minutes. Psychiatric assessment to take place within 12 hours of call
14. Establish and pilot a Children’s Surgical Network across SWL which meets the
standards of the new London SCN Children’s Surgical Guidelines (2015)
15. Apply the agreed Integrated, Out of Hospital and Community Based Care Principles
Framework for adult community services across the system
16. The Crisis Response initiative, due for implementation in winter 2015/16, will be
developed and run with full year effect for 2016/17
17. Providers to reach Level 4 of the NHS e-Referral Service Maturity Model by the end
of 2016/17. This will be supported by CCG activities to promote ERS utilisation in
primary care
18. The co-development and introduction of a shared information governance model
between health and care providers in SWL, to support sharing of clinical information
between organisational boundaries in support of direct patient care
19. Providers to work with commissioners to agree incentives to make progressive
improvement in the timeliness, accuracy and completeness of data in patient
records in support of specific use cases agreed within the SWL IM&T Strategy
20. Providers to work with commissioners to agree a baseline and trajectory for
increasing the rate of Summary Care Record or GP records access in emergency
departments
48