1. NHS West Kent Clinical Commissioning Group 1 Commissioning Intentions 2014-16 Progress Report for PPG Chairs Gail Arnold November 2015

2. NHS West Kent Clinical Commissioning Group 22 A reminder: What are “Commissioning Intentions”? Commissioning Intentions are the commissioning projects and programmes of work West Kent CCG identifies each year to deliver Mapping the Future for the population of West Kent. They support improvements in patient outcomes, quality and efficiency in key areas of the health and social care system, as shown in the ‘Blueprint’ on the next slide. 2014-15 represented year 1 of Mapping the Future

3. NHS West Kent Clinical Commissioning Group 33 Our Mapping the Future Blueprint

4. NHS West Kent Clinical Commissioning Group 44 Overview of our Commissioning Intentions There are approximately 35 Commissioning Intentions supporting all domains of the Mapping the Future Blueprint They typically run across multiple years They are monitored for their delivery of i)improvements to quality ii)improvement s to patient outcomes iii)their cash-releasing contribution to the annual Quality, Innovation, Productivity and Prevention (QIPP) target Quality, patient outcomes and value for money is the ‘Triple Aim’ of the Five Year Forward View

5. NHS West Kent Clinical Commissioning Group 55 Our Key Commissioning Intentions Planned & Integrated Care Mental HealthUrgent CarePrimary Care Transforming Outpatients Crisis CareIntegrated Out of Hours (OOH) New Primary Care Circulatory (CVD)DementiaAmbulatory Care Sensitive (ACS) Conditions Children’s Community Nursing Model DiabetesPrimary Care MHPharmacy Common Ailment Scheme (CAS) Medicines Optimisation (MOS) and QIPP Respiratory (incl. Chronic Obstructive Pulmonary Disease (COPD)) Child and Adolescent Mental Health Services (CAMHS) Home Treatment Service (formerly Enhanced Rapid Response – ‘ERRs’) Looked After Children Preventing FallsImproving Access to Psychological Therapies (IAPT) GP in A&EMaternity Key schemes have the largest impact on improving health in West Kent

6. NHS West Kent Clinical Commissioning Group 66 Planned Care Transforming Outpatients – forecast 50% benefits / 50% saving Adoption of Kinesis: Elective admissions being avoided uptake still variable on GP by GP basis. Rollout of new specialities is ongoing but slower than planned CVD, Respiratory – on track (100%) Diabetes – 0% saving / benefits facing clinical challenge over suitability of discharging patients and fit with future service redesign work. Preventing Falls – 50% savings / 50% benefits forecast due to lower than planned falls avoidance

7. NHS West Kent Clinical Commissioning Group 77 Mental Health Crisis Care – 0% benefits / 0% savings planned for 15/16 has been divided into smaller schemes; Street Triage, MH in Police and Crisis Café with each suffering a delay. Work is ongoing with key stakeholders to agree affordable county-wide solutions. Dementia – good progress made in improving diagnosis rate; work still needed to achieve 67% (2/3rds) by March 2016 IAPT and Placements on track (100% outcomes forecast); out of area significantly reduced to control cost CAMHS – delays to the rollout and implementation against plan - benefits to follow in 16/17

8. NHS West Kent Clinical Commissioning Group 88 Urgent Care Scheme on track (100%) Ambulatory Emergency Care Pharmacy First Common Ailment scheme New Integrated Out of Hours (OoH) Services: Combining traditional GP OoH service, Primary Care Stream (PCS) and Home Treatment Service (HTS) Suitable referrals increasing for the (HTS) Increased activity in PCS – TWH live Nov Savings returning to plan Home Treatment Service (was ‘ERRS’) – outcomes and savings 90% Frail Elderly – benefits planned for 1617; strategy in development Take Home & Settle service provides high patient satisfaction

9. NHS West Kent Clinical Commissioning Group 99 Primary Care New Primary Care – impact in 1617 developing as part of 1617 planning, supporting move to Federations and MCPs Co-commissioning decision reached Practice support in form of coaching, clinical micro-systems development, protected learning driven forward Decision made to take Children’s commissioning in-house; fold into planning for 1617 £2.5m Prescribing control of c£65m annual Practice expenditure (MOS and QIPP) – on track

10. NHS West Kent Clinical Commissioning Group 10 How are we doing? Key schemes “Heatmap” at Month 6 2015-16 Planned & Integrated Care Mental HealthUrgent CarePrimary Care Transforming Outpatients Crisis CareIntegrated Out of Hours (OOH) New Primary Care Circulatory (CVD)DementiaAmbulatory Care Sensitive (ACS) Conditions Children’s Community Nursing Model DiabetesAdult MH Placements Pharmacy Common Ailment Scheme (CAS) Medicines Optimisation (MOS) and QIPP Respiratory (incl. Chronic Obstructive Pulmonary Disease (COPD)) Child and Adolescent Mental Health Services (CAMHS) Home Treatment Service (formerly Enhanced Rapid Response – ‘ERRs’) Looked After Children Preventing FallsImproving Access to Psychological Therapies (IAPT) Frail ElderlyMaternity Opportunities to correct performance still exist in-year

11. NHS West Kent Clinical Commissioning Group 11 Tracking progress CCG Outcomes Indicator Set (OIS) status reported each month in our ‘Integrated Performance Report’ (IPR) Granular level assurance and challenge each month at Internal PMO meeting – chaired by Ian Ayres Monthly PMO reporting cycle (see next page) Regular assurance reporting to NHS England e.g. A&E 4 hour waits Dementia Diagnosis Cancer waiting times System resilience Early Intervention in Psychosis (EIP) Visibility of all schemes on West Kent CCG Flightpath 

12. NHS West Kent Clinical Commissioning Group 12 Monthly Assurance Cycle Project Lead PMO PMO & Project Lead (can include Clinical Lead, Programme Head, Finance Support & others) Thu Fri Mon Tue Wed Thu Fri Mon Mon-Fri: Update project plans and submit to PMO by 12pm Friday Fri-Mon: Review updated project plans Mon-Weds: Fortnightly Review meetings; 30mins-1hr duration Tues-Thurs: Formal feedback to PL and Sponsors from review meetings Thurs: Create Programme Status Reports and circulate prior to Friday 9am Internal PMO Board AO, PMO, SET & Programme Heads AO update (weekly) PMO & AO Tue Wed Updating Plans Reviewing Plan Status Reporting Status Provide support to Project Leads as required 12pm Submissions Week Review Week

13. NHS West Kent Clinical Commissioning Group 13 Appendix – Kinesis performance

14. NHS West Kent Clinical Commissioning Group 14 Appendix – Kinesis performance

15. NHS West Kent Clinical Commissioning Group 15 Appendix – Kinesis performance

16. NHS West Kent Clinical Commissioning Group 16 Appendix – Kinesis performance

17. NHS West Kent Clinical Commissioning Group 17 Appendix – Kinesis performance

18. NHS West Kent Clinical Commissioning Group 18 Appendix – Kinesis performance

19. NHS West Kent Clinical Commissioning Group 19 Appendix – Kinesis performance