Clinical Commissioning Group

Patient Prospectus April 2013

A Clear and Credible Plan for Commissioning Health Services. i Practice Address Postcode Telephone Alton Street Surgery Alton Street, Ross-on Wye HR9 5AB 01989 563646 Belmont Medical Centre Eastholme Avenue, Belmont, HR2 7XT 01432 354366 Cantilupe Surgery (and Hampton Dene Surgery) 51 St. Owen Street, Hereford HR1 2JB 01432 268031

Colwall Surgery Stone Drive, Colwall, Worcester WR13 6QJ 01684 540323 Fownhope Medical Centre Lower Island, Orchard, Commonhill Lane, HR1 4PZ 01432 860235 Fownhope, Hereford Golden Valley Practice The Surgery, Harold HR2 0EU 01981 240320 Greyfriars Surgery 25 St. Nicholas Street, Hereford HR4 0BH 01432 265717 Herefordshire GP Access Centre Asda Building, Belmont Road, Hereford HR2 7JE 0330 1239309 King Street Surgery 22a King St, Hereford HR4 9DA 01432 272181 Kingstone Surgery Kingstone, Hereford HR2 9HN 01981 250215 Market Surgery Market Street, Ledbury HR8 2AQ 01531 632423 Moorfield House Surgery 35 Edgar Street, Hereford HR4 9JP 01432 272175 Much Birch Surgery Much Birch HR2 8HT 01981 540310 Nunwell Surgery 10 Pump Street, HR7 4BZ 01885 483412 Pendeen Surgery Kent Avenue, Ross-on-Wye HR9 5AH 01989 763535/ 763536 Quay House Medical Centre 100 Westfaling Street, Hereford HR4 0JF 01432 340320 Sarum House Surgery 3 St. Ethelbert Street, Hereford HR1 2NS 01432 265422 St Katherine’s Surgery Market Street, Ledbury HR8 2AQ 01531 633271 The Marches Surgery Westfield Walk, HR6 8HD 01568 614141 The Kington Medical Practice Eardisley Road, Kington HR5 3EA 01544 230302 Wargrave House 23 St Owen Street, Hereford HR1 2AB 01432 272285 Weobley & Staunton on Wye Medical Practice Gadbridge Road, Weobley HR4 8SN 01544 318472 Westfield Surgery The Health Centre, HR6 8HD 01568 612229/612084 Westfield Walk, Leominster

ii A Clear and Credible Plan for Commissioning Health Services. Foreword

As Chair of NHS Herefordshire Clinical Commissioning Group I am privileged to introduce you to the CCG. GPs and Clinicians are at the heart of these new organisations established under the Health and Social Care Act 2012.

Clinicians will use their close relationships with patients and partners to focus on the key health challenges in Herefordshire, use our tax payers’ money efficiently and, most importantly of all, deliver improved health outcomes for the residents of Herefordshire.

As an authorised Clinical Commissioning Group from 1 April 2013, I have taken time to reflect on how our CCG will be able to deliver these promises in these challenging and changing times. I believe that unless GPs and their patients they serve are at the heart of the commissioning process, we Dr Andy Watts cannot maintain the current rates of health improvement. Chair, NHS Herefordshire CCG.

The NHS is subject to the same financial This documents aims to share the pressure as other organisations. However, story of the health needs of the by working with skilled staff, using robust people of Herefordshire and to outcome measures, and where necessary, taking bold decisions, the people of demonstrate how Herefordshire Herefordshire should expect to gain longer, Clinical Commissioning Group healthier lives. (CCG) will deliver improved health outcomes for its population. Our aim is to work in partnership across Herefordshire to ensure we are making the best use of public funds, improving health outcomes, and also to ensure the services are designed with the engagement of patients and the public.

Finally, it is important that we ensure patients receive high quality care that is safe, reliable and consistent and makes best use of innovation in technology and systems, avoiding waste and strives to prevent disease and its impact on people’s lives.

A Clear and Credible Plan for Commissioning Health Services. 1 Who are we?

Herefordshire Clinical Commissioning Group (CCG) is responsible for the commissioning, planning, payment and performance management of healthcare services on behalf of the local Herefordshire population. The Herefordshire CCG comprises of 24 practices and walk in centre, all working to provide and commission - or buy - high quality health services, helping to reduce health inequalities for our patient population, which is currently 183,500.

We are a membership organisation, whereby GPs across the county directly elect 4 GP members to the CCGs Governing Body, the membership body meets on a quarterly basis to review, discuss and consider key commission programmes and decisions.

Our Vision Put simply, we want to create high quality health and care services that benefit everyone in Herefordshire. The kind of services that we would want available for our friends and family, if they were unwell, or needed help and support with a condition that impacted their lifestyle.

In essence we want to create a high quality, sustainable and integrated Herefordshire health economy with the public and patients at the heart of everything we do.

2 A Clear and Credible Plan for Commissioning Health Services. Our Mission

• To be accountable to Herefordshire’s patients and public, who are at the heart of everything we do. • To have strong, close links to front line clinical practice • To enable patients and public to take responsibility for themselves • To ensure equality and quality of services and outcomes • To maintain continuous and meaningful staff engagement • We aim to be a high performing CCG

• Alton Street Surgery CCG Herefordshire CCG • Belmont Medical Centre 24 GP practices, one Walk in • Cantilupe Surgery (and Centre and Out of Hours provider - Hampton Dene Surgery) Population • Colwall Surgery Primecare, population: 183,500 (2011 • Cradley Surgery census) • Fownhope Medical Centre CCG Lead Andy Watts • Golden Valley Practice • Greyfriars Surgery Health & Wellbeing Herefordshire • Herefordshire GP Access Centre Board • King Street Surgery County Council Herefordshire County Council • Kingstone Surgery • Ledbury Market Surgery Wye Valley NHS Trust, 2gether NHS • Moorfield House Surgery NHS Providers Foundation Trust • Much Birch Surgery • Nunwell Surgery Independent Providers Nuffield Health, Spire Healthcare • Pendeen Surgery Worcestershire Acute Hospitals NHS • Quay House Medical Centre Main out of county Trust, Gloucestershire Hospitals • Sarum House Surgery providers NHS Trust, University Hospitals • St Katherine’s Surgery Birmingham NHS Foundation Trust • The Marches Surgery • The Kington Medical Practice ‘Wye Valley NHS Trust (WVT) is the main provider of acute, • The Mortimer Medical Practice • Wargrave House community and social care service in Herefordshire, while 2gether • Weobley & Staunton on Wye provides our mental Health Services’ Medical Practice • Westfield Surgery Our Values The Herefordshire CCG has a strong clinical focus and record of engagement with partners which is reflected in its values, which are: • Quality First • Prevention of ill-health • Decisions driven by the views and involvement of our patients/best practice • Integration with a wide range of Partners • Openness and honesty in all that we do • Contribution of all our members and staff

A Clear and Credible Plan for Commissioning Health Services. 3 How we spend your money

As your Clinical Commissioning Group, we have a responsibility to spend your money wisely and we are responsible for approximately £218 million pounds (2013/14) of public money to commission or buy improvements in health and health services.

Herefordshire Clinical Commissioning Group and our predecessor bodies have a good track record of delivering improved use of resources and financial balance.

The pie chart opposite shows a breakdown of Herefordshire’s Commissioning Group’s planned spend for 2013-14:

Herefordshire CCG Budget:

NHS Healthcare - 69%

Non NHS Healthcare - 12%

GP Prescribing and Dispensing - 11%

Primary Care and Other Developments - 1%

Running Cost - 2%

Reserves - 5%

4 A Clear and Credible Plan for Commissioning Health Services. Our Population Challenge

• Herefordshire is a large, predominantly • People in Herefordshire enjoy a good rural county with a low population standard of health and well-being. Life density and an older age profile than expectancy is higher than the national both the region and average for both men and women, and is nationally in and Wales. higher than neighbouring counties.

• The county has a relatively elderly • Mortality rates for cancer, circulatory population, with 26 per cent of the diseases and chronic conditions remain population currently above retirement lower than in other areas, yet these age, compared to 20 per cent nationally. figures are significantly affected by different patterns of risk-taking. These • The number of people aged 65+ is are in turn influenced by social and forecast to continue to increase, but economic factors such as income and more rapidly than in recent years, and education. is expected to be 57 per cent higher in 2026. The number of people aged 85+ is • Smoking is the single most important expected to almost double, from 5,400 to cause of avoidable ill-health and 10,200 in 2026. premature death

• The number of people between 16 and • Rates of alcohol-related hospital 64 is expected to fall steadily from 2011, admissions are increasing as the post-war ‘baby-boomers’ move into retirement age. • The health and wellbeing and independence of older people is a key • Compared with 2009, there are forecast priority for Herefordshire, which will only to be 5 per cent fewer people aged 16-64 be achieved through robust multi agency in the county by 2026, which will have a partnerships including an enhanced role significant impact on those households for the third sector. where care is provided by a family member.

• The number of children and young people living in the county is decreasing, and the numbers under 16 is predicted to continue to fall until 2016.

Herefordshire England Population (2011 census) 183,477 53,012,456 Area (km2) 2,180 130,395 Population Density 84 406 (People per km2)

A Clear and Credible Plan for Commissioning Health Services. 5 Lifestyle & Health Improvement Challenge The results of the 2011 health and well-being survey of adults in Herefordshire has yielded a more in-depth understanding of patterns of smoking, alcohol consumption and lifestyle behaviour generally.

• Smoking remains the major cause of preventable death within Herefordshire. Recent evidence on smoking in Herefordshire show that just over 1 in 5 adults currently smoke (similar to national rates).

• Alcohol misuse is the third greatest overall contributor to ill health, after smoking and raised blood pressure. Over half of Herefordshire residents drink alcohol on a weekly basis including 11% who drink alcohol almost every day. 40% of all adults drink alcohol at levels above the recommended guidelines on at least one day per week including 19% who binge drink. Among Herefordshire residents there were just over 3,500 alcohol related hospital admissions in 2011/12. There are on average around 64 alcohol-related deaths per year in Herefordshire (similar to national rates) and most of them are men (65 per cent).

• In terms of other aspects of healthy lifestyles in the county, just over a third of Herefordshire adults are overweight and a further 20% obese or morbidly obese. Adult men in Herefordshire are significantly more likely to be overweight but less likely to be obese than the adult women. Around 40% of young adults (16-24 years) are overweight or obese. Almost 30% of adults in the county do not meet minimum physical activity guidelines on any day of the week and significantly more men than women meet the minimum recommended physical activity guidelines. Almost two thirds of adults in Herefordshire consume less than the recommended five portions of fruit or vegetables on per day.

Our changing population

Year Age 2012 2013 2014 2015 2016 2021 0-19 -1% -2% -3% -3% -4% -5% 20-39 -1% -1% 0% 1% 1% 5% 40-64 0% -1% -2% -2% -3% -7% 65-84 5% 8% 11% 15% 18% 30% 85+ 2% 5% 10% 14% 17% 43% All Ages 0% 1% 1% 2% 2% 5%

25% of the county’s The number of people aged The number of people aged population, 45k people, are at 85+ is expected to almost or above state retirement age 65+ will increase at a faster rate • 43% rise from 2011 to 2021 double • Compared to 20% regionally & 19% • 2011: 5,800 nationally • 2021: 8,300

6 A Clear and Credible Plan for Commissioning Health Services. What we want to achieve

Our strategy is based on a deep and comprehensive understanding of Herefordshire’s popu- lation or, in other words, you - our patients and your health needs. In particular, we will seek to tackle the health factors linked to deprivation and inequality, and continue to support other core areas such as health dementia and mental health and learning disabilities. This means that we will target our resources efficiently at those areas that will have the greatest impact on health outcomes, whilst ensuring that what we do is affordable and within our annual budget.

Therefore, our core strategy will be focus on the following 4 key strands and all our works streams will be clearly linked with clear measurable outcomes:

• Preventing ill-health and Improving Health • Improving Planned Care • Improving Urgent Care • Leading the Local Health System Our Goals Our Goals will enable the Herefordshire CCG to prioritise its work programmes and investments in a changing environment.

• Demonstrating clinical leadership and foster integrated working relations across the whole health system, including social care. • Commissioning the best available care for Herefordshire residents, going beyond existing solutions and providers. • Improving quality and safety of care with defined outcomes. • Giving stakeholders and clinicians responsibility for managing pathways and incentivising them to deliver desired outcomes. • Reducing variations in quality of primary care. • Improving Care closer to home (with a particular focus on older people and rural locations). • Improving sustainability and resilience through enhanced clinical networks and early adoption on best practice. • Putting prevention at the core of our work. • Helping to inform patient choice. • Working with our County hospital and providers to the benefit of Herefordshire.

A Clear and Credible Plan for Commissioning Health Services. 7 Working in Partnership Partnership working has been key to the success of NHS Herefordshire and will continue to be so for the CCG going forward. Across the Herefordshire economy it is important, in obtaining positive outcomes for residents that the respective organisations work closely together. That is the CCG, and its member practices, along with:

• Wye Valley Trust • 2gether Foundation Trust • Herefordshire Council • Voluntary Sector

There is a strong track record in Herefordshire of these organisations working in partnership, such as improving delayed discharges from Wye Valley and strong emergency planning arrangements.

• Health and Wellbeing Board: NHS Herefordshire and now Herefordshire CCG is now active and fully engaged member of Herefordshire’s Health and Wellbeing Board. It’s currently leading the development of one of the key strands of the Joint Health and Wellbeing Strategy which focuses on delivering a sustainable health and social care economy. The CCG also regularly engages and involves the board in the development of its plans and commissioning intentions. We are also working with the HWBB to establish a joint and co- ordinated approach to communications and engagement.

• Primary Care: The CCG is to be clinically led, with the GPs of its 24 practices at its heart. A key strategic target is the active participation of GPs in the commissioning agenda. In addition, many of the CCG’s key plans will require primary care participation and reform e.g. virtual wards, use of Map of Medicine, risk stratification and anticipatory care, and prescribing changes. The CCG have established a new Primary Care development group with representation from across the County to drive forward this work. Feeding into this work will be a locality network of practices based around 4 areas, the CCG is also developing a Primary Care development plan.

8 A Clear and Credible Plan for Commissioning Health Services. Giving Patients a Say The CCG recognises the importance of engaging the local community in shaping the service priorities and how they will be delivered. We regularly work with a wide range of partners including Healthwatch Herefordshire as well as other community and voluntary organisations such as the in addition to our commissioned service providers and we have also opened up our board meetings every quarter to the people of Herefordshire.

We have also just launched the ‘ Our NHS’ Membership scheme which will keep members updated with our latest health initiatives and enable everyone to be involved in our focus groups and consultations going forward, all helping to plan and shape Herefordshire’s local health service. You can join today by completing a registration form on our website or if you have any other enquiries please get in touch via our enquiries section on our website.

Within the Herefordshire CCG, each GP practice group has a Patient Participation Group (PPG) which links into the district-wide Patient Participation Group, creating another information flow of information with the CCG.

In addition, the CCG has an active lay member whose role is to champion patient and public engagement at Board level.

“How will this decision I make affect the next patient that comes through the door?” Dr Ian Tait Our Track Record The CCG is establishing a track record for delivery of key service improvements across Herefordshire including: • Delivering our QIPP savings for 2012/1013 • Ensuring financial balance is achieved for the CCG delegate budgets • Rolling out and engaging clinicians in the development of map of medicine pathways • Sustained delivery of medicines optimisation programme • Working closely with colleagues to ensure quality and performance is maintained across Herefordshire • Establishment of engagement mechanisms and channels with Clinicians across Herefordshire County, including the establishment of the GP Parliament. • Completion of phase one of the Urgent Care Review. • Active role on Health & Wellbeing board and lead organisation on system transformation for partnership • Working in partnership with Public Health and Herefordshire Council and NHS England. • Development of the local ‘Our NHS’ scheme to ensure Herefordshire are part of all our discussions and developments and help shape our services going forward.

A Clear and Credible Plan for Commissioning Health Services. 9 Herefordshire Clinical Commissioning Group Herefordshire Clinical Commissioning Group Brockington 35 Haford Road Hereford HR1 1SH

Tel: 01432 260618

www.herefordshireccg.nhs.uk

10 A Clear and Credible Plan for Commissioning Health Services.