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QIPP initiative analysis: summary by PCT by type – shown cumulatively for impact on gap. QIPP initiative analysis: detail by PCT by year. Cumulative impact of initiatives on cumulative gap. Cumulative impact of initiatives on cumulative gap. In £m’s. Menu of improvement opportunities.

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menu of improvement opportunities6
Menu of improvement opportunities

Initiative: Right Care, Right Place


Reconfiguration of local secondary services in as part of shift to polysystems (e.g. outpatients and diagnostics)

Redesign of certain planned and LTC pathways (e.g. diabetes, COPD, MSK, sexual health, end of life and dementia)

Decommission and/or introduce evidence based thresholds for PoLCE

Primary care management of out patient referrals


Currently no structured or integrated care for COPD and adult asthma patients

Improve the diabetes care pathway and ensuring delivery of a greater part of the pathway in the community.

Expand the current model of service and use the Long Term Conditions models for delivering a Heart Failure service in

the community.

Establish Referral Management Centres as part of a package of measures to address referral management


Savings will be achieved by decommissioning – in year 1 and 2, with patients actively discharged to primary care.

Implementation of LTC Development Programme will raise the standard of primary care to achieve Tier 1 services.

From year 3, savings will be achieved by continued primary care management and shift to community based walk-in

multi-disciplinary clinics.

Target to shift 80% of OP activity to community settings

menu of improvement opportunities7
Menu of improvement opportunities

Initiative: Specialist services


KCH is accredited as a HASU and Major Trauma Centre

GSTT has the Dimbleby Cancer centre

Vascular inpatient services across KCH and GSTT are to be centralized onto one site


Improve access to cancer services

Improve secondary prevention for cardiac and vascular diseases.

Prevention and improved management of stroke and heart disease


Decentralizing some of the ambulatory specialist services (inc. chemotherapy) across SEL

Centralising of specialist services e.g. aspects of cardiac

Centralise the number of paediatric inpatient units

Reductions in hospital admissions

Improved quality of services to those who are at the end of their lives

menu of improvement opportunities8
Menu of improvement opportunities

Initiative: Cancer


Implement the CSL Cancer model of care


Overseeing enhanced recovery after surgery (ERAS) in all acute trusts in a range of tumour sites.

Meeting the 14 day turnaround from the cervical screening test to receipt

Implementing the acute oncology measures for all trusts with an A&E

Commissioning new models of care for systemic therapy services

Implementation of revised tariff and recharge mechanisms for commissioning of systemic therapy services



14 day Turnaround

Establishment of an acute oncology service in all hospitals with an A&E

Systemic therapy

menu of improvement opportunities9
Menu of improvement opportunities

Initiative: Urgent Care

The focus of this initiative is:

Development of Urgent Care Centres

Diversion to primary care for primary care interventions


Build on the success of the rapid response team

Single point of telephone access to urgent care

Providing greater clarity for local people on how to access these services.


Reduced inappropriate use of A&E

Better management of primary care conditions in primary care

Increase the number of terminally ill cancer and non cancer patients

enabled to die in their own home.

menu of improvement opportunities10
Menu of improvement opportunities

Initiative: Medicines management


Drugs related savings

Maximising the scope for further in year savings on drugs.

New contract monitoring processes for high cost drugs


The growth rate in 2009/10 for primary care prescribing was 2.9%

Increase for 2010/11 on 2009/10 spend was 1%

Current forecast is £1million overspend on primary care prescribing budget of £35million.


Reductions in spend achieved by:


Clinical effectiveness/VFM

Leverage increased buying power of purchasing consortia / more effective procurement of clinically effective drugs

Enforce compliance for drugs for OP prescriptions

Ensure drugs are used within guidelines

Increased use of generics and reduced variability on prescribing