Annual General Meeting [This slide up on entry] 15 September 2016

Welcome! Who we are A review of our year Financial position Summary of performance Public questions David: Welcome to the Annual General Meeting of NHS Doncaster CCG reflecting on our achievements and challenges in the last financial year: 2015/16. We have a brief presentation from me, from our Chief Officer, Jackie Pederson, and from our Chief Finance Officer, Hayley Tingle, and then there will be an opportunity for any public questions. So today we’ll describe our values, review our year, look at our financial position and finish with a summary of performance before we open for any public questions. We can’t promise to have the answers to all your questions at our fingertips today, but any we can’t answer we will carefully record, take away, and respond to you outside of the meeting.

Who we are Presented by our Chair We’ll start off my describing who we are as an organisation.

Chair of the CCG Dr David Crichton GP at Bentley Surgery Elected Chair of the CCG by our Member Practices from 1 April 2016 Membership organisation: 43 Member Practices I’m David Crichton, and I am at GP at one of our local surgeries in Bentley. I was elected Chair of our CCG by our Member Practices from 1 April 2016. I chair our Governing Body. It is very important to me that we are a membership organisation – we are comprised of the 43 Member General Practices in Doncaster and they delegate to our Governing Body to run the organisation.

What we do A statutory NHS body We buy (or “commission”) local healthcare services for the Doncaster population Planning services based on our population’s needs Securing services that meet these needs Monitoring the quality of care provided We are a statutory NHS Body, authorised by NHS England. We buy (or “commission”) local healthcare services for the local Doncaster population: We plan services based on our population’s needs – using health needs assessments, quality data, activity data and patient experience data. Our plans are approved by our Governing Body. We secure services that meet these needs – procuring from a range of healthcare providers and capturing the service we require from our providers in contracts. We then monitor the quality of care provided through those contracts, reporting outcomes through our monthly Quality & Performance Report to our Governing Body.

Our Governing Body Chair 10 elected Locality Leads 3 Lay Members Audit Committee Remuneration Committee Quality & Patient Safety Committee Engagement & Experience Committee Executive Committee Primary Care Commissioning Committee Chair 10 elected Locality Leads 3 Lay Members Chief Officer Chief Finance Officer Registered Nurse Secondary Care Doctor Our Governing Body comprises: Myself as Chair 10 elected clinical Locality Leads – 2 from each of the 5 Localities in Doncaster into which our Member Practices are grouped 3 Lay Members Our Chief Officer Our Chief Finance Officer A Registered Nurse And a Secondary Care Doctor Our Governing Body is supported by a range of Committees: Audit Committee – focussing on risk, integrated governance and finance Remuneration Committee – setting staff salaries Quality & Patient Safety Committee – overseeing and assuring the quality and safety of services which we commission Engagement & Experience Committee – leading engagement with our population, listening to patient experience and addressing inequalities Executive Committee – managing the operational side of our organisation Primary Care Commissioning Committee – making decisions on general practice commissioning responsibilities

Our Member Practices These are our 43 Member Practices, which are spread across the Doncaster area and grouped into our 5 “localities”: North West – covering areas including Askern, Bentley, Carcroft, Scawthorpe, and Scawsby. North East – covering areas such as Thorne, Moorends, Hatfield and Dunsville. Central - covering the centre of Doncaster. South West – covering areas including Mexborough, Conisbrough, Balby and Edlington. South East – covering areas like Armthorpe, Rossington, Bawtry and Tickhill.

What we stand for Our Vision: Work with others to invest in quality healthcare for Doncaster patients Our Values: The needs of our patients are paramount We will drive forward continuous improvement Relationships based on integrity and trust Mission Statement: A high quality and accountable Clinical Commissioning Group, encouraging responsible partnership engagement in a transparent climate of ongoing learning in order to create a patient-centred yet financially astute and corporate approach to commissioning Early on, we developed our vision, values and missions statement. These set out what we stand for as an organisation. The key words for us are “quality healthcare”, a “patient focus”, and “continuous improvement” through “excellent relationships”. We sum this up in our strapline for our 309,000 population: “Helping you keep well”.

A review of our year Presented by our Chair & Chief Officer We’d now like to move on to review our work over the past year.

Recognising our former Chair & Chief Officer We are a new Chair & Chief Officer team, both starting in post on 1 April 2013. We would like to recognise the hard work and determination of our previous Chief Officer, Mr Chris Stainforth, and previous Chair, Dr Nick Tupper. They led and grew the organisation over the last 3 years since our establishment and left it on a really sound footing at the end of the financial year. This report is testament to their and the wider team’s work. Mr Chris Stainforth Dr Nick Tupper

Catalysts for change Care out of Hospital Coordinated care Care of the frail The focus for our five year commissioning strategy is on three inter-connecting areas as catalysts for change:   Care out of Hospital – care provided outside of a hospital setting, either in a patient’s home or based around a primary care community team. Care of the Frail – supporting an ageing Doncaster population with increased life expectancy where patients can experience multiple medical conditions and greater clinical complexity. Coordinated Care – commissioning integrated care across a whole system that is responsive to patient needs, uses the latest technology to support service delivery, and develops enhanced access to information across partner organisations.

Our priorities PRIORITY PATHWAYS SYSTEM CHANGE Community Services Intermediate Care Primary Care Urgent Care End of Life Care Care Homes Mental Health Cancer Children’s Dementia Our 5 year commissioning strategy Moving Forward, Getting Better is refreshed annually and sets out our plans for delivering our vision for health care services in partnership to meet the needs of the Doncaster population. It recognises the challenge in ensuring healthcare services are affordable and sustainable in an environment of low financial growth, but in the context of continuing demand for services and a reduction in funding for other public services. We describe 2 distinct areas of our Strategy: Our system change programmes, focussing on transforming care across the local health economy Our clinical priority pathways where we are leading pathway and service redesign and partnership working to improve outcomes

Holistic community nursing care Single Point of Access Intermediate Care Health Needs Assessment – 1,000 people Fed back in January Now designing the new model SYSTEM CHANGE Community Services Intermediate Care Primary Care Urgent Care End of Life Care Care Homes Understanding the needs of residents to influence a future Care Home Strategy Primary Care Strategic Framework 4 pillars: Keeping people well Responsive primary care Proactive coordinated primary care Extended primary care Woodfield 24 More people dying in the place of their choice I’d like to take you through each of our system change areas in more detail, highlighting a few of our key achievements throughout the year . . . SEE SLIDE FOR NOTES. October 2015: launch of new-look urgent care services Urgent Care Centre Same Day Health Centre GP Out of Hours

Mental Health Cancer Children’s Dementia Single Point of Access launched in October 2015 for individuals experiencing a crisis Working in partnership with peer support organisations Mental Health Cancer Children’s Dementia Catch cancer early with Doncaster Rovers: “Tackle lung cancer early and get extra time” Prostate cancer: “Dribbling, not shooting” “Be breast aware” – with the Doncaster Belles Increase in early diagnosis New community paediatric model from April 2015 Autism Spectrum Disorder pathway redesign Mental Health & Wellbeing Plan And now let’s take a look at some highlights from our clinical priority areas . . . SEE SLIDE FOR NOTES. 5,000 Dementia Friends in Doncaster Awareness raising Admiral Nursing service for those diagnosed with dementia

Sustainability & Transformation Sustainability & Transformation Plan Place based plan Working Together In December 2015, the NHS shared planning guidance outlined a new approach to help ensure that health and care services are built around the needs of local populations. To do this, in this new financial year every health and care system in England is producing a multi-year Sustainability and Transformation Plan (STP), showing how local services will evolve and become sustainable over the next five years – ultimately delivering the Five Year Forward View vision of better health, better patient care and improved NHS efficiency. To deliver plans that are based on the needs of local populations, local health and care systems came together in January 2016 to form 44 STP “footprints”. Ours is based on a South Yorkshire & Bassetlaw footprint. We are currently developing the joint plan. We are also developing a Doncaster Place Based Plan to support this, and there is real energy and enthusiasm about coming together as a Doncaster community. Collaborative working is very important to delivering the government’s Five Year Forward View, and we are part of a partnership with the 8 CCGs across South & Mid Yorkshire, Bassetlaw and Derbyshire to work collaboratively on commissioning services provided at scale such as Hyper Acute Stroke services.

Patient engagement Why engage? It is the right thing to do! Good engagement also generates insights about the experience of our patients, carers and public who access the service we commission. These insights feed directly into our commissioning activities – they influence how we commission services. This makes us a smarter health investor, able to achieve better outcomes and better value for our population. Patient engagement is vitally important to us in the CCG. Not only is it the right thing to do, but good engagement also generates insights about the experience of our patients, carers and public who access the service we commission. These insights feed directly into our commissioning activities – they influence how we commission services. This makes us a smarter health investor, able to achieve better outcomes and better value for our population. When we are commissioning, we aim to think about the outcomes our patients need from the service, the activity that needs to flow through the service, the quality of the service, and the patient experience of the service – all within a value for money envelope.

Levels of engagement On our strategic plans and priorities.   CONSULTATION On our strategic plans and priorities. ENGAGEMENT On how we specify outcomes, redesign pathways or services and procure services. VALIDATION Of the quality and performance of the services we commission. There are different levels of engagement where we try to listen to our population: When we formally consult our population on our strategic plans and priorities – like those we highlighted earlier in this presentation – looking at what we should be focusing on. When we engage with current and future users of services to help us to redesign services and pathways. When we seek patient experience of the services we commission to validate the quality and performance data which we already collect. Our patients tell us when things are going well – and when they are not.

Types of engagement . . . Partners: Chair’s column Website Newsletters Partners: Chair’s column in Free Press Health Ambassadors Health campaigns Engagement Workshops And these are some of the many types of engagement over the past year . . . We have refreshed our website, increasing the amount of information available. We undertake surveys using the strapline “Talking Points” – do watch out for these. Examples include care home care, carer support, and access to specialist hospital services. We run health campaigns – the one on the slide is in partnership with the local football team and is “Show the red card to medicines waste in Doncaster”. We have regular newsletters called “In Touch” which update our population and partners on our commissioning activities. Where we are seeking to hear patient voices on a specific topic, we run engagement workshops – for example on Mental Health wellbeing. We bring members of Practice Participation Groups together in a Network to hear their views on primary care commissioning. We have a weekly Chair’s column in the Free Press. We use social media a lot to cascade health messages and invite to take part in surveys. We video patient stories and show them at commissioning meetings. We work closely with our partners to hear the patient voice – Healthwatch Doncaster, Doncaster CVS, Team Doncaster. We have developed a pilot of Health Ambassadors in each of the groups who we hear from most seldom. They tell us what they think of our commissioning plans and commissioned services. Videos of patient stories PPG Network Social media

Annual Accounts Presented by our Chief Finance Officer David/Jackie: I would now like to introduce to you our Chief Finance Officer, Hayley Tingle, to take you through the financial position.

Annual Accounts Year-end accounts for 2015/16 are complete; we met all our statutory financial duties Prepared under International Financial Reporting Standards (IFRS), in accordance with the Department of Health Group Manual for Accounts 2015/16 The Statement of Comprehensive Net Expenditure captures our gross expenditure and income £446,656,000 allocation £436,934,000 net operating costs £9,722,000 surplus Our year-end accounts for 2015/16 are complete. I am pleased to report that we met all our statutory financial duties Our accounts were prepared under International Financial Reporting Standards (IFRS), in accordance with the Department of Health Group Manual for Accounts 2015/16 The Statement of Comprehensive Net Expenditure captures our gross expenditure and income. The outcome was: £446,656,000 allocation £436,934,000 net operating costs £9,722,000 surplus

Summary of financial performance Duty Target £’000 Performance Expenditure not to exceed income (Achieve a Surplus) 447,071 437,349 Capital resource use does not exceed the amount specified in Directions Revenue resource use does not exceed the amount specified in Directions (Total Allocation) 446,656 436,934 Capital resource use on specified matter(s)does not exceed the amount specified in Directions Revenue resource use on specified matter(s) does not exceed the amount specified in Directions (Programme) Revenue administration resource use does not exceed the amount specified in Directions (Admin/Running costs) 7,190 6,464 This slide summarises our financial performance.

Financial position moving into 2016/17 Financial allocations for 2016/17 have created a very challenging financial position Growth 2.08% i.e. £8.9m Additional costs exceed the growth allocation Inflation on contracts Prescribing Continuing Healthcare Demographic growth Acute referrals Running cost pressures Gap deficit of £8.9m – efficiency programme needed Moving into 2016/17, financial allocations have created a very challenging financial position. We received growth of 2.08%, which totals £8.9m. However the additional costs for 2016/17 exceed the growth allocation. These costs include inflation on contracts, prescribing costs, costs of Continuing Healthcare, demographic growth in our population, increasing referrals to hospital, and running cost pressures. To support this position, we have needed to put an efficiency programme in place to meet a gap deficit of £8.9m. This is a very challenging position for us as an organisation, and reflects national pressures both on CCGs and our providers.

Managing the finances System transformation will be critical – e.g. intermediate care model Strong financial control during 2016/17 will be crucial to ensure delivery of the CCG’s financial targets The local health system will only remain financially sustainable through integration and collaborative commissioning, through working closely with primary care, providers and the Local Authority Use “Right Care” areas to target efficiency programme In order to manage this position: System transformation will be critical – e.g. our intermediate care model bringing care closer to home Strong financial control during 2016/17 will be crucial to ensure delivery of the CCG’s financial targets The local health system will only remain financially sustainable through integration and collaborative commissioning, through working closely with primary care, providers and the Local Authority We will need to use the “Right Care” areas identified nationally by NHS England to target our efficiency programme.

A summary of our performance I’ll now hand you back to Jackie/David for a summary of our year’s performance.

Our annual review 2015/16 by Commended us on the clear and coherent CCG strategy Noted good progress in 2015/16 on urgent care, end of life care and mental health crisis care Noted our aim to focus on the transformation of intermediate care services in the year ahead Noted the significant challenge of local health and social care system sustainability in 2016/17 CCG Assurance Framework 2015/16: Our annual review by NHS England: Commended us on the clarity and coherence of our CCG strategy Noted good progress in 2015/16 on urgent care, end of life care and mental health crisis care Noted our aim to focus on the transformation of intermediate care services in the year ahead Noted the significant challenge of local health and social care system sustainability in 2016/17 The CCG Assurance Framework resulted in a “good” rating across all the areas of: Well Led Organisation Delegated Functions Financial Management Performance Planning Well Led Organisation Delegated Functions Financial Management Performance Planning   Good

Governance Annual Governance Statement: no control issues Head of Internal Audit Opinion: significant assurance of a sound system of internal control ISA 260 Report from External Auditors to those charged with Governance: proper arrangements to secure economy, efficiency and effectiveness in our use of resources In terms of Governance, we have received 3 positive reports. Our Annual Governance Statement identified no control issues. The Head of Internal Audit Opinion gave significant assurance of a sound system of internal control. The ISA 260 Report from External Auditors to those charged with Governance concluded that we have proper arrangements to secure economy, efficiency and effectiveness in our use of resources.

Annual Report & Accounts We would like to formally present to you our Annual Report and Accounts. Following that summary of our year, we would like to formally present to you our Annual Report and Accounts.

Public questions That concludes our presentation. We would now like to open up to the floor for any public questions.