1. Welcome to our Annual General Meeting 2017/18
On screen for arrival of guests

2. Heather Moulder, Acting Chair
Welcome
Heather Moulder, Acting Chair
Thank everyone for coming
Introduce yourself and your role
2017/18 was a challenging year for BCCG but there were some real successes too and today we want to spend a little bit of time reflecting on and sharing these with you
We continued to strive to improve services for our residents while operating in a challenging environment of unprecedented demand within the system and responding to significant financial pressures
Our work with partners in general practice, hospital and community settings and in Local Authorities is helping us to manage patient flows and maintain good quality services in Bedfordshire, while identifying areas for improvement that will benefit our patients.
We know, from listening to our residents and from clinical conversations, that where it is clinically appropriate to do so, patients would rather be treated in their own home or in a community setting so this year we have focused on the development of our new Out of Hospital Strategy, which underpins our work.
Another focus for 2017/18 was the provision of new services to support children and ongoing investment in mental health services to ensure they are given as much consideration as physical health – Alan will talk in more detail about some of this important work we have been doing in these areas
NEXT SLIDE - AGENDA

3. Agenda Welcome Heather Moulder Acting Chair 2017-18:
Our year in review
Alan Streets
Interim Accountable Officer
Annual Accounts
Roger Hammond
Deputy Chief Finance Officer
Spotlight on Diabetes
Dr Sanhita Chakrabati Diabetes Clinical Lead and
Dr Shashidhar Ponnala Diabetes GP Lead
Questions
Panellists
Talk through the agenda items

4. Alan Streets, Interim Accountable Officer
2017/18: Our year in review
Alan Streets, Interim Accountable Officer
Thank everyone for coming
Introduce yourself and your role
Today I will be sharing with you some insights to BCCG from 2017/18 - a reminder of who we are, what we do, how we work and most importantly how we made a difference to people in Bedfordshire through our work with local partners to commission and deliver high quality, safe and sustainable health services in our area.

5. What do we do?
We are responsible for planning, organising and buying NHS-funded healthcare for the 440,300 people who live in Bedford Borough and Central Bedfordshire Council areas.
We’re working hard in your community to make a difference
We work with patients and partners including the local authority to make sure we provide the care that the people of Bedfordshire need and ensuring we provide the best services with the money we have allocated to us
We have a diverse population that is continuing to grow and age:
- in Bedford by more than 8,000 in the next 3 years with the fastest rise in adults 65 and over
- in Central Bedfordshire, the population is growing fast and we are expecting to see a 58% increase in people aged over 65 between 2015 and 2021
These are the factors we have to take into consideration when planning future health service provision

6. We’re accountable to you
We’re accountable to our member practices, patients and public
All our work is:
scrutinised by a number of committees
supported by our Clinical Leads
… to ensure we are delivering in the best interests of patients
Bedfordshire CCG is YOUR NHS.
We work in your interests and we are accountable to you.
We work with Lay Members, GPs and a whole host of other organisations and individuals to make sure that we’re delivering the right services for our communities.

7. Our Governing Body We met 7 times in public. Accountable Officer
Chief Finance Officer
5 GP/Practice Locality Chairs
3 lay representatives
Secondary Care Consultant
Registered Nurse
We met 7 times in public.
As Managers in the NHS, we are accountable to our Governing Body and ultimately our GP Members.
The Governing Body is made up of Lay Members from private and public sector – who bring experience from their working lives – as well as GPs, Nurses and members from Healthwatch.
Governing Body is responsible for passing decisions.
It is a totally transparent process – we met 7 times in public last year and members of the public were given the opportunity to listen to and respond to the discussions we had at the meeting.

8. Our Committees
There are a number of sub-committees, chaired by lay members, that report into the Governing Body
o   Audit
o   Remuneration Committee
o   Primary Care Commissioning
o   Integrated Commissioning and Quality Committee
o   Finance and Performance
o   Patient and Public Engagement Committee
The Governing Body isn’t the only Board we report to
There are a number of Committees that report into Governing Body – to scrutinise everything we do – from how we engage with and involve the public in our decisions to how commission our services, make sure that we’re working to the highest quality and manage our finances.
All of the committees we work with are geared towards one goal – improving the health of people in our communities.

9. All working to improve health
Cancer
Chronic Obstructive Pulmonary Disease (COPD)
Coronary Heart Disease (CHD)
Diabetes
Mental Health
Stroke
We have worked with clinicians and our local authorities to understand what the most prevalent illnesses are in our communities, some of which are also national priorities, and we’re focusing our attention on tackling these and improving the lives of the people who live with these conditions in Bedfordshire.
We used national funding to invest in our cancer programme aimed at delivering better outcomes for patients and achieved 7 of the 8 national cancer standards
You will hear more about our work on Diabetes later in the agenda but we are doing some great work here and now have over 1000 patients enrolled in ‘Healthier You - a national Diabetes Prevention programme that was rolled out to support people at high risk of developing Type 2 diabetes
In addition to physical ill health, mental health and wellbeing is a priority. Approximately 40,000 people in Bedford will experience mental ill health at some point in their lifetime and around half of them experience mental health problems by the age of 14. By promoting good mental health and intervening early, we can help prevent mental illness from developing and reduce its effects when it does.

10. Talk through some of the key highlights not already mentioned:
Following an extensive procurement process that was supported by our public and other stakeholders, we appointed East London Foundation Trust (ELFT), one of just a few Trusts that have been rated Outstanding by the Care Quality Commission (CQC), as the new provider for Community Health Services in Bedfordshire.
We know, from listening to our residents and from clinical conversations, that patients would prefer where it is clinically appropriate to do so, to be treated in their own home or in a community setting. That is why we have focused this year on developing a new Out of Hospital Strategy, which underpins our work.
2017/18 also saw the roll out of ‘Primary Care at Home’ model to improve primary care in the community and help residents take responsibility for managing their own care. With our GP Members, we are taking steps to improve access to primary and urgent care and look forward to launching new initiatives in 2018/19, which will further enhance services locally.
We have worked closely with local partners to build sustainable secondary care across BLMK and strengthen urgent and emergency care in Bedfordshire, with a
new shared provider established to deliver out-of-hours GP access in both Bedfordshire and Luton

11. Some more examples of the work we undertook in 2017/18 to improve our services to ensure the best possible outcomes for our patients
(talk through)

12. Maintaining quality and safety Financial sustainability
Four focus areas
More integrated care
Maintaining quality and safety
Out of hospital care
Financial sustainability
Better access to appointments out of hours
A centralised signposting service through NHS 111
More robust GP services
Retained and improved services for people with
mental health needs
Ensure patients are signposted to the right services
In 2017/18 we focused on these key areas to help us achieve our vision, purpose and objectives – in the boxes you can see some of the benefits these are bringing for our patients
Supports patients to remain independent and at home, reducing the need for admissions to hospital
Ensure we can continue to commission quality services for patients

13. The future Supporting primary care via ‘Primary Care Home’
Launching new initiatives to improve access to primary and urgent care, which will further enhance services locally
Joint executive leadership structure with Luton and Milton Keynes CCGs

14. Roger Hammond Deputy Chief Finance Officer
Annual Accounts
Roger Hammond
Deputy Chief Finance Officer

15. How we spent our money?
Net budget of £562.4m of which £9.9m was running costs.
We buy healthcare services according to the needs of our population

16. Where are we? (in year performance)
2014/15: £43.2m (Deficit)
2015/16: £19.9m (Deficit)
2016/17: £14.4m (Surplus)
Impressive recovery but a very difficult 2017/18.
2017/18: £3.9m (Deficit)

17. 2017/18 in a nutshell Planned £11m surplus
- Activity pressures in early months
- 2016/17 one-off benefits and year end assumptions
- National pressures (e.g. prescribing)
- NHSE imperatives (e.g. winter pressures)
- £19.5m QiPP savings
Amended target £7.2m deficit
Special Measures (Jan’18)

18. Reported Monthly Deficit

19. Performance Overview Legal Directions lifted (Summer 2017)
Revised Target achieved
Special measures (Jan ‘18)
Unqualified Audit
£19.5m QiPP savings

20. Improving outcomes for patients with Diabetes 2017-2021
Dr. Sanhita Chakrabarti
Diabetes Clinical Lead, BCCG
Dr Shashidhar Ponnala
Diabetes GP Lead, BCCG

21. Diabetes Case for Change
Rising number of people with diabetes
8.0% (29,744)
Forecast to rise to 9.2% (42,680) by 2035
High prevalence of obesity - a key contributor to the development of Type 2 diabetes
Lack of personalised care planning with patients as part of their Diabetes Annual Review
Some variation of care across practices
High rate of activity and expenditure on unplanned Diabetes admissions
High rate of amputations and admissions for people with foot care problems

22. Our transformation plan to improve care for patients with pre-Diabetes 2017-2021
Issue
Solution
A rising number of patients with pre-diabetes
NHS Diabetes Prevention Program (Healthier You)
A joint initiative from Public Health England, NHS England and Diabetes UK.
Long term intervention - 13 group sessions, spread across a minimum of 9 months.
Participants aim to make positive changes to their lifestyle to achieve 3 key goals:
Weight loss
Achievement of dietary recommendations
Achievement of physical activity recommendations
The programme commenced in May 2018.

23. Our transformation plan to improve care for patients with pre-Diabetes 2017-2021
Issue
Solution
Patients not achieving NICE recommended treatment targets (HbA1c, cholesterol and blood pressure).
Lack of access to structured education.
High number of admissions to hospital with diabetic foot disease and high number of amputations.
Diabetes Treatment & Care Programme
Personalised Care Planning for patients diagnosed with Diabetes supporting improved understanding and management of Diabetes, supported by specialist nurses.
Increasing access, availability and uptake to specialised Diabetes Structured Education.
Improved access to community foot protection team and hospital multi-disciplinary foot team
Transformation Plan supported by investment programme of £XXXX, including 2-year NHS England funding.

24. 2017/18 Achievements in Diabetes Care and Outcomes:
14% reduction in Minor Amputations
(forecast of 54% reduction for 2018/19)
44% increase in Structured Education referrals
56% increase in Structured Education places
2017/18 Achievements in Diabetes Care and Outcomes:
24% reduction in Major Amputations
(forecast of 81% reduction for 2018/19)
12,000 patients received foot checks
+3,000 Care Plans developed by Patient and GP
1,012 enrolled onto Diabetes Prevention Programme

25. Bedfordshire Diabetes Improvement Network
The Transformation Plan has been led by the The Diabetes Network ‘Team’ which includes all of the following key stakeholders:
Bedfordshire CCG
Bedford Hospital NHS Trust
Luton & Dunstable Hospital University Hospital NHS Trust
East London Foundation Trust
Bedford Borough Council
Central Bedfordshire Council
Diabetes UK
Health Watch
Patients
Together, we are confident of continued improvement for our patients as we continue to expand and improve the programme in and beyond.

26. What our patients are saying …
‘I would like to let you know about my satisfaction over the consultation and personal care plan I have received from my GP in dealing with my Diabetes.
I have had a personal care plan and support from my GP and I must say that the difference it has made is huge. This is very much different to the traditional treatment and talks I have been having over the years with different GP’s and makes me feel that my GP very much understands my personal treatment needs and it is no longer a generic discussion. This has restored my faith back in the NHS’
Bedfordshire CCG Patient

27. What our GPs are saying…..
‘The pathway is fully supported by the new gold standard comprehensive template. Its ability to meticulously complete a comprehensive annual assessment has hugely reassured both us as clinicians and our patients.
I also gladly receive the prominence which has been given to the lifestyle measures section (with embedded patient information) as this is an integral part of the management process.
Finally I would like to thank Dr Ponnala, GP clinical lead, and his team for introducing the new diabetic care planning pathway.’
Dr Roshan Jayalath, Bedfordshire GP

28. For more information about Diabetes visit: www. diabetes. org
For more information about Diabetes visit: To find out if you are at risk of Type 2 Diabetes, visit:

29. Questions