AGM slides 30 September 2014

NHS Trafford Clinical Commissioning Group
30th September 2014
Dr Nigel Guest, Chief Clinical Officer
Dr Kath Sutton, Chair
2013/14 Operational Performance
Gina Lawrence
Chief Operating Officer / Director of
Commissioning and Operations
Our Constitution promises to update you on:
How members of the public have been involved
and engaged
Delivery of our Quality Strategy
Improvements made across Primary Care
Services (GP’s)
Annual Public Involvement
 Communication and awareness program for the
implementation of Trafford New Health Deal
 Patient involvement in service development including
personal health budgets
 Development of New Health Deal Patient Reference
Group to scrutinise integrated care
 Recruitment to Patient Reference and Advisory
 Equality delivery system: where local stakeholders
graded us as a CCG as amber (developing) on our
performance against Goal 4 of the framework.
Progress against delivery of the Quality Strategy
NHS Trafford CCG has a three year Quality Strategy which is in the
process of being refreshed; we have three main ambitions in respect of
quality these are:
Safer Care: We will ensure the care we commission is safe
Better Care: We will ensure that the care we commission is clinically
effective delivering better health outcomes for our patients
Patients at the heart of care: We will ensure that we will engage,
listen and respond to what our patients want at every stage of the
commissioning process, to ensure our patients have a voice in
everything we do.
NHS Trafford CCG Quality Strategy
Achievements 2013/14:
• CCG hospital visits
• Quality standards in all contracts
• Commissioning for Quality and Innovation Schemes (CQUINs)
in all providers across Greater Manchester encouraging them to
use change improvement methodology to sustain change
• Pressure ulcers
• Early warning system in place
• Achievement of all locally agreed Commissioning for Quality and
Innovation Schemes (CQUINs) in all providers
• Expert commissioners in place
• Patient engagement framework
Quality improvements made across primary
medical services (GP’s)
Quality Improvement Programme
Locality partnership working
Management of high risk patients
Areas of work commenced / completed in 2013/14
• Quality and performance
• Adult Safeguarding
• Urgent Care services
• Cancer
• Patient Care Co-ordination Centre
Performance Highlights for 2013/14
Central Manchester Hospitals (CMFT)
• Delivered the A&E standard of 95% of patients being seen, treated and discharged
within 4 hours of arrival across the year
• Patients’ privacy and dignity were prioritised and all patients were cared for in a same
sex ward
• Waiting times were kept short and all national standards were delivered
• Patients on a cancer pathway received timely diagnostics and treatments throughout
the year
Wythenshawe Hospital (UHSMFT)
• Speedy access to diagnostic tests to support clinical decision making was achieved
throughout the year
• Following a stroke, most patients spent at least 90% of their hospital stay on a
dedicated stroke unit
• Recall systems for patients attending the breast service were changed to be brought in
line with national best practice
• Waiting times were kept short and national standards were delivered
• Patients on a cancer pathway received timely diagnostics and treatments throughout
the year
Quality Highlights for 2013/14
Central Manchester Hospitals (CMFT)
• Achieved in full the majority of CQUINs
• The Quality Standards as set out in our contract with the Trust were fully met in
• CMFT has undertaken a large programme of work in relation to harm free care with a
focus on pressure ulcers
• CMFT were inspected by the Care Quality Commission (CQC) in December 2013,
following this action plans were put in place around nutrition and records
Wythenshawe Hospital (UHSMFT)
• Achieved in full 27 quality improvement indicators (CQUINs), and partially achieved 6
• The Quality Standards as set out in our contract with the Trust were met in full for the
majority of areas. Where quality standards were not met in full and action plan was put
in place.
• Following an inspection from the Care Quality Commission (CQC) an action plan was put
in place monitoring the quality of service provision.
Trafford Community Services (Pennine Care Foundation Trust)
• These services achieved all CQUINs and Quality Standards last year.
Adult Safeguarding 2013/14 – year of
partnership working and reform
• Led the reform of Trafford Adult Safeguarding Board
• Established Operational Adult Safeguarding Board
• Implemented new governance and risk management arrangements
• Implementing Prevent agenda across local health services
• Working with children’s services to look at the whole family picture
• Working to support implementation and develop understanding of
Mental Capacity Act, 2005
• Supporting the Deprivation of Liberty Safeguards
• Working with NHS Providers and contractors to improve understanding
of safeguarding adults
• Working to improve care, standards and safeguard vulnerable people in
Care Homes
Trafford Urgent Care Services- Planned
changes to Trafford General Hospital
• 27th November 2013 – A&E Department closed
• 28th November 2013 – Urgent Care Centre opened (08.00- midnight
daily) (impact on CMFT, UHSM & SRFT)
• Community Services delivering – enhanced services
in the community, including Rapid response, community Matrons,
IV therapy service etc.
• Travel Bureau in place to support patient transport
• Travel support scheme in place by Trafford CCG to support patients
Contact numbers
• Enhanced services - 0300 323 0303
• Travel Bureau - 0161 976 2555
• Link services - 0845 605 5505
Trafford Urgent Care Centre
This department is open from 0800 – midnight
This department will treat:
• All A&E activity delivered by ambulances(some Trafford
Patients will be taken to other hospitals due to their
complexities and symptoms decision by NWAS )
• All activity which self-present
• The medical admissions unit will receive all admissions by
This department is fully staff with A&E staff , the department
will treat a wide range of emergencies.
Patients will be treated quickly by professional and
competent staff.
Cancer: 2013/14
Macmillan GPs appointed:
– Dr Helen Marsden – End of Life care
– Dr Ann Harrison - Cancer
2013/14 Cancer was (and still is) a priority for the CCG:
– To influence the development of cancer services within the local
commissioning structures.
– To improve cancer awareness in primary care to improve standards
– To educate primary health care teams
– To support pathway and service redesign
– To enhance communication between all levels of care to promote a
seamless service and improved patient experience.
Living With & Beyond Cancer pilot – 2 GP Practices
Patient Care Co-ordination Centre
• A Proactive Health and Social Care System
• The patient care co-ordination centre is the ‘glue’ that
will hold the provision of services together
• All patient journeys will go through this service
• It is an essential part of our integration strategy
• Will deliver efficiencies to all organisations
• Patients always getting the right care at the right time
• A focus on complex cases and vulnerable people
Patient Care Co-ordination Centre
• Since October 2013 we have been running a tender
process to select a provider capable of delivering the
• We have spent a significant amount of time engaging
in dialogue with providers to ensure that they will be
able to deliver a service which meets the needs of
the Trafford population
• We expect the PCCC to be in place, and making a
difference to patients in Trafford, by June 2015
2013/14 Financial Performance
Joe McGuigan
Chief Financial Officer
2013/14 Financial Duties / Performance
• Trafford CCG achieved all of its financial duties for 2013/14
• Delivered financial balance; achieving a surplus of 1% (£2.8m)
meeting NHS England requirements.
• Remained within the notified revenue Cash Limit and its running
cost target (£25 per head less than 2%)
• Managed to pay over 95% of its suppliers invoices within the
NHS target of 30 days
• Delivered £6.5m of savings, exceeding its plan by £0.5m
• Had an unqualified and clean audit report; accounts and value
from money perspective
New investments in 2013/14
• £1.7m (£3m in 14/15) in Community Services, Urgent
Care, Community Matrons, IV Therapies etc.
• £1m key mental health initiatives; RAID/ RADAR/ IAPT
• £200,000 in a new stroke early support discharge service.
• £300,000 supporting new developments in COPD (chronic
obstructive pulmonary disease) services
• £100,000 to improve access for patients with
Musculoskeletal conditions
2013/14 – Where was the money spent?
What services did we commission from our hospitals?
• 29,000 ‘planned’ treatments; average £1,100 each
• 25,000 ‘emergency’ treatments; average £1,900 each
• 328,000 outpatient appointments; average £100 each
• 88,000 A&E attendances; average £92 each
• 3,900 days in critical care; average cost of £1,200 each
So, how much did this cost in 2013/14?
Critical care
High cost drugs & devices
Direct Access
What other services did Trafford CCG commission?
• A total of 4.8m of prescribed drugs; at a cost of £36m or just
under £160 per person in Trafford
• Community (c£20m) and Mental Health Services (£18m)
• Funded nursing care and continuing care support and
placements; at a cost of c£11m
• Emergency and non-emergency ambulance services; £6.5m
• GP ‘Out Of Hours’ services; c£1.7m
Financial Position, now and going forward
National and local finance looking forward
• People continue to live longer; not necessarily healthier; so
health illness prevention will need to be targeted to right
• TCCG has to deliver savings of £22m over next 5 years; £80m
across health services within Trafford economy; challenging !
• Public involvement/engagement to focus on agreed investments
• Clinical led re-design with General Practitioners, hospitals,
social care working together to deliver sustainable better
• TCCG will continue to integrate care; greater quality/efficiencies;
in line with its 5 year strategic plan
Future NHS Trafford CCG plans 2014/15
Dr Nigel Guest
Chief Clinical Officer
Priorities and work underway and
planned for this year
• Co-commissioning
• Cancer (local and Greater Manchester wide)
• Cervical screening
• Personal health budgets
• Adult safeguarding
• Mental Health (local and Greater Manchester wide)
• Diabetes
• Musculoskeletal Services
• Community dermatology
• Clinical Assessment and Treatment Service
• Cardiology
• Better Care Fund
Co-commissioning in primary care
Trafford CCG will look to take back some of primary
care commissioning, including but not exclusively;
• Contract management of extended GP services
• Education and training
• Complaints management
• Development of new services
• Revising existing contracts
Cancer (Greater Manchester level): 2014/15
Trafford CCG’s intentions as the lead organisation for
cancer at a Greater Manchester level are:
• Support the Specialist Teams in buying compliant
• Develop and implement revised service specifications
for breast cancer and acute oncology services
• Develop a GM commissioning strategy for cancer
Cancer (local level): 2014/15
Raising profile of Macmillan GPs
Primary Care
– Analysis of cancer referrals and GP education
– Dermatology audit carried out
– Consider Macmillan Quality Standard Mark for practice
Priority areas for Trafford CCG
Palliative/End of Life
Screening with a particular focus on;
- cervical screening
- bowel screening
- breast screening
Support of Living With & Beyond scheme for a further year
Cervical Screening: 2014/15
• Delivery of a joint Trafford CCG and Trafford Council Cervical
Screening Plan
• Committed to achieving the national target – striving for 80% of
eligible patients to have had smear by April 2015
• Joint plan contains over 15 new initiatives including:
– A patient survey asking Trafford residents what the barriers
are to attending for a smear
– Trafford local poster and radio campaign titled ‘It only takes
a minute’
– Work with local community groups including BME community
groups and Gay and Lesbian foundation
– Intensively working with GP practices with lower than
average screening rates
– Bridgewater Services extending their service to offer smear
for mums attending Children's Centres
Personal Health Budgets
• The offer of a Personal Health Budgets is made to all patients
who are eligible for continuing healthcare funding.
• Successful implementation of Personal Health Budgets
programme – patients are already using these
• A group are now meeting to offer this more widely to patients
• The programme works with three third sector organisations
Adult Safeguarding 2014/15 – year of public
engagement and participation
• Implement the requirements of Care Act 2014
• Further Prevent training
• Revision of adult safeguarding policies and procedures
• New training programmes – specialist and expert practitioner programmes for
• Public engagement – Adult Safeguarding Board to be open to public from April
• Adult Safeguarding Reference Groups to include public representatives – shape
and influence
• Recruit more “lay members” to sit on Adult Safeguarding Panel Hearings
• Targeted advertising campaigns throughout 2014/15
• Increased public awareness of and participation in Adult Safeguarding
Mental Health across Greater Manchester
Association of Governing Groups (AGG) 2014/15
• Leading joint working with key partners across Greater
• Working with Greater Manchester Police on delivering the
Crisis Concordat
• Development of Greater Manchester Alcohol Strategy
• Development of a learning disability standard to reduce
premature deaths
• Development of a Joint Health & Social Care Self
Assessment for learning disabilities
Mental Health progress in Trafford 2014/15
Performance in line with national / local priorities
• Improved access to psychological therapies
• More dementia diagnosis + post diagnostic support + less
• Working to reduce demand on Police service
• Psychological liaison service in place across Trafford
• More autism support
• Extra community eating disorders services
• Fewer restrictive secure hospital placements
• Public sector reforms – Early Intervention and Working Well
• People with diabetes in Trafford are more likely than the general
population to have:
– Myocardial infarction 83.9%
– Stroke 77.2%
– Hospital admission, heart failure 22.3%
• Trafford Diabetes Network has been established to produce a
Diabetes Strategy for Trafford focusing on prevention, early
diagnosis and care.
• The Strategy builds on work already done around integrated
• The Diabetes Strategy for Trafford will be presented to Trafford
CCGs Governing Body in February 2015.
Musculoskeletal Services
• Service review discovered a lack of :
– integration
– not enough capacity
– increasing patient demand
• Patients and professionals agreed that the service should be:
– joined up
– provided by a multi-disciplinary team
– self-management and prevention focused
– more capacity
• A service model has been created to ensure that future
musculoskeletal services will be outcome driven and not activity
based and support the above requirements for a successful
Community Dermatology
• Issues with capacity
• Business case approved by Trafford CCG’s
Management Team.
• Procurement process has commenced to identify one
provider - to manage conditions that do not require
specialist intervention at secondary care level across all three CCG areas to get best value.
• Notice is being served on our main providers.
• Two community locations to be identified.
(Clinical Assessment and Treatment Service)
• Trafford’s current performance:
o Year to date 2014 to M4 80% of 85% contract
o £753k of services used, £152k not used up to M4
• GPs should continue to utilise CATS
• Current contract ends Feb 2016 – Care UK will stop
accepting referrals from November 2015.
• 30% of cardiology conditions are regarding irregular
heart rhythm issues; 80% of these could be managed
in the community
• E-consult service being set up to support GPs
• Supported by ECG clinical interpretation service
• A Locally Commissioned Service will be set up with
Primary Care for the ECG service
Better Care Fund
• National initiative to improve care for the most frail
and elderly residents
• Brings together existing health and social care
resource into one budget
• This will be £15.4m for Trafford
• Aims are to reduce admissions to hospital, reduce
the amount of time people spend in hospital and
supporting people to remain at home.
• Three Projects: (next slide)
Better Care Fund
Community health and
existing social care offer
to delivered as one
Improve patient
Avoid duplication
Aligned to
neighbourhood model
Health and
Social care
Frail and
Falls Service
Reducing the amount of time
people spend in hospital
Avoiding admission
Geriatrician support in the
General practice for Nursing homes
Education to improve skills across
the workforce
End of Life
Improving patient, family
and carer experience
Greater connectivity
between services through
Prompting advance care
Supporting the voluntary
sector to deliver nonclinical care
Post / web
5pm on
Looking ahead:
Introducing the NHS Trafford CCG
Public Reference and Advisory
Panel (PRAP)
Priscilla Nkwenti
Panel Chair, Trafford CCG
Public Reference &
Advisory Panel
• Trafford CCG is committed to putting the voice of
patients, public and stakeholders at the heart of
• The Public Reference & Advisory Panel will be
recruited to represent the views of the Trafford
public and its representative groups.
• Sub-committee of Governing Body
• Meet monthly initially, then bi-monthly
Clinical Policy
Culture &
For example:
Clinical redesign – the panel will be able to review and comment on Project
Initiation Documents of upcoming projects (this will be highlighted later in the
Clinical commissioning – A PRAP representative attends the Locally
Commissioned Service Group meetings, which discusses progress on work
programmes for the implementation of locally commissioned and enhanced
services with GP, pharmacy and optometrist providers. PRAP will also consider
the delivery of commissioned services from the perspective of value for money
& contribution to health of Trafford population
Prioritisation – A PRAP representative sits on the CCG’s Individual Funding
Request Panel
Public engagement – PRAP can provide advice regarding the most
appropriate way to communicate and engage. PRAP recently considered how
best to capture patient stories from a wide selection of communities in Trafford
Culture and values – The PRAP will be a key contributor to the assessment
and evaluation of the CCG’s performance in respect of its desired culture &
Public Reference and Advisory Panel
4 x Public Reps
 North – Shabir Abdul
Central – Gill Leng
 West – George Devlin
 South – Pat Lees
4 x Third Sector/Voluntary
Organisation Reps
 Ann-Marie Jones - Age UK
 Chris Jacob - 42nd Street
 Khan Moghal - Voice of BME
 Lesley Thornton – Counselling &
Family Centre
 Priscilla Nkwenti – CCG Vice Chair/Lay member lead for engagement
4 x GP Patient Participation Group
North (Ann Day to cover)
 Central
 West – John Howe
South – Lesley Spencer
1 x Trafford Healthwatch Rep
 Brian Wilkins
North – Old Trafford, Stretford
Central – Sale, Ashton on Mersey
West – Flixton, Urmston, Davyhulme,
South – Altrincham, Timperley, Hale
Where does the Panel fit in?
Governance & Commissioning focus
Trafford CCG Governing Body
Finance &
- Prioritisation
- Policies
- Projects
- Locally Commissioned
Quality &
Public Reference
& Advisory Panel
Further opportunities for PRAP rep
involvement, for example:
2 x PRAP Reps to sit on:
- Individual Funding Request Panel
- Process Review Panel
Trafford Clinical Commissioning Group
Integrated Care
Reference Group
GP Patient
Groups Feedback
Additional groups
to be developed
What has the panel been involved in
Upcoming work programme:
• Projects include:
End of Life
Falls Strategy
Primary Care Strategy
Respiratory Programme
Patient Care Coordination Centre – role on
Programme Board
• Other projects will come to the panel once they are up
for redesign
Concluding remarks

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