Consistency in clinical pathways and contractual arrangements across the CCG footprint Dr Joe Mays 14 October 2015

2012/13 equiv costs for Exeter patients (RDE only) Full Year As at Month 3 FOT As at full year 2014/15 NORTH DEVON PATIENTS @ 2015/16 tariff 2013/14 2014/15 2015/16 2012/13 equiv costs for Exeter patients (RDE only) diff volumes tariff Pathway 1 £2,798 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and Discharged Home 31 £86,738 21 £58,758 6 £16,788 24 £67,152 8 £22,384 £0 £3,410 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and Discharged Home 67 £228,470 52 £177,320 14 £47,740 56 £190,960 Pathway 2 £5,937 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred back to NDDH 4 £23,748 1 2 £11,874 £6,549 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to NDDH 5 £32,745 £11,618 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred to PHT £23,235 £12,230 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to PHT Pathway 3 £3,740 Short Stay Admission NDDH, trf to RDE for Angio and Discharged Home £18,700 £942 £4,352 Short Stay Admission NDDH, trf to RDE for PCI and Discharged Home £34,816 7 £30,464 £17,408 £23,870 £6,594 Pathway 4 £6,879 Short Stay Admission NDDH, trf to RDE for Angio, trf back to NDDH   £7,491 Short Stay Admission NDDH, trf to RDE for PCI, trf back to NDDH Pathway 5 >2 midnight Admission NDDH, trf to RDE for Angio and Discharged Home 69 £409,653 70 £415,590 £83,118 £332,472 19 £112,803 £813,225 -£397,635 >2 midnight Admission NDDH, trf to RDE for PCI and Discharged Home 64 £419,136 61 £399,489 £91,686 £366,744 18 £117,882 £746,000 -£346,511 Pathway 6 £9,076 >2 midnight Admission NDDH, trf to RDE for Angio, trf back to NDDH 33 £299,508 £217,824 £36,304 16 £145,216 £72,608 £89,760 £128,064 £9,688 >2 midnight Admission NDDH, trf to RDE for PCI, trf back to NDDH £58,128 £5,336 Totals 296 £1,653,986 248 £1,388,475 53 £281,573 212 £1,126,292 76 £420,479 £1,922,632 -£534,157

As at full year 2014/15 NORTH DEVON PATIENTS @ 2015/16 tariff 2012/13 equiv costs for Exeter patients (RDE only) diff Pathway 1 2798 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and Discharged Home 58758 3410 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and Discharged Home 177320 Pathway 2 5937 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred back to NDDH 23748 6549 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to NDDH 32745 11617.5 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred to PHT 12229.5 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to PHT Pathway 3 3740 Short Stay Admission NDDH, trf to RDE for Angio and Discharged Home 942 4352 Short Stay Admission NDDH, trf to RDE for PCI and Discharged Home 23870 6594 Pathway 4 6879 Short Stay Admission NDDH, trf to RDE for Angio, trf back to NDDH 7491 Short Stay Admission NDDH, trf to RDE for PCI, trf back to NDDH Pathway 5 >2 midnight Admission NDDH, trf to RDE for Angio and Discharged Home 813225 -397635 >2 midnight Admission NDDH, trf to RDE for PCI and Discharged Home 745999.5 -346510.5 Pathway 6 9076 >2 midnight Admission NDDH, trf to RDE for Angio, trf back to NDDH 89760 128064 9688 >2 midnight Admission NDDH, trf to RDE for PCI, trf back to NDDH 5336 1922631.5 -534157

As at full year 2014/15 NORTH DEVON PATIENTS @ 2015/16 tariff 2012/13 equiv costs for Exeter patients (RDE only) diff Pathway 1 2798 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and Discharged Home 58758 3410 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and Discharged Home 177320 Pathway 2 5937 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred back to NDDH 23748 6549 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to NDDH 32745 11617.5 Blue light direct (or from NDDH A&E) to RDE / Musgrove (Angio only) and transferred to PHT 12229.5 Blue light direct (or from NDDH A&E) to RDE / Musgrove (PCI only) and transferred back to PHT Pathway 3 3740 Short Stay Admission NDDH, trf to RDE for Angio and Discharged Home 942 4352 Short Stay Admission NDDH, trf to RDE for PCI and Discharged Home 23870 6594 Pathway 4 6879 Short Stay Admission NDDH, trf to RDE for Angio, trf back to NDDH 7491 Short Stay Admission NDDH, trf to RDE for PCI, trf back to NDDH Pathway 5 >2 midnight Admission NDDH, trf to RDE for Angio and Discharged Home 813225 -397635 >2 midnight Admission NDDH, trf to RDE for PCI and Discharged Home 745999.5 -346510.5 Pathway 6 9076 >2 midnight Admission NDDH, trf to RDE for Angio, trf back to NDDH 89760 128064 9688 >2 midnight Admission NDDH, trf to RDE for PCI, trf back to NDDH 5336 1922631.5 -534157

HRG NDHT RDEFT PHNT Total AVERAGE COST Cost (£) Count EA36A - Catheter, 19 years and over 922055.1573 759 530061.9867 451 1452117.144 1214.828929 1175.30374 EA49Z - Percutaneous Coronary Interventions with 3 or more Stents, Rotablation, IVUS or Pressure Wire 210233.9147 68 79181.13736 26 289415.0521 3091.675217 3045.42836

Primary Care Actions Practice level data Improve primary and secondary prevention Improve referral quality Clinical Referral Guidelines Community Cardiology Service

Adopt, Improve, Defend Groups including representatives from all three providers Focus on analysing significant gaps first Initially try to understand why the gaps exist

Adopt, Improve, Defend Agree action plans Groups including representatives from all three providers Focus on analysing significant gaps first Initially try to understand why the gaps exist Agree action plans How should we write a CCG-wide specification which supports change