1. Putting Patients First Involving Voluntary Organisations in healthcare Thursday 18 th April 2013 1

2. Who’s who... Speakers: Dr Bhaskar Bora Chairman & Clinical Lead Facilitator: Julie Van Ruyckevelt Participation & Insight Communications, Engagement and Public Affairs KMCS

3. Welcome and introductions The plan for the session: Introduction to the CCG...  Who we are; what we do; how we do it Getting to know each other...  Finding out about local voluntary organisations  Checking what we would like from each other  Exploring how we can work together to make a difference to people’s experiences of care

4. Dartford, Gravesham and Swanley Clinical Commissioning Group Update Dr Bhaskar Bora

5. Setting the scene A Clinical Commissioning Group - a collection of GP member practices who have agreed to come together under one ‘umbrella’ organization – the CCG Its purpose is to collectively commission and be responsible for the delivery of healthcare to patients within a defined geographical area that is (preferably) coterminous with a local authority. DGS CCG comprises 34 practices (107 GPs) covering Dartford, Gravesham & Swanley. It serves a population of 249,000 making it the 2 nd largest CCG in Kent & 3 rd largest in Kent & Medway.

6. The CCG The CCG is run on a day to day basis by a ‘Governing Body’ made up of elected GPs & appointed leaders. In addition, we have a small team of commissioners and managers. We are also buying in, and sharing some corporate functions to be more efficient and to maximise what we spend on front line care

7. Who are we?

8. The Governing Body Board MemberPortfolio of responsibility Dr Bhaskar Bora Dr David Woodhead, Accountable Officer Chair & Clinical Lead. Also accountable for Clinical Quality, Safety, Information Systems and Medicines Management Accountable lead for the CCG – interest in non-elective care, Contracts and finance Dr Liz Lunt, Deputy Clinical AOLead for mental health & community care Patricia Davies – Deputy AO Bill Jones Operational lead for the organization Chief Financial Officer Dr Bali ChalapathyLocality lead & lead for T&O, Neurology, planned care Dr Chirag PatelLocality lead & lead for planned care & education Dr David ShortLocality Lead & Lead for safeguarding and children Mike GilbertCompany Secretary Su XavierPublic Health Consultant Geoff WheatChief Nurse Dr Mike BeckettSecondary Care Consultant (A&E at WMUH) Jacqueline ArdyLay Member – Registered Nurse Rosemary Bolton Ashley West Lay Member – Public & Patient Engagement Lay Member - Governance

9. The Team Commissioning and Support Staff: Karen Barkway, Gerry Clark, Zoe McMahon, Anne Gibbins, Chris Singleton, Bev Dennis, Kate Hamlin-Hawes, Sunday Adeniyi Jabeen Egan (lead Pharmacist) supported by the DGS medicines management team Nursing & Quality Team – Shared across North Kent Finance and Back Office Team – Shared across North Kent From our Support ‘bought in’ Services who include: Amy Igweonu, Sumona Chatterjee, Wendy Lakin

10. Authorisation to become a Statutory Body Required to submit evidence to meet 119 criteria across 6 domains: 1. Clinical Focus and Added Value 2. Engagement with patients/communities 3. Clear and Credible Plan 4. Capacity and Capability 5. Collaborative Arrangements 6. Leadership Capacity and Capability

11. What we are responsible for Commissioning of healthcare for patients in DGS (about 70% of the total budget) This includes the main categories as follows across both the independent sector and NHS providers:  Acute hospital care  Mental health & LD services (with some exclusions)  Community Care (community nursing, therapy, pharmacy)  Maternity services, children and young people  Ambulance services

12. What we are NOT responsible for There are a number of services which will be (due to their complexity, more far reaching impact beyond the local geography, or to avoid a conflict of interest) commissioned directly by the NCB. These include:  Specialist services – e.g. specialist cancer care, trauma, renal services, HIV, neurosurgical care, forensic care, prison health, etc.  Primary care – GP contracts and salaries, dental and pharmacy contracts & performance.  Health Visiting

13. The New NHS Structure

14. The Local Landscape

15. The Commissioning and Engagement Cycle JFMAMJJASOND www.institute.nhs.uk

16. Our Commissioning Priorities for 2013/2014

17. The Budget 2013-14 Forecast Budget allocation £285,000,000 Budget pressures: 80% is consumed by Acute Care Demographic growth (+1.8m) Pay and Prices + 20% Continuing (nursing) Care + 20% High Cost Drugs

18. Key Commissioning Priorities Children and Maternity Integrated Commissioning Long Term Conditions Mental Health Planned Care Urgent Care Prescribing

19. Unscheduled care and Long Term Conditions Integrated health and social care teams, single point of access for patients and clinicians, reducing duplication between health and social care, streamlining care to patients. Pathways to redirect patients to the most appropriate service - development of specific pathways of care - supporting the implementation of 111 locally. Model of care in A&E - ensure patients are reviewed and treated by the most appropriate clinical team for their needs. Increase the diagnosis of dementia and support for patients via case management of patients an integrated team, and ensure ‘dementia friendly hospitals’

20. Planned care Consultant and GP co-ordination Discharge Planning – ensuring patients are discharged with minimal delay Improved Urology pathways – timely, appropriate investigation Local Provision of Nerve Conduction Studies Paediatric Orthopaedic pathways Use of Teledermatology Service Repatriation of elective activity at King’s, Guy’s and South London for non-specialist care to local providers

21. Children’s and maternity care Extend the Community Children's Nursing Service to DGS area Increase in numbers of HVs A new multi-agency intensive support service for disabled children with severe challenging behaviour. Post abuse and sexually harmful behaviour services Invest in the Medical advisors role in relation to adoption medicals

22. Mental health services Development of talking therapies in primary care - reduce waiting times Primary care mental health workers - shared care with primary care - support to patients in recovery Payment by Results (PbR) implementation - pathway redesign - working closely with secondary care Improve outcomes and the experience of care of service users Reduction in waiting times for CAMHS

23. Medicine Optimisation Shared Care Guidelines on use of Melatonin Fentanyl Patches Review of Esomeprazole Prescribing Review Vitamin D prescribing Nice guideline implementation eg anticoagulation

24. Inequalities What we’ve achieved already Reducing CVD across all localities = real reductions in standardised mortality = reduction in admissions = increase in quality and length of life through targeted treatment, = better use of resource = wider economic benefits to the tax payer.

25. 5 year trend in hospital admissions rates for DGS

26. Mortality rates from CVD 2007-2011

27. Directly age standardised mortality rate from Cardiovascular disease trend 2007-2011

28. Directly age standardised emergency admission rates CCGs 2007-2011

29. Directly age standardised emergency admission rates cardiovascular disease DGS CCG trend 2007-2011

30. Directly age standardised mortality rate CHD, DGS trend 2007-2011

31. Challenges Target resource Delivering high quality care Local care

32. Working with voluntary organisations – the engagement landscape PPG Chairs Group How will we work together to make a difference to people’s experiences of care?