CVD Optimal Service Design Workshop Defining “what to change” using the NHS Right Care methodology Part of the NEW Devon Way

Optimal Service Design Workshop Structure Activity timing Introduction and Purpose of Today 15 mins The purpose of today’s workshop Why NEW Devon CCG has adopted NHS Right Care How NEW Devon CCG uses NHS Right Care in QIPP planning Gap Analysis 55 mins Summary of deep dive findings Review of deeper performance analysis Best practice / optimal practice review Q&A on deep dive findings Adopt, Improve, Defend (AID) 65 mins Work in groups to define: Which best/optimal practice should be adopted Which current practice should be improved Which current practice can be defended Feedback AID recommendations

Optimal Service Design Workshop Structure - continued Activity timing Service Redesign 30 mins Taking AID outputs, design the specification for the service Action / strategy planning 15 mins Produce action plan for new service specification and define strategic statements for longer term improvement Workshop Feedback 5 mins Feedback to make workshop a better learning experience Questions Final opportunity for questions

Optimal Service Design Workshop Introduction & Purpose of Today

Optimal Service Design Workshop Purpose To understand how NHS Right Care is used by for NEW Devon CCG To understand the theory behind NHS Right Care To understand the findings of the service deep dive and further analyse the topics selected for improvement To design optimal service solutions to: Resolve issues identified during the analysis Set performance parameters for the new service design Identify any strategic requirements Reduce unnecessary variance in outcomes, quality & cost To learn a standardised approach to evidence based change in NHS NEW Devon CCG

Systematic QIPP Development Adoption of NHS Right Care NHS NEW Devon CCG must maintain a continuous list of improvement opportunities to ensure that QIPP requirements can be met each year To do this we must adopt a standardised approach to QIPP development that will bring clarity and assurance to the QIPP proposals NHS Right Care is designed for CCGs to tailor to their purposes using the overall methodology as a blueprint NHS NEW Devon CCG will develop its use of the Right Care system in outline and refine it as the QIPP programmes develop, effectively testing it with delivery and improving as we go 5YFV “closing the gap” target for NEW Devon is to be upper quintile across the board, therefore all opportunities will be valued at a top 20% indicator The deep dive has selected areas showing variation in the service that we need to change to meet peer performance and move towards national upper quintile We are here to identify and agree changes to the service to improve outcomes, cost and quality

Systematic QIPP Development NHS Right Care Overall Methodology We are here “What to change”

Systematic QIPP Development Phase 1 - Where to look Where to look will happen once each year to produce a high level ranked list of opportunity to pursue We do this using a series of nationally available indicative data comparing our performance against a selected peer group of health economies The output of this phase is a scoped and ranked list of opportunity Commissioning for Value Atlas of Variance Programme Budgeting Local Interpretation Benchmark, value, rank and prioritise themes using agreed national and local data. Identify opportunity of top ranked themes. Produce a scope per theme. Present scope to steering group for go/no go decision. Themes ranked With a scope per theme

Systematic QIPP Development Phase 1 - Where to look (2015/16 data) We have ranked all services by value (a combination of demand, outcomes, cost and performance) For 2015/16 NHS Right Care shows a total value against peer of £116M and against the national upper quintile position of £268M 16 of the 22 categories have been selected for deep dive review in 4 waves in 15/16 These are not the QIPP targets but an indication of where our services are sub optimal compared with other health economies

Systematic QIPP Development Phase 2 part 1 - What to change What to change starts with a deep dive exercise focusing on the selected theme The deep dive pack is analysed (today’s exercise) and QIPP plans are defined with sufficient evidence to produce a project mandate. The output of this phase is a project mandate NHS Right Care deep dive is completed (4 weeks) Detailed deep dive is analysed and prioritised and planned targets defined (3 days ) Implementation plans are drafted, business cases defined and project mandate produced (2 days) Mandate assessed at steering group for go/no go decision Note: An example mandate is in your handouts

Systematic QIPP Development Phase 2 part 2 – What to change – today’s workshop Once the mandate is approved we can undertake deeper analysis of the selected QIPP projects This deeper analysis culminates in an optimal service design workshop including providers, patients and CCG members The output of this phase is a project initiation document including the new service design, strategy and implementation plans Assess gaps to best in class Clinically led pathway redesign Strategy for theme Complete Strategy to action plans, full business case, & full PID Test against gold target and initial objective Full PID assessed at steering group for go/no go decision

Systematic QIPP Development Phase 3 - How to Change Once the PID is approved we can start to implement the planned changes Implementation will follow the NHS NEW Devon CCG turnaround methodology and will seek to deliver benefits as fast as possible Projects will be delivered and sustained under the Turnaround governance structure

Optimal Service Design Workshop Systematic QIPP Development Questions?

Optimal Service Design Workshop Gap Analysis Deep Dive Summary

Optimal Service Design Workshop Gap Analysis Performance Analysis Review

Optimal Service Design Workshop Gap Analysis Best / Optimal Practice Review

Optimal Service Design Workshop Gap Analysis Questions?

Optimal Service Design Workshop Adopt, Improve or Defend

Optimal Service Design Workshop Adopt, Improve, Defend What: Identify the key elements of the service that are sub-optimal Determine if there is better practice for the element Elect to adopt better practice, improve current practice or defend current practice How: Map the backbone of the service in patient flow order Under each mapped step record the performance of the step Identify better practice for the suboptimal steps and put it under each step Elect to Adopt, Improve or Defend for that element Patient managed in primary care Patient managed in primary care then referred on Patient seen at outpatients but discharged at first appointment Patient receives follow up appointment Patient admitted Pathway Backbone 38% more than average in primary care 72% patients referred on from primary service 29% more than average discharged at first appointment 23% more than average follow up appointments 4.8% more patients admitted than average Pathway Performance NICE guidance on primary care management Gloucester model for primary care management Oxford model for O/P triage NICE guidance on patient initiated follow up Royal College recommendation on decision to admit Better practice Defend Adopt Improve Adopt Adopt AID

Optimal Service Design Workshop Service Redesign What: Having elected an AID category for each step of the service define what the step will look like and how it will perform Specify reasons with evidence for any defend decisions How: Map the backbone of the new service Under each mapped step record the expected performance Record key changes to current step to achieve the new one - “must” statements If necessary add a strategic statement for the step Patient still managed in primary care Patients requiring acute service identified early Patient triage completed by DRSS for GPwSI service Patient initiated follow up iaw NICE guidance Conservative treatment offered iaw guidance New Backbone 38% more than average managed in primary care 50% reduction of patients managed in two settings 40% reduction in discharge at first appointment 25% reduction in follow up appointments 4% reduction in admissions Expected Performance Currently best use of interface service in UK - Change spec for primary service - GP funding for back referrals Setup GPwSI service Adopt Oxford triage protocol - Standard letter to patient - Reappointment “hot line” Conservative treatment made available Key Changes / Defend evidence To increase primary care management To use patient decision aids To reduce surgical intervention Strategic statements

Optimal Service Design Workshop Action Planning What: Determine actions to make the key changes happen Align the actions with the project timescale: Implementation = making the change Delivery = measuring the benefit How: Complete a post it for each action as shown Put the post it on the timeline where the task starts Add new planning categories as they emerge For quick wins: date is ASAP; position on the timeline is not relevant Action: stop all physio referrals to outpatients Outcome: 2,300 unnecessary outpatient referrals stopped, 500 back referrals to GPs started Date (from –to): ASAP Owner: F Bloggs, commissioning lead Implementation Delivery Planning Category Sep Oct Nov Dec Jan Feb Mar Strategy Commissioning policy Pathway changes Quick wins

Optimal Service Design Workshop Workshop feedback

Optimal Service Design Workshop Next Steps In the next two weeks, the CCG project team will: Complete a project plan and business case for the proposed changes (PID) Complete any further analysis required to support the business case Identify and inform stakeholders of the planned changes Submit to the CCG turnaround steering group for formal acceptance as a QIPP scheme

Optimal Service Design Workshop Thank You