West London CCG QIPP Plan 2015/16 Governing Body meeting 20 January

Introduction QIPP target of 3% of allocation = £10.2m Total net savings of just over £8.3m already identified, with gap of £1.9m Schemes already identified range across planned care (£3.9m), unplanned care (£1.2m) and transactional savings (3.2m) 2

Context Our current recurrent funding is around £88m more than we should be receiving. We don’t yet know how quickly, if at all, our funding will move away from the historic level towards the capitation target. The financial sustainability of the CCG relies on QIPP delivery and the major transformational work contained in the Shaping a Healthier future programme The CCG needs to generate QIPP savings each year to: – offset the growth in demand for services year on year – support the Out of Hospital Strategy by transferring funding from acute providers to primary and community based care – provide the CCG with financial sustainability as it moves towards the capitation target 3

A 10 year planning model has been produced for the CCG. The purpose of undertaking longer term financial planning is to demonstrate the impact of decisions on the future finances of the CCG, so that we can give due regard to the longer term financial viability. This includes determining what we can afford to spend recurrently and what we can only afford to spend non recurrently (i.e. one off expenditure). The graphs below illustrate this. The first graph shows the ‘do nothing’ scenario, where we make no savings or investments in new services and allow expenditure to continue in line with existing trends. The second graph shows the financial model on which the 2014/15 budget is based. In this graph, the investment budget is split between investment that we can make recurrently and investment that we can make non recurrently. The third graph uses the same QIPP and investment figures overall, but all investments are now recurrent. Graph 1 – do nothingGraph 2 – current financial plan Graph 3 – all investments recurrent The graphs demonstrate that: 1)Without a savings plan each year, the CCG will move into deficit in the future 2)While we can afford to make significant investments if we understand our recurrent position, we would quickly move into deficit if we spend all the money recurrently. QIPP and the 10 year financial model

Overview of schemes 5 Scheme type Scheme Code Scheme name GROSS Savings (£000) Investment (£000) NET Savings (£000) Clinical LeadProject Lead Transactional savings WL030Jointly Commissioned Services (BCF)£254£0£254TBCJayne Liddle WL027Estates void cost reduction£684£0£684N/AKate Brady WL028Transforming Nursing and Care Home Contracting (BCF)£79£0£79TBCJayne Liddle WL033Out of area contracts efficiency (3%)£365£0£365TBC WL034ICP decommissioning£100£0£100Dr Fiona ButlerJayne Liddle WL035Specialist Housing Strategy for Older People£619£0£619TBCJayne Liddle WL032Decommissioning Enhanced Access LES£903£0£903N/ASimon Hope WL036Decommissioning heart failure nursing£174£0£174Dr. Naomi KatzMatthew Henry Productivity Total£3,178£0£3,178 Unscheduled care WL007NEL admissions - Community Independence Service (BCF)£1,559£1,129£430Dr Fiona ButlerJayne Liddle WL008A&E - Community Independence Service (BCF)£179£0£179Dr Fiona ButlerJayne Liddle WL003Excess bed days£160£0£160Dr Fiona ButlerJayne Liddle WL008aUCC/A&E (other schemes)£500£50£450TBCKatie Beach Unscheduled Care Total£2,398£1,179£1,219 Planned care WL009Referral Standardisation Scheme£1,085£0£1,085 Dr Rachael Garner Katrina Mindel WL031a-dOut of Hospital Services - acute savings£804£0£804TBCSimon Hope WL031eOut of Hospital Services - community savings£328£0£328TBCSimon Hope WL013Community cardiology and respiratory£1,000£600£400Dr Naomi KatzMatthew Henry WL014Primary Care Children's Hubs£150£0£150Dr Naomi KatzDavey Thomason WL015Primary Care Prescribing£1,000£0£1,000TBCChris Corfield WL025Community Ophthalmology Service£404£220£184TBCKatie Beach Planned Care Total£4,771£820£3,951 Grand Total£10,347£1,999£8,348 CCG target to deliver 3% £10,225 Gap against 3% target -£1,877

Transactional efficiencies 6 Scheme type Scheme CodeScheme name GROSS Savings (£000) Investment (£000) NET Savings (£000) Scheme Description and Objectives Transactional savings WL030 Jointly Commissioned Services (BCF) £254£0£254 BCF contractual savings scheme to review all existing jointly commissioned services with S75 and S256 partnership arrangements, to ensure services provide value for money and are aligned with the objective of integrated working. WL027Estates void cost reduction£684£0£684 Reduction in void space costs at St Charles from services moving in in the latter part of 2014/15 and during 2015/16, as well as leases ending in two other estates across the CCG area. WL028 Transforming Nursing and Care Home Contracting (BCF) £79£0£79 BCF scheme to create a single care home placement contracting team across health and social care and to develop outcomes based specifications, maximise value and ensure appropriate and timely provision reduces pressure on hospitals. WL033 Out of area contracts efficiency (3%) £365£0£365Challenges to out of area trusts – detail of this scheme being developed WL034ICP decommissioning£100£0£100 Efficiencies from bringing the ICP in-house – detail of this scheme being developed WL035 Specialist Housing Strategy for Older People £619£0£619 Identification a new provider of nursing and residential accommodation to improve the physical facilities from which care services are provided, as well as generating revenue savings. WL032 Decommissioning Enhanced Access LES £903£0£903 Decommissioning of the CCG's Enhanced Access LES, which has been funding enhanced access in practices, including at lunchtimes. WL036 Decommissioning heart failure nursing £174£0£174 Decommissioning of CLCH heart failure nursing service as part of cardiology and respiratory procurement Productivity Total£3,178£0£3,178

Unscheduled care 7 Scheme type Scheme Code Scheme name GROSS Savings (£000) Investment (£000) NET Savings (£000) Scheme Description and Objectives Transformational savings (unscheduled care) WL007 NEL admissions - Community Independence Service (BCF) £1,559£1,129£430 Development of a Tri-borough Integrated Community Independence Service (CIS), which provides a range of functions, including rapid response services to prevent people going into hospital, and rehabilitation and reablement which enable people to regain their independence and remain in their own homes. WL008 A&E - Community Independence Service (BCF) £179£0£179 Development of a Tri-borough Integrated Community Independence Service (CIS), which provides a range of functions, including rapid response services to prevent people going into hospital, and rehabilitation and reablement which enable people to regain their independence and remain in their own homes. WL003Excess bed days£160£0£160 Transformational scheme aimed at a reduction in excess bed days by making effective use of the Community Independence Service to discharge people from hospital in a timely manner WL008aUCC/A&E£500£50£450 Increase availability of GP appointments and provide 7 day GP access as part of the Prime Minister’s Challenge Fund, as well as potentially implementing UCC re-direction as part of the SaHF specification at Chel West and St Mary’s. Unscheduled Care Total£2,398£1,179£1,219

Planned care 8 Scheme type Scheme Code Scheme name GROSS Savings (£000) Investment (£000) NET Savings (£000) Scheme Description and Objectives Transformational savings (planned care) WL009 Referral Standardisation Scheme £1,085£0£1,085 The aim of the Referral Standardisation Scheme (RRS) is to reduce variation in referral rates across GP practices through peer review and audit. West London CCG has higher referral rates per thousand than its neighbouring CCGs in the Tri-borough, as well as significant variation between practices. The modelling for this scheme includes the specialities where the CCG has the highest spend. WL031a-d Out of Hospital Services - acute savings £804£0£804 The GP federation will be providing a range of out of hospital services and savings are based on shift of care from hospital to primary care. Model currently based on savings in diabetes/endocrinoolgy, near patient monitoring, ring pessary and ECGs WL031e Out of Hospital Services - community savings £328£0£328 The GP federation will be providing a range of out of hospital services and savings are based on shift of care from community to primary care. Model currently based on savings in wound care (levels 1 and 2) and phlebotomy WL013 Community cardiology and respiratory £1,000£600£400 Procurement currently underway for community cardiology and respiratory services, which are expected to shift 70% of outpatient first and follow up attendances into community. WL014Primary Care Children's Hubs£150£0£150 Savings anticipated from the reduction of OP attendances and A&E attendances in paediatrics, linked to the roll out of children’s hubs in primary care. WL015Primary Care Prescribing£1,000£0£1,000 Savings scheme based on implementing best practice prescribing in primary care. Each practice will be supported by practice link pharmacists to remain within budget. WL025 Community Ophthalmology Service £404£220£184 Procurement currently underway for community ophthalmology service, which is expected to shift 28% of outpatient firsts and 50% follow ups into community, as well as 70% of appropriate procedures. Planned Care Total£4,771£820£3,951