Operational Plan Summary 2012/13

Contents Forward by Carl Ellson, South Worcestershire CCG Chair Section 1Introduction to South Worcestershire Section 2Our vision, values, objectives and priorities Section 32011/12 Achievements Section 42012/13 Corporate objectives Section /13 Commissioning priorities Section 6Our priorities in more detail authorisation engagement local service priorities joint service review finance and quality, innovation, productivity and prevention (QIPP) Section 7 Contact us Glossary

Forward by Carl Ellson, CCG Chair The NHS reforms have placed clinicians absolutely at the forefront of improving healthcare commissioning and in South Worcestershire we are determined to grasp this challenge and to improve services and outcomes for our population. Now that the Health and Care Bill has been passed, we will be concentrating this year on our application to be authorised as a statutory organisation which will provide us with the responsibilities and freedoms we require to commission the best care possible within the resources available to us. This Operational Plan Summary reviews our achievements in 2011/12 and sets out our overall vision and priorities and importantly how we will deliver these during 2012/13. A full version of our plan is also available. We are undoubtedly in a period of great change, with the health care reforms and the country’s wider financial challenge greatly influencing how we approach 2012/13. We will be working collaboratively with patients and the public, our NHS providers, other CCGs, the Local Authority and the voluntary sector to deliver much of the work outlined in our plan. The Joint Services Review of Worcestershire health services is a major component of this collaborative work across the county and I am committed to us playing a major role in shaping the outcome of that work. Dr Carl Ellson Clinical Executive Lead and Accountable Officer South Worcestershire CCG

AreaPracticesPopulation Droitwich and Ombersley 537,768 Evesham, Bredon & Broadway 649’873 Malvern Hills & Pershore 1187,557 Worcester City10117,235 Total32292,433 Introduction to South Worcestershire South Worcestershire CCG will be the biggest of the three CCGs in Worcestershire, accommodating approximately half of the health budget being delegated in the County. We are a collection of 32 General Practices serving a population of 292,000 people. The age and demographic profile for South Worcestershire is similar to that of the county as a whole. However, there is a slightly greater proportion of people aged 65 or more. Despite what appears to be a typical population profile, there are challenges that we will need to address. For example: The significant proportion of the elderly population at risk due to rural isolation. There are significant areas of social deprivation in urban parts of South Worcestershire’s area. Across South Worcestershire there are significant variations in the appearance of chronic long term conditions. Mental health is the single largest area of long term disease related spend.

Our Board NameRole GP RepresentativesPortfolio Dr Anthony KellyChair, Clinical Lead for DroitwichJoint commissioned services Dr Carl Ellson Clinical Lead for SWCCG and Accountable Officer Overall strategic development Dr David Farmer Clinical Lead for Evesham, Bredon and Broadway Medicines Management, primary care & innovation Dr Jonathan Thorn Joint Clinical Lead for Malvern Hills and Pershore Community services Dr George Henry Joint Clinical Lead for Malvern Hills and Pershore Quality Dr Felix BlaineJoint Clinical Lead for Worcester CityLong term conditions Dr Nikki BurgerJoint Clinical Lead for Worcester CityUrgent care, planned care & acute services Secondary Care Representatives TBCSecondary Care Clinician Lay Representatives Rob Parker Vice Chair, Lay Member & Non Executive representative for West Mercia Cluster Board Margaret JacksonLay member Stuart BourneCo-opted member Management Team Representatives Simon TrickettChief Operating Officer Mary WaltersInterim Chief Finance Officer Jo GallowayInterim Executive Nurse Dr Anthony Kelly Dr Carl Ellson Dr David Farmer Dr Jonathan Thorn Dr George Henry Dr Felix Blaine Dr Nikki Burger

Our vision and purpose We exist to ensure that the population of South Worcestershire enjoy lives which are as healthy as possible. To achieve this we will aim for the following: South Worcestershire Clinical Commissioning Group will be recognised as a model organisation for providing innovative and creative healthcare services for its patients. Our Practices will work together to achieve goals and maximise primary care efficiency. We will use scarce resources wisely and our community will understand that unpopular decisions are taken in the interests of the community as a whole. Ten years from now the delivery of healthcare for residents of South Worcestershire will have improved significantly and NHS care provided will guarantee clinical quality for our patients. Our core purpose as an organisation is to: Improve the health of our patients by commissioning high quality, value for money healthcare services. Listen to and gains the respect of the community Work in partnership with statutory, voluntary and private sector organisations for the betterment of the population we serve Invigorate healthcare delivery by creating value based competition founded on improved patient outcomes. Pioneer new and innovative ways to provide healthcare. Throughout this Operational Plan we will outline how we plan to meet this purpose and ultimately deliver our Vision. Whilst our vision will take a number of years to deliver, this plan outlines the steps that we plan to take over the coming 12 months.

Our values To deliver our vision for South Worcestershire we need to build and develop a successful organisation that is clear in what it is trying to achieve. Successful organisations have clear values; values which everyone who works in the organisation share. Last year, our Board took time to develop and share these values and they continue to drive our work. We recognise that for values to be more than “nice words” we need to act upon what we say. Our Organisational Development Plan (a separate document which underpins our Operational Plan, outlines in far more detail how we plan to embed these cultural values in everything we do. Organisational Values (1)Be clinically effective, quality focused and patient centred. (2)Secure value for money in everything we do. (3)Be an organisation that values its staff. (4)Not tolerate mediocrity – to have “why not”, rather than “cannot” embedded in our vernacular. (5)Be nimble, decisive, proactive and dynamic (6)Challenge bureaucratic NHS behaviour. (7)To demand of each other what is right, even if our actions and decisions impact on our popularity.

2011/12 Achievements In our 2011/12 Business Plan, we set out 6 priorities areas for the financial year. Below is a summary of the progress that we have made against each priority PriorityProgress 1.`Financial stability and Quality, Innovation, Productivity and Prevention (QIPP) We used the national QIPP framework throughout the year to help us to deliver more services within the same resources and with the use of our risk reserve, remained in financial balance. Worcestershire as a whole health economy delivered a £3m surplus which will be added to our budgets for 2012/13 and help us to deliver the required QIPP saving (see page 22) 2. Organisational DevelopmentThis has been a major area of work for us throughout the year in preparation for our application to be a statutory organisation. Key achievements have been: The size and geographical footprint of the CCG has been approved by the Strategic Health Authority In December 2011, we held elections for Board members and have implemented a new Board and supporting committees We have agreed the functions that we will discharge as a CCG and the functions that we will buy in from a support organisation We have developed an organisational structure for our CCG and completed a process of staff consultation We have developed and started to implement a development programme for Board members and other clinicians and staff in the CCG

2011/12 Achievements continued In our 2011/12 Business Plan, we set out 6 priorities areas for the financial year. Below is a summary of the progress that we have made against each priority PriorityProgress 3. EngagementEngagement with our practices: We have continued to work closely with all our practices to ensure that they are true members of the CCG. Practices receive a weekly briefing on national & local development, they attend monthly locality meetings and each practice was visited from Dec – March by a clinician and manager from the CCG Board. SWCCG has a website which includes a members section. Engagement with the community: we have developed a draft engagement strategy which we have consulted on at 2 public meetings and have begun to implement. We have 2 lay members on the CCG Board. Engagement with the Local Authority: Worcestershire has established a Health and Well Being Board which brings together the Worcestershire CCGs, Local Authority and health providers to agree overall priorities and ensure that all partners work to improve health outcomes for the community. We have fully participated in this important forum and Dr Carl Ellson has been elected as Vice Chair. 4. Working in partnership with our providersWe have established monthly Liaison Boards with Worcestershire Acute Trust and the Health and Care Trust which have enabled consultants and GPs to directly review clinical pathways. Dr Anthony Kelly is acting as Clinical Lead for the on-going Joint Strategic Review (JSR) of health services within Worcestershire.

2011/12 Achievements continued In our 2011/12 Business Plan, we set out 6 priorities areas for the financial year. Below is a summary of the progress that we have made against each priority PriorityProgress 5. Urgent CareWe are developing an overall urgent care strategy and progressed a number of elements of that strategy: GPs have worked in A&E throughout the winter to explore ways in which primary care can contribute to patients seeking urgent care 8 practices have piloted a system of GPs offering patients telephone appointments as a means of increasing capacity for patients seeking urgent appointments with their GP Risk stratification tools have been piloted by 2 practices to identify patients at risk of hospital admission Aconbury wards at Worcestershire Royal Hospital have been closed and rehabilitation services have been re-provided in the community at Timberdine together with a hospital at home service and enhanced intermediate care services 6. Community ServicesWe have developed a service specification for integrated community teams following extensive consultation with our practices. We will be working with the Health & Care Trust to implement during 2012/13. We have developed a model for enhancing care to patients in nursing and residential homes which will again be implemented during 2012/13.

Our corporate objectives We have defined these objectives for 2012/13 AreaBaselineOur aspiration for one year ahead CCG Development A newly formed organisation on a journey towards authorisation. An authorised CCG that is competent to take on full responsibility from 1 April 2013 Delivering QIPP2011/12 plan delivered with a £1.2m surplus£5.7m QIPP savings delivered for 2012/13 with clear plans and milestones already established for 2013/14 and 2014/15 Managing the health economy Scope of the review just being established, with clear SWCCG involvement approved. Clear decisions made and agreed that are in the best interest of our community. Improving access to A&E WAHT has fallen short of the 95% target for every month of 2011/12. WAHT regularly achieves the target, where non achievement is the exception. Improving stoke services WAHT consistently fell short of both key targets for time spend on a specialist bed and rapid access to services during 2011/12. WAHT regularly achieves these targets, where non achievement is the exception. Improving Primary Care All practice performance benchmarked against indicators – cross reference to quadrant for methodology and areas for improvement identified Priorities for 2012\13 will continue to focus on Access, Screening, Prevention and practice specific improvements Improving patient safety There were two “Never Events” reported up to February 2012 at WAHT No Never Events reported and other patient safety risks thoroughly investigated Health visitorsHealth visitor numbers in Worcestershire fell from 102 in June 2011 to 96 in February 2012 – when they should have been increasing. Health Visitor numbers meet the Strategic Health Authority’s approved Health Visiting Implementation Plan. Areas of highest need 6 practices in high deprivation areas showing increased mortality risks. To have made significant inroads in addressing these inequalities and to have developed a clear plan for tackling them.

2012 /13 Commissioning Priorities SWCCG is committed to working with partner organisations in order to achieve the best health outcomes for the people of Worcestershire. For 2012/13 priorities have been shaped by the constituent practices with checks back to our partners and the NHS Operating Plan to assess alignment. During 2012/13, we will develop ever closer dialogue with partners to ensure a more integrated approach and evidence based commissioning. The steps that we are taking are: Sharing and analysing the data from the Joint Strategic Needs Assessment (JSNA) through the locality groups. Building a culture that uses evidence and data to shape decision making. Business Intelligence reports will be used as a key data source. Consulting on and implementation of a public engagement plan to understand the priorities of patients. Continuing as a key player of the Health & Well Being Board with Dr Carl Ellson as vice-chair. Fully participating in the Joint Service Review of hospital and community services in Worcestershire Developing a partnership model of commissioning which demands quality services but which seeks to understand and resolve challenges faced by providers. Our partnership model in action: We are working closely with Worcestershire Health & Care Trust & with Worcestershire Local Authority to develop integrated community teams, so that district nurses, care managers, occupational therapists, physiotherapists, social workers and others all work closely together within multi-professional teams to deliver seamless care to patients, improving communication & avoiding duplication.

Our priorities in more detail Authorisation By April 2013, the government aims for all Clinical Commissioning Group to be authorised as statutory organisations and to take over full commissioning responsibilities. Primary Care Trusts and Strategic Health Authorities will be abolished on 31 st March All CCGs are required to submit an application to the National Commissioning Board to be authorised as statutory bodies. Applications will be made in 4 ‘waves’. South Worcestershire CCG, together with the other 2 Worcestershire CCGs has elected to submit an application in Wave 2 on 1 st September The application process has a number of phases: Preparation – over the spring and summer, we will be gathering evidence to demonstrate our capacity and capability to commissioning services for our local population Stakeholder survey-in July, the National Commissioning Board will send a survey to all our constituent practices and a range of other stakeholders to seek their views on the CCGs capability Application- the formal application will be submitted on 1 st September Site Visit – During October, 6 members of the National Commissioning Board will visit us to discuss our application Outcome – During November, we can expect to hear whether our application has been successful. The National Commissioning Board has the powers to authorise CCGs in full, to authorise with conditions with a development plan to be followed before full authorisation or to reject the application. For any CCG which fails to achieve authorisation by April 2013, the National Commissioning Board will manage commissioning for that population until such time as the application is successful.

Our priorities in more detail Engagement We recognise the role that engagement has in identifying the opportunity to improve services – both through proactive involvement in planning and through responding to patient and community views following their involvement with our services. We also recognise that it is important to engage with a wide range of individuals and groups, not just those that are active and easy to access. Our intentions for engagement are to: Make sure engagement is absolutely integral to how we work and to build communications and engagement into the commissioning process to ensure that all commissioned schemes have been developed considering patient and stakeholder feedback. Understand our communities and their needs and develop a culture that involves patients and the public at all levels of decision making. Develop methods of communicating with and engaging South Worcestershire residents to assist the organisation to develop a real understanding of the local population and significant ideas and opinions amongst communities. Ensure people are fully informed and that we are open and honest about what is possible and create flexible opportunities for people to be involved Establish excellent relationships with stakeholders and inside and outside of the health economy to achieve joined up engagement, messages and campaigns. Develop processes, infrastructure and capacity to deliver effective engagement Ensure that all engagement is accessible and takes into account the varying needs of different groups of the local population. Support the planning and delivery of campaigns and initiatives. Contribute to the development of an operating model for Healthwatch and raise awareness of Healthwatch among local Public Patient Participation Groups and other patient fora.

Our Engagement Plan The key aspects of our engagement plan are to provide the right opportunities for engagement. This includes: Participation in decision making from a relatively small group of those who wish to be actively involved. Informed contribution through a range of participative bodies that contribute to the wider debate Providing information of interest to the public on ideas, innovations and major decisions.

Engagement In implementing this plan to date, we have: Set up public meetings to consult on our draft plan. Commissioned a project to help us work with the people of the 6 most deprived wards in Worcester City to help us work in partnership with the community to commission services which better meet the needs of local people. This year, we will: Develop our processes to ensure that we build engagement into our routine business, including collecting and acting on patient feedback. Seek feedback on our own performance as an organisation. Establish a patient, public and stakeholder committee to advise SWCCG Board. Consult on establishing SWCCG as a ‘membership’ organization. Develop a strong partnership with LINk (Healthwatch from 2013). Jointly train commissioning professionals & our members to carry out quality monitoring visits at our provider organisations.

Local response to our draft engagement plan What we asked you… Does the Levels of Engagement Diagram (below) make sense and is it easy to understand?

What you told us… Levels of engagement

Our priorities in more detail Priorities for local service development At a development day held in October 2011,SWCCG priorities for local improvement in 2012/13 were defined as: The development and implementation of a new service model for integrated community services which maximises value, enhances the patient experiences and keeps patients at home wherever clinically appropriate. The development and implementation of enhanced support for patients in care homes drawing on the evaluation of the 2 year pilot in Malvern Hills & Pershore Locality. Enhancement to primary care mental health services which meets NICE guidance, delivers value for money and frees capacity in secondary care mental health services. Three development priorities for 2012/13: (1)A new service model for integrated community services. (2)Enhanced support for patients in care homes. (3)Enhanced primary care mental health services

Our priorities in more detail Managing our local health economy – Joint Services Review A strategic system wide approach is being taken to fundamentally review the options for securing a high quality financially sustainable providers. We are actively involved in this process and will participate fully. The review is chaired by Bryan Smith, Non-Executive Director for West Mercia, with Dr Anthony Kelly, SWCCG Board member acting as Clinical Lead. SWCCG has representatives on the 4 work streams of the review as follows: The results of the Joint Services Review will not be known until later in the year and therefore our focus in the coming year is on participating in the review to the fullest extent and we will outline our response to the major issues in next year’s operational plan. However, right now we have a clear understanding of what we want the JSR to achieve for our community and patients. Our ambitions include to achieve sustainable high quality services that are as close to, if not in, people’s own homes. This will needs to come through enhancing quality, capacity and capability in the role of primary care and community teams, investment in enabling technology, a stronger focus on preventing illness and the virtual elimination of urgent care admissions for known high risk groups. As well as delivering transformational change, this also means addressing the core weaknesses in our current system around access to services such as A&E and Stroke. These are bold ambitions, but by engaging in the process, working with our stakeholder, partners and community we are confident that we can make significant strides in this very positive direction. Emergency CareDr Nikki Burger, SWCCG Urgent Care Lead Dr Carl Ellson, SWCCG Clinical Lead Planned CareDr John O’Driscoll, Member of SWCCG Health & Care Trust Liaison Board Women & Children’s ServicesDr Anthony Kelly, SWCCG Board Chair Elderly CareDr Felix Blaine, SWCCG Board Member.

Delivering Quality, Innovation, Productivity and Prevention (QIPP) QIPP (quality, innovation, productivity and prevention) is the government’s approach to health services achieving more from the resources available to enable us to manage the growing needs of an aging population. Across Worcestershire the QIPP challenge for 2012/13 is £11.4m. The estimated share of South Worcestershire’s contribution to this total is £5.7m. Further work is being undertaken to establish the exact value but for the purposes of this plan we are aiming for the £5.7m. The following pages provide an overview of the QIPP programme along with a summary of actions around what SWCCG will do specifically to support delivery of these targets. SWCCG recognises the importance of owning and delivering the QIPP agenda, not just because of the contribution it makes to the financial health of the CCG, but also because of the opportunity it provides to significantly improve quality and genuinely transform the way in which some services are delivered.

Our priorities in more detail - Financial plan and QIPP The annual budget of £310,452,038 for South Worcestershire CCG represents the projected spending requirement for 2012/13. This sum includes an agreed transfer of £2m from Wyre Forest CCG and this enables South Worcestershire to start the year with an operational risk reserve of £2.95m, which equates to 1% of the overall CCG budget. The budget requirement is dependent on the CCG delivering the commissioner QIPP schemes of £5.7m. This is a risk that can be managed through robust project management of the QIPP programme. Service Budget £m Secondary Healthcare (including Worcestershire Acute Trust £119.5m and Worcestershire Health & Care Trust £35.7m) CCG Schemes2.2 NICE / PbR Exclusions1.7 Partnership & Non NHS Agreements7.0 Mental Health Placements3.1 Continuing Healthcare10.6 Pooled Budgets/Joint Commissioning35.7 GP Prescribing & Dispensing47.3 APMS Contracts (Walk in Centre & Out of Hours)4.1 Earmarked Reserves2.3 CCG Running Costs1.0 Operational Risk Reserve3.0 Other0.5 Total Budget Available310.5

Delivering QIPP – our urgent care projects VisionValues Strategic Objectives GoalsPrioritised Initiatives To be recognised as a model organisatio n for providing innovative & creative healthcare services for its patients To be clinically effective, quality based and patient centred To secure value for money in everything we do To be an organisation that values its staff We will not tolerate mediocrity. “why not” rather than “cannot” will be embedded in our vernacular We will be nimble, decisive, proactive and Dynamic We will challenge NHS bureaucratic behaviour We will demand of each other to do what is right even though our actions and ultimate decisions may impact upon our popularity To help patients understand urgent care services To help patients access services appropriately To ensure patients are assessed and treated promptly and the right place To only admit people to hospital when necessary To facilitate improvement of hospital systems, reduce delays & facilitate early discharge To provide care at home or as close to home as possible Managing urgent and emergency care differently at the front door To implement recommendation from the Joint Service Review To explore new models of care for acute hospital “front end” services Primary Care AccessTo improve access to primary care through introduction and roll out of Patient First initiative Long Term Conditions Management To implement integrated community teams To use the risk stratification tool to better target health resources To embed self management To implement tele-health Care High Performing providers Lead Joint Strategic Review Establish & develop liaison boards Build confidence in providers Improve quality in primary care Robust alternatives to admission Commission comprehensive community IV service Expand Hospital at Home Support for patients in Care Homes To commission a network of clinical support for patients in care homes (including those with nursing) To commission enhanced medical support for patients in care homes (including those with nursing) End of Life Care To give everyone, regardless of diagnosis, the opportunity to make a choice about their preferred place of care and death in the last year of life and enable that choice to be realised Ambulance Services To implement alternative pathways of care to reduce ambulance conveyance rate to hospital To commission medical support for ambulances Walk In CentreTo review the role of the WIC and explore options which maximise the potential of WIC in its contribution to the efficient delivery of urgent care services Out of Hours Services Support for care homes To develop closer working with A&E and community hospitals facilitating access to beds OOHs Effective & efficient use of capacity across the system NHS 111 development Develop Directory of Services with WMAS Development of capacity hub Proactive support for patients with mental illness To implement RAID model supporting patients (& carers)with Dementia, self harm and substance misuse Commission primary Care mental Health Service (IMHAT)

Delivering QIPP – our planned care projects ProjectAim Orthopaedic Triage (ICATS – integrated clinical assessment and treatment service) Continue to triage patients through orthopaedic practitioners to ensure that patients receive the correct intervention & only those requiring consultant opinion are referred to secondary care. QIPP savings target of £634,000. Out-patient follow-up appointments Work with our hospital colleagues to ensure that only patients who clinically require a follow-up are seen in out-patient clinics. QIPP savings target of £314,000. Ophthalmology Continue to work with consultant ophthamologists and local optometrists to ensure that patients receive clinically appropriate care. QIPP savings target of £40,000. Mental Health Develop a patient pathway which provides an enhanced service in primary care, reducing the number of referrals to consultant psychiatrists and create more capacity for those with serious mental health problems. QIPP savings target of £177,000.

Delivering QIPP – our primary care schemes ProjectAim Intra-venous therapy in a community setting Improve assess to IV therapies at home or in a community setting, reducing both planned and emergency admissions to hospital. Facilitate early discharge from hospital for patients requiring on-going IV therapy. Leg Ulcer Pathway Implement the leg ulcer pathway across SWCCCG which will ensure that all patients with venous ulcers have access to trained nurses and diagnostic facilities in the community Medicines Management Lower expenditure on prescribing by moving to generic, clinically safe brands. QIPP savings target of £1.1m. Integrated Community Teams Implement an integrated system of nursing, therapy & social care teams to improve communication, reduce duplication & provide proactive care which keeps more patients as well as possible in the community, thus reducing emergency admissions Clinical Support for Care Homes Develop enhanced assessments for patients in care homes to ensure they receive the same level of services as people in their own homes

Contact us The government reforms of health services which have culminated in the Health and Social Care Act (2012) aim to increase the accountability of health care organisations to their local population. We seek to be an open, transparent organisation which is accessible and listens to our local community and all our stakeholders. Read more about us on our website - where you will find a full version of our Operational Planwww.southworcsccg.nhs.uk We will be holding further public events during 2012/13 and we are in the process of building a list of members and volunteers to work closely with us. Read more about these opportunities in our Engagement Plan. We look forward to hearing from you.

Glossary A&EAccident and Emergency CCGClinical Commissioning Group CQUINCommissioning for Quality and Innovation GPGeneral Practitioner ICATSIntegrated Clinical Assessment & Treatment Service IVIntra-venous JSNAJoint Strategic Needs Assessment JSRJoint Services Review LINkLocal Involvement Network NHSNational Health Service NICENational Institute of Clinical Excellence PPIPatient and Public Involvement PRGPatient Reference Group QIPPQuality, Innovation, Productivity and Prevention RAIDRapid Access Interface Discharge SWCCGSouth Worcestershire Clinical Commissioning Group WAHTWorcestershire Acute Hospital Trust