Clinical Commissioning Group – Thursday 6 April 2017

Transformation Board & Integrated Commissioning Update

 We’ve been talking the last few months about putting the budget with the local authority and the CCG

 We’ve started integrated commissioning committees and board – we had the first engagement meeting last week and the first board meeting is next month

 The terms of reference for the Integrated Commissioning and Transformation Board have been sent out electronically as well as the governance structure

 There are two Integrated Commissioning Boards – the Hackney Integrated Commissioning Board and the Corporation of London (COLC) Intregrareted Commissioning Board

 The Hackney Integrated Commissioning Board is formed of two things – the Hackney Integrated Commissioning Committee and the City and Hackney CCG Integrated Committee

 The COLC Integrated Commissioning Board is formed of two things – the COLC Integrated Commissioning Committee and the City & Hackney Integrated Commissioning Committee

 The Transformation Board will be supported by four worksteams – children and young people, prevention, planned care and unplanned care

 You can view the integrated commissioning governance structure here and the FAQ’s here

 Interviews were held last week for two of the workstream director roles – Siobhan Harper who is the current Planned Care Programme Director will be the director or the new Planned Care Board and there is a job share between two people from the two local authorities for the prevention role

 Children’s and young people will probably happen in 2018/2019 – the unplanned care role will be readverrtised as they did not appoint to that post

 Mental health is not its own workstream – it will feed through all of the boards

Question: Where does Public Health lie in all of this? Answer: Public Health is there but they will be sitting on the Transformation Board.

Question: Does this include GP commissioning? Answer: No – there might be some overlap but that will be advised though contracts committee.

Question: What was your rationale around fragmenting mental health Answer: We don’t think its fragmentation, we think it’s an integration of mental health into those workstreams, currently we think it’s quite fragmented sitting in its own programme because we aren’t exploring those opportunities from integrated health – this presents us with an opportunity.

The Governing Body want to see a gateway process before the workstreams go live – they have to go through a set of checkpoints before they start to take on responsibility for delivery.

Question: Is there primary care representation in the four workstreams? Answer: They are clinically or practitioner led much like the current programme board structure where we have clinicians chairing them – this will be emulated in the new worksteams.

GP Query: The unplanned care board is led by Homerton – there are also 3 Homerton representatives on that board and only 2 GP representatives, I have a bit of anxiety as a lot of our money is pooled and we don’t have an equitable voice.

Response: The Unplanned Care Board is not led by Homerton but it is chaired by Tracey Fletcher, we also have CHUSE and Confed on the Transformation Board. We need to remember that the statutory responsibility of the CCG will never change, we’d need a change of legislation to do that – the different boards can’t make decisions that will impact on our statutory responsibility to deliver. Nothing will ever go to a vote because they are not voting structures.

STP and Devolution Update

 You may recall there was an outline of workstreams within the STP we were going to focus on, these have been narrowed down to a set of initiatives which have gone to NHS England for sign off

 Still bland flavour in terms of the specifics of what the STP will do and what level they will do it

 Currently nothing to update on apart from the issue of control totals – the financial elements which affect us locally

 We have a risk reserve and we are mandated to hold back a certain level of money, we’re now being asked to pool our money with North East London to help some of the more deficient areas of East London, that £3.7M has been transferred over

 There are ongoing discussions with the STP about what level of QUIP we’re required to deliver within 17/18 – currently proposing to develop about £5M of redesign schemes to deliver quality improvement and productivity

 What’s different about us locally is the schemes we have identified are deliverable – we are confident we will be able to deliver £5M worth of change

Question: Has this been publicised? Do Hackney residents know that their health money is going to other areas? Answer: People do know but they sway of angry voices hasn’t been heard – it’s been covered by local media and Jonathan McShane has been very vocal about it.

Healthy Start Scheme

 Healthy start is a national scheme which aims to improve nutrition for low income families – it provides vouchers for healthy start vitamins and vouchers that can been spent on fruit/vegetables and milk

 Maternal vitamin tablets – for all pregnant women and women up to one year after having a baby

 Children’s vitamin drops provided from 4 weeks until 4th birthday

 There is a low uptake of the scheme so please let your patients know

 The vitamins are distributed in all community pharmacies in Hackney and two pharmacies in the City of London (Boots on Aldgate Road and Niemans on Goswell Road)

 There are registration forms but a patient can just go straight to the pharmacy and fill in the forms there – this isn’t like the national scheme where they have to be stamped by a health professional

 We are also piloting distributing them at children’s centres – the pilot is about to finish so we will be analysing the data soon, if it’s improved uptake we will roll it out more widely

 Please do what you can to promote the scheme – we have developed prompts within the various templates (antenatal, postnatal and 6 week baby check) there should also be links in the guidance notes

 Please do still keep promoting the national scheme – we don’t want people to go directly to the pharmacy to get their vitamins because its easier and then miss out on the opportunity to get the food vouchers

Question: Do the women need proof of pregnancy? Answer: No

Question: With the recommendation that women take folic acid pre conception, can they get the healthy start vitamins preconception? Answer: No, they will need folic acid prescribed pre conception

Question: Do they need to fill out a form for the national scheme? Answer: Yes and it need to be stamped by a health professional

CEG Template Genie

 CEG have an idea of creating a template genie  One of the most common complaints we receive from local practices is lack of information of difficulty finding information

 We thought of having a one stop template – we have created one and there is a draft version on EMIS that you could use today

 When you go to template options, it comes up with a little template which has all the different sections for information – it is effectively a template with readily available information

 The whole idea of it is that you don’t go away from EMIS

 If you have any specific bits of information you want on the City and Hackney template, let Luis know

Question: It’s not a clinical template is it? Answer: No it’s an information template.

Query: It’s a great idea but will need constant maintenance, do you have the resources for this? Answer: Yes, Luis will be managing this. Question: Does CEG have any appetite to make this patient facing? Answer: We haven’t thought about it but it could be an idea – I will talk to Keith and see what he thinks

Dementia Update

 Dr Carmel Beadle our CCG Dementia Clinical Lead attended the CCF to provide a dementia update – she is new to the role so if you have any ideas or feedback, please email her ([email protected])

 There is a national aim that 67% people of people estimate to have dementia get a diagnosis, we are doing well with 76.1%

 Cynical people might think why are we trying to diagnose people with dementia just to get the numbers up and what services are available once they get their diagnosis

 There are benefits of giving people a diagnosis – allows them to have care plans while they have capacity to do so, it opens up doors for dementia medication which may slow the progression of their dementia and it opens up services to them – if they have a carer they will get an assessment and a carers allowance

 Carmel is going around practices to try and identity numbers of patients who we may have missed, there is some NHS data that says there

 Our pathway for diagnosing hasn’t changed – if someone presents to you and your worried about their memory you can do a GPCOG and takes about 4 minutes, the dementia bloods to look at reversible causes of memory loss, you can then refer to the single point of entry and they will offer an appointment in 4 weeks followed by a follow up appointment in 12 weeks which is where someone will get their diagnosis

 The Alzheimer’s s society has 4 advisors that cover City and Hackney – they follow the patient throughout the first year following their diagnosis

 The Hackney Caribbean Elderly Organisation takes referrals from GPs – people can also self- refer

 Dementia template – not quite on EMIS but it will be soon, the main thing that is different is that there is a prompt for CMC

 It is ideal to use CMC rather than something like Hackney Care Plan is that lots of our alliance members are going to have access to CMC

Question: Are there any plans to get more dementia advisors? Answer: There is one other person they are thinking about recruiting so there might be 5 people but at the moment that is what the funding is for

GP query: Crisis – out of hours, when the behaviour is really challenging especially in the care homes when they lash out with other residents it’s not ideal to send them to A&E, there should be another system