Date:
Rushbrook House Paper Mill Lane Bramford Ipswich Suffolk IP8 4DE
Tel: 01473 770000 Fax: 01473 770201 Website: www.ipswichandeastsuffolk.nhs.uk
Dear
NHS Ipswich and East Suffolk Clinical Commissioning Group Outline Commissioning Intentions 2016/17
We are pleased to enclose a copy of Ipswich and East Suffolk Clinical Commissioning Group’s (IESCCG) Outline Commissioning Intentions for 2016/17. This sets out the context within which we will be commissioning services and outlines how we wish to work with all our providers and system stakeholders. The framework of our Commissioning Intentions is to deliver even better care for the people of the east of Suffolk within a more sustainable system. These Commissioning Intentions also provide details of the key initiatives and changes that we expect to implement in 2016/17.
The Commissioning Intentions this year are provided in Annexes:
Annex A – CCG Commissioning Intentions for 2016/17; Annex B – List of scheme developments.
This document sets out the clarity and direction the CCG intends to take for 2016/17 and the services and the priorities we will be focusing on as we enter into a new contractual year. Key to our success is the strong relationships we have built with our partners and we look forward to continuing working with you in a proactive and positive manner.
2016/17 presents the Ipswich and East Suffolk health system with a series of significant challenges including maintaining and improving quality in the face of ever tighter budgets and demand pressures relating to on-going demographic changes. Our Commissioning Intentions signal the need for commissioners and providers to work together to integrate care wherever possible to improve outcomes for our population. A shared approach to development will remain key to our continued success.
Please do not hesitate to contact us should you have any further questions.
Yours sincerely
Julian Herbert Dr Mark Shenton Chief Officer Chairman
IPSWICH AND EAST SUFFOLK CLINICAL COMMISSIONING GROUP
Commissioning Intentions for 2016 – 17
September 2015
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CONTENTS
Page Ipswich and East Suffolk CCG No.
1. Introduction 4
2. Context 4
2.1 Demographics 4
2.2 Improvement ambitions/clinical priorities 5
2.3 Financial 7
3. Strategic Direction 8
3.1 Introduction 8
3.2 Integrated Care 9
3.3 Planned Care 10
3.4 Mental Health/Children and Young People 12
3.5 Medicines Management/High Cost Drugs 15
3.6 Primary Care 16
3.7 Continuing Health Care 17
4. Public/Patient Engagement 18
5. Patient Safety and Quality 18
5.1 Patient Safety 18
5.2 Quality/Patient experience 19
6. Promoting Healthy Outcomes 19
7. Market Reviews 21
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8. Commissioning and Contracting Principles in 16/17 21
8.1 Application of standard contract 21
8.2 Lead commissioning arrangements – other local/national initiatives 22
8.3 Activity and pricing 22
8.4 Performance data/information 23
8.5 Informatics strategy 24
8.6 Contractual Quality requirements 25
8.7 Commissioning of Quality and Innovation (CQUIN) 25
9. Workforce 25
10. Conclusion 25
Appendix B
1. Integrated 26
2. Planned Care 30
3. Mental Health and Children and Young People 32
4. High Cost Drugs 37
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COMMISSIONING INTENTIONS – 2016/17
1. Introduction
1. This Appendix sets out the context within which the Clinical Commissioning Group (CCG) is operating in and provides a summary of the CCG’s planned approach to meeting the challenges which arise.
2. CONTEXT
2.1 Demographics
Demography
1. The number of registered patients in general practices in Ipswich and East Suffolk CCG as at quarter 3 of financial year 2014/15 was 396982 persons of all ages (males: 197043; females: 199939).
2. As at 2014/15 quarter 3 persons aged 65 years and over formed 21.1% (83594/396982) of the population of registered patients in Ipswich and East Suffolk CCG.
3. The resident population of Ipswich and East Suffolk CCG is increasing in size and ageing. The resident population is projected to increase in size to 403200 persons of all ages in 2016 and to 444100 persons of all ages in 2036. In 2016 persons aged 65 years and over will form 22.3% of the resident population. In 2036 persons aged 65 years and over will form 30.7% of the resident population.
Deprivation
4. Ipswich and East Suffolk CCG is generally an affluent area, with pockets of relative deprivation in Ipswich and also in Felixstowe and Stowmarket.
5. The most deprived general practices in Ipswich and East Suffolk CCG are located in Ipswich: Hawthorn Drive, Burlington Road, Barrack Lane, Orchard Street (both practices).
Life expectancy and main causes of death
6. Life expectancy in Ipswich and East Suffolk CCG is relatively high. In 2010-12 life expectancy at birth in males was 80.7 years, and males could expect to live 82.1% of their life in “good health”. In 2010-12 life expectancy at birth in females was 84.0 years, and females could expect to live 80.1% of their life in “good health”.
7. In 2010-12 life expectancy at age 65 in Ipswich and East Suffolk CCG was 19.5 years in males and 21.8 years in females
8. In calendar years 2012-14 the main causes of death in Ipswich and East Suffolk CCG were neoplasms (29.1% of all deaths in 2012-14 (3231/11102)), diseases of the circulatory system (27.7% (3080/11102)) and diseases of the respiratory system (13.4% (1482/11102)).
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Morbidity and hospital activity, including mental illness
9. In 2008/09-2012/13 standardised emergency admission ratios for coronary heart disease (103.1), stroke (103.5) and myocardial infarction (137.3) in Ipswich and East Suffolk CCG were significantly raised compared to England as a whole (100).
10. Regarding health inequalities, there was no gradient in Quality Outcome Framework (QOF) crude prevalence rates for coronary heart disease in deprivation quintiles in Ipswich and East Suffolk CCG in financial year 2013/14.
11. In 2007-11 the standardised incidence ratio for colorectal cancer in Ipswich and East Suffolk CCG (107) was significantly raised compared to England as a whole (100).
12. Dementia is a main cause of ill health in Ipswich and East Suffolk CCG, mainly in the elderly. It is projected that there will be 6391 persons aged 30 years and over with dementia in Ipswich and East Suffolk CCG in 2016 and 7460 persons with dementia in 2021.
13. In 2012/13 the QOF crude prevalence of depression in persons aged 18 years and over in Ipswich and East Suffolk CCG was 6.4% (20017 persons on QOF depression registers; England: 5.8%).
Lifestyle
14. In 2013 the estimated prevalence of smoking in persons aged 18 years and over in Ipswich and East Suffolk CCG was 16.2% (estimated number of smokers in CCG: 50449; England: 18.4%).
15. In 2011-13 the alcohol-specific mortality rate in persons of all ages in Ipswich and East Suffolk CCG was 6.5 deaths per 100000 residents (75 deaths; England: 11.9).
2.2 Improvement Ambitions/Clinical Priorities
1. The Five Year Forward View sets out the direction for the NHS and shows why change is needed and what it looks like. It identifies the need to take decisive steps to break down the barriers in how care is provided between family doctors and hospitals, between physical and mental health and between health and social care. The vision includes more care delivered locally but with some services in specialist centres organised to support people with multiple health conditions and not just single diseases.
2. The Suffolk Health and Wellbeing Board has set out a vision for the people of Suffolk to live healthier, happier lives with reduced inequality of life expectancy. The Board has agreed four strategic outcomes based on information from the Joint Strategic Needs Assessment and evidence that shows action in these areas will help us to attain our strategic aims:
Every child in Suffolk has the best start in life. Suffolk residents have access to a healthy environment and take responsibility for their own health and wellbeing. Older people in Suffolk have a good quality of life. People in Suffolk have the opportunity to improve their mental health and wellbeing.
3. This vision will be delivered through the strategy which is set out in the 5 year Strategic Plan and is informed by the Health and Care Review programme which is developing plans to design and commission integrated services focusing on three key strategic areas:
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A national drive looking for integrated health and care which saves money and improves outcomes and experiences for customers. A wish to work better together locally across the system to ensure that we make best use of resources and minimise impacts of savings on customer care. To take full advantage of the potential of partnership working to prevent need and an increase in people’s independence.
4. Nationally, there is a potential funding gap of £30bn by 2020/21. The Five Year Forward View states that if we fail to match reasonable funding levels with wide-ranging and sometimes controversial system efficiencies, the result will be some combination of worse services, fewer staff, deficits, and restrictions on new treatments. The document sets out scenarios for closing this gap through a combination of demand reduction, efficiencies and funding increases.
5. Locally, major providers are projecting significant deficits for 2015/16 and 2016/17 and the CCGs have challenging on going Quality, Innovation, Productivity and Prevention (QIPP) targets to meet in order to retain financial balance.
6. The Health and Care Review has developed a model for delivery of integrated health and care in Suffolk. System partners have agreed that they wish to pursue working towards an Integrated Care Organisation (ICO) which will aim to:
Work with system partners to deliver the agreed Health and Care model. Join up acute, primary care community and social care services more effectively. Deliver efficiencies for the Health and Care system. Promote Suffolk as the location of choice for recruitment and retention.
7. A Shadow ICO Board has been set up to oversee the development of plans and a phased implementation during 2016/17. System-wide workstreams will progress the detailed planning and implementation.
8. The commissioner and providers will need to work together in close partnership to develop new payment systems, contracting methods, technology improvements and workforce plans in order to support the new model of integrated care.
9. New payment systems are likely to include a combination of activity-based, outcomes-based and capitated payment approaches which will together most benefit patients.
10. It is the commissioner’s intention to develop a capitated payment system with the ICO accountable for a wider range of population needs compared with individual provider organisations. There will be greater incentive for coordinated, integrated working across health and social care with risks identified early, earlier intervention and the right treatment arranged at the right place at the right time. The payment system will be designed to:
Promote primary, secondary and tertiary prevention
• To keep people healthy (and not requiring costly interventions) • Early diagnosis and treatment • Investment in recovery, rehabilitation and re-ablement
• Efficient allocation of resources across health (and social care)
• ICO judges the best intervention • ICO incentivised to provide care in the most appropriate and lowest cost care setting • ICO invests in care coordination • Promote investment in productivity and innovative solutions
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11. The payment system will promote the long-term, sustainable well-being of the whole person by reimbursing providers for delivering specified quality outcomes for patients rather than particular treatments or inputs. It will incentivise best practice efficient and accessible delivery of care, to make sure that NHS funding goes as far as it can for patients.
12. The payment system can help to make sure that financial risks in the NHS, caused by demand pressures or operational performance, sit with those organisations, whether commissioners or providers, that are best able to influence or absorb them in the context in which they arise. The commissioner and providers will work together to agree the risk sharing arrangements that minimise financial risks to local health systems and maximise benefits to patients from NHS funding.
2.3 Financial
1. The health system in Ipswich and East Suffolk faces significant financial challenges that require a different approach going forward if we are to build a sustainable service in the future. A considerable amount of work designed to address this is already underway across the system but it is important that we set out the financial context for 2016/17 and how we expect this to impact on contracts.
2. The CCG financial allocation has for some years, been below its ‘fair share’ target and this has placed a significant amount of tension on the system. Indicators are that we expect to see some growth in funding over the next few years taking us closer to target ‘fair share’ by 2018/19. However, only funding for 15/16 is ‘firm’ and the increase provides only a 33% improvement on distance from target 2014/15, leaving the CCG 3.4% below its ‘fair share’ target. Locally we estimate we will still be at least 2.5% away from target allocation in 2018/19.
Base 2014/15 15/16 16/17 17/18 18/19
Registered Population 395,928 399,089 402,257 405,429 408,618
£ ‘per head’ 1,017 1,065 1,074 1,085 1,097
Distance from Target % -5.10 -3.40 Not Stated Not Stated Not Stated
3. Recent work carried out by the CCG suggests that if nothing changes, the CCG would be faced with a £85m recurring deficit by 2018/19. Based on the current modelling the financial gap that needs to be closed in 2016/17 is at least £22.6m. We recognise the difficulty of this and therefore, we intend to work constructively with providers to align and combine CIP plans with QIPP initiatives as much as practicable (please refer to section 3.4 and 5.2).
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3. STRATEGIC DIRECTION
3.1 Introduction
1. Since November 2013 Ipswich and East Suffolk and West Suffolk Clinical Commissioning Groups have worked closely with partners, in particular Suffolk County Council and Healthwatch, to engage the wider Suffolk community on the future of health and social care services in west Suffolk and east Suffolk.
2. A review of the above feedback, local experience, national policy and evidence has identified a number of key themes which have been progressed in the service redesign over the last year and will guide our continued work in 2016/17:
The health and care system should empower individuals to take a more proactive role in managing their care, including the prevention of ill-health. From the individual’s perspective, the system’s response must be more integrated. Many patients have complex needs which require close operational cooperation between professionals from different backgrounds, organisations and the wider community. This includes improving the access routes into the system, such that the professionals in first contact with patients have the necessary knowledge of both the individual’s history and how to work closely with other professionals and organisations to provide the most integrated and efficient response leading to best outcomes. The emergency departments of both hospitals are under severe pressure, and the system needs to ensure that their expertise is focused on genuine emergencies with other professionals supporting urgent care cases.
3. These themes have been incorporated into the system design, and include the following features:
The major building blocks of the new system are Integrated Neighbourhood Teams. Social care, community health services and some aspects of mental health services is beginning to be organised and delivered at neighbourhood level, starting in East Ipswich (covering the postcode areas on IP3 and 4). In particular, there will an increased emphasis on the teams managing their populations in a systematic way, using risk stratification tools to identify the individuals at higher risk, and placing care plans which are joint between all relevant agencies. Some individuals will be sufficiently complex to require a case co-ordinator; the most appropriate person for this role will depend on the team’s view on which professional is most appropriate to that individual’s needs.
Communication between healthcare professionals will be improved. One component of this is reviewing our NHS 111 and Out of Hours services during 2016/17 as well as continuing to develop an Urgent Care Centre at Ipswich Hospital so that we look to create a more integrated urgent care model in line with the emerging national model.
4. 2016/17 will be about continuing to develop and implement this significant system reform and redesigning the way health and social care systems work in particular through the development of an Integrated Care Organisation (ICO) bringing together system partners in a different delivery vehicle as described in the next section.
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3.2 Integrated Care
1. Our current model of care remains overly dependent on the use of hospital services rather than self-care, early intervention and admission avoidance in the community. Whilst services work together they can often appear disjointed. Evidence shows that there is increased pressure nationally on acute services with increased numbers of admissions and readmissions to acute settings. There are often delays in people being discharged home and breaks in care services as different parties start and end provisions at transition points. Robust support is required within the community in line with Health and Social Care Integration (HaSCI), Supporting Lives Connecting Communities (SLCC) and the outcomes from the Health and Care Review, which specifically focused on two programmes of work the Health and Independence Review and Urgent Care Services.
2. The programme for 2016/17 will focus on intervening earlier, admission avoidance, joining up care better between and across organisations and supporting people who are currently being admitted to hospital. This will enable the local health and care system to improve outcomes, person satisfaction and get better value for money. Better care, with people being seen in the 'right place, at the right time, by the right person' and 'care closer to home' is the only way to maintain quality of care in the face of increasing demand and limited resources.
3. The programme is part of a series of related projects forming the Integrated Care Programme which is building on work previously undertaken to develop and integrate proactive, reactive and re-ablement services in order to ensure that at times of urgent need, when clinically correct, people are supported in the community and where possible maintained at home. The objective being to improve their health and well-being by helping to keep them as independent and active as is possible.
4. The CCG facilitates a System Urgent Care Group (SUCG) (operational) and Integrated Care Network (ICN) System Forum (strategic) which are both designed to bring together all parts of the health, social and voluntary care system relating to urgent care and develop and implement the joint programme of work.
5. The Integrated Care Workstreams priorities will focus on the following elements of a patient’s pathway:
Education and self-care utilising trigger tools to prevent the need for patients to access emergency and urgent care services with a greater emphasis on use of ‘proactive’ services. Enhanced support to ensure patients can remain in their own homes and return to their independence. Greater formal recognition of the role of family carers, the voluntary care sector and independent organisations as partners of care through the neighbourhood networks. Increased co-ordination and co-operation at the point of delivery between health, social care and voluntary sector services through the integrated neighbourhood teams. Better integration of services involved in care when a patient presents either proactively or reactively ensuring they are assessed holistically to include physical, emotional, mental and social wellbeing. Promoting all services to work together providing in and out-reach services who provide single assessments; develop shared care plans with patients/carers; develop and use a common standard framework; promote self-care and use assisted technology throughout the patients pathway whether this is proactively or reactively. When required, access to services simplified to reduce the number of entry points to the system. Improved flexibility and resilience to cope with surges in demand including consistent expansion of services to provide a service 7 days a week.
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Improving access to Urgent Primary Care through the pilot Prime Minister’s Challenge Fund hub in Ipswich and the development of an Urgent Care Centre.
6. Specifically the Integrated Care Workstream will:
Operationalise services within the development of a Health, Wellbeing and Reablement Centre in order to deliver a hub or shop-front to deliver services for urgent care and admission avoidance amongst other service. Through evaluation and redesign of Connect East Ipswich, redesign and localise further the Connect (proactive) model in particular Neighborhood Networks and Integrated Neighborhood Teams across Ipswich and East Suffolk. Block purchase Community Reablement Beds with primary step-up, step-across and step-down function during winter 2016/17 and look to develop as part of a longer term out of hospital bed strategy and commissioning plan. Provide an integrated 24/7 reactive care model and consolidation of admission avoidance services e.g. Crisis Action Team (CAT), Emergency Assessment Unit (EAU), Early Intervention Team (EIT), Frailty Assessment Base (FAB), East of England Ambulance Service (EEAST), Community Intervention Service (CIS) etc. Consolidate the Integrated Falls and Fragility Fracture Care and Prevention programme and services to form part CAT (reactive) model and Connect (proactive) model. Explore further redesign of Care Home programme and Very Sheltered Housing. Work with colleagues in Suffolk County Council to progress Integrated Recovery, Rehabilitation and Reablement services. Improve the identification and management of complex patients. Improve access to Urgent Primary Care through the pilot Prime Minister’s Challenge Fund hub in Ipswich and the development of an Urgent Care Centre. Consider what the future shape, scope and service model of urgent and community services might be after the expiry of the letting period covered by the mini-procurement and contract extensions.
7. The above priorities will be achieved through continuing to work closely with our partners, in particular with West Suffolk Clinical Commissioning Group, Suffolk County Council and our local providers plus the community and voluntary sector.
3.3 Planned Care
1. The overarching model for planned care services across the CCG is set out in figure one below:
Figure One: Planned Care Model
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2. The principles for commissioning services within the planned care programme, which have been endorsed by the Ipswich and East Suffolk System Integrated Care Network (ICN) are:
to commission where possible at a whole specialty level to commission as a whole pathway of care from prevention through to acute care to commission where possible and appropriate as an outcome based approach and not a process approach to utilise the most effective contract mechanism to achieve the outcomes we have set including exploring prime and alliance contracting and longer contract lengths e.g. 5 years to align finances across a whole pathway of care moving away from a PbR model to a programme budget of other alternative approach and offer incentives as part of this against outcomes achieved.
3. In the context of the strategic approach set out above the main programmes for the Planned Care Workstream for 2016/17 are continuing service transformation across Musculoskeletal Services (MSK) (including trauma and orthopaedics, rheumatology, pain management, spinal, and physiotherapy), Respiratory, Ophthalmology, ENT and Urology. In addition, work will continue on outpatients and elective care transformation and a refreshed focus on service transformation within Gastroenterology utilising a similar approach and principles to how we are transforming the services listed above.
4. We will continue to work through the Clinical Transformation Groups (CTGs) bringing together patients and carers, local providers, clinicians and managers to transform each speciality through developing an overarching clinical model ready for the CCG to commission.
5. The focus for Planned Care in 2016/17 across the programmes of work highlighted above will be to:
Introduce single points of access and a single platform to access all relevant disciplines for each specialty programme of work Clear clinical pathways with minimum data sets and referral thresholds in primary care Triage undertaken holistically by qualified senior clinicians with broad skill set Application of patient decision tools and self-management tools embedded in the generic pathway of the service A common IT platform across the service and ideally integrating with primary care Multidisciplinary decision making with consultant input allowing for direct listing for surgery where appropriate Address the variation in diagnostic testing and use within pathways Adopt public health preventative measures such as weight management, smoking cessation and health coaching Improve the learning loop/education with primary care on referral and skilling up primary care Interface with voluntary care sector where appropriate Promote and increase the use of self-management with patients prior to referral and follow-up. Continue to improve demand management across the system and in particular ensure an efficient and appropriate number of outpatient attendances are generated and follow up attendances are reduced through introducing viable options for ongoing support to patients non face to face.
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Shift where appropriate planned care to primary and intermediate level services as part of an overarching service model as outlined above (including but not exclusively focussed on Ophthalmology, Respiratory, Ear Nose and Throat/Audiology, Urology, Musculoskeletal and Gastroenterology.
6. In addition to the above we also will be:
• Reviewing our Diabetes Service tiered model of care as required due to contract expiration. • Working with the national e-referral team to roll-out the new functionality of this system change. • Working with our current provider to continue to optimise the cardiology community service. • Working with partners to ensure that the patient pathway for clinical management of obesity (for whom tiers 1 and 2 services) where it is clearly part of an associated pathway e.g. osteoarthritis hips and knees to ensure that all patients have the opportunity to access support. • Continuing with the Unexplained Weight Loss (UWL) pathway moving from phase 1 to phase 2 to run an UWL clinic at Ipswich Hospital. Nationally, the new National Strategy for Cancer was published recently which will work to support the aspirations, most notably to introduce the new 2 week wait guidance and symptom specific pathways. The Community Cancer Nurse Pilots will continue to March 2016, we are currently reviewing funding opportunities to continue this work. • Ensuring our Clinical Priorities Policy is understood by primary care and all providers and continuing to review our Low Priority Procedure Policies, adding additional procedures where clinically appropriate. • Reviewing our Clinical Priority, Prior Approval and IRF Procedures during 2015/16 to ensure that in 16/17 our processes continue to be robust. • Participating in the NHSE Collaborative Commissioning Oversight Group (CCOG) to support the regional specialised commissioning work programme. We will ensure that we acquire any financial gains from improved patient flows and quality of services. • Ensuring that there is a consistent, evidenced-based, cost-effective commissioning programmes for the implementation of all services and will require collaborative working with providers to identify and implement changes which provide more cost effective pathways for the local health economy.
3.4 Mental Health/Children and Young People
1. The priorities identified in the 2016/17 Commissioning Intentions will be achieved through working closely with our partners, in particular Suffolk County Council (SCC), Norfolk and Suffolk NHS Foundation Trust (NSFT), Ipswich Hospital Trust (IHT), the voluntary sector and our regional Clinical Networks including the Children, Young People and Maternity Clinical Network and the Mental Health, Dementia, Neurological Conditions, Learning Disability and Autism Network. We will where possible commission jointly with Suffolk County Council to deliver fully integrated community care pathways for adults and children.
2. Children and Young People
The focus of the Children and Young People’s Workstream will be in the following areas:
The on-going safeguarding and promoting the welfare of children and young people. Promoting early intervention and prevention approaches through education, parenting support and child development services.
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Improving joint working between health, education, early years, children’s social care, the voluntary sector and other agencies. There will be a continued focus on simplifying access points, child and adolescent mental health services (CAMHS) and looked after children. Reducing the number of children being admitted to hospital and funding those admissions appropriately. Work closely with West Suffolk CCG as the incoming lead provider of the new community services contract and Suffolk County Council (SCC) to determine the preferred model of care over the lifetime of this contract and beyond. This will include reviewing and redesigning specialist community paediatric medical, nursing and therapy services and improved integration of those with the wider health, social care and education system including end of life care for children and young people. Mobilisation of the recently procured emotional health and wellbeing services including the primary mental health workers.
3. Maternity
Assess and form a local response to the forthcoming NHS England led review of our local Maternity service offer, including perinatal and postnatal pathways. Build upon the recent Perinatal Mental Health pilot in 2015/16 embedding the outcomes from the 2014 NHSE sponsored Sustain project focussing on perinatal service pathways and respond to the expected national commissioning guidance and earmarked investment (late 15/16) for perinatal care. Development of personal health budgets in accordance with national guidelines.
4. Mental Health
The CCG will continue to implement the 2015 Integrated Mental Health Strategy working towards greater integration of specialist mental health services with the wider health and social care system as below. We will continue to work closely with NSFT to review the existing Access and Assessment/IDT operational model and make changes where necessary. We will support the national focus on new mental health access and waiting time standards being introduced from April 2016. We have set out the topics of our 2016/17 Mental Health commissioning intentions under the three broad themes of our joint CCG/SCC Adult Mental Health Commissioning Strategy, which is due for completion in autumn 2015, namely Early Intervention and Prevention, Recovery and Rehabilitation and Crisis (incorporating the MH Crisis Concordat).
5. Early Intervention and Prevention
Promotion of early intervention and prevention through development and training of Primary Care mental health services. Primary Mental Health Service (previously Suffolk Wellbeing Service) - ensure the robust and successful implementation of the newly procured service from July 2016, including the extended scope to incorporate the commissioning of Primary Mental Health Workers (PMHWs) with SCC.
6. Recovery and Rehabilitation
Mental Health Rehabilitation Pathways - consider and scope the range of services supporting patient’s recovery and rehabilitation through a joint review with SCC and NSFT. Supported Housing - we will support the shared procurement of the Early Supported Housing contracts with SCC. 13
7. Crisis
24/7 Crisis Response (including delivery of the Suffolk multi-agency Mental Health Concordat) - for adults and children, including review and audit of the current pathway for people with personality disorders (Night Owls Service) and respite beds; more than 50% of people experiencing a first episode of psychosis will be treated with a NICE (National Institute for Health and Care Excellence)-approved care package within two weeks of referral. Police Triage Service - we will implement and mobilise a service that will provide on the spot advice to police officers who are dealing with people with possible mental health problems, leading to people receiving appropriate care more quickly, resulting in better outcomes and a reduction in the use of section 136 and attendance at A&E. Suicide Strategy - we will support the development of the strategy and implementation of recommendations in partnership with Suffolk County Council and Suffolk Constabulary.
In addition, there will continue to be a focus around children and adolescent mental health services (CAMHS), autism, dementia and marginalised vulnerable adults (MVA) as set out below.
8. CAMHS
The Suffolk Children’s Emotional Health and Wellbeing Strategy will be refreshed in 2015/16. We will continue to focus as a county-wide system working in partnership to implement the priorities identified in the strategy, and as set out in our Transformation Plan requested by NHS England (to be completed in Autumn 2015). The key areas of focus will be:
Single Point of Access - scoping of a single multi-agency point of access for all children’s emotional health and wellbeing referrals. Children’s Eating Disorders - working with NSFT to develop our existing East and West Suffolk Children’s Eating Disorder services to ensure the requirements of the August 2015 national commissioning guidance are met (including access and waiting time standards to be implemented from 2017/18). Crisis Care - to consider our commissioned response to children in crisis and full link up to the Suffolk Crisis Care Concordat for example in work already started in relation to the Innovations Pilot. Improving Access to Psychological Therapies (IAPT) - roll out the Children and Young People’s IAPT programme to ensure that CAMHS commissioned services deliver a choice of evidence-based interventions by 2018. Central monies will also support increased access to training via CYP IAPT for children under five years and for staff working with Autism and Learning Disabilities. Perinatal Mental Health - see comment under Maternity Services. Tier 4 CAMHS Services - we will support the commissioning of Tier 4 services as required, the responsibility of which is likely to return to CCGs in the future. We will support on-going exploration of opportunities for better integrate local Tier 3 and Tier 4 CAMHS provision.
9. Autism
We will ensure that people of all ages have access to earlier assessment and diagnosis for Autism and ASD and are supported to access the services that they need. We will re-model the service in response to the JSNA refresh / evaluation and work jointly with SCC to implement the national Austism Strategy “Fulfilling and rewarding lives: the strategy for adults with autism in England,” the subsequent updates and the statutory guidance.
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10. Dementia
We will continue to support and promote early diagnosis of dementia and ensure those diagnosed are appropriately recorded on GP registers. Post Diagnostic Services Model - extension of existing contracts to March 2017 for post diagnostic services to align with SCC contracts. We will work through the Mental Health and Learning Disabilities Joint Commissioning Group with SCC to either align or jointly commission alternative arrangements, from the point of early diagnosis through to advance care planning and end of life care. Dementia Friendly Initiatives - we will work with our 25 practices to promote the establishment of dementia-friendly health and care environments. Our dedicated Care Homes Clinical Support Manager will work with care homes in order to support and facilitate these initiatives. Could we be explicit about joint work with SCC and other partners on all these pieces of work.
11. MVA
This service is currently provided by North Essex Partnership NHS Foundation Trust and is due to cease at the end of January 2017. The service provides support for vulnerable groups and communities, including the homeless, ex-offenders and migrant workers. The service will be reviewed with the support of a new county-wide needs assessment, currently being undertaken with Public Health, and re-commissioned accordingly. Finally we will continue to develop personal health budgets in accordance with national guidelines; review the pooled fund agreement as it comes to an end in 2016; and continue the development of mental health payment mechanisms including the definition of care packages with Norfolk and Suffolk Foundation Trust and partnering commissioners and mental health coding.
12. Learning Difficulties
Our priorities for 2016/17 for LD are:
Continuing to focus on improving the care and management of people with Learning Disabilities in primary care and the uptake of health checks. Further embedding NSFT’s new Learning Disabilities service model for adults and children and consider the impact on other providers to ensure care pathways are joined up across organisational boundaries. Continue to reduce the number of our of area placements where appropriate ensuring the Winterbourne Review is fully implemented in line with recommendations made in the pending national service model for people with a learning disability and/or autism. Taking every opportunity to improve awareness of Learning Disabilities. Work jointly with SCC and the Learning Disability Partnership to implement the Joint Learning Disability Strategy recognising links with SLCC and with connect sites development including NNs and INTs.
3.5 Medicines Management/High Cost Drugs
Medicines Management
1. The focus of the Medicines Management workstream for 16/17 will be;
Continue to improve the safety, quality and consistency of prescribing for our patients Improve medicines optimisation in primary care by developing one service for practices incorporating areas such as; polypharmacy, self-care, reducing waste, formulary adherence and staying within budget. 15
The new oral anticoagulant service for primary care will be decommissioned. Continue to work with all providers to improve formulary adherence. Work with providers to address the increasing demand and abuse of pregabalin. Align the work being done in primary care to encourage patients to self care for minor ailments with secondary care. Work with providers to reduce wastage of medicines. Work with providers to tackle inappropriate polypharmacy and promote rational deprescribing. Review current prescribing of medication for diabetes from primary and secondary care to identify any efficiencies that can be made
2. Deep Vein Thrombosis (DVT) Local Enhanced Service (LES)
Explore the inclusion of rivaroxaban into the DVT LES
3.6 Primary Care
The CCG will work with NHS England as joint commissioners of primary care to ensure primary care contracting is seamless. These draft commissioning intentions will be circulated for comment to local practices prior to their publication. These commissioning intentions have been informed through the CCG clinical strategy, the primary care strategy and national policy requirements. In 2016/17 there will be a focus on the following areas:
1. Explore the potential for full delegation of primary care commissioning (model 3)
2. Work with local practices to develop proposals how the requirement for 7 day working will be achieved (in line with nationally negotiated changes in GP contracts)
3. Develop, specify and commission the primary care aspects of the frailty pathway
4. Explore with member practices the potential to;
Aggregate existing and any further potentials local enhanced services (LES) into one agreement to streamline reporting and other requirements with an increased emphasis on outcomes and value for money Take a similar approach with LES commissioned by Public Health Aggregate overlapping LES and directed enhanced services (DES) for example the multi-disciplinary team (MDT) LES, the Admission Avoidance DES and the Nursing Homes LES whilst placing increase emphasis on the care of frail patients.
5. Review with NHS England and member practices opportunities to revise both QOF and national DES’s to reflect local needs and ambitions and in particular to reduce overlap with local schemes.
6. Ensuring that all patients are able to access the full range of services from primary care for example the LD health check DES.
7. Work with NHS England and local practices to enable the commissioning and planning of new buildings that enable the achievement of the CCG’s strategies, for example by the use of criteria such as enabling working at greater scale, supporting joint working between practices, joint working with other agencies, including co-location of services and integrated neighbourhood teams
8. Review and refresh the current Personal Medical Service (PMS) development framework to align with CCG clinical and service priorities and building upon the experience of 2015/16 16
9. To explore with member practices, Suffolk GP Federation and the Local Medical Committee (LMC) how the CCG can commission some services in such a way as to encourage working at a scale larger than a single general practice.
10. Working with local practices explore how services can be commissioned that support activity that reduces inappropriate variation in service use.
11. Working with local practices and the Suffolk GP Federation explore how further services can be provided in a more local setting (as opposed to a hospital setting) where this is safe and cost effective.
12. Review with local practices and other potential providers how additional support might be provided to Learning Disability (LD) care homes to improve care and help avoid admissions to hospital.
3.7 Continuing Health Care
In 2016/17 the Continuing Healthcare Team (CHC) will continue the transformation programme commenced in June 2015. It will deliver by the 31st March 2017:
Improved patient and carer experience National framework compliant practice – consistently delivered Standardised, lean, processes (internal to the CCG and system-wide) Sustainable, motivated and skilled workforce (internal to the CCG and system-wide) Assured value from commissioned care packages
These goals will be delivered through improvement to:
the CCG’s CHC provider services (direct patient service provision) the CCG’s commissioned CHC services (from NHS trusts, care package providers; care package brokers and Commissioning Support Units) the CCG’s CHC commissioning function (including joint working with Suffolk County Council)
Improvement projects initiated in 2015 will be completed to deliver sustainable business change and the realisation of anticipated benefits. These projects include:
1. CCG’s CHC provider services
a. Process redesign, development of standard operating procedures (SOPs) and delivery of business change for: • Fast Track Applications • CHC Screening Process • CHC Full Consideration Process • CHC Eligibility Decision-Making • CHC Commissioning a care package process (including Personal Health Budget (PHB) process) • CHC Review Process • Funded Nursing Care (FNC) Eligibility Decision-Making • FNC Review Process • Local dispute resolution process
b. Backlog clearance project delivery for: • >28 day backlog for full consideration • CHC 3 mth and annual review backlog • FNC 3 mth and annual review backlog
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2. CCG’s commissioned CHC services
a. Stakeholder agreements (in particular from NHS trusts and Suffolk County Council), to the system-wide CHC standard operating procedures and their contribution/role in delivering them. b. Contracts with NHS providers of CHC Fast Track, screening and full considerations which include the delivery of the SOPs and process and outcome Key Performance Indicators (KPI’s). In particular with the community healthcare provider. c. The nursing home procurement project. d. Contracted brokerage services for PHB facilitation, as required. e. Outsourced Previously Unassessed Periods of Care (PUPoC) cohort 1 clearance (by North East London Commissioning Support Unit)
3. CCG’s CHC commissioning function
a. Value review of care package costs. b. Contracts in place for all care package provision c. A commissioning strategy for future CHC services (including alignment with emergent delivery models for the assessment and case management of people in the community with long term complex care needs) d. An implemented new operating model for a sustainable CCG CHC service (processes, organisation, technology and accommodation, information)
4. PUBLIC/PATIENT ENGAGEMENT
1. Ipswich and East Suffolk CCG is committed to involving the public and patients throughout the commissioning cycle; in developing our plans, setting our priorities, service re-design and in monitoring the quality of our services through feedback. The CCG will work with patients, the public and providers to close any gaps between the expectation of quality and perception of quality of service received. The CCG is also focused on targeting health inequalities and improving the health of those most in need. The CCG will further strengthen its relationships with the voluntary and community sector to further increase community resilience so that the people of Suffolk can live in communities where they are cared for and their non-clinical needs are met.
2. For 2017/18 we will work further with CCG colleagues to ensure that all patient and public involvement and engagement will be central to all their future commissioning intentions.
5. PATIENT SAFETY and QUALITY
5.1 Patient Safety
The CCG commits to work as part of the local Patient Safety Collaborative which is being established as a further response to the report, “A Promise to Learn – a commitment to act”, which made a series of recommendations to improve patient safety; and called for the NHS ‘’to become, more than ever before, a system devoted to continual learning and improvement of patient care, top to bottom and end to end.’’ The CCG further endorses the aim of the ‘Sign up to Safety’ campaign to make the NHS the safest healthcare system in the world by creating a system devoted to continuous learning and improvement, where provider quality reporting is explicit.
The CCG will work with local Maternity services to ensure the recommendations of the Report of the Morecambe Bay Investigation and National Midwifery Review are considered and where appropriate implemented in local maternity services.
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The CCG will work with regulators and providers to ensure relevant and appropriate recommendations as a result of the Savile Report are implemented.
The CCG has a statutory obligation to ensure that staff and arrangements are in place to meet the Adult Safeguarding and the Special Educational Needs and Disabilities (SEND) Reforms, and in 2015/16 the CCG received external non-recurrent funding from NHSE for this purpose.
In order to ensure continued funding for the SEND reforms in 2016/17, the CCG will restructure its funding commitment to the Multi Agency Safeguarding Hub (MASH) to meet our statutory obligations to fund the Designate Safeguarding Professionals (CYP) Adult Safeguarding professionals (Adult) and SEND (CYP) Clinical Officer. The MASH service is currently funded solely by the three CCGs locally (West Suffolk Clinical Commissioning Group, Ipswich and East Clinical Commissioning Group, Great Yarmouth and Waveney Clinical Commissioning Group), and accordingly, with effect from 1 April 2016, will require funding from all members of the Safeguarding Board – namely the three CCGs, IHT, WSFT, NSFT, Suffolk Community Healthcare (SCH). This will bring the funding of the Board in line with the approach in other localities.
5.2 Quality/Patient Experience
Valuing mental health equally with physical health is a theme of NHS England’s Call to Action. Achieving ‘parity of esteem’ will require a fundamental change in the way services are commissioned. Consideration will need to be given to equitable distribution of resources and supporting the commissioning of services which tackle the association between physical and mental disorders. The CCG is working on the key priorities of services for Improving Access to Psychological Therapies (IAPT), dementia, response to serious case reviews and the application of the mental capacity act to address parity of esteem objectives.
The CCG is committed to improving support for people with care needs and their carers and will continue to deliver the national objectives set out by NHS England ‘Better Care for Carers’
6. PROMOTING HEALTHY OUTCOMES
The CCG works closely with its partners in Suffolk County Councils Public Health Department. The following is an update on Public Health’s Commissioning Intentions which the CCG will review in the period leading up to 2016/17.
1. Embedding Making Every Contact Count within contracts and service provision;
2. Develop a workplace health programme within their own organisation;
3. Support the proposal that some of Public Health (PH) grant should be used to create a wider PH network to support primary prevention and decrease health inequalities within local authorities, with an agreed Memorandum of Understanding (MOU) to ensure the terms of the ring fenced grant are met;
4. Consider the co-commissioning of some lifestyle services as part of the Healthy Lifestyle Service procurement;
5. Agree to the development of an evidence based prevention strategy for Suffolk with robust partnership contribution and strong system wide governance arrangements.
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6. Due to increases in demand for health and social care services in Suffolk and an environment with limited resources there needs to be an escalation of Prevention so that all partners play a role. System Leaders Partnership in 2014 agreed to; support MECC by embedding the approach into contracts and service provision; developing a workplace health and wellbeing programme within each of the leaders organisations; a Public Health allocation to District and Borough Councils to support primary prevention and decrease health inequalities; the development of an evidence based Prevention Strategy for Suffolk.
7. The aim of Prevention in the system is to improve population health by to limiting the onset, or reduce complications of conditions such as diabetes, cardiovascular disease, other long term conditions and some cancers which are associated with lifestyle. It aims to provide an evidence based approach to deliver health improvement and reduce health inequalities by decreasing the gap in life expectancy and adding life to years.
8. A Suffolk Prevention Strategy will be informed by the 2015 Annual Public Health report and will go to the Health and Wellbeing Board for ratification in January 2016.
All staff who have face to face contact with patients complete Making Every Contact Count training (45 min e-learning – 3 x 15 min modules – and a 1 hour workshop) Improve referral pathways to LiveWell Suffolk for patients who require support for; Tobacco use harm reduction and smoking cessation; adult weight management for obese patients; child weight management for children who are overweight or obese Develop a workplace health and wellbeing programme for staff and volunteers Emphasize self-care to all patients using CCG commissioned services Ensure Secondary Prevention is systematic by working with general practices to increase referral rates to Diabetes Education and Self Management for Ongoing and Newly Diagnosed (DESMOND) and elective surgery rehabilitation services Implement all recommendations set out in NICE guidance about Vitamin D in at risk groups. In particular ensure all bounty packs given to pregnant women via antenatal clinics contain a Healthy Start registration form and a leaflet about local suppliers of Healthy Start vitamins Ensure smoking at time of delivery data is recorded accurately at antenatal visits. Any pregnant smoker identified either by a CO reading or by self-report must be referred to LiveWell Suffolk for stop smoking support - CO monitoring for mothers attending for first visit and referral to stop smoking services is recommended by NICE guidance PH26. Ensure that maternity services accurately record smoking at time of delivery information by asking the mother at birth and not recording from previous notes at booking. Improve the number of Women whose smoking status at time of delivery was not known to no more than 3% as per England average currently 25%.
References and Links
Vitamin D: increasing supplement use among at risk groups:
http://www.nice.org.uk/guidance/ph56/chapter/1-recommendations
Link to MECC e-learning:
http://www.suffolkcpd.co.uk/
Registration along with the first part of the training can be located by searching for ‘MECC’ or by looking under event code M15001 for part one.
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7. MARKET REVIEWS
1. A number of procurements have been undertaken by the Ipswich and East Clinical Commissioning Group during 2015/16 and there continues to be a flow of tenders to be released.
2. Services for procurement include
Service Likely tender start* Service Implementation Date*
Primary Care Mental Health Summer 2015 July 2016
Care Homes – joint procurement with Autumn 2015 Spring 2016 Suffolk County Council
Marginalised and Vulnerable Adults Spring 2016 Early 2017
*These dates are subject to Governing Body approval
3. There are further services with market review planned and/or specifications in development, these include:
Respiratory services Ophthalmology Gastroenterology 24 ECG MSK Frailty Ear Nose and Throat (ENT) Urology Dementia Community Services Community Reablement beds
8. COMMISSIONING AND CONTRACTING PRINCIPLES IN 16/17
8.1 Application of Standard Contract
1. The CCG will commission all healthcare services, via the Standard NHS Contract and as such all Providers will be expected to comply with its standard nationally mandated terms. Where these commissioning intentions result in any significant changes to the terms of our contracts, we will apply reasonable notice periods to providers in line with contractual requirements
2. The CCG has in the region of 200 health service contracts spanning the NHS and independent/private sector and each of these contracts has an expiry date. The terms of the NHS constitution and the requirement to comply with procurement law means that all expired contracts should be scrutinised by the CCG in order to determine whether contracts are to be decommissioned, tendered or extended. In 2016/17 a number of key contracts will require renewal. Many of the contracts are Suffolk wide, commissioned with West Suffolk CCG. Should the CCGs decide on different directions of travel there will need to be a mutually agreeable solution on whether there will be a divergence and contracts split. 21
8.2 Lead Commissioning Arrangement other Local/National Initiatives
1. The CCG anticipates working closely with West Suffolk CCG in particular to ensure a coherent approach to commissioning is maintained. Ipswich and East Suffolk CCG intends to continue with the lead commissioning arrangements agreed in 2015/16. As with current multilateral contracts there may be variations to the schedules within those contracts to reflect the differing priorities of each group and a separation of the budget elements to each CCG.
2. In most cases the CCG will seek to enter into associate agreements with other CCGs outside of Suffolk where other CCGs geographically host the service in question.
3. The CCG is a member of the Suffolk Commissioner’s Group. This forum works collectively to deliver a joined up approach to commissioning Suffolk services for delivery of elements of the joint Health and Wellbeing Strategy and other areas of agreed joint working as appropriate. The Group will work in 2016/17 to agree plans to deliver the joint strategic aims where cross organisational commissioning is required and to deliver system leadership in the optimum use of resources to deliver the best overall outcomes for Suffolk residents.
4. This approach allows strategic alignment with Suffolk County Council (SCC) in particular the Section 256 for re-ablement.
5. The CCG is also a member of the Suffolk Leaders Partnership (SLP) which exists to provide system leadership for delivery of elements of the joint Health and Wellbeing Strategy. The SLP will be a key system enabler to drive the delivery of programmes for 2016/17.
8.3 Activity and Pricing
1. Where appropriate, require providers be compliant with 2016/17 National Tariff guidance and national data definitions. However, the CCG will look to move to alternative payment options where appropriate and permitted. In particular, though not limited to, urgent and emergency care and specific elective specialties where one provider holds the vast majority of market share.
2. Review day case procedures expected to be undertaken as outpatient procedures and specify commissioning levels.
3. Require compliance with national guidance over recording of day cases versus outpatient procedures and recording of short stay non elective admissions versus outpatient or appropriate ambulatory care tariff.
4. Develop pathways for outpatient services to achieve maximum efficiency and quality of care, e.g. one-stop clinics, multidisciplinary clinic, parallel clinics and triage to most appropriate clinics
5. Review maternity pathways to ensure compliance with Payment by Results rules and no duplication of payments especially correct recording of transfers.
6. Identify potential services eligible for Best Practice tariffs and agree plans/timetable for introduction (must have adequate supporting information)
7. Review of tariffs for urgent and emergency care which may require local tariffs to be developed and agreed (including, but not limited to, short stay emergency paediatric admissions)
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8. Agree a local tariff for non-elective 0 Los based on how long the patient stayed linked to what was done to the patient e.g. diagnostic tests plus Outpatient vs. admission tariff.
9. Undertake a specific review of, and alternative recording and payment mechanism for, Paediatric non elective admissions with a length of stay of less than 6 hours.
10. Review of all local tariffs
11. The CCG would like to review all specialist nurse led clinics with a view to agreeing a local price, a block contract or moving these into community settings.
12. The CCG will carry out a review of all low priority procedures currently done with a particular focus on compliance with the CCG’s policies. We require all providers to fully comply with the CCG’s Low Priority Procedures policies and where the review demonstrates a repeated lack of compliance the CCG will consider decommissioning procedures from the non-compliant provider(s).
13. In line with Clinical Transformation Group (CTG) work in MSK, Ophthalmology, Urology, Frailty, ENT and Respiratory, the Commissioner reserves right to move to procurement for all or part of these services during the course of 16/17
14. The CCG wishes to decommission all A&E outpatient clinics.
15. All coding and counting changes must be notified in writing to the Commissioner by 30th September 2015 in detail specifying Point of Delivery, and Healthcare Resource Group if applicable, activity numbers and reason for change. The Commissioner shall not implement or agree changes without this level of detail.
16. As part of work on Integrated Care Organisation (ICO) the CCG will look at a number of alternative payment systems.
17. As part of a CTG and system wide health and care review, the CCG will look to implement an urgent care centre in 2016/17.
18. The CCG will implement a referrals management process for non-GP referred activity. Any outpatient activity carried out by the Trust will not be paid for if this doesn’t originate from a central referral management system or GP.
19. The CCG reserve the right to decommission or re-commission all services currently commissioned.
20. Reduction of follow-ups – the CCG hope to agree a set of principles with our major providers to ensure more patients are able to self-manage their long term conditions.
The CCG wishes to formalise referrals from A&E to GP out of hours services.
8.4 Performance Data/Information
1. For all contracts the CCG intends the following:
Providers will be required to submit all information within formats agreed with the CCG. In order to improve standardisation of information between providers the CCG may review, change and agree with provider new formats to easier understand activity and performance.
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Continued on-going compliance with the reporting requirements of UNIFY 2, SSNAP, Open Exeter, SUS, and any other national or locally mandated datasets, which includes compliance with the required format, schedules for delivery of data and definitions as set out in the Health and Social Care Information centre (HSCIC) Guidance and All Information Standards Notices (ISNs), where applicable to the service being provided; Where the provider is part of a multi provider pathway then the provider will be expected to proactively participate in the development of integrated information flows that are consistent, complete and timely and compliant with all required data items; Any accountable provider who sub contracts out to other providers should provide evidence and assurance to the CCG that their contracts and schedules with the sub contracted provider are consistent with their contract with the CCG, so that all providers can be held accountable on the same basis; Continues proactive participation in the provision of daily information to support the system wide urgent care dashboard; Submission of any patient confidential data to the DSCRO (Data Service for Commissioners Regional Offices) timetable. Providers transact their information flows in compliance with all requirements in accordance with Information Governance as set out by Information Commissioner’s Office. To work with provider reporting on eReferral service as that functionality becomes available In addition for any new community contract the CCG requires the following: Completion, as a minimum, of the Community Information Dataset and on-going development to ensure that the provider is able to submit the Community Information Dataset to SUS and as an interim measure will be able to submit it locally to the CCG through the DSCRO; Where statutory reporting is required to UNIFY2, eReferral service, Omnibus, Open Exeter and other statutory reporting for a then the provider should ensure that they are N3 compliant; Compliance with ISN 0149 where completion of NHS Numbers is a mandatory requirement.
8.5 Informatics Strategy
1. Healthcare is delivered more efficiently and seamlessly for patients when shared electronic health records, infrastructure and information are deployed widely across care settings, and this is the best way to provide integrated care, particularly for the most complex or vulnerable patients. We will support this whole systems approach by leading the Suffolk Informatics Partnership, which, in the interests of patient care and effective, efficient integrated working, commits to: Promoting and advancing integration and interoperable record sharing capability – the Suffolk Shared Care Record; Ensuring informed patient consent and information governance is central to this programme and overcoming obstacles that prevent progress; Developing a network of integrated and accessible public services infrastructure Developing a pan-system strategy for ‘Improving Population Health and Wellbeing by the use of Information, Intelligence and Innovation’ – IPHWi
2. In particular we will be working with all providers to progress the Suffolk roadmap against the National Information Board ‘Personalised Health and Care 2020’.
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3. To show our commitment to information sharing for improved healthcare we will move our continuing Health Care team to SystmOne, and will evaluate how this opportunity connects and supports the wider health and care system.
4. Underpinning our Informatics Strategy is the need for fit for purpose IT Service Management. We intend to progress our redesigned IT services by focus on high quality service provision, innovative utilisation of technologies, and best value for the public purse.
8.6 Contractual Quality Requirements
1. We will aim to use a consistent and proportionate approach to local quality requirements for all our providers as far as possible, but acknowledge that some variation may be necessary to reflect individual circumstances. These will be discussed and agreed as part of the usual contract negotiation process with changes introduced to reflect any key focus areas or new performance/quality issues that have come to light during 2015/16, as appropriate.
2. Where performance against quality requirements has been managed via a remedial action plan (RAP) during 2015/16 and this plan has not been completed (e.g. milestones run on into 2016/17) we expect all conditions of the RAP (including any contractual penalties) to be carried over into the 2016/17 contract.
8.7 CQUIN
1. It is likely that CQUIN will be applicable in 2016/17. The CCG intends to continue with its preference for a small number of large local schemes that promote quality and health economy sustainability with measurable outcomes that rewards will be based on.
2. Providers are encouraged to begin to consider ideas that meet this brief for discussion as part of the annual contract negotiation.
9. WORKFORCE
1. The workforce will need to be highly flexible to respond to changes in how healthcare is delivered in Suffolk. As services across health and social care become integrated and delivered in a more flexible way in the community, providers and commissioners need to work together and, as appropriate towards easing the transfer of staff between different employers and ensure they can minimise cost and maximise efficiencies where the workforce overlaps. The CCG will commission services where the provider can demonstrate that they have a robust workforce plan, education and training strategy that delivers an appropriately skilled and competent workforce that provides high quality and safe services for patients, carers and families.
10. CONCLUSION
1. 2016/17 presents the Ipswich and East Suffolk health system with a series of significant challenges not least maintaining and improving quality in the face of ever tighter budgets and demand pressures relating to on-going demographic changes. It is critical in this year that commissioners and providers work together to integrate care wherever possible thereby eliminating waste, improving communication and improving patient experience. System partners have agreed that they wish to pursue working towards an ICO to deliver the new health and care model. This is likely to require a different approach to the alignment of rewards to the achievement of system objectives and may require a radically different approach to payment and contracting approaches. We look forward to working with you to meet these challenges.
25 Commissioning Intentions 2016-17 – Annex B
Appendix B
1. INTEGRATED CARE
Ref Workstream Scheme Continuation New scheme of 2015/16 for 2016/17 scheme
ICHWRC Health, Wellbeing To continue to operationaliee services within the HW and RC which will be Yes No and Reablement delivered in partnership by health, social care and the voluntary sector Centre (supports providing a practical way to deliver a ‘hub’ or ‘shop front’ to deliver services proactive and for urgent care and admission avoidance within the Health and Social Care reactive models) Integration (HaSCI) Model. Closer co-ordinated working, so better outcomes for people and appropriate, joined up clinical, social and voluntary service responses. Consideration during 2016/17 should be given and linked to 2015/16 piloted models i.e. PM Challenge, Crisis Action Team and Frailty Assessment Base. In addition new procurement opportunities will be considered as part of new specifications such as Suffolk Wellbeing Service; Improving Assess to Psychological Therapies and Marginalised Vulnerable Adults. Other areas that are being considered to be included as part of the HW and RC are Dementia, Learning Disabilities along with exploring opportunities for some services provided by Ipswich Hospital to be based there.
ICCON Connect; throughout Through the evaluation of the Connect East Ipswich (IP3/4 area) redesign Yes No Ipswich and East and localise further the Connect model for implementation throughout Suffolk Area - The IESCCG, this programme aims to take a new proactive approach to the Proactive Model delivery of local services for the IESCCG population. To ensure that health and social care services are integrated at the point of delivery, giving those with long term conditions greater ownership of their own care. Ensuring system-wide effectiveness and efficiencies via joined up working. Promoting single assessments; shared care plans; common standard framework; self- care and assisted technology.
26 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation New scheme of 2015/16 for 2016/17 scheme
ICCRB Community To block purchase via the wider 3-5 year plan for the CCG Care Home Yes No Reablement Beds procurement up to 24 community re-ablement beds for the period November (supports reactive to March in a care home with nursing and therapy commencing each winter. model) This will follow a separate six-month community re-ablement beds pilot from October 15 to March 16. The primary focus will be to ‘step up’, ‘step across’ and step down’ patients for short term re-ablement purposes and to help people accommodate their illness or condition by regaining confidence and learning/re-learning the skills necessary for daily living.
ICCAT Crisis Action Team To provide a 24/7 extension to and consolidation of admission avoidance Yes No (CAT) - The services, including therapies and voluntary care sector, through a multi- Reactive Model agency solution to resolving crisis situations within the community setting to avoid A&E attendances and emergency admissions. 2016/17 programme to encompass and consolidate other emergency entry points/services such as Community Intervention Service, Emergency Assessment Unit, Early Intervention Team and Frailty Assessment Base with links to East of England Ambulance Service Trust as alternatives to rapid response community based services through the CAT model. Promoting single assessments; shared care plans; common standard framework; self-care and assisted technology.
ICFRA Frailty Programme; Frailty Clinical Transformation Group established in 2015 to develop and Yes No including FAB - agree a service model which will form part of the CAT (reactive model) or Frailty Assessment Connect (proactive model) this will be procured if appropriate and Base (supports implemented during 2016 which covers all health needs of the population proactive and pertaining to frailty. In addition to evaluate the six month FAB pilot and reactive models) include as part of the overall CAT model.
27 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuatio New scheme for n of 2015/16 2016/17 scheme
ICFAL Falls To consolidate the Integrated Falls and Fragility Fracture Care and Prevention Yes No Programme; to programme and services to form part of the CAT (reactive model) or Connect be included in (proactive model). This will include supporting the 2014-2019 Strategy for the Frailty Integrated Falls and Osteoporotic Fragility Fracture (IFFF) Prevention and Care. Programme (supports proactive and reactive models)
ICCHO Care Home To consider additional areas to improve outcomes and support admission Yes No Programme; prevention. Such as Learning Disabilities linked to LD Health Checks and LD consideration to serious case review. In addition to consider applying the Care Home LES model extend learning to support VSH through extending the role of the Clinical Support Manager of to Very Care Homes. This will improve outcomes associated with end of life care, other Sheltered quality indicators within the Care Home LES plus promoting alternative services Housing (VSH) for Admission Prevention Services i.e. CAT and FAB.
ICIRR Integrated To work with colleagues in Suffolk County Council to progress integrated Yes No Recovery, recovery, rehabilitation and re-ablement services linked to proactive and reactive Rehabilitation aspect of Health and Independence Programme. and Reablement (IRR)
ICCOP Complex The CCG has identified that less than 2% of patients account for approximately Yes No Patients £18 million pounds of cost in hospital admissions and appointments alone. The CCG will look at operational and commissioning actions which can improve the care for and reduce the cost incurred by these patients including the development of a Super MDT which brings together clinicians on a regular basis from across care settings.
28 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuatio New scheme for n of 2015/16 2016/17 scheme
ICPMC Prime Minister's The National and CCG strategy, endorsed by the Health and Wellbeing Board, Yes No Challenge and involves the creation of an Urgent Care Centre. The Prime Minister's Challenge Urgent Care Fund involves non-CCG funding for an extended hours General Practice. The Centre CCG will look to commission an Urgent Care Centre with features adapted from the Challenge Fund site during 2016/17.
ICSC Self Care The CCG will look to continue its emphasis of self care through core service Yes No commissioning and, where appropriate and evidence, specific projects, which may include assistive technology.
ICAF Atrial Fibrillation The CCG will consider options to reduce the incidence of stroke in patients with Yes No atrial fibrillation through improved clinical decision-making around anti- coagulation
ICPRO Replacement of The CCG will look to continue the implementation of the Health and Care Yes No NHS111, Review through the re-specification and re-commissioning of these services over OOHGP, adult the course of 2016/17 including working with current providers to pilot changes and children's were agreed. community services
29 Commissioning Intentions 2016-17 – Annex B
2. PLANNED CARE
Ref Workstream Scheme Continuation New scheme of 2015/16 for 2016/17 scheme
PCMSK MSK Commissioning a different clinical and business model for the provision of MSK Yes No for our patients. To deliver improved patient experience, improved outcomes and population health with more integrated service arrangements. Services included are: Rheumatology, Trauma and Orthopaedics, Pain Management, Physiotherapy, Spinal PCOP Ophthalmology Commissioning an integrated approach for the delivery of ophthalmology Yes No services with the development of more services at an intermediate level as a core part. PCUR Urology Commissioning a new Urology service model to achieve the required service Yes No elements of a best practice Urology Model of Care with a single point of access and one stop shop concept central to the design. Pathways included in the transformation include, Male Lower Urinary Tract Symptoms, Retention, Acute Loin Pain, Continence PCENT ENT To review and commission enhanced local ENT services. Five priority areas Yes No have been identified: 1.Development of a an Intermediate level service utilising local GPs with special interests, 2. Hearing Aids, awareness, patient education and maintenance/support 3. Adult Audiology- optimisation of pathways 4. Development of Children's Services Pathways 5. Access to Speech and Language Therapy. Review of pre-referral guidance. PCCA Cardiology Work with Ipswich Hospital Trust to develop interdependent, standardised and Yes No seamless pathways for all patients with cardiology conditions that meet the current and emerging needs of patients and in line with best evidence and practice as it emerges. Complete a review of the heart failure element of the current SCH contract.
30 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation New scheme of 2015/16 for 2016/17 scheme
PCRE Respiratory To commission an integrated service model that supports delivery of services Yes No in the community (where appropriate), supported by detailed whole system integrated pathways. PCGA Gastroenterology To explore the commissioning of an intermediate gastroenterology service, Yes No bridging the gap between primary and secondary care which would provide a unified quality service in locations that are closer to home.
PCCT Clinical We will ensure our Clinical Priorities Policy is understood by primary care and Yes No Thresholds all providers. We will continue to review our Low Priority Procedure Policies, adding additional procedures where clinically appropriate. Our Clinical Priority, Prior Approval and Individual Funding Request Procedures will be reviewed during 2015/16 to ensure that 16/17 our processes continue to be robust.
PCCEL Cancer and End We will continue with Unexplained Weight Loss (UWL) pathway moving from Yes No of Life Phase 1 to Phase 2 to run an UWL clinic at Ipswich Hospital. To implement key components of the new National Strategy for Cancer. To introduce the new 2 week wait guidance and symptom specific pathways. The continue with the Community Cancer Nurse Pilots until March 2016, and to explore opportunities for extending and to continue the work
PCOT Outpatient To ensure services are efficiently delivered. To develop more non face to face No Yes Transformation options. To work with providers to ensure appropriate new to follow-up ratio.
PCDI Diabetes To review the tiered model of care for potential re-procurement post the Yes No expiration of the current contract.
PCOT Outpatient To continue to ensure services are efficiently delivered including further Yes No Transformation developing more non face to face options and working with providers to ensure appropriate new to follow-up ratios.
31 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
PCHLEP Health Lifestyles The CCG will explore opportunities to improve the outcomes of surgery by Yes No prior to Elective reducing smoking rates and obesity rates in patients. Procedures
3. MENTAL HEALTH AND CYP
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
MHIW IAPT and To jointly commission with WSCCG a primary care mental health model Yes No Wellbeing which brings within in IAPT and Wellbeing.
MHMVA Marginalised To address barriers experienced by marginalised groups in accessing Yes No Vulnerable mainstream services by developing close working relationships with primary Adults care medical practices and secondary care providers including IHT to support and manage marginalised patients whilst on the ward reducing Delayed Transfer of Care and readmission.
MHCLD CYP LD Suffolk CCG’s including Great Yarmouth and Waveney and SCC ACS are Yes No Redesign working in partnership with Norfolk and Suffolk NHS Foundation Trust, the existing provider of Learning Disability Services, to transition a predominantly bed based model into a high quality community care based integrated community service with a reduced number of inpatient beds.
32 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
MHALD Adults LD Suffolk CCG’s including Great Yarmouth and Waveney and SCC Adult Yes No Redesign Community Services are working in partnership with Norfolk and Suffolk NHS Foundation Trust, the existing provider of Learning Disability Services, to transition a predominantly bed based model into a high quality community care based integrated community service with a reduced number of inpatient beds. MHDPD Dementia Post Commissioners will continue to work with existing providers to re-model Yes No Diagnosis (to existing services and resolve boundary issues within the current pathway include End of and develop an Outline Business Case to confirm commissioning Life Care for arrangements post April 2017. people with Dementia) We will work with our local communities to promote the establishment of dementia-friendly health and care environments for example pharmacies. MHOHM Improving joint There will be a specific focus on simplifying access points, Child and Yes No working Adolescent Mental Health Services (CAMHS), looked after children. These between health, include: education, early years, children’s Transformation Plan Delivery social care, the Single Point of Access voluntary sector Crisis Care (see Innovations Bid) and other Secondary Services agencies Early Intervention and Prevention (including End Looked After Children Eating Disorders Service of life care for Perinatal Mental Health Pathway Children and CYP IAPT Young People)
33 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
Re-design of specialist community paediatric medical, nursing and therapy No Yes services and improved integration of those with the wider health, social care and education system. This includes:
Paediatric Medical Services Paediatric Physiotherapy Paediatric Occupational Therapy Paediatric Speech and Language Therapy Community Nursing Community Audiology and Newborn Hearing Community Clinical Psychology and Therapy
Exploring opportunities for better integration of tier 3 and 4 CAMHS services: Innovations Bid
End of life care for Children and Young People
MHHR Mental Health A joint review with Suffolk County Council of mental health interaction with Yes No Rehabilitation rehabilitation, employment and housing services. and Recovery
Crisis Care Support the development of the strategy and implementation of Yes No Concordat recommendations in partnership with WSCCG, Suffolk County Council and including Suffolk Constabulary Including the 24/7 Crisis Response through the Suicide Strategy delivery of the Mental Health Crisis Concordat and associated Action Plan. (to include Crisis services in Mental Health)
34 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
Autism Pathway To explore the redesign of the autism pathway in the latter part of 2016/17. Yes No Redesign Personality For adults and children, including review and audit of the current pathway Yes No Disorder for people with personality disorders (Night Owls Service) and respite beds. Pathway Redesign Psychosis With more than 50% of people experiencing a first episode of psychosis will Yes No be treated with a NICE-approved care package within two weeks of referral.
Dual Diagnosis To explore the redesign of the dual diagnosis pathway in the latter part of No Yes Pathway 2016/17. Redesign
Development of We will continue to promote early intervention and prevention through Yes No Primary Mental development and training of Primary Care mental health services Health Care to support early intervention and prevention
National Drive We will continue to support and promote early diagnosis of dementia and Yes No to Increase ensure those diagnosed are appropriately recorded on GP registers Dementia diagnosis Rate
35 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
CAMHS The Suffolk Children’s Emotional Health and Wellbeing Strategy will be Yes No Redesign (West refreshed in 2015/16. We will continue to focus as a county-wide system Suffolk CCG working in partnership to implement the priorities identified in the strategy, leading) and as set out in our Transformation Plan requested by NHS England (to be completed in Autumn 2015). Key areas of focus will be:
Single Point of Access – scoping of a single multi-agency point of access for all children’s emotional health and wellbeing referrals Children’s Eating Disorders – working with NSFT to develop our existing East and West Suffolk Children’s Eating Disorder services to ensure the requirements of the August 2015 national commissioning guidance are met (including access and waiting time standards to be implemented from 2017/18) Crisis Care – to consider our commissioned response to children in crisis and full link up to the Suffolk Crisis Care Concordat for example in work already started in relation to the Innovation Pilot
Improving Access to Psychological Therapies (IAPT) – roll out the Children and Young People’s IAPT programme to ensure that CAMHS commissioned services deliver a choice of evidence-based interventions by 2018. Central monies will also support increased access to training via CYP IAPT for children under five years and for staff working with Autism and Learning Disabilities Perinatal Mental Health – see comment under Maternity services Tier 4 CAMHS Services – we will support the commissioning of Tier 4 services as required, the responsibility of which will likely return to CCGs in the future. We will support on-going exploration of opportunities for better integrate local Tier 3 and Tier 4 CAMHS provision.
36 Commissioning Intentions 2016-17 – Annex B
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
Midwifery Assess and form a local response to the forthcoming NHS England led No Yes Review review of our local maternity service offer, including perinatal and postnatal pathways.
4. HIGH COST DRUGS
Ref Workstream Scheme Continuation of New scheme for 2015/16 2016/17 scheme
PW34 Prescribing Robustly monitor high cost drugs and devices commissioned by the CCG to Yes No workstream ensure payment is only made appropriately
PW35 Prescribing Work with Providers to ensure that NICE Technological Appraisals (TAs) are Yes No workstream implemented within 90 days
PW36 Prescribing Provide horizon scanning to forecast the likely impact of new NICE TAs Yes No workstream before their implementation
PW Prescribing Work with provider to move from day case to outpatients infusions for No Yes workstream administration of high cost drugs
PW Prescribing Work with the provider to investigate the feasibility of assessing patient’s No Yes workstream drug tough levels and antibody levels, where relevant, to assess whether escalation of treatment is appropriate
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