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Hartlepool and Stockton-on-Tees Clinical Commissioning Group. Dr Boleslaw Posmyk, Clinical Chair Dr Paul Williams, Stockton-on-Tees Locality Lead. What we aim to do in our presentation. Describe to you: Our journey so far The people we work with and on behalf of

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hartlepool and stockton on tees clinical commissioning group

Hartlepool and Stockton-on-Tees Clinical Commissioning Group

Dr Boleslaw Posmyk, Clinical Chair

Dr Paul Williams, Stockton-on-Tees Locality Lead

what we aim to do in our presentation
What we aim to do in our presentation

Describe to you:

  • Our journey so far
  • The people we work with and on behalf of
  • Our challenges, opportunities and risks
  • Our plans for improvement
  • How we do things around here:

Our decision making and our leadership

meet our team
Meet our Team
  • We are a membership organisation of 40 general practices with devolved decision making to our Governing Body
  • Our team has a strong clinical focus, bringing together a broad range of skills and experience together with a passion for improving the health outcomes of our communities
slide4

Our Journey

  • Two pathfinder groups – Hartlepool and North Tees
  • Merged into one CCG (40 General practices) April 2012, with first Shadow Governing Body meeting as a sub-committee of NHS Tees
  • Rationale for coming together:
    • Shared vision and values
    • Similar health needs, levels of deprivation, challenges
    • Share acute, community and mental health providers
    • Avoids duplication
    • More financially robust
    • Increased pool of clinicians willing to take on lead roles
    • Small enough to maintain effective practice engagement through strong locality focus and co-terminosity with LAs
    • Offered potential for synergy and sharing of good practice
    • Still able to work effectively with neighbouring CCGs especially South Tees
slide5

Hartlepool & Stockton-on-Tees CCG

Population c285,000

40 General Practices

Hartlepool & Stockton-on-Tees CCG

Population c285,000

40 General Practices

slide6

Meaningful Engagement - Our Stakeholders How we are working “together”

Stockton-on-Tees Borough Council

Health and Wellbeing Boards

Hartlepool Borough Council

40 Member practices

Local Safeguarding Children's Boards

Commissioning Support

Safeguarding Adults Boards / LD partnership

Providers

Hartlepool and Stockton-on-Tees

CCG

Public Health

Community Groups

Patient participation groups

Clinical Networks

LINks/

Healthwatch

NHS Commissioning Board/LAT

Other CCG’s/Northern CCG Forum

Professional Clinical Leadership

Voluntary Sector

slide7

Meaningful Engagement – our communities

Communication & Engagement strategy

Local Events

PPGs

LiNKs/Healthwatch

Scrutiny Forums

slide8

Our Health Challenges

Rank distribution of electoral wards in various deprivation groups

Hartlepool and Stockton compared with England

Index of Multiple Deprivation (IMD) 2010

7934

Most affluent wards

in England

(7567) Ingleby Barwick East

7139

6346

Park (6412)

5553

Electoral

ward

rank

position

4760

3967

3173

2380

1587

793

Most deprived wards

in England

1

(17) Town Centre

Dyke House (44)

Stockton

A population of ‘two halves’

Hartlepool

A population with

little relative affluence

slide9

Ingleby

Barwick

Parkfield

& Oxbridge

Stockton

Centre

One of the

consequences

of differences in risk

are differences

in outcomes…

Life

expectancy

Men

78

74

69

Women

82

78

74

Life expectancy

reduces

sharply

within

very short

distances

from

periphery to centre

9 years for men

8 years for women

The starkness of inequalities in health

slide10

Our Health Challenges

High levels of deprivation

Mortality from suicide & undetermined injury; Cancer; circulatory disease; Gastrointestinal disease; and Respiratory disease worse than England mean

Levels of health worse than Average

Smoking related deaths higher than average

Health

inequalities

Hospital stays for alcohol admissions higher than England average

Life expectancy lower than average

Healthy eating, smoking & obesity worse than England average

High levels of

child poverty

slide11

Our Plan at a glance

J S N A

H&

WB

STRAT

EGIES

S

T

R

A

T

E

G

I

C

O

U

T

C

O

M

E

S

Our Vision

Reduced inequalities / Improved wellbeing

Our Aims

commission high quality, sustainable and evidence based services that respond to local need, bring care closer to home and are cost effective

work in partnership to reduce health inequalities and improve the health and wellbeing of the population

Look for opportunities to innovate, involving users, carers, staff providers and the public in transforming services

Our Values

Engagement &

Patient

focus

Quality & safety

Value, efficiency and affordability

Integrity and honesty

Courage

Accountability

Our Work streams

Health & Wellbeing

Out of hospital care

Acute in hospital care

Mental Health, LD & Dementia

Medicines Management

Our Priorities

  • Address health inequalities
  • Improve lifestyles
  • Focus on particular groups i.e. carers and children
  • Transform community care (TAPs)
  • Bring care closer to home
  • Care home management & quality
  • Improve productivity
  • Choice & quality
  • Streamline care pathways
  • Reduce urgent care attendances
  • Develop MH/LD
  • Improve equity
  • Improve Dementia care
  • PHBs
  • Safe, rational and cost effective use of medicines
  • Reduce variation
slide12

Managing Financially Sustainable Position up to 2016

Technical Efficiency Programmes

Investments

Underlying Cost Pressures

Income Shifts

£’000s

Future planning assumptions are:

- Lower Growth - Increase in inflation - Lower Tariff Efficiencies - Increase in demographic demand

slide13

Our QIPP Challenge

  • Benchmarking Tools Utilised to identify outliers
    • NHS Comparators – emergency admissions, A&E attendances, outpatients per 1000 population
    • PBMA – identify high spending poor outcomes
    • PBR Benchmarking – identifies provider performance issues ie new to review ratios
    • Prescribing EPaCT
    • Variation in spend on specialities across Tees
    • Variation across practices
  • What it told us – increasing activity in acute sector, prescribing above national average, local FTs where not performing to top quartile in some areas, significant variation in referrals, admissions and resource use across GP practices
  • What we did –
    • Looked for evidence of effective improvement methods (Kings Fund, National QIPP programme, Institute of Innovation programmes, VMPS/NETs)
    • Engaged our practices and providers
    • Developed our QIPP programme around what the benchmarks told us and grouped these against our workstreams, developed our Delivery Plan
    • Developed our monitoring arrangments
improving quality and safeguarding
Improving Quality and Safeguarding

Improving quality is at the heart of what we do

  • Safe and tested governance with our systems and processes
  • Implementation and monitoring of Quality Dashboards
  • Robust provider Clinical Quality Review Groups
  • Development of a Quality Assurance Framework for all commissioned services
  • Embraced Legacy Document – now preparing to receive Quality Handover Document
  • Committed to driving up quality in primary care - GVISQ

Recognising our statutory responsibilities for safeguarding

  • Working with our Local Authority partners
  • Executive Governing Body appointment (Nurse)
  • Supporting our Local Safeguarding Children’s Boards and Adult Protection Committee’s

Preparing for the future

Sir Robert Francis

slide15

Constitutional & Governance arrangements

NECS

Council of members

Locality groups x 2

Hartlepool

H&WB

Delivery

team

Governing

Body

Stockton

H&WB

Workstreams

Governance &

Risk

Funding

panel

Audit

Remuneration

QPF

Safeguarding

Boards

Partnership / QIPP delivery board

Quality & Safety

Group

CQRG

slide16

Capacity and Capability

Chair

GP GB members & locality leads

Local NECS

Team &

Collaborative

commissioning

Clinical Workstream Leads

Chief Officer Designate /

Accountable Officer

Chief Finance officer

Executive Nurse

Commissioning development / Deliver Manager

Corporate Governance and Risk Officer

Head of Quality and Safeguarding (designated Adults safeguarding)

Assistant Finance Managers

Partnership & Innovations Manager

Corporate Office Administrator

Designated Nurse Children’s Safeguarding

Designated Doctor and LAC lead

Partnership Project Officer

Admin Support

slide17

Risks and Mitigations

  • Developed different opportunities at all levels of the organisation
  • Strong relationships, strong governance, high awareness
  • Clinical Engagement
  • Improving quality & safety
  • Economic environment and financial challenge
  • Hospital Reconfiguration

/ Momentum

  • Robust QIPP plans & track record of delivery, preparation, contingency, good governance
  • Evidence based Clinical mandate, strong relationships with OSC, good public engagement

The biggest task is alignment………..

slide18

The difference we are making

  • Highly effective GP, public and other stakeholder engagement
  • Winner of HSJ National award for Efficiency, Medicines Optimisation
  • Safer Care NE; Adult safeguarding award
  • Finalists for Commissioning Organisation of the Year (HSJ); Vision Award – use of data, NE lean Academy; spread of innovation,
  • Reduced variation in primary care - improved clinical quality
  • Transformed community services – commissioning for clinical outcomes
  • Progressing Momentum Pathways to healthcare; redesigning 46 clinical pathways, improving patient experience, reduced length of stay, increasing productivity
  • QIPP delivery – securing financial sustainability