1. Annual General Meeting 6 th September 2016 Medici Medical Centre, Luton

2. Introduction Dr Nina Pearson Luton GP and Chair 2

3. Agenda Introduction – Nina Pearson How are we doing? – David Foord ‘A Luton Family’ – Jeannie Szumski Care closer to Home Primary Care – Nina Pearson Mental Health Services – John Wilkins Community Services – Linda Sharkey and Geoff Lambert How much does it cost? – Alan Davies What do our people say? – Alison Ryan Sustainability and Transformation Plan – Colin Thompson and Nina Pearson Urgent Care update – Nicky Poulain Activity – Angela Duce Closing remarks – Nina Pearson

4. How are we doing? David Foord Director of Quality and Clinical Governance

5. A Luton Family Jeannie Szumski Practice Nurse and Board Member 5

6. A Luton Family George (88) Joe (45) and Hazel (42) Sam (23) Emma (18) (Mike (30) and Shabana (28) Nasreen (6)

7. Primary Care 7

8. Mental Health Services John Wilkins Managing Director and Deputy CEO Bedfordshire and Luton Mental Health & Wellbeing Services

9. Community Services Linda Sharkey Service Director Geoff Lambert Non-Executive Director

10. At Home First – Intensive Case Management 10

11. How much does it cost? Alan Davies Chief Financial Officer 11

12. Financial Summary 2015/16 12 Luton CCG £'000 (deficit)/surplus In yearCumulative 2013/14Actual-5,275 2014/15Actual-13,372-18,647 2015/16Actual-5,559-24,206 2016/17Plan3,000-21,206 AllocationActual spend Running Costs £'000 4,695 4,679 Weighted population 212,732 £ Running costs per head of population22.0721.99 Revenue deficit of £5.5m in 15/16 (in line with Plan), increasing the cumulative deficit to £24.2m Planning for a surplus of £3m in 2016/17 CCGs are required to live within their running cost allocations (per head of population) – Luton achieved this in 2015/16

13. 13

14. Revenue Allocation and Plan for 2016/17 Good uplift to Luton allocation for 2016/17, gross increase £18.4m, 7.4% – Compares to 3.4% average all CCGs, 3.0% minimum – However, Luton still remains 3.9% / £10.2m below capitation target – Includes recurrent impact of non-recurrent allocations made in 2015/16 Original Plan was to breakeven in 16/17, surplus from 17/18 Early April requirement from NHS England to improve position for 16/17 to £3m surplus QiPP target for 16/17 £7.0m (2.9%) The plan includes the provision of a 1% Transformation reserve and a 0.5% Contingency reserve, in line with NHS England business rules Planning for an increase in programmed services expenditure of 4.3%, net of QIPP savings of 2.9%. This includes a significant full-year effect investment in Mental Health services and the Better Care Fund, as well as overall demographic/non-demographic growth of c.3% and tariff increases of 1.1% This position represents a significant improvement to the underlying financial position of the CCG, which accumulated a deficit of £24.2m by the end of 2015/16 14

15. 15 How we are using the growth monies in 2016/17

16. What do our people say? Alison Ryan Interim Director of Operations

17. What our Stakeholders Say – Annual 360 o Survey Annual survey allows stakeholders to provide feedback on working relationships with CCGs Carried out in April 2016 with 44 Stakeholders invited to take part 65% response rate The Survey consisted of questions around five components of assurance which were set by NHS England; Well-Led, Performance, Finance, Planning and Delegated functions Five local questions on End of life care, Improving Access to Psychological Therapies (IAPT); improving identification of Dementia, Primary Care access and Early identification of Cancer

18. Outputs from Survey Most improvement in: – The blend of experience and skills in the CCG Leadership – Confidence that the CCG will deliver plans – Improved outcomes for patients – Suggestions from stakeholders Areas for Improvement (but still above average): – Communicating Commissioning Decisions – Involving and engaging the right people in commissioning decisions – Clinical leadership in the CCG delivering quality improvements Full details of the survey available on tables 18

19. Visioning Day – Key actions taken forward Closing the Health and Wellbeing Gap Consistent messaging and communication across the whole health and social care system Use assets innovatively for planning Take actions after decisions are made accepting ‘good enough’ Closing the Care and Quality Gap Increase collaboration Individualised personal plans Develop culture of continuous improvement Closing the Finance and Efficiency Gap Digital systems that talk to each other Pooled budgets to reduce fragmentation in the system

20. Outputs for 6 Clinical Areas 20 Cancer Provide more information on prevention Mental Health Increase integrated working Maternity Family engagement Dementia Reliable, personalised support Diabetes Understanding of needs and providing education to understand condition Respiratory Self-efficacy and resilience Further outputs from visioning day available on tables

21. Sustainability and Transformation Plan Dr Nina Pearson Luton GP and Chair Colin Thompson Accountable Officer

22. Urgent Care Update Nicky Poulain Director of Commissioning and Integration

23. 1 year on - Urgent Care Update 31,000 patients a year attend the Walk in Centre 28,000 patient contacts a year with Out of Hours 38,500 patients a year attend the Urgent GP Clinic Over 97,500 Primary Care Contacts without including in-hours GP appointments or A&E activity classified as Primary Care In-Hours Primary Care remains inconsistent across practices. (some have same day appointments including telephone triage and some still close early) How can we increase access but reduce unnecessary demand on Primary Care without increasing the demand on Urgent Care?

24. 1. Procurement of the Integrated Care Advice Service (formally known as 111 /Out Of Hours) 2. Public Consultation for the Urgent Primary Care Hubs: - Luton Town Centre (aligned to 2a) - Co-Location at Luton & Dunstable Hospital Site 2a. Public Consultation for the Town Centre GP Practice 3. Development of Clinical Assessment, Advice and Treatment Service (Professional Hubs) 4. Development and Implementation of Self-Care Strategy 5. Development and Implementation of Ambulance Pathways 6. Review of Urgent and Emergency Pathways (EG: DVT, Falls and Psychosis) 7. Development and Implementation of Primary Care Access Strategy 8. Ensuring all Urgent and Emergency services have appropriate access to patient records Key Stages achieved last year:

25. No patient should have to attend A&E as a walk in because they have been unable to secure an urgent appointment with a GP. This means having robust services from GP surgeries in hours, in conjunction with comprehensive out-of-hours services An important focus & measurable outcome

26. Luton CCG and its System Resilience Group members recognise that the patient is at the centre of everything that we do The strategy is to ensure that, as part of Step 1, the patient has the support in place to look after themselves through promotion of SELF CARE by ensuring our Communication and Engagement plan is being developed to strengthen the successful social marketing, self-care and patient education. The CCG works closely in partnership with our local Public Health colleagues to support the prevention and wellbeing agenda Step 2 of the strategy is to integrate and redesign our URGENT services The final step is to ensure our EMERGENCY services are as effective and as efficient as possible Luton Urgent & Emergency Care Services

27. Right advice or treatment first time Vision for Luton Urgent Care System The new model aims to provide seamless, simple access to Urgent Care Services for Luton patients

28. Who, How, What can we do? Emergency Care How do we ensure Emergency is the last resort? Urgent Care How do we make sure 111 has the right pathways? How do we make sure patients know where they can go for urgent care? How do we prevent patients tipping into the Urgent Care System? Primary and Community Care How can we support alternatives to GPs? How do we fully utilise the Community provision? How do we make sure patients use the right services at the right time? How do we make sure they know what services are available? Self Care How do we make sure patients can care for themselves before needing intervention? How do we all own the prevention agenda? How do we fully utilise the Third Sector and Patients?

29. National Vision for Urgent and Emergency Care

30. Implementing the Changes Angela Duce Assistant Director of Operations 30

31. Closing Remarks Dr Nina Pearson Luton GP and Chair 31