Transforming health and care outcomes for the people of Basildon and Brentwood

Our 5 year strategic plan

Working for a better NHS for everyone NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Inside this 5 year plan Who we are

Aims and Objectives 4 CCGs are responsible for commissioning (i.e. planning, Chairman’s View 5 designing and buying NHS services) for everyone who Interview with the Chief Officer 6 lives in their local area, in particular CCGs are Foreword by Essex County Council 8 responsible for planned hospital care, rehabilitation Have your say and get involved 9 care, urgent and emergency care, most community Our vision and values 10 health services and mental health and learning Our changing communities and strategic disability services. To fulfil these responsibilities we challenges 12 work with local healthcare professionals, local Quality and Safety 14 authorities, voluntary organisations and others to make sure that local people have safe health services Aims 1 and 2: Excellence in Primary Care and Named that meet their needs, within the financial resources Accountable Professional Teams -Excellence in Primary Care 18 that are available. We have a duty to involve and -Practical steps towards integration 21 listen to patients and our local communities when we -Named Accountable Professional Teams 22 make decisions about local services.

Aim 3: Specialist Pathways of Care We are led by our Governing Body, which is principally -Integrated Frailty 26 formed of clinical representatives of our four localities -Musculoskeletal 28 groups. Our Board sets our strategy and direction, as -Respiratory 29 well as ensures that the CCG is delivering its’ statutory -Diabetes 30 duties and ambitions for the health and care of -End of Life 31 everyone who lives in Basildon and Brentwood. -Why do we need to change? A carers’ story 32 -Cardiology 34

-Mental Health 35

-Children & Young People 36

-Learning Disabilities 38

-Cancer 40

-Stroke 41 On page 32 of this

plan we reproduce Resources, Outcomes and Enabling Activities

-Resources 44 the story of a carer -Targeted outcome improvement 46 which shows why -System structure and sustainability 48 change is needed. -Delivering the NHS Constitution 49

-Core enablers 50

-Glossary 53

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Our vision is to see transformed health Key points outcomes for the The communities we serve are aging, living with more long term conditions placing greater strain on health and care people of Basildon and services. We know that people’s experience and outcomes from health and care services are not as good as they Brentwood. should be. This strain is magnified by the rapid development of new treatments and technologies, the increasing costs of meeting safety and other core guidance alongside poor We have developed this infrastructure in a number of areas. plan by listening to our We cannot deal with this set of challenges without significantly changing the way that health and care services work and set out within this plan the steps we will take to local communities, change health and care delivery so it will provide consistent, high quality, holistic and integrated care for our member practices and communities. key stakeholders There are three key area of work that we have identified to change service delivery: through consultation, Firstly, working with our member GP practices to strengthen and develop primary care services so that they meet the focus groups and needs of today’s communities. individual feedback. Secondly, by restructuring current health and care services around local communities and giving everyone with a long term need or condition a named person who will be accountable for getting the best possible outcomes for In this plan we set out them, working as part of this community based team. Finally by improving specialist care so that it is more the 3 aims which we will consistent, evidence based and draws on innovative thinking from across the UK and beyond. This will include a work towards to achieve new frailty service and the integration of health and care our vision and the 4 services for people with learning disabilities. To do this we will need to change the way we work as objectives by which we commissioners, and notably we will need to develop new governance models and working arrangements between will measure our success the CCG, Essex County Council and other key public sector agencies. at delivering this vision.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan We have three aims and four core objectives for

the next five years.

Aim 1: Aim 2: Aim 3: Excellent Primary Care Named Accountable Professional Specialist Pathways of Care Teams We will develop a new set of quality markers We will simplify the current complex web of We will roll out a set of specialist pathways to support general practice to strengthen and services for people with long term need with which will break down existing barriers in develop their core primary care. an aligned set of professionals working in service delivery, be that organisational

practice networks – radically reducing the configuration, setting of care or different We will seek to focus on understanding number of handovers in people’s pathways. disciplines for people who need additional variation in clinical practice and outcomes and care. build a support offer to support practices We will ensure that there will be a single which have development needs. individual accountable for a person’s health We will adopt evidence based practice, and care where they have a long term need. interventions and we will expect that people We will explore new models of general will be returned to their Named Accountable practice, focusing on delivering both episodic We will empower that person to make Professional Team following receipt of care in care and continuity of care. decisions to improve outcomes and self- a specialist pathway. management through better care planning.

Objective 1: -People have the right to good experience: self-reported experience of health and care services. -No-one should be harmed: The number of incidents in health and care services that lead to harm. -Nursing and residential care as the very last resort: The number of people in residential/nursing care. Reduce avoidable harm, improve individual -Reducing premature mortality: Under 75 mortality rates from cancer, respiratory and cardiovascular outcomes and improve experience within local disease. health and care services. -Better quality of life: Improved quality of life for people living with long term conditions in Basildon. -Children should be safe: Number of child protection cases opened and closed, and length of time open. -Reducing inequalities for people with learning disabilities: Number of people with learning disabilities with a health check and health action plan

Objective 2: -Delivery of the referral to treatment 18 week standard at an individual speciality level and across all services. -Delivery of the 4 hour A&E standard, with an absolute reduction in the number of people who have Consistently deliver the standards as set out in to wait longer than 4 hours in A&E. the NHS Constitution -Delivery of the 2 week, 31 day and 62 day cancer standards. -Delivery of the 15% access rate for psychological therapies for people who need it.

Objective 3: -Our stakeholders and members believe the CCG has clear and visible managerial and clinical leadership. An organisation of clinical and managerial -Our people think the CCG is a great place to work and be developed in. leaders who have the necessary skills, capacity - We deliver on our plans and intentions. and capability to lead positive change for the communities we serve.

Objective 4:

-By 2018, our health and care economy will be in overall financial balance. A financially robust health and care economy -Over the 5 year plan period, we will create £13m of non-recurrent funding to help secure which has the necessary resource to deliver transformational change. our vision to transform outcomes for the people of Basildon and Brentwood.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Delivering consistently better outcomes Chairman’s view

Within our Annual Report for 2013/14 we reflected as an organisation on our first year of operation as a NHS Clinical Commissioning Group, we reflected on the steps we had taken to build a sustainable, well run organisation and the steps we had taken to strengthen clinical leadership in the commissioning of NHS services for the people of Basildon and Brentwood. We also outlined the steps we have, and continue to take to improve the quality, safety and performance of the local NHS and to build a more financially resilient organisation.

However, we also identified the need for the CCG to develop its’ strategy for improving the health and care outcomes for our local communities based on our knowledge and recognition that in a number of areas we are not consistently delivering the clinical outcomes or commissioning services which provide as good an experience of care as we want to see. In addition to these challenges we also recognised the need to transform the services we commission in order to deliver a financially robust health and care system for the future. This strategy sets out how we intend to make the necessary changes to rectify these issues to ensure that all key health and social care providers who serve our communities are safe, effective and financially sustainable.

Clinical Commissioning Groups are unique organisations within the NHS, we have the opportunity to use our status as a membership organisation to draw on the experience and expertise of our membership, made up of all the GP practices in Basildon and Brentwood to tackle both the day-to-day and systemic issues faced by local services and I believe, with the steps we outline within this strategy to integrate the commissioning of services this expertise will be further strengthened by drawing on the expertise of colleagues in social care. I believe this is a document of intent, which provides the roadmap by which we will change services, to make them fit for the 21st century, and fit for the people who need them.

Dr Anil Chopra Chair

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan Interview with the Chief Officer

What is this document all about? So what does the CCG intend

The purpose of this document is to to do? set out our commitment to change local health and care services in In this plan we set out a clear -New specialist services for order to deliver our vision to direction and set of intentions as to musculoskeletal conditions, people transform health outcomes with the the future of health and care at end of life and across stroke and people of Basildon and Brentwood. services for our local population, cancer services. these include: As a CCG, we got off to a rocky start -A new integrated health and care but we have made significant -A new set of local quality standards service for adults with a learning progress over the course of the past for primary care, setting a clear disability. 12 months and I’m pleased that we distinction between care continuity are rightly recognised as an and episodic care and the To deliver this ambition, we will organisation which is now getting development of new episodic require new commissioning the basics in place. primary care centres. arrangements and within this plan we set out our intention to become However, we now need to focus our -The right for people with long term a commissioning care trust which will energies on resolving a number of need to have an accountable bring together health and social care long standing issues identified by professional as part of a wider team, commissioning as well as our our local population and member combining existing health and care intention to explore other practices, we know that health services to reduce service complexity commissioning platforms with our outcomes in Basildon and and improve outcomes. local district councils where this will Brentwood should and can be better best serve our local community. -An integrated frailty service and it is our duty to bring this bringing together health and care change about – within this services to provide specialist care document we set out our plans to and support to some of the most do this and to give the people of vulnerable people in our community. Basildon and Brentwood better This will include new models for long services, which improve their term care, including the creation of a outcomes and also allow us to dementia village. ensure that we make better use of the money that taxpayers give us to commission NHS services.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

What do you see as the key And to sum up? challenges to this plan?

I am incredibly fortunate to be able As you will see, this plan calls for to lead an organisation which has a radical change in the way that health team of talented and committed and care services are both people who want to make a real and commissioned and provided in the meaningful impact on the health future and this will be difficult as it and care of our local communities. will involve changing roles for In order to make the changes people who work in health and care necessary we have to continue to services, and equally the focus on developing our team, as I organisations which currently believe that the only way we will provide those services. deliver this plan is by being a values based organisation whereby we We also need to tackle the fundamental splits within the way consistently and reliably do the right

that services are commissioned, be thing for local citizens. that by NHS organisations or local This plan sets out how we will seize authorities. We set out within this what is an exciting opportunity to plan how we believe we can do this, bring about real change which will but this will require an unparalleled radically improve health and care level of trust and co-operation outcomes for the people we serve across a range of stakeholders. and secure a health and care service Finally, and most importantly, I that is fit for the twenty first century. recognise that we have to truly listen

and action the views of our local communities as we develop these

plans, this is vital if we are to enable our local communities to look after Tom Abell

themselves, and each other better. Chief Officer

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Working together to improve outcomes

Foreword by Dave Hill, Executive Director for People Commissioning, Essex County Council

ECC welcomes the Basildon and Brentwood CCG 5 Year Plan which gives a clear commitment to improving quality and outcomes for local residents within a modern, sustainable health and care system. The maturity and ambition within the plan builds on a successful first full year and strong clinical and professional leadership within the CCG sits at the heart of this success.

The plan quite rightly takes a bold step in placing collaboration at the centre of its approach and sees meaningful and lasting integration between social care and health services as an opportunity to break down traditional barriers and offer real improvement in the experience of patients and service users. The intention to build improvement through developing the excellent partnership arrangements already in place, both locally though our joint integrated commission team and county wide through the Essex Health and Wellbeing Board, is surely the best way to meet joint challenges we face and is fully supported by Essex County Council.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan Have your say and get involved

We want to hear your views on Become a Patient Leader or a member of our Patient and health and care services in Basildon Community Reference Group and Brentwood so we can make changes, big and small to fix The Patient and Community Reference Group and our Patient Leaders problems, improve outcomes and scheme are our formal mechanisms for ensuring patients and members of your experience from the services the community have their voices heard when decisions are being made that we commission. about local health services.

There are many ways you can do this, as illustrated on this page. Join a Patient Engagement Group in your area

There are four patient engagement groups linked to GP practices within Basildon and Brentwood – for information please ask at your local GP surgery or visit our website.

Take part in an online survey Tell us about your experience or what you Surveys over the last year include a consultation on the redesign of the Children’s and Adolescent Mental Health Service; a questionnaire on the think development of end of life care within Basildon and Brentwood and a short questionnaire on this plan. You can feedback directly to the organisations which provide your services on NHS Choices, or you can email or tweet us at [email protected] or Come and meet our Governing Body @BB_CCG. Our Governing Body meetings are formal business meetings of the CCG You can also give us a call if you board, held in public. There is an opportunity for local people to ask a want to speak to somebody question at every meeting. For details of the next meeting, visit our about your experience, our website. number is 01268 594586.

Ask us to come and speak to your group or club

We are always looking for opportunities to talk directly to local people – invite us to talk at your local community group or club.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Our vision is to see transformed health outcomes for the people of Basildon and Brentwood.

We work for a better NHS for everyone – collectively as a team and in partnership with others when this will best deliver our vision.

To deliver our vision, we have adopted

the core NHS values as set out within the Compassion NHS Constitution:

We ensure that compassion is central to Working together for patients the care we commission and respond with humanity and kindness to each Patients come first in everything that we person’s pain, distress, anxiety or need. do. We fully involve patients, staff, We search for the things we can do, families, carers, communities and The NHS belongs to however small, to give comfort and professionals inside and outside of the relieve suffering. We find time for the people. NHS. We put the needs of patients and patients, their families and carers, as well communities before organisational as those we work alongside. We do not boundaries. We speak up when things It is there to improve our health and wait to be asked, because we care. go wrong. wellbeing, supporting us to keep

Improving lives Respect and dignity mentally and physically well, to get better when we are ill and, when we We strive to improve health and We value every person – whether patient, wellbeing and people’s experiences of cannot fully recover, to stay as well their families or carers, or staff – as an the NHS. We cherish excellence and as we can to the end of our lives. individual, respect their aspirations and professionalism wherever we find it – in commitments in life, and seek to the everyday things that make people’s understand their priorities, needs, abilities It works at the limits of science – lives better as much as in clinical practice, and limits. We take what others have to bringing the highest levels of service improvements and innovation. say seriously. We are honest and open human knowledge and skill to save We recognise that all have a part to play about our point of view and what we can in making ourselves, patients and our lives and improve health. and cannot do. communities healthier. Commitment to quality of care It touches our lives at times of basic Everyone counts human need, when care and We earn the trust placed in us by We maximise our resources for the compassion are what matter most. insisting on quality and striving to get the benefit of the whole community, and basics of quality of care – safety, NHS Constitution make sure nobody is excluded, effectiveness and patient experience – discriminated against or left behind. We right every time. We encourage and accept that some people need more welcome feedback from patients, help, that difficult decisions have to be families, carers, staff and the public. We taken – and that when we waste use this to improve care and build on our resources we waste opportunities for successes. others.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

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Kathy Whitbread, Administrator and Rob Hunt, Business Manager – two members of the CCG team. NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Our changing communities and strategic challenges

Changing demographics and Segmentation analysis of our population required to achieve this being outlined in expectations on public services within Basildon Town points to some of page 40. the critical challenges we need to tackle with a disproportionate number of Finally, we believe it is likely that over the In 1948 when the NHS was created there people within Basildon Town being course of this plan we will see further were 5.5 million people aged over 65 placed within the following ACORN changes in the inter-NHS commissioner and only 200,000 of these were over 85. segments: responsibilities, particularly with respect By 2011 there were 12 million people to the role of NHS England and CCGs in aged over 65 and 1.4 million of these  Striving Families the commissioning of NHS services. were over the age of 85.  Young Hardship Specifically, we expect that CCGs will be  Difficult Circumstances expected to take on additional This situation is mirrored across Basildon responsibilities around the and Brentwood as we have seen a rapid Given these findings, a specific issue commissioning of primary care to increase in the number of people living which we recognise needs to be resolved increase, which we will adopt in line with longer lives. over the period of this plan is developing our plans for improvement of primary Increase in CCG population by age band commissioned services. This is so that care, outlined on page 15. Equally, we between 2002 and 2012 (HSCIC) they can better engage with this cohort believe there may be some services, of our community given that traditionally currently designated as ‘specialist 0-19 20-64 65+ it is these groups which find it most commissioning’ being re-designated as difficult to trust and engage with CCG commissioned services. This plan

statutory services and who could achieve does not specifically consider this issue better outcomes for themselves and their given the current uncertainty over the

families. likelihood of any changes to specialist commissioning.

Political outlook and funding 1,859 6,715 6,400 Technology 3% rise 4% rise 17% rise In developing this plan, we have We serve some of the most affluent and considered the likely political and funding A key challenge and opportunity that we most deprived communities in England, outlook for health and care services in expect to emerge over the course of the with the greatest levels of deprivation order for us to be able to deliver a set of next 5 years is the role that technology being found in Basildon Town. Our actions to bring the overall health and could play in transforming how health population is significantly less diverse care economy into financial balance and and care services are delivered and also than that of England, although more deliver on the national expectations be used to promote better self-care and diverse than most other districts in Essex, being placed on health and care services. management to reduce reliance on core this diversity is also increasing as we see health and care services. more people move to our area from Firstly, within this plan we have assumed places such as east London. that present levels of funding constraint Over the five year planning horizon, the continue and over the course of this plan CCG will remain committed to it’s Alongside an aging population, we have have assumed income growth of 1.7% previously stated aim of maintaining and a changing burden of disease within our per year through to the 2018/19 financial improving the inter-operability of clinical local communities – over 50% of our year. Further information on income and systems, based on those used in general community has one or more long term expenditure is available at page 33 of this practice as we see this as a critical health condition such as heart failure, plan. building block to deliver the new service asthma or chronic kidney disease. models as outlined within this plan. Secondly, we have considered within this There is currently significant health plan the role that the integration of In addition, we recognise that the new inequalities across our communities, with health and care service commissioning service models that we outline within this unacceptable differences in life and provision will play, and in particular plan should have the use of technology expectancy across Basildon and seeing integration as the default position as a core element and as such we will be Brentwood as well as different of future commissioning arrangements looking at adopting new contractual experiences of services – people with between the CCG, Essex County Council forms and models which encourage long term conditions report significantly and other agencies. Details of our investment in technology to deliver lower health related quality of life in parts intentions for integration are throughout better outcomes and improve the of Basildon compared to England this plan, with our specific plans on the efficiency of local health and care whereas people in Brentwood report supporting governance and services. significantly better health related quality organisational changes which will be of life.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

In November 2013 we held a workshop focusing on the future shape and direction of NHS services, this picture identifies some of the challenges we identified at the workshop.

Safety and meeting core guidance radically new forms of treatment, Without change, these pressures will particularly based around the rise of place unacceptable pressure on what is We expect over the course of this plan genetics which will allow for people to already poor quality infrastructure, that the level of regulation placed on receive highly personalised treatments particularly in respect to General Practice health and care services will increase. and drugs. We expect that these premises. This is a positive move to ensure changes will radically change the way in consistent levels of safety and quality which a number of services will be As such, we recognise that a new care but will clearly place further pressure delivered within the future. approach is needed and radical new on service providers as we see a range of options need to be explored to resolve new areas of focus, including prescribed Infrastructure current issues, the pressures that are staffing levels, and a requirement for likely to emerge and to support the more services to be available 7 days a In addition to the current demographic implementation of the new service week. profile of our population, we also expect models as outlined within this plan. that over the course of this plan we will We also expect to see a number of see significant housing development We specifically explore these issues and medical breakthroughs over the course across the Basildon and Brentwood area. set out our high level intentions in regard of this plan which will provide the to the development of the primary care opportunity for us to commission estate on page 40.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Quality and safety

One of the fundamental cornerstones to CQUINs and quality schedules and a firm improvements in services. To enable the the success of all the aims and objectives commitment to achieve the National feedback on all commissioned services, for the next 5 years will be to ensure that Quality Premium. the CCG is committed to effectively high quality, safe patient care is integral correlate and analyse feedback. The to all services commissioned by Basildon A further key element to the success of indicators from patient experience is an & Brentwood CCG. Through strong the CCGs quality agenda is to ensure that essential part in early identification of committed leadership the CCG has the extensive partnerships are developed failing services and the CCG will ensure vision and strength to put quality at the with relevant healthcare providers, social that to give a comprehensive, heart of all that we do as an organisation. care, peer commissioning organisations triangulated account of what is As a result quality can be seen as an and allied health professionals and most happening to patients and people, all essential “golden thread” running importantly our patients and carers. data is reported. This in turn reflects through all the CCGs organisational Therefore, ensuring patient safety and some of the key recommendations of functions of clinical, corporate and quality the agenda are a key focus in the Robert Francis QC. financial governance. commissioning and contracting processes of all services. Additionally, the CCG is committed to work in strong collaboration with the

Clinically As part of those commissioned services, Quality Surveillance Group (QSG) to Effective the CCG will proactively maintain a share intelligence in relation to any areas robust quality monitoring framework of concern, which will again enable early which will include appropriate and detection of poor quality services. effective incentives, and sanctions, Value Quality Safe ensuring measures and monitoring Quality, Innovation, Productivity and frameworks are in place to continuously Prevention (QIPP) - QIPP is a large improve patient safety. Some elements transformational programme for Basildon of this quality monitoring framework and Brentwood CCG seeking, through

Patient involves monitoring through Clinical productivity, prevention and innovation, Experience Quality Review Groups. Each major to improve the quality of care that the provider contract will be reviewed on a CCG delivers. QIPP involves engaging

monthly basis through a Clinical Quality clinicians and patients to lead and A key strategy that will enable the quality Review Group (CQRG) which is chaired support change. We will work with our agenda to be adopted throughout all the by the CCG Chief Nurse and attended by local health partners to develop organisational functions of the CCG will members of the commissioning team, integrated QIPP plans that address the be all CCG staff embracing the Chief contracts team and representation for local quality challenge. It is essential that Nursing Officer’s concept of 6Cs, and the quality and safety agenda for the the impact of productivity savings on the applying its ethos into everyday work. organisation. The CQRG is a key part of quality of care delivered is monitored the formal contract management process closely and the CCG will ensure that a There are multiple policy drivers that and the group has a set agenda built on Quality Impact Assessment tool will influence and improve the quality the requirements for quality, safety and review all QIPP plans. agenda across the NHS. Some of which patient experience in the contract as well are; as any new national drivers. The minutes Through a robust strategic quality  National guidance which the of the group go to the CCG Quality and framework, Basildon and Brentwood CCG CCG uses to inform decision Patient Safety and Quality Committee. A is confident that it will achieve its making further facet of the quality monitoring commitment to deliver high quality  Safety and quality measures framework will be Quality Review visits, patient care and a positive experience for that have been identified as either as part of a planned programme patients and carers ensuring that care is key indicators of provider of quality inspection or more reactively as safe and effective, learning the lessons performance a result of triangulated information which from recent reports such as Francis and has highlighted a concern or poor Berwick. Identified local priorities for patient performance. safety, experience and quality of care. Further detailed information can be These drivers are used to determine the The CCG recognises that the key to obtained from “Basildon and Brentwood monitoring and reporting mechanisms ensuring high quality safe patient care is CCG Patient Safety and Quality Strategy required locally in the delivery of the delivered across its locality is to ensure V2.0” quality agenda. Some real examples will that patient and carer experience be the collaborative agreement of robust influences commissioning decisions and

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NHS Basildon and Brentwood Clinical Commissioning Group Lisa Allen, our Chief Nurse 5 year plan

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan Aims 1 and 2: Excellence in Primary Care and Named Accountable Professional Teams

We believe that the foundation of an Our second aim is the creation of effective health and care system is ‘Named Accountable Professional excellent primary care, particularly Teams’ – this has come from GP services. feedback from our local communities that if you have a For too long, GP services have not range of complex needs you have to been given the attention that they work with an array of different deserve and our first aim of services in health and care who Excellence in Primary Care sets out don’t speak to each other, and for how we intend to address this. whom no-one appears to be in charge. In this section we set out our plans to create opportunities for new As part of this plan, we are making a models of general practice, firstly commitment to everyone who has focusing on the provision of episodic long term need that they will have a care, with expanded access which single individual who is accountable better meets the expectations of for co-ordinating their care and citizens, and secondly allowing for securing better outcomes for them. better continuity of care for people with long term need, giving GPs the To do this we will remove the time to be able to co-ordinate and existing service silos and create provide more holistic care to the teams made up of community, people in our community who really mental health, social care and other need it, working in partnership with professionals who will act as, or work health and care partners. with each Accountable Professional to deliver an individual’s goals and target outcomes.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

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William Guy, Head of Commissioning who leads our Commissioning and Contracting team NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Aim 1: Excellence in Primary Care

What is it? How will we achieve it? Expanding Capacity: Premises: See ‘Environment and Over the five year period, 2014 to 2019, Excellent clinical outcomes: infrastructure’ plan on page 40. We will define ‘Excellent Primary Care’, we will ensure that every person in our and identify and address unwarranted population is able to benefit from Workforce: By 2019, the CCG will seek to excellent primary care, 7 days a week. variation between general practices, increase the local GP workforce by 33 through the introduction of a defined, GPs, by working in collaboration with cogent set of quality markers that We will focus on three areas to secure Health Education East of England (HEEE) this aim: demonstrate the quality of primary care and the Essex primary care workforce services. This will include quantitative group, to develop a transformation indicators of essential processes that 1] Achieving excellent clinical outcomes, programme and explore joint and ensuring that member GP practices, underpin high quality provision and also recruitment initiatives required to and the people registered with them, qualitative indicators of primary care develop the optimum future workforce. determined health outcomes which have know that the services being offered are delivering the best possible health traditionally been more difficult to assess. Locally we will seek to increase the outcomes in terms of safety, clinical This ‘Practice Quality Assessment Tool’ number of training practices from 9 to 12 will be used to: effectiveness and positive patient over the next 5 years, in part because experience. evidence shows that GP registrars often -Provide a benchmark for practices to stay in the area where they trained once 2] Improving access to services by assess their own performance; they qualify. We will also use the matching access to the differing needs of environmental standards to be attained individuals, effectively managing the -Provide a mechanism for identifying, by training practices as a benchmark for challenge of both increasing complexity and providing support to practices which all practices to aspire to, increasing the of need, and rising demand for services, attractiveness of existing practices to are struggling to achieve the optimum within the population served by our prospective new GPs. quality across all elements of service; general practices. We will also run regular recruitment fairs 3] Ensuring local primary care providers -Provide our population with to promote the CCG area and our have the necessary capacity, in terms of comprehensive information about each practices to locally qualifying GP workforce, premises and resources, to practice, including key quality outcomes registrars and to attract GPs from out of deliver the standards of care expected data, to assist in their choice of general the area. and maintain sustainability. practice. In relation to practice nurse capacity, we Local general practice capacity is will work with local practices that have currently below the optimum level for the Improving Access: low levels of practice nurse input to size of population served, both in terms We will seek to match access to the understand how increasing nursing of physical space (estimated floor space needs of our communities by defining support may benefit the practice and deficit of over 3,000m2, plus a number of two distinct aspects of primary care their registered population, and also existing premises are in poor condition) provision: support practices seeking to increase and workforce (there is a current shortfall their nursing provision, possibly through of 18 GPs in our area compared to the 1] Provision focused on episodic care: collaboration with local providers of nationally recommended rate of 1,835 offering services to people who do not community nursing services. patients per GP; and 7% of GPs in our have long term or complex conditions, area are aged over 65, with 40% in the How will we measure impact? but may require reactive clinical 50-64yrs age group). consultation, assessment and treatment Excellent clinical outcomes:

for isolated minor illnesses or injuries 1] Annual assessment of number of In addition, analysis indicates that practices which demonstrate practices in our area utilise practice (including the development of a GP achievement against all the locally nurses to a lesser extent than the surgery based at Basildon Hospital); agreed quality markers – Target: 100% of national average - i.e. providing 26% of routine health screening and health BBCCG GP practices consistently meet all total consultations against 34% promotion and advice; 1 quality markers by December 2019 nationally These shortfalls will be further exacerbated by projected local housing Improving Access: 2] Provision focussed upon continuous developments bringing a further 25,000 Episodic care: care which will offer continuity of care to additional residents to our area. 2] 10% year-on-year decrease in people people with long term or complex attending BTUH A&E with primary care conditions, requiring a Personal Care conditions, during ‘in-hours’ period. Plan which specifies the range of 1 Trends in Consultation Rates in General proactive, multi-disciplinary services to 3] By 2019 – 50% decrease in people Practice 1995 to 2008: Analysis of the attending A&E with primary care be provided, based upon holistic QResearch® database. - Professor Julia conditions more than 3 times in a 6 assessment of each individual’s needs. Hippisley-Cox & Yana Vinogradova (NHS month period. Information Centre: September 2009)

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

The next 5 years Continuity of care: We plan to undertake the following steps 4] People with a long term condition will over the next 5 years to achieve this plan, report a health related quality of life with details being included within the equal to or better than the national CCGs’ 2 year operational plan: average Co-commissioning of primary 2014/15 5] 95% of people with a Personal Care 1] GP chaired BB CCG ‘Quality in Primary care Plan report a positive experience of the Care’ working group, with representation care they receive from each locality, to develop a defined We are working with NHS England set of quality markers, to be agreed by to develop new governance and Expanding Capacity: CEG in March 2015. shared commissioning arrangements Premises – see Environment and 2] Workforce development plan to be infrastructure plan on page 40. developed, and signed off by CEG in order to help deliver our

Excellence in Primary Care and Workforce: 3] Commence ‘GP Practice @ BTUH’ Named Accountable Professional project 1] General Practitioners Team’s aims. Net gain in w.t.e. GPs in BB CCG general 2015/16 practice: 4] Pilot ‘Practice Quality Assessment Tool’ Although we have indicated that we 5 w.t.e. GPs in 2015/16, with eight practices (two per locality), do not currently see a role for the 8 w.t.e. GPs in 2016/17, including one practice requesting CCG in the direct management of 10 w.t.e. in 2017/18, support to improve provision. Wider 10 w.t.e. in 2018/19; implementation plan, drawing upon pilot core primary care contracts, we do outcomes signed off by CEG. want to build an arrangement that 2] Practice Nurses 5] Work with four practices (one per will provide sufficient flexibility in 2014/15 – optimum number, and type, locality) to explore effective mechanisms order to allow us to support our of PN appointments/1000 reg. for differentiating the service offered to member practices to make the population defined people requiring episodic care, from the necessary changes as outlined in this arrangements for those requiring 2015/16 onwards – annual 10% increase continuity. CEG to assess resulting plan. in the number of practices offering analysis and determine approach to be agreed optimum number, and type, of taken to differentiated practice across BB At this time we see significant PN appointments/1000 reg. population. CCG. opportunities in having a greater

6] Implement first stage of CEG approved role in how current Directed 3] Availability of GPs & PNs - by 2017, Workforce Development Strategy 95% of people surveyed by each practice Enhanced Services (DESs) operate express satisfaction with access to GP 2016/17 with our members and how we and PN provided services. 7] Roll-out of ‘Practice Quality could combine these with other Assessment tool’ for all BB CCG practices, activities and funding streams to and provision of support for practices with identified difficulties in provision. deliver maximum impact on local citizens. 8] Commencement of ‘GP Practice @ BTUH’

9] Support GP practices (on CCG-wide basis) who wish to adopt ‘differentiated

practice’ approach to access.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan The role of community pharmacy

Essex Local Pharmacy Committee (LPC) has provided us with a commentary on this strategy and the role that community pharmacy can play in helping to deliver this plan.

access walk-in services without Support for those with long-term There are fifty NHS community appointment and without formal conditions. pharmacies in Basildon and “registration” benefits many of our Brentwood, providing dispensing younger or more chaotic patients. We need to acknowledge that our and other medicines services to our patients will have frequent contact patients, and also having regular Unplanned care with their community pharmacist, contact with our residents who do and that much routine monitoring not otherwise engage with health We need to recognise the role that could be conducted at the services. The concentration of community pharmacies play in pharmacy when patients receive pharmacies is higher in more meeting unplanned care needs, and prescription services, for example deprived areas, enabling pharmacy develop this further to reduce the respiratory and diabetes monitoring, to tackle many health inequalities. demand on inappropriate and less which would improve choice and cost-effective providers and to convenience for patients. This capacity is not often utilised by release capacity in General Practice. BBCCG, and we should consider This should consider both acute opportunities, both within the NHS needs and needs for those with long pharmacy contract and through term conditions. local commissioning, to work with our community pharmacies in Acute needs developing our strategic plan. Many acute needs and self-limiting

Healthy Lifestyles, Make Every conditions are dealt with by Contact Count. community pharmacies daily. However challenges such as Community Pharmacies are well deprivation, lack of patient placed to deliver healthy lifestyle education or confidence, and messages and services to residents habitual use of GP or Urgent Care who would not otherwise consider services mean that this capacity is themselves to be patients. Stop not fully utilised. We need to smoking services, some sexual promote community pharmacy as a health services and NHS first and most appropriate contact Healthchecks are already where possible, and consider commissioned from pharmacies, and services to ensure those on low we must make further efforts to incomes are empowered to use promote these, and to consider local community pharmacy services commissioning for certain elements through medicines rebate schemes of the service, for example or minor ailments services. identifying and monitoring hypertension or alcohol screening and brief interventions.

Pharmacies’ extended opening hours makes many services more accessible for our working population, and the opportunity to

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PracticalNHS Basildon and Brentwood steps Clinical Commissioning towards Group integration 5 year plan

Nick Presmeg holds the joint role of Chief Operating Officer and Director of Integrated Commissioning between the CCG and Essex County

Council, here he outlines his thoughts on the steps we will need to take to deliver this plan.

This plan sets out a clear commitment improving outcomes for the population of Basildon and Brentwood CCG with a core ambition to remove the divide between NHS and Social Care services. This represents a real opportunity to make a difference in the lives of our residents and will ensure we are fully prepared to successfully implement the Care Act and the new provisions it places on both the NHS and Social Care.

We will do this through combining our respective organisational commissioning and planning capacity, using the local Better Care Fund to pool our financial resources to deliver real change and improved services. We are well on the way to making this a reality with ECC and CCG staff already working together on a daily basis, an ECC Director joining the CCG Executive Team and a County Cllr sitting on the B&B CCG Board. I expect this process to continue and accelerate to as we join up our services and integration develops. The plan sets a clear commitment to develop integrated approaches across all our services. When it makes sense, we will do this by working with other CCGs within County-wide partnerships, good examples of this being found in our approach to Learning Disabilities and Children’s Services. Our frail elderly services will be integrated with primary care services and the new Named Accountable Professional Teams will be locally focused. This will allow Social Work and Occupational Therapy practitioners to be fully embedded in the NAPTs and broader networks of professionals. As we develop this approach we will implement single assessment frameworks, pooled health and care personal budgets and joined up health and care referral and support pathways.

The real change we want to deliver through this 5 Year Plan means that we will give most frail and vulnerable members of our community and their Carers much earlier offers of preventative support. Our focus will be on supporting independence through reablement and a service offer that is personalised, giving choice and control with the reassurance of a named person who will be available to help when needed. We will only assess people’s needs in hospital beds as a last resort and will reduce the numbers of people requiring residential and nursing care towards the end of their life.

Within our specialist pathways for Physical Impairment, Learning Disabilities, Mental Health and Sensory Services we will co-locate health and care practitioners, offer joint service pathways and focus on progression, employment and independence. We will continue to expand the use of personal budgets to help people remain in control of their own lives and reduce periods of acute care though integrated early response and crisis support service. For children and young people we will deliver an integrated Children’s Health and Care local offer which offer focuses on early intervention and offering the right care at the right time. This will be supported by much closer working with those services such as education and housing that are essential to improving outcomes for young people and their families.

Whilst improving Safeguarding will remain at the core of what we want to do better, we are also planning improvements in Special Educational Needs, access to Joint Personal Health Budgets, Integrated Child and Adolescent Mental Health Services, Domestic abuse and expanded Family Solutions teams. Two key first steps will be a Public Health 5-19 Healthy Child Programme review and a review of Specialist pathway and long term condition service.

This is an exciting time and I‘m convinced that the strong commitment to collaboration and service integration outlined within this plan, alongside the focus on teams of professionals working together and offering support much earlier, is essential in delivering the improvement21 in health and care outcomes our local population both deserves and expects.

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Aim 2: Named Accountable Professional Teams

What is it? deterioration in an individual’s condition. 3] Improvements in the self reported The Care Coordination Team will be quality of life for people living with long Our second aim is to transform the way funded as an 18 month pilot from mid- term conditions that people with complex needs are 2014, funded through the £5 per head cared for by establishing Named allocation made to our member practices 4] the rate of emergency re-admission Accountable Professional Teams (NAPTs), in-line with the ‘Everyone Counts’ into an acute hospital setting within 90 who will be responsible for ensuring that recommendations. days of an initial admission, for people vulnerable individuals receive the right under the care of the NAPT, will be care, in the right place, at the right time, The Care Coordinator will, in turn, work reduced by 20%, by replacing the complex arrangements with existing health and social care teams which currently exist within our local to deliver required services. From April 5] the rate of admission into long-term health and care system. 2015, the Better Care Fund will be used nursing and residential care for people to jointly commission the relevant health under the NAPT will be reduced by 10% Initially, the NAPTs will work with older and social care services, in order to people living with frailty, and the model deliver the integration of provision will subsequently be offered to all people required to form the Named over 18 years old, who have a long term Accountable Professional Teams. condition or need. It is expected that the NAPTs would first In practice this will mean that each operate as shadow integrated care individual with long-term needs will have organisations with access to a combined a named professional (their ‘Care health and social care budget. Initially Coordinator’) who will work with them to this will be for specific related service agree a Personalised Care Plan, areas, moving to include all relevant specifying the health and social care budgets over time and ultimately services that they will receive in order to towards a formally configured single maintain their independence and well- integrated care organisation, delivered being, and how and when these services under Prime Provider arrangements. will be provided. . Whilst the focus will initially be on older The Care Coordinator will, in turn, be people living with frailty, the aim is that part of a wider team of professionals who eventually everyone with an identified have responsibility for service provision in long term need will have a named ‘Care the core service areas (i.e. physical Coordinator’ working as part of a wider health, mental health, social care) and will NAPT. be responsible for ensuring that the specific elements of care to be offered A specific area under this plan that we are delivered in-line with each Personal intend to review, in conjunction with local Care Plan: Each of these teams will be authority and voluntary sector colleagues led by the individual’s ‘Named GP’, who is re-establishing the role of the ‘home will take responsibility both for the help’ to support people with low level provision of high quality medical input needs in their own homes. and maintaining an over-view on the care being offered to each individual. How will we measure impact?

We will assess impact of the NAPT on the Therefore, the development of Named basis of the following expected Accountable Professional Teams clearly outcomes. aligns with the requirements of the new

GP contract to develop the role of Within 1 year of commencement of the ‘Named GPs’ for the over 75s and also service: supports the development of 7 day working. 1] 100% of people under their care will

have a comprehensive Personal Care

How will we achieve it? Plan, developed in collaboration with the The development of NAPTs will begin individual concerned (and their carer with the commissioning of the Care where appropriate); Coordination Team, consisting of a GP practice-aligned Care Coordinator and 2] 95% of people with a Personal Care Healthcare Assistant (HCA) level staff, Plan report a positive experience of the who will provide close monitoring of care they receive; identified individuals and provide the Care Coordinator, and Named GP with an early warning of any perceived

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

The next 5 years

We plan to undertake the following steps over the next 5 years to achieve this plan, with details being included within the CCGs’ 2 year operational plan:

2014/15 1] Commissioning of an 18 month Care co-ordination Team pilot, focusing on older people living with frailty, utilising the ‘£5 per head funding’, as a precursor to formal establishment of Named Professional Teams

2] Modelling of the Named Professional Team concept as a foundation for the development of fully integrated health and social care provision for people living with frailty, to be commissioned under ‘Prime Provider’ arrangements.

2015/16 3] From April 2015 – Provision of the Named Professional model enhanced by direct alignment of Adult Social Care teams, on a geographical basis, becoming co-terminus with community health service teams and GP practice clusters

4] Procurement of a Prime Provider service for older people living with frailty, consolidating the Named Professional Teams within a unified model of provision.

2016/17 5] Award, and mobilisation, of contract for the management of older people living with frailty via Prime Provider arrangement for providing Named Professional teams

6] Pilot application of the Named Accountable Team model to the care offered to all people over 18 years old, with a long term condition.

2017/18 7] Continued evaluation of delivery (against specified outcomes) by the Prime Provider of care for older people living with frailty, and negotiation of any required variation to contract.

8] Procurement of the Prime Provider model for care of people with a LTC.

2018/19 9] Continued evaluation/monitoring of delivery against specified outcomes for people with frailty and LTCs.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Aim 3: Specialist Pathways of Care

Whilst within this plan we set out an At the core of this plan is the ambition to shift the majority of care increasing adoption of lead provider for people with long term needs to a models, whereby a single primary care footing, we recognise organisation takes responsibility for that people will still need to be able managing entire care pathways and who will be accountable for to access specialist care when they delivering better outcomes for have additional needs that cannot people who receive care under be managed within their Named these pathways. Accountable Professional Team. In addition, across a number of Based on our analysis of current these pathways, notably frailty and health outcomes and the way in learning disabilities we plan to fully which current services are operating integrate services across health and social care to provide for more we have identified a number of holistic care, better outcomes and pathways which we will focus on greater efficiency. over the course of this planning . period. These pathways are:

Frailty Ambulatory Care Cardiology Diabetes Respiratory Cancer Stroke Care Learning Disabilities End of Life Musculoskeletal

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NHS Basildon and Brentwood Clinical Commissioning Group Dr Subrata Basu, one of our Associate 5 year plan Clinical Directors and local GP who focuses on improving stroke care.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Integrated Frailty Programme

What is it? How will we achieve it? How will we measure impact?

Current care services for people who are The programme will be delivered The expectation of this programme is frail living in Basildon and Brentwood are through the design and implementation that we would commission an outcomes often fragmented and complex. Services of a new model of care for frail patients. based model of care. Through are often reactive in nature and not well Critically, the CCG and Essex County consultation with stakeholders we will coordinated across the multiplicity of Council want to commission a model that determine the detail of the outcomes we health and social care providers. This both empowers providers as well as are seeking to achieve. However, they results in an inconsistent experience and increasing their level of accountability for are likely to include; sub optimal outcomes for frail people effective management of patients across and their carers as well as creating a the health and social care system. - Holistic care that enables disproportionate reliance on hospital personalisation services. The Programme will consist of four key components; - Self reported improvements in The Integrated Frailty Programme is a quality of life and client experience key transformation programme to enable 1. Development of the model and their carers us to deliver its strategic objectives and -Service specification development - Independence and an ability to will see us working with Essex County maintain service users in their Council to jointly commission an -Outcomes/Performance Indicator preferred care setting and avoid effective, proactive and integrated health Development periods of crisis. and social care pathway for frail people and their carers. -Service model development - Delivery of a less complex health and social care system that is Central to the pathway is the 2. Scoping of the model straightforward for users/carers and coordination of care centred around professionals to navigate -Line by line review of existing contracts people’s physical, mental and emotional and services to determine whether they - Good quality early diagnosis and needs. This programme would have clear are included in the scope of any intervention for all (including those interface with the Named Accountable procurement programme with dementia and mental health Professional Teams programme. needs) -Understanding the interface between By incorporating provision of mental the frailty pathway and other key - A sustainable and stable care health services within this pathway we pathways such as the accountable system and workforce professional model would seek to provide holistic care for - Supports a proactive preventative patients with complex needs. 3. Market Development approach and self-management

Within this new pathway we will devolve -Working with incumbent and new - Reduction in unplanned care a set of related budgets and activities to providers to understand the admissions and crisis admissions the new pathway provider, including opportunities and challenges with any relevant unplanned care spend at new model and how providers could lead - Reduction in permanent residential hospital, continuing healthcare and social system reform and nursing care admissions care. 4. Consultation with Stakeholders - An integrated model of care that maximises value (quality and cost) Finally, this project directly relates to our -Consultation with users, carers, across the healthcare system. objective to make admissions to nursing providers, advocates and other key and residential care as the very last resort stakeholders on the new model for people needing long term intensive care. A key objective which we want to secure through this work programme is the development of a dementia village to provide higher quality options and better experience for people who need long term care.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

The next 5 years We plan to undertake the following steps over the next 5 years to achieve this plan, with details being included within the CCGs’ 2 year operational plan:

2014/15

1] Model development including the scoping, outcome definition; Key facts about the frailty programme:

2] Market development and consultation

3] Consultation and engagement with >A new health and care frailty service, bringing together existing service users and a wide range of stakeholders commissioned services.

4] Financial modelling

2015/16 >New lead provider contract who will be incentivised to improve 5] Procurement Process outcomes and deliver enhanced levels of efficiency.

6] Contract development of wider service portfolio to support delivery of the Frailty Model >Introduction of new models of care for people who need long

7] Scoping of future dementia services term residential and nursing care, including the establishment of a including the potential for a “dementia village” dementia village.

2016/17

8] Frailty Model goes live >Improving independence, providing early diagnosis and providing 9] Service development/refining much better levels of support to carers and families.

2017/18

10] On-going performance management >We believe that these changes will lead to reductions in 11] Scoping of further admissions to hospital and residential or nursing homes. procurement/model implementation

12] Commissioning of “Dementia Village”

2018/19

13] Second phase of procurement process/model roll out

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Musculoskeletal (MSK)

What is it? How will we achieve it? The next 5 years

We are working in collaboration with Through joint procurement of a new We plan to take the following steps over Thurrock Clinical Commissioning Group community provider, we will work with the next 5 years to achieve this plan, with and Basildon and Thurrock University BTUH to ensure that the model meets details being included within the CCGs’ 2 the needs of local communities. Hospitals NHS Foundation Trust (BTUH) year operational plan: to procure a provider for MSK Development of the service requirements community services to join up pathways, 2014/15 reduce duplication of service and reduce was through engagement and variation in care. consultation with general practice and citizens ensuring that the new service 1] Participate and evaluate the procurement and award of contract to MSK comprises the orthopaedics, reflects local clinician and community rheumatology and pain services and will identified “wants”. new provider be only for patients whose condition is not deemed an emergency or as a result How will we measure impact? 2] Launch new service (1.4.2015) and of trauma, as these will continue to be monitor impact managed by hospital services. There are 1] Reduction in waiting times across two key elements to our work on this affected specialities. 2015/16 pathway: 2] Patient reported outcome measures. 3] Monitor the impact of 2014/15 Community services – a new service model (start April 2015) that will 3] Surgical intervention rates. 4] Develop local network to ensure comprise of a central point for referrals, engagement across all providers with assessing patients, treating and reviewing new model the impact of the services intervention and where required referring them to the 2016/17 secondary care provider of the patient’s choice for ongoing treatment. 5] Monitor and review service model Prescribing – Each component of MSK will be supported by a prescribing 6] Roll out any tools/processes formulary to support clinical decision developed via network making and standardise care across providers. 2017/18

7] Move more acute activity to out of hospital service model

>Integrated pathway for orthopaedics, rheumatology and pain 8] Increase to manage semi-elective care by the community Hub management services.

2018/19

9] Consider and review Hub, and need >Allowing people accessing services to have informed choice about for consultant domiciliary service

the care they receive – reducing unnecessary interventions and 10] Explore feasibility of self-referral to

the Hub and how this would be allowing alternative management. managed and the impact this may have

on capacity, ensuring no impact on referral to treatment time

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Respiratory

What is it? How will we achieve it? The next 5 years

Chronic Obstructive Pulmonary Disease We have established a clinical network We plan to undertake the following steps (COPD) is the second highest condition for respiratory to drive improvements or over the next 5 years to achieve this plan, for unplanned emergency admissions pathway/service development or with details being included within the redesign areas outlined above. The across our local population. CCGs’ 2 year operational plan: network has representatives from each provider locally, the strategic clinical Our Joint Strategic Needs Assessment 2014/15 (2013) identified COPD as having poor network and voluntary sector. patient outcomes, including high non- -Embed the network (established late elective admission rates and high We will engage widely in the 2013) mortality from COPD. development of each pathway to ensure awareness and that it addresses and -Develop COPD and other respiratory In order to drive improvements in COPD meets local needs and it is shared with management the following suite of the CCG localities and Patient and pathways and roll out across providers COPD tools were prioritised and Community Reference Group (PCRG) to for the defined areas developed by the south west Essex maximise potential for co-design and respiratory network: engagement. 2015/16

Exacerbation pathway – putting in place How will we measure impact? -Monitor the impact of 2014/15 pathways for people whose condition pathways gets worse which means that they do not 1] Reduction in unplanned emergency admissions. need to attend hospital. -Monitor impact of GRASP COPD

Patient Passport – self-management plan 2] Reduction in length of stay in the 2016/17 enabling more patients to be acute which should start to reduce with empowered to manage their condition the introduction of the pathways -Shift of pathway into Named on a day to day basis and when in crisis or experiencing an exacerbation of their 3] Increased identification of people with Accountable Professional Teams. COPD with support. COPD through application of the GRASP COPD. -Monitor impact of psychological Nebuliser pathway – ensure that there is therapies a robust system in place for nebuliser 4] Reduction in under 75 mortality rate prescribing, issuing and review of the use from respiratory disease. -Monitor impact of respiratory of nebulisers minimising the unnecessary pulmonary and home oxygen service 5] Improved self-reported quality of life use of long term nebulisers. (service start April 1 2015) for people living with COPD. Early discharge pathway – enable the 2017/18 safe and effective discharge of COPD patients to ensure their length of stay is -Review COPD telemedicine projects optimised and discharge proactively planned. used in the community

Prescribing – Each pathway will be -Implement or review existing community supported by a prescribing pathway or pharmacy projects that support COPD formulary to support clinical decision patients in the community making and standardise care across providers 2018/19

-Consider potential procurement for revised community service model that incorporates all components of non- acute respiratory service function

-Review impact of pathways and services and impact on acute capacity

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Diabetes

What is it? How will we achieve it? The next 5 years

Our Joint Strategic Needs Assessment Thurrock CCG is leading the south west We plan to undertake the following steps (2013) identified diabetes as having poor Essex clinical network for diabetes to over the next 5 years to achieve this plan, patient outcomes: drive improvements or pathway/service with details being included within the development or redesign areas. The CCGs’ 2 year operational plan: – Mortality is high network has representatives from each provider locally, the strategic clinical 2014/15 – High incidence of amputation network and voluntary sector. -Embed the network (established late – Poor prescribing of medication We will engage widely in the development of each pathway to ensure 2013) In addition there is a low use of the 9 awareness and that it addresses and standards of good diabetes care within meets local needs and it is shared with -Develop pathways and roll out across primary care which if adopted would the our localities and Patient and providers for the defined areas improve patient outcomes Community Reference Group (PCRG) to maximise potential for co-design and 2015/16 In order to drive improvements in engagement. diabetes management we have -Review foot service model (include how established a diabetes clinical network How will we measure impact? it works/integrates with vascular service) across south west Essex which is focusing on the following areas: 1] Reduction in unplanned emergency -Review use of technologies, spend and admissions for diabetes related reasons. procurement requirements Prescribing – The medicines management team within the CCG will 2] Reduction in length of stay in hospital. 2016/17 work to ensure that there are prescribing pathways developed to support clinical 3] An increase in the number of people -Pathway shift to Named Accountable decision making and standardise care living with diabetes who receive the 9 Professional Teams across providers standards of good diabetes care in general practice. The review and expansion of the use of -Monitor impact/introduction of insulin pumps and other technologies will psychological therapies 4] Reduction in under 75 mortality rates be explored and developed for cardiovascular disease. -Monitor impact of changes to service Areas where service provision has model concerns or are outliers in delivery will be 5] Self reported quality of life for people reviewed for example gestational living with diabetes. 2017/18 diabetes care, renal diabetic management -Review telemedicine/device and other technologies used in the community Service review and pathway development – the current service model across south west Essex has been in place for 4 years. -Implement or review existing community Part of the work the network will be pharmacy projects that support patients undertaking will be to review this model in the community and identify areas for development or gaps in provision 2018/19

-Review impact of pathways and services and impact on acute capacity

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

End of Life Services

What is it? How will we achieve it? The next 5 years

“One chance to get it right2” outlines the The CCG is working with both its local We plan to undertake the following steps priorities for patients in their last days of hospice providers to develop a service over the next 5 years to achieve this plan, life and this is the basis upon which we model that reflects the public with details being included within the consultation feedback and general have started reviewing the model for end CCGs’ 2 year operational plan: of life care that we commission. practice needs. 2014/15 We are focusing on 3 areas within this Close working with all partners from project: concept to service specification will ensure a model that delivers the -Produce service specification from patient engagement exercise identifying Service redesign - In March 2014 the outcomes we want for our population CCG launched a consultation exercise to priorities for end of life care gather what the public prioritised as To ensure wider engagement in the important for end of life care. The development of the revised service -Work with providers to ensure they can information gathered will inform the model consultation and feedback is deliver the end of life service model that future model of community hospice being sought from with the CCG localities we are commissioning services and Patient and Community Reference Group (PCRG) to optimise engagement -Pilot a single point of access for end of and ensure the service truly delivers the End of life register and planning – using life services CQUINs (Commissioning for Quality and needs of the population. Innovation) incentives for providers to 2015/16 adopt and roll out training, education, How will we measure impact? use of the end of life register and -launch new service model for hospice individual plan of care. This will enable 1] Monitoring of uptake of training – this more patients to be cared for in their will ensure that staff have the skills and services (April 2015) preferred place of care and support them competencies to manage patients at end to die there; whilst ensuring after death of life and will be evidenced via CQUIN -Introduction and roll out of treatment care is accessible for those close to them reporting during 2014/15 escalation plans as an additional part of the patient’s plan of care Prescribing – Working with all providers 2] Monitor patient numbers added to the to develop a formulary for end of life coordinated care end of life register each 2016/17 care that supports clinicians to prescribe year monitored during 2014/15 via anticipatory medicines and works with CQUIN reporting -Monitor and review service model pharmacies to ensure that key medicines 3] Monitor patients achieving their are accessible when needed -Novation of pathway into the frailty preferred place of death – ongoing programme. monitoring via contractual meetings and performance measures for CCG 2017/18

4] Reduction in the use of the continuing healthcare fast-track route for people in -Introduction of outcome indicator set as hospital. the national work is shared

-Work with providers to develop local tariff in line with the national guidance

2018/19

-Adoption of the national tariff (if published)

-Ongoing review and monitoring of services to ensure meeting outcomes required by the CCG

2 One chance to get it right: Leadership Alliance 2014

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Why do we need to change services?

In August 2014 Healthwatch Essex wrote to us with a story of someone’s experience of health services, although this story relates to cancer and end of life care, it dramatically illustrates some of the best and some of the worst of how health and care services operate in our area – the story is reproduced in abridged form here with the full

story being available on the Healthwatch Essex website.

The Accidental Carer would go as far as to describe it But we also met with a few Ann died last year of breast as brutal. There was no situations and people that fell cancer, which had spread to her discussion of possible further short. I had to confront and brain. treatment, and no sensitivity battle with these on Ann’s behalf For 30 years she was my partner, displayed. We felt abandoned, and this caused me a lot of stress guide, refuge and dearest friend. as if we had been tossed over a and mental conflict that I had to For the last year of her life I wall to an unknown and conceal from Ann. cared for her almost full time. I frightening land. It felt as if there The Home Care Service wonder how many other was an invisible wall, and that accidental carers are out there, once crossed there was no The speed and efficiency with unexpectedly thrust into a life communication with or which our home care package total foreign to them and for possibility of a ‘visit’ to the other clicked into place when Ann left which they have no preparation. side – perhaps for alternative the hospice to be at home was After Ann died I decided that I treatment. impressive. There were three would share my experiences in agency carers in particular who Lovely People, Limited Resources the hope of helping other undertook home care visits for ‘family’ carers and possibly Looking back, I have only Ann. They deserve special contributing to improvements in admiration and gratitude for the praise. Ann’s face just lit up the care system itself. great majority of people and when they arrived. Briefly she services who contributed to was almost happy. To see her Our Journey and The Wall Ann’s care; for the commitment like that lifted my sprits too. Ann was first diagnosed with and kindness of NHS community They showed what care truly is. breast cancer just before nurses, and other NHS services In contrast there were two other Christmas 2006. After four years and staff, Ann’s GP and other like care workers who carried out of gruelling treatment and an “all the pharmacist who never let us their tasks as quickly as possible clear” diagnosis at one point we down. Also for the local hospice and left. They did not establish were told in early 2010 that and the lovely people who any real communication with secondary breast cancer had worked there, albeit with limited Ann, and they did not show any spread to her brain. Surgery was resources. Their compassion extra little thoughtfulness that not an option for her and after and care for both and Ann and would add to Ann’s trust and whole brain radiology she was for me as her care shone comfort in their hands. The handed over to Palliative through. Later on, day visits to difference was stark. Medicine. the hospice were one of the small pleasures that Ann The handover to Palliative enjoyed. Medicine was particularly traumatic and badly handled. I

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

The Great Divide Bureaucracy and System Failure with the limited time and energy I had. But my written complaint This leads me on to some of the The process put me under a received no reply until it was too shortcomings which I great deal of stress and pressure, late for Ann. Sadly this was not encountered along the way – rather than relieving it. Towards the only failure of compassion importantly of processes, but the end, I did find a carer from a care agency – the second also within organisations. I support organisation which was occurrence (from another observed a ‘great divide’ able to take up the role of agency) being accompanied by between the NHS and Social advocate to try and get the help some totally unprofessional Services – the two are not joined I was asking for. But the behaviour. up and do not work together. immediate result was a lot of The resulting bureaucratic mire is bureaucracy, which was too Ann was a brave and wonderful extremely difficult to navigate – much for me to deal with at the lady, whose nature was to invite especially for carers who are time: in the end I gave up. warmth and kindness and already under a lot of strain and Carers need respite and support respond to it. Predominantly the do not have the time or energy and I feel there is a failure of people who cared for and to battle with red tape. understanding within the NHS helped her through the last commissioning process. months and days provided this For example, as the warmth and kindness and a high responsibilities of being a full- I also experienced a fundamental degree of professional skill. time carer increase, it’s so flaw in the contractual model There were even some happy important to have some time off. between the NHS and care times on the way. But there Although in my heart I wanted to agencies. It seems to me that were occasions when individuals be with Ann all the time, I the contract between the NHS and systems failed her as a needed some respite. I and the home care services is patient and me as her carer. approached NHS Community exactly that – a contract between They ranged from practical Services about this, and was two organisations that excludes support to a true attitude of care given two nights per week sit-in the third and most important – and compassion, which should care from an agency. But the the end user – the patient. surely be at the top of the list for NHS would not fund any And I found a lack of anyone in a caring profession. daytime respite care as it was not compassion and understanding classed as a clinical need for me, These failures of culture and at the centre of home care or Ann. They suggested I practice need to be addresses agencies. For example, two contact Adult Social Care and changes made for the good months before Ann died, the Services – but I was passed on a of all accidental carers out there home care service decided that merry-go-round from one and their patients. Ann should be put on ‘bed care’. person to another, at one point This meant care workers would returning me to where I had no longer help Ann out of bed, started. for example to use a commode. We were not consulted about this. The decision seemed

abrupt and premature – I was

still able, alone, to get her out of bed. The impact on Ann was devastating. I tried to fight it

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Cardiology

What is it? How will we measure impact?

Through exploring areas of cardiology Atrial Fibrillation (AF) that are impacting on the whole system, 2016/17 the three areas of focus are: 1] Reduction in the number of unplanned emergency admissions for AF. - Shift of pathway into Named Atrial fibrillation – identified as the top priority as one of the top three reasons 2] Reduction in the number of patients Accountable Professional Teams for unplanned admissions to emergency presenting to the emergency department department. There is a need to review with a suspected stroke who have AF - Implementation and management of the pathway for management of AF. undiagnosed. pathways

Direct access diagnostics – to enable Direct Access -Utilisation and review of health care wider access to diagnostics will improve technologies including telehealth for pathway and accuracy of primary care 3] Increase in primary care registers for patient group registers AF and Heart Failure patients 2017/18 Heart Failure – supporting improved case Heart Failure finding, end of life care and reviewing the -Review Rapid access chest pain pathway for patients including supported discharge Increased compliance from primary, service/pathway community and secondary care to the Prescribing – Each area will be supported pathway that is developed, improved -Review consider development of one by a prescribing pathway or formulary to outcomes for end of life patients, wider stop cardiology service model for support clinical decision making and access to out of hospital provision and community standardise care across providers care including more specialist community service provision - Consider use of other technologies for How will we achieve it? example patient management tools e.g. The next 5 years mobile apps The CCG has established a clinical network for cardiology to drive 2018/19 improvements or pathway development We plan to undertake the following steps in the three priority areas outlined above. over the next 5 years to achieve this plan, - Increased use of non-invasive The network has representatives from with details being included within the technologies each provider locally, the strategic clinical CCGs’ 2 year operational plan: network and voluntary sector. - Review model and need for enhanced 2014/15 Ensure wider engagement in the community led service development of each pathway to ensure -Establish network and prioritise awareness and that it addresses and pathways meets local needs and is shared with the CCG localities and Patient and -Develop pathway and roll out across Community Reference Group (PCRG) to maximise potential for co-design and providers for the defined areas engagement. 2015/16

-Monitor the impact of 2014/15 pathways

-Review cardiac rehabilitation model and potential to expand to include heart failure patients

- Review strategies for promoting

primary prevention including smoking cessation, weight loss etc.

-Use of GRASP AF/HF and other case

finding tools used in primary care.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Mental Health 4] Physical and mental health - Mental 7] Increase in number of people using health will become integral to each of the personal health budgets. What is it? specialist pathways, for example, psychology in COPD. Each of these The next 5 years Over the next five years there will be a pathways (stroke, COPD, cancer etc) We plan to undertake the following steps period of transition and mental health have been developed in conjunction with over the next 5 years to achieve this plan, commissioning will become embedded in Mental Health Commissioners. In turn, with details being included within the our changing structures, including the the vast majority of current mental health CCGs’ 2 year operational plan: named accountable professional and services will be integrated into health and frailty programmes. care services during the course of this 2014/15 strategy. Training NHS staff to better identify and Initial steps have been taken to integrate respond to the needs of people with the mental health agenda into the work SMI registers will be audited to ensure mental health needs being done for physical health. There is that people are receiving the correct now a monthly forum for physical and care. All mental health inpatient and mental health Commissioners and community staff to have received Clinical Directors to discuss and devise A shared care protocol is in pilot stage appropriate training in physical health care and the identification of physical work plans. which will lead to more cohesive health needs. management between GPs and

Patient involvement is key and we are secondary care colleagues. Development of the models and working with patient groups to make pathways-in conjunction with patient certain that they are involved in the 5] Integration with Local Authority – we groups, voluntary sector, primary and process of commissioning services and will work with our Local Authority secondary care colleagues. changing pathways. colleagues to provide advice, employment and housing support to Identification of the overlap and gaps in We are working with our Voluntary people with mental health conditions. physical and mental health pathways.

Sector Colleagues to plan and develop a We will also embed prevention and Consultation with the Voluntary Sector strong recovery college which will serve wellbeing pathways into our work. regarding a Recovery College. the South Essex area. 6] Provider and Market Management- Signing up to the Crisis Care Concordat. How will we achieve it? Over the next five years we will see a SMI audit. transition to Payment By Results and Our 5 year plan involves 6 areas of work: tariffs as opposed to block contracts. 2015/16 This will provide an opportunity for Pilot integrated IAPT, Recovery 1] Developing primary mental health care Community Mental Health Teams personal health budgets and market – Our main focus in the next few years is (CMHT) practice based model. testing. Alongside this work we will to improve the Improving Access to assess the viability of core secondary care Recommendations for the future of core Psychological Therapies (IAPT) mental health services. secondary care mental health services programme with a view to increasing published. access and recovery rates. The How will we measure impact? implementation of the recovery college 2016/17 will provide further input for people who 1] Reduction in suicide rates. Mental health services transition into are being looked after in primary care, Frailty and Named Accountable with this work being novating into 2] Increase in life expectancy of people Professional programme.

Named Accountable Professional Teams. on the SMI register. Introduce specified pathway of health prevention work with individuals who 2] Improving crisis care - using the Crisis 3] Increase in recovery rates, especially in suffer from a mental health problem (e.g. IAPT. Care Concordat as a guide to safe, obesity / alcohol). integrated crisis care, we endeavour to 4] Reduction in crisis events and A&E ensure access to care is available twenty 2017/18 attendances, particularly in younger four hours a day. Review of pathways and services. people. 3] Recovery and Secondary care - There 2018/19 5] Improvements in completeness of High proportion of personal health will be a switch to recovery based care dementia registers. budgets amongst people with mental which will involve encouraging, educating health conditions. and supporting people with mental 6] Improvement in Care Programme health conditions to live healthy, fulfilling Approach (CPA) management. and satisfying lives.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Children and Young People increasing confidence within the system Integrated commissioning; to manage these common conditions. These high impact pathways include; We know that no one partner can plan, Ultimately we want children and young commission or deliver services people to be physically healthy,  Head Injury emotionally healthy, resilient, and live independently if we want to deliver high  Febrile Illness safely within their communities. We aim quality care for children and young  Bronchiolitis to enable this by ensuring they and their people in the most cost effective way.  Gastroenteritis families receive quality health care and  Asthma We share the ambition across children’s are clear about what services are agencies in Essex that where it is both available in their area and how to quickly We will continue to work on high impact practical and pragmatic to, we will access the most relevant one at the pathways as indicated by need across the earliest point of need, at the right place commission together for more efficient system and over the next five years are and at the right time. This will be and effective integrated pathways across include; acehieved within the wider context and health and social care and are committed principles that are illustrated in the Essex  ADHD to engage with and develop the Children’s Partnership Effective Support  Allergies governance vehicles that will enable that Windscreen which is a conceptual model  Epilepsy to happen. Of particular focus over the for meeting children and families’ needs next five years will be; whilst ensuring the safeguarding of  Diabetes children and young people is paramount. Maternity  Special Educational Needs Reforms, including: The Effective Support of Children, Young People and Families Guidance supports There is an increase in demand for -Education Health Care Plans all partners, including health practitioners maternity services and work is required -Local Offer working with children and families, to ensure that the maternity health -Joint Commissioning economy at large, as well as individual understand pathways of care and -Personal Health Budgets units is sufficient, safe and ensures support and how the wider children and young people’s systems work together to appropriate activity to reduce risks of  Integrated Child and Adolescent meet their needs and protect them from poor outcomes for mothers and their harm. children. Whilst Maternity is a core NHS Mental Health Services service delivered by acute trusts delivery  Public Health 5-19 Healthy Child occurs in the community and has How we will achieve it Programme review interdependencies with primary,  Domestic abuse community and partnership services so in There are a number of strategies, plans  Family Solutions order to achieve our ambitions a number and initiatives in place across Health of activities incorporated as part of the  Early Intervention services and with our partners such as works that are; Specialist pathway and long term Essex County Council (ECC), Basildon 

District Council (BDC), the third sector, condition service reviews  Maternity Capacity Review (for Public Health and Education aimed at which BBW CCG is lead improving outcomes for children and Safeguarding commissioner for Essex) young people (birth to 18 and 25 years  Transfer of Health Visiting Services for those with special needs). They all to Local Authority Public Health in Safeguarding children is one of the reflect the ambitions of partnership October 2015 highest priorities for Basildon and working better together to deliver better  Local Authority activity such as Brentwood Clinical Commissioning health and social outcomes for children Children’s Centres re- and young people and this will be Group (BB CCG). Underpinning our commissioning achieved through; commitment to support all children to

achieve their full potential we are Service specific developments; Universal and specialist clinical pathways committed to ensuring that the risk of of care; As well as work aimed at reducing neglect, physical, sexual, or emotional unnecessary hospital admissions which harm to all children and young people in We will continue to improve universal will consequently release savings, the BB is minimised and clinical specialist pathways in order system also focuses on increasing the The CCG will work closely together, and, by working closely with our health quality of services for children, young in turn, will work closely with local providers and public health e.g. health people and families. We have a number authorities, LSCBs and SABs, to ensure visiting, sexual health and drug and of examples of these pieces of work: there are effective NHS safeguarding alcohol services. However there are a arrangements across each local health number of specific high impact pathways  Sickle Cell pathway and localization community, whilst at the same time identified within QIPP that by working of services ensuring absolute clarity about the with other partners, for example  Review of psychological support to underlying statutory responsibilities that education, will work towards reducing Children and families of children each commissioner has for the services avoidable demand on the statutory with long term conditions that they commission, together with a health system including GP visits, A&E clear leadership and oversight role. visits and hospital admissions, as well as

36

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Strengthened partnership working; caesarean section. As a result -Continence review mothers experiencing less complex -Maternity Capacity Review Our plans for improving outcomes for and traumatic birth experiences will -Joint planning with Local Authority for Children’s Centres and Health Visiting children and young people will be be less vulnerable to problems with strengthened by better partnership -Representation at partnerships breast feeding, post natal working not only across the health -Design Integrated Paediatric Vision, depression and attachment all of system but with our statutory partners in Strategy and Plan 2015 - 2020 which enable children get the best education and social care and with physical, emotional and social start Basildon and Brentwood Borough 2015/16 Councils, the police and local voluntary in life. -Implementation of Integrated Paediatric and community sector organisations. Strategy & Plan for 2015 These partnerships include;  Numbers of calls made to Essex -Implementation of re-commissioned

Initial Response Team, Early Help CAMHS  South Essex Paediatric Engagement Hub and CAMHS Doorway will -Implementation of EHC Plans and Group measure the success of providing Personal Health Budgets  Patient Engagement Group -Review High Impact Pathways information and advice early to  Basildon and Brentwood local -Sickle Cell implementation enable children, young people and Health and Well-Bing Boards -Continence review implementation their families the right services at  Basildon and Brentwood – South -Maternity capacity implementation the right time and place as well as -NHS Commitment to Carers West Children’s Partnership Board ensure proactive safeguarding and implementation  South Essex Stay Safe Group (Local building resilience in families; Safeguarding Board) 2016/17 and beyond  Basildon Local Strategic Partnership  Nos. of child protection and Implementation and review of Paediatric Strategy & Vision that will incorporate all children in need cases open and Measuring Impact activity within the 5 year plan. closed by Essex Social Care, as well

as length of time open will indicate The impact of our plans will be indicated by a number and range of quantitative the children and young people are and qualitative measures related being sufficiently safeguarded from specifically to each actions within the physical, emotional and domestic Paediatric Strategy and Plans and abuse; ultimately by the evidence that outcomes have health outcomes have improved for  Nos. of Education and Health Care children and young people and Plans will indicate the numbers of efficiencies within the system realised, relating to but not exclusively; children receiving holistic needs- led, better co-ordinated care that  GPs visits, A&E visits, hospital will ensure maximum opportunities admissions and referrals to for building resilience as well as pathways will measure the success ensuring effective integrated of High Impact Pathways’ commissioning with our partners implementation and the ability for and achieving the efficiencies to be children and young people to had from the process. develop the resilience to managing their conditions effectively whilst The wider impacts of successful delivery protecting their physical health. of these plans will support the educational, social and economic needs  As a result of the maternity capacity of children, young people and families review we expect to reduce the with co-relations with measures such as number of complex births, in for example school attendance and particular those in relation to educational achievement. women with high pre-existing medical conditions and/or those The Next 5 Years brought about during pregnancy as a result for example of high BMI. 2014/15 This will reduce need for complex, -Re-commissioning of CAMHS costly coordinated care between -Special Educational Needs Reform Implementation acute and community services, as -Named High Impact Pathways well as the need for medical -Sickle Cell implementation interventions during birth e.g.

37

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Learning disabilities • Specialist learning disability health service and support that avoids and social care services are not people being placed in intensive Adults with Learning Disabilities working effectively together and service models. people experience a fragmented Our aim is to enable adults with learning care pathway • The programme is focussed on 5 disabilities to lead ordinary lives with the main areas: same life expectations, opportunities and • There is an over reliance on service • Enhanced Operational Capacity outcomes as other citizens. This involves models that contribute to having the same expectations with dependency (residential and day • Challenging Behaviour regard to housing and employment, the care) same opportunities to participate fully in • Housing • There is a deficit in available their local communities; and the same housing, particularly specialist access to mainstream public services, • Family Carers housing in the Basildon area. including health services, as their non- disabled peers. • Employment • Carers are not being supported to plan for the future resulting in too The number of people with learning How will we do it? many emergency placements being disabilities: made A Modern Model of Integration – It is estimated that there are 4,629 adults Learning Disabilities • There are not enough adults with with leaning disabilities living in the learning disabilities in employment Basildon and Brentwood area, and that The Michael Report: Healthcare for All 835 will have moderate or severe (2008) and the Mencap report: 74 Lives • The estimated increase in costs for learning disabilities (the group most likely and Counting (2012) provide clear social care services alone is to need specialist health or social care evidence that people with a learning estimated to be £27 million by services). In 2013/14 there were 614 disability have unequal access to health March 2017 as a result of adults with learning disabilities receiving services and are often at risk through demographic pressures. failures to make reasonable adjustments social care services and in 2011/12 there to meet their needs. were 1,391 adults registered with GP Increasing Independence is a 3 year practices. programme of work to transform The impact of these greater health needs learning disability services. and unequal access to general health The impact of demography: services is that people with a learning Its aims are to: The number of adults with learning disability are likely to die prematurely. The recently published Confidential disabilities receiving on-going care • Ensure services promote Inquiry into Premature Deaths of People services has increased by an average of independence rather than create with a Learning Disability: 2013 2.8% per annum since 2011. There has dependence. also been an increase in the prevalence (University of Bristol; Improving Health of people with complex needs and • Support people with behaviours and Lives Learning Disability Public behaviours that challenge and as a result seen as challenging to move from Health Observatory) identifies from the the numbers receiving intensive services hospital to community based cohort they studied that men with has increased by an average of 5.2% per settings . learning disabilities died on average 13 annum. years sooner than men in the general • Reduce the numbers of people in population; and women with learning The need for change: residential care disabilities died 20 years sooner than women in the general population. • People with learning disabilities • Support people to progress to less Overall, 22% were under the age of 50 continue to experience health intensive forms of community when they died; 43% of the deaths inequalities, reduced life based support. investigated were identified as expectancy, and poor access to ‘unexpected’ and 42% ‘premature’ whilst • Ensure the numbers of people in health services. fewer deaths of people with learning employment matches “best in class” disabilities (38%) were reported to the • Too many adults with learning authorities. coroner compared with the general disabilities are living in hospitals population (46%). because their behaviours are seen • Manage demand on the system through a systematic programme of as challenging The view is that an integrated health and progression and move on activities social care team is best placed to take and by developing a range of responsibility for the end-to-end health

38

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan and social care experiences of people • The proportion of people who use • Integrated Pan Essex Health and with LD. This will support an services who say that those services Social Care strategy agreed. improvement in safeguarding and have made them feel safe and access to services, enhancing the secure. • Create additional operational experiences and outcomes from both capacity to deliver the “Increasing health and social care. • Compliance with safeguarding Independence” programme processes. Measuring impact: 2015/16 Independence , Choice and Control: The impact of our plans will be indicated • Pan Essex Integrated by a number and range of quantitative • The number of people that have Commissioning arrangements in and qualitative measures and ultimately moved on from residential care. place including pooled budget & by the evidence that health outcomes Integrated Commissioning Team. • The number of people that have have improved for adults with learning become more independent and less • Integrated pathways for all cohorts disabilities. These include: reliant on services. specified. Health: • The number of admissions to • Integrated operational service • The number of people with Health registered care that have been specification developed for Action Plans in place. avoided. specialist health and social care teams and new contracts • The number of admissions into • The number of people receiving a developed. Assessment and Treatment units cash payment (either via a social and secure services care or health personal budget). • On going implementation of the “Increasing Independence” • The number of people in • The number of adults with learning programme. Assessment and Treatment units 3 disabilities in employment. months after being assessed as 2016/17 The next 5 years ready for discharge. • Implement new integrated health 2014/15 • All people currently “stuck” in In- and social care contracts. Patient services will have moved to • Agree approach to Integrated • Reduction in number of Assessment community based services. Commissioning Arrangements with and Treatment beds achieved Essex, Southend and Thurrock Housing: across Essex diverting investment to community based services. • Implement strategy for people with • The number of people with learning behaviours that challenge and disabilities supported to live in their • On going implementation of the complete the moves from in-patient own homes. “Increasing Independence” services to community services for programme. Carers: those people identified in the Winterbourne programme. • Carer reported quality of life (as reported in the bi-ennial Carers • Complete an analysis of the Survey) specialist health provision in South Essex to understand costs & activity • Proportion of carers who report for each CCG area. that they have been included or consulted in discussion about the • Agreements in place with Southend person they care for life (as and Thurrock about services that reported in the bi-ennial Carers will be commissioned in partnership Survey) and services that will be commissioned locally. Feeling Safe: • Ensure the same health • The proportion of people who use interventions and services are services who feel safe accessible to people with learning disabilities that are available to any other citizen within Essex.

39

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Cancer How will we achieve it? 2014/15:

1] audit pathways for patients diagnosed -Work with Providers to review inter trust What is it? with cancer transfer policy

The JSNA has identified Cancer as being 2] undertake feedback from patient -Undertake root cause analysis to identify one of its five clinical priorities. Whilst our groups to improve services causes and issues for delays CCG wide cancer survival in under 75’s is 3] review and analyse the outcome of above England, the CCG aspires to -Undertake analysis of mortality rates, achieve the best of European survival patient experience survey to drive improvements survival rates, suspected cancer referrals rates. and screenings. 4] review pathways with providers The key issues for the CCG are: -Undertake GP audits 5] undertake on-going RCA analysis and Screening review Trust audits -Review and audit of emergency presentations We are an outlier for breast screening, 6] review one year survival data and with there being a wide variation across undertake audit of primary care -Provide support and education to our communities for cervical and bowel Primary Care screening. 7] undertake GP audit to identify key issues and enable us to develop a -Develop E Referral system to improve program of work to improve outcomes Community quality of 2WW referrals 8] undertake review of referrals process 2Week Wait referrals – wide variation in to improve quality of referrals 2015/16 Practices 9] Raising GP awareness of symptoms to -Develop and implement program of 8.42% of all cancers ( January 2014 to promote prompt referrals work following GP audits May 2014 ) presented via emergency routes 10] support GPs with decision making -Review specific pathways tools to enable appropriate referrals Secondary Care -Review and undertake demand and How will we measure impact? capacity modelling * Performance - significant proportion of patients are not receiving treatment The CCG has committed, through the 2 -Review and trial new future models of year Operational Plan to reduce the within 62 days cancer care under 75 mortality rate from Cancer. * Patient voice data suggesting 2016/17: considerable dissatisfaction with local We will use 1 year and 5 year survival secondary care services survey. rates and also supplement with local -Implement future cancer service models standards: of care Our focus is on: *By April 2016, 90% of GP Practices are -Develop evaluation framework for future 1] Detecting cancer early in primary care within the best practice range for - their service model and reducing waiting times to full ratio for 2WW referrals and positivity diagnosis and definitive treatment. ratios -Review and benchmark survival rates, 2WW and screenings 2] Delivering fast, effective treatment and *By April 2016, no population group will care, to ensure all people have access to be a statistical outlier in terms of -Repeat GP audit to complete audit cycle services that maintain good health and screening coverage for all screening independence. programmes. 2017/18:

3] Improving outcomes The next 5 years -Review specific pathways

We want less people to die from cancer, We plan to undertake the following steps -Evaluate future model more people surviving after receiving over the next 5 years to achieve this plan, 2018/19: treatment and more people taking up with details being included within the our the offer of cancer screenings. 2 year operational plan: -Review specific pathways

40

NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Stroke 3] Improve access to stroke unit and -Reduce usage of unnecessary anti- treatment to save lives psychotic drugs What is it? 4] Provide care and support to stroke

Stroke is an acute neurological disease survivors to adjust to life after stroke 2015/16: that is caused by cerebral ischemia, 5] Improve training and awareness for cerebral infarction, or cerebral staff in care homes -Undertake GP Audit haemorrhage and may lead to permanent disability. Stroke is a 6] Ensure intense rehabilitation and -Improve case finding for Hypertension preventable and treatable disease. The community support is provided JSNA identified stroke as being one of -Reduce usage of unnecessary anti- immediately after stroke the key clinical priority areas for the CCG. psychotic drugs For our population we want : 7] Improve access and provision for -Undertake patient interviews emotional and psychological support 1] People of all ages to have the lowest -Implement training program for staff in possible risk of having a stroke, and 8] Improve services working together care homes where stroke occurs to have the best across all aspects of care pathways chance of surviving and returning to -Deliver Primary Care education independence quickly 9] Reduce readmission and compliance to treatment through psychotherapy -Undertake a consultation on the future 2] Improved standards of stroke care provision of hospital acute care. resulting in fewer deaths and lower levels How will we measure impact? of disability -Develop process and outcomes We will use clinical benchmark indicators, evaluation 3] Better detection and management of mortality rates, incidence rate and risk factors with lower incidence of stroke improvements in the level of disability to 2016/17: measure success. In addition we will 4] Greater public awareness about stroke develop an evaluation framework to -Reduce usage of unnecessary anti- leading to faster attendance to stroke assess the impact of our work. psychotic drugs unit / A&E attendance to stroke unit diagnosis and treatment The next 5 years -Implement training program for staff in care homes We will focus our efforts and work on We plan to undertake the following steps preventing stroke (identifying those at over the next 5 years to achieve this plan, -Undertake evaluation risk of stroke and providing care to with details being included within the minimise risk ); detecting stroke quickly; CCGs’ 2 year operational plan: -Improve case finding for Hypertension diagnose and provide fast and effective treatment of care; supporting life after 2014/15: -Develop future service models for stroke; improving long term recovery and HASU/ASU reducing long term disability; focus on -Improve case finding for hypertension early rehabilitation to promote early 2017/18: -Review stroke pathways improvement; improve training and -Reduce usage of unnecessary anti- awareness for staff, patients and carers -Review clinical psychological service psychotic drugs provision How will we achieve it? -Implement training program for staff in -Develop patient questionnaire and care homes 1] Raise awareness of risk factors, signs of undertake interviews stroke, and promoting healthy lifestyles - Implement new service model -Develop patient handbook 2] Early detection and management of 2018/19: risk factors like hypertension and -Implement training education program hypercholesterolemia and metabolic for staff in care homes -Implement training program for staff in syndrome care homes -Undertake baseline analysis and develop KPI’s -Evaluate new service model HASU/ASU

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan Resources, outcomes and enabling activities

In this section of our strategy we outline some of the challenges that we believe this strategy will help resolve. Firstly, we outline the financial challenge we face as an organisation and how we plan to use our resources differently and more efficiently.

Secondly, we outline the outcomes and measures by which we will measure whether this strategy is successful and that we will use as an organisation to help guide the decisions we make.

Finally we discuss some of the changes to system structure and the sustainability of clinical pathways and current organisations that we believe are likely to be required to deliver the strategy and our target outcome measures.

We also discuss some of the enabling activities that are required in order to deliver this strategy, including impact on premises and technology, how we will seek to engage our local communities and the organisation development challenges we face.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

43

Ricky Gill, Commissioning Manager, who focuses on unplanned care and cancer NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Resources and Outcomes

This plan sets out the clinical programme Delivering financial sustainability • Demographic growth areas which we will use to drive forward • Non demographic growth - this The national position on the financial the delivery of our commissioning covers the increase in demand on challenges facing the NHS in the next five agenda. Each portfolio has a number of services that are disease/prevalence QIPP schemes in place or under to 10 years have been well documented. driven. A 10% uplift has been development. The CCG currently has the The system has moved from a period of applied to Continuing Healthcare following groups: regular high growth to a period of costs to reflect the aging population minimal growth. This has presented and the increasing cost of care  Planned care significant financial challenges as it is packages  Unplanned care coupled with the impact of an aging  Quality • The national assumptions are the population who are living longer, with a  Children’s Services basis for all inflation and business greater burden of disease, with new  Mental Health rules technologies and drugs adding to the  Medicines management increasing costs of healthcare. Our ‘do nothing’ challenge is shown in The table overleaf shows the summary of the table overleaf with the likely case The high level modelling undertaken the CCGs’ Financial Plan which scenario giving a ‘do nothing ‘ gap suggested that the NHS is facing a £15- demonstrates that the CCG is planning to between demand and resources of £74.1 20bn shortfall in funding which needs to achieve a 1% surplus in all financial years million by 2018/19. be addressed in any sort of service of the planning cycle. The plan has been developed using the agreed national change. In order to address the sustainability of planning assumption and a number of the health economy and the CCG in It is clear from the level of saving local assumptions reflecting the expected particular there is a requirement to required that there is no scope to carry changes in population, technology and deliver sustainable recurrent QIPP on with the same kind of NHS services. It drug changes and the impact of the programmes in conjunction with provider will be the responsibility of Clinical CCG’s QIPP programme. organisations. Commissioning Groups as the clinical leaders of the new system to ensure that In 2014-15 we are planning a QIPP QIPP is our day to day business and the there is significant transformation of the programme of £10.009m in order to basis on which we make decisions. Our NHS to ensure it can deliver the required achieve the required level of surplus. The aim is to develop integrated level of healthcare to patients going plan has been developed over a number commissioning in partnership with the forward. of months and subject to robust Local Authority and community health challenge and risk assessment. The CCG care. This will be achieved by: In June 2013 the Spending round used a number of benchmarking tools to announced £3.8bn of funding to ensure identify potential QIPP including the  Integrating operationally existing closer integration between health and commissioning for value tool and health and social care teams under social care. This is described as ”a single information. The majority of this plan has the leadership of GPs through our pooled budget for health and social care been negotiated into our contracts for Named Accountable Professional services to work more closely together in this financial year. The QIPP plan for Teams programme. local areas, based on a plan agreed 2015-6 is £7.6m and includes the 10%  Transforming the way we between the NHS and local authorities”. reduction in running costs. commission services, including This is now called the Better Care Fund exploring opportunities for co- (BCF). The BCF comes into full effect in In 2014-15 and 2015-16 the CCG will commissioning of primary care 2015-16 but plans need to be in place by have 2.5% and 1% non-recurrent monies services with NHSE and lead March 2014. available for transformation projects to provider models support the delivery of the 5 year  Building the infrastructure in In order to assess the financial challenge strategy. This non recurrent resource will primary care and the community to for the CCG a ‘do nothing’ model has also be used to support provider manage our population been developed. This takes the current organisations as they make the necessary  Developing specialist pathways recurrent budget position and the likely structural changes to enable them to  Targeting resource at those patients forecast outturn for 2013/14. To this support the revised ways of working who need it most position a number of assumptions have required to deliver a strong integrated  In reviewing data and risk stratifying been applied: service and to achieve financial in partnership we are increasing sustainability. • Inflation and efficiency on tariff responsibility for case management

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

The CCG has also provided a 0.5% contingency in each year. This will be used to address any potential financial risks as they arise in year.

The CCG has made significant progress in 2013-4 to improve financial stability and planning. The plan developed reflects this and the confidence of the CCG in future delivery.

Financial Position

Revenue Resource Limit

£ 000 2013/14 2014/15 2015/16 2016/17 2017/18 2018/19

Recurrent 306,129 312,540 321,955 327,559 332,947 338,427

Non-Recurrent 2,919 286 3,129 3,500 4,047 4,442

Total 309,048 312,826 325,084 331,059 336,994 342,869

Income and Expenditure

Acute 173,701 173,721 171,671 168,772 173,666 178,702

Mental Health 30,592 30,163 27,445 27,444 27,691 27,939

Community 38,538 36,397 36,106 36,106 36,432 36,760

Continuing Care 12,629 13,891 15,280 16,808 17,396 18,005

Primary Care 38,572 40,353 39,391 41,361 43,635 45,259

Other Programme 8,337 7,211 24,322 29,118 26,303 23,501

Total Programme Costs 302,369 301,736 314,215 319,609 325,123 330,166

Running Costs 6,390 6,387 5,743 5,743 5,743 5,743

Contingency - 1,574 1,626 1,660 1,686 1,722

Total Costs 308,759 309,697 321,584 327,012 332,552 337,631

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Targeted outcome improvement People have the right to good No-one should be harmed:

To align the way we manage our experience: organisation and assess progress against delivering our strategy we Improved Reduction in the have identified a set of outcome metrics against which we will assess experience of number of our progress. health and care incidents that lead Although these are our key metrics, there are other ways we measure services to harm our performance which can be found throughout this plan.

Adding years to life - reducing Better quality of life: premature mortality: Reduction in the Improved quality under 75 mortality of life for people rate from cancer, living with long respiratory and term conditions in cardiac disease Basildon

Nursing and residential care as Children should be safe: Equality for all: the last resort: Reduction in the Number of child Number of people number of protection cases with a learning admissions to opened and disability with a nursing/residential closed, and length health check and care of time open. health action plan

Measures for Outcome 1: Measures for Outcome 2: Reduce avoidable harm, improve individual Consistently deliver the standards as set out outcomes and improve experience within in the NHS Constitution local health and care services

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Reducing waiting times for Reducing waiting times in A&E: Reducing waiting times for elective surgery: cancer diagnosis and treatment

Delivery of the 4 18 week standard Delivery of 2week, hour standard, at speciality level 31 and 62 day absolute reduction and across all cancer standards. in people waiting services. 4+ hours in A&E

Improving access to Leadership Our people psychological therapies:

Clear and visible Our people think Delivery of the 15% officer and clinical the CCG is a great access rate for leadership place to work and psychological be developed in. therapies.

System financial balance: Transformation funding: Delivery

Overall financial Creation of £13m We deliver on our balance of health of non-recurrent plans and and care economy transformation intentions. funding

Measures for Outcome 3: Measures for Outcome 4: An organisation of leaders who have the A financially robust health and care necessary skills, capacity and capability to economy which has the necessary resource lead positive change for the people we to deliver our vision to transform outcomes serve

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

System structure and sustainability To achieve our objectives providers will:

The commissioner perspective 1] Work collaboratively across populations within Lead Provider (or Through QIPP and other programmes similar) models. we have achieved efficiency of £10m in 2014/15 and has a further challenge of 2] Will have increased their service £64m to be delivered over the next 5 capacity through sharing administrative years. ECC through its transformation and managerial costs and where it is programme has identified savings of sensible to do so, will have merged £195m leaving a further challenge of commercially. £42m to be delivered by 2016/17”. We share the national ambition to address Alongside these changes, we recognise this challenge through deeper that hospital services face significant integration with social care and have financial and quality pressures in the jointly committed with ECC to a BCF of future which will only partially be solved £22m. However, given the characteristics through the steps outlined within this of our population, the requirements of plan, as such we are committed to an the Care Act, the overall growth in Essex wide review of the current demand that both we jointly face with configuration of hospital services in Essex the local authority and the likelihood that and the development of options to the ‘austerity challenge’ placed on all improve the quality, safety and financial public bodies will continue; QIPP viability of the hospital sector in Essex, programmes supported by deeper this work will be in partnership with CCGs integration with social care will not in across Essex and hospital trusts. itself be enough to achieve system sustainability. A more fundamental transformation is needed.

The commissioning intentions that will be developed to support the delivery of this plan will realign our contractual and procurement timelines. This will allow us to jointly deploy CCG and ECC resources against our shared outcomes and provide the opportunities for providers to develop holistic and person centred pathways of care and new collaborative commercial arrangements that release resources.

The provider and wider system impact of this plan

We recognise that providers are often in the best position to develop solutions, but that to do so need clear priorities and freedom to innovate. In each of 3 aims within this plan Excellent Primary Care, Named Accountable Professional Teams and Specialist Pathways of Care, we are providing early indication of our priorities and signalling the need for close collaboration with and between providers as being the key ingredient in delivering successful outcomes.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Delivering the NHS Constitution

During 2013/14 the health and care system largely achieved the performance standards as set out in the NHS Constitution, however we continue to experience pressures on a daily basis across both planned and unplanned care.

We have co-ordinated a number of system wide events over the course of the past year to understand the challenges we face and some of the solutions, the challenges we identified were:

-Growing demand on the urgent care system.

-Access to care and support over 7 days.

-Poor coordination/understanding of daily pressures across the system.

-Patient flow through the system (including discharge arrangements from hospital).

-Making the best use of resources (particularly in the community).

-Risk stratification of patients and service users to help us plan services appropriately.

This plan set out some of the long term steps we will take to help address a number of these challenges but we recognise that action has to be taken in the short term to ensure we maintain and deliver the access standards to our local communities.

These issues and the actions we are taking in the immediate term are set out in our Operational Resilience and Capacity Plan which is available on our website.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Core enablers joined up services within shared Co-designing and involving local procurements. As an early step in communities in how we develop Building the foundations for developing the organisational services governance and assurance we will integrated and collaborative require, the CCG has provided a commissioning In developing this strategy the CCG position on its Board to an ECC has used a number of mechanisms County Councillor. Through collaborative to ensure that the key aims and commissioning processes the We understand that as CCT it will be objectives as outlined within this overarching ambition is to integrate expediting obligations and statutory plan are in line with the views of our the delivery of care, health and responsibilities on behalf of us, ECC local communities. wellbeing services in a way that and NHS England for which final embeds our outcomes and builds liability is non-delegable. We took early iterations of this system resilience and long-term Consequently, the CCT will be collaboration. document and our aspirations to our accountable to those bodies line Patient and Community Reference within agreed schemes of delegation In our first year we have deepened Group and we have held focus and structures of reporting. our integrated working with ECC groups with both member of our

Social Care Services and have We foresee the functions held within Patient and Community Reference appointed the Council’s Integrated the CCT being overseen by a new Group and our Patient Leaders on Director for Vulnerable People to governance arrangement which will each of the 3 aims as outlined within joint position as Chief Operating take the form of a Joint Board that Officer of the CCG. The integrated this plan. will be accountable to both ECC and Director has bought a team of our Board. This Board would invite commissioners that now work As we move into the more detailed representation from both Basildon alongside CCG colleagues and is the development and implementation of and Brentwood Councils. Our first step in joining up our respective these plans we will continue to use intention is to establish a shadow organisation’s planning and joint board that will oversee the these existing mechanisms of commissioning capacity. Our development of arrangements and engagement and involvement to integrated work has prioritised frailty the transfer of functions into the ensure that the services that we and the transformation of CCT from June 2016. commission reflect the needs and community services and through the

Better Care Fund we have joined up views of our local communities and As a Member organisation we our financial resources to we will also seek to engage more understand and acknowledges both collaboratively commission health broadly, using new techniques to its own and its partners’ and care solutions built around the organisational responsibilities and help us engage with communities needs of people rather than that often, to meet our aims and which we want to make the biggest organisations. objectives, we will have to work difference to – which are often those

within a broader collaborative We believe that to achieve this we which are most difficult for environment. We do not foresee need to deepen our integrated communities to engage with. the journey to establishing a CCT as arrangements with ECC and put in a one way transfer of delegations to place the building blocks for an Alongside our own engagement and the CCT and (in relation to organisation that has the technical involvement processes we will commissioning for some aspects of capacity, governance arrangements continue to engage regularly and Children’s and LD services) fully and political consent to hold the expect a similar transfer of freely share information with delegated authority that would allow arrangements from CCGs to ECC to Healthwatch Essex on our plans and it to become the Clinical Health, take place. To achieve this ambition developments, giving them the Care and Wellbeing Commissioner we are fully committed to for the population of Basildon and opportunity to identify concerns and embedding and developing the role Brentwood. things we’ve missed in our thinking of the Essex Health & Wellbeing from their own research and Board and the programme will Our ambition is to have achieved oversee as a lynchpin of system and intelligence. Commissioning Care Trust (CCT) inter organisational governance. status by September 2016 and over the next two years we will look to expand integrated appointments, pooled funding arrangements and

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Brentwood Community Hospital

Technology and premises

We recognise that having the priority given to those with the most Options include redeveloping, existing appropriate infrastructure, both in terms immediate population growth, time- practice/s, relocation to a new site or a of premises and technology, is a critical bound development opportunities new standalone practice. For either element in the provision of high quality and/or urgency of remedial need: option, assumption is that a minimum of services. further c500msq of primary care estate Basildon west (Laindon): would be required. It is proposed that Premises time bound development, linked to BBCCG works closely with NELFT Over the next five years the CCG, in redevelopment of the adjacent shopping community provider to explore shared collaboration with NHS England, NHS centre. options in this area given that they Property Services and our member already have a number of sites in the practices, will work to ensure that the Pitsea: neighbourhood, some underused. primary care estate within our locality is Population growth of c. 15,000 will fit for purpose. In response to the local probably necessitate the development of Brentwood: area plan, NHS Property Services new primary care premises. The Dipple There are three main geographic zones (NHSPS) have confirmed that in the Medical Centre is in urgent need of within the emergent primary care Basildon district there is currently a GP replacement and may provide a suitable network; includes continued work on practice floor space and funding deficit brown field development; there are also filling the void space in Brentwood of -3,464m2 and £8,725,160, opportunities to explore shared Community Hospital, which could respectively, associated with the capital redevelopment on other local sites with provide services to support the emerging cost required to bring existing floor Basildon Council. practice network in this area. Hutton space provision up to a standard suitable Clinic and four of the six Highwood to manage natural population growth. Wickford: bungalows have been declared surplus NHS PS also calculate that population Potential for 3,000 new residents (c1,200 to CCG requirements. Work is underway arising from the proposed growth set out new dwellings at an estimated occupancy with NHS Property Services to facilitate in the draft local plan (possibly c25,000 of 2.5) in addition to the Runwell the disposal of the property. new residents in the Basildon and development (already underway), which Billericay areas over the next 2-5 years) although is geographically in Mid Essex, Billericay: would require additional development patients may choose to register in Up to 5,500 new dwellings are proposed, funding of £3,252,000.3 Wickford. Additional capacity may however, Basildon Council have advised require redevelopment of existing that this scale of development is unlikely In addition there are currently a number premises, or progressing proposals for a to be reached within the next five years. of practice premises in poor condition new Wickford Health Centre to include It is proposed that practices deliver and in urgent need of replacement or expansion. Capacity may also be services under the auspices of the refurbishment. created or found within existing GP emerging GP networks. Therefore, the local challenge in relation practices, depending on the scale/location of the population growth to premises is significant. and housing developments.

To address premises capacity issues BBCCG is working with the Essex Basildon central: Strategic Partnership Board to identify Developments are proposed to a and prioritise a number of estate maximum of c3,350 dwellings, est c8,500 developments for primary care. We will new residents which would require focus on six geographic zones, with additional capacity and premises.

3 Source: NHS Property Services

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Technology providers with making necessary Organisation and system leadership Improving the coordination and adjustments in their use of integration of service provision is at information systems. We will be refreshing our the heart of the local health and Organisation and System Leadership social care systems quality and We will also seek to support our Development Plan in early 2015 in sustainability plans. The member practices to introduce web- response to this strategy and to development of common based information systems. These reflect on how well the existing plan information and data systems, systems will allow patients to easily shared between all key provider access information about available has worked and to identify how it organisations, will be essential in services, find advice on self-care and can be strengthened further. Our achieving this goal. the most appropriate service to current Organisational Development access for a range of common Plan can be found on our website. Equally, we intend to take full complaints, and access virtual advantage of all opportunities that professional assessment and advice The diagram on this page outlines technology can offer in improving in a safe and effective manner. our approach to development and patient access whilst also reducing how we support both CCG clinicians demand in GP surgeries, by Finally, in order to explore the and officers to develop within the supporting our population to more opportunities for the use of readily access information and self- CCG and take on new challenges so technology to help people stay at care advice, as well as improving that they are appropriately equipped home, we will explore with our their ability to engage with health and developed to deliver our partners the opportunity to secure a care professionals without the need strategy. for face-to-face consultations. technology partner who can work with us both on improving our data In order to support the development informatics capability and the of integrated information and data greater use of technology to help systems between local providers we will ensure that the ability to share people stay at home for longer information with existing systems electronically is an explicit requirement when commissioni ng new services, or re- commissioni ng existing services. It is recognised that this is likely to represent a cost pressure for providers, and we will consider including a ‘technology premium’ in relevant future contracts in order to support

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

Glossary

2WW Two Week Wait

ACORN Segments Used for population segment analysis

AF Atrial Fibrillation

BBCCG Basildon & Brentwood Clinical Commissioning Group

BCF Better Care Fund

BDC Basildon District Council

BTUH Basildon & Thurrock University Hospital

CAMHS Child & Adolescent Mental Health Services

CCG Clinical Commissioning Group

CCT Commissioning Care Trust

CEG Clinical Executive Group

CMHT Community Mental Health Team

Concordat Agreement/Contract

COPD Chronic Obstructive Pulmonary Disease

CPA Care Programme Approach

CQC Care Quality Commission

CQUINS Commissioning for Quality & Innovation

DES Direct Enhanced Service

ECC Essex County Council

Episodic Care Care for a patient with an irregular (unexpected) period of illness

Formulary A reference book containing a list of pharmaceutical products with details of their use, preparation, properties, and formulas

GRASP AF/HF GRASP-AF is an audit tool that assists GPs to study their clinical data enabling them to improve the management and care of patients with atrial fibrillation and to reduce their risk of stroke through appropriate intervention with anticoagulation. The tool also assists with case-finding activity, helping GPs to establish more accurate prevalence rates within the practice population. GRASP-HF is an audit tool as above but relevant to the management and care of patients with heart failure (HF) with left ventricular systolic dysfunction (LVSD).

H&WB Health & Wellbeing

HCA Health Care Assistant

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

HEE Health Education England

HF Heart failure

IAPT Programme Includes Access to Psychological Therapies

JSNA Joint Strategic Needs Analysis

KPIs Key Performance Indicators

LD Learning Disability

LTC Long Term Conditions

MSK Musculoskeletal

NAPT Named Accountable Professional Team

NELFT North East London Foundation Trust

NHS PS NHS Property Services

NHSE NHS England

Outliers Outside the usual parameters

Payment by Results Paid according to performance as opposed to a block contract

PCRG Patient & Community Reference Group

QIPP Quality, Innovation, Productivity & Prevention

RCA Root Cause Analysis

Recovery College/s Offer courses to increase your knowledge and skills about recovery & self-management of your mental health

SMI (Register/Audit) Standard Mortality Indicator

SSNAP Performance Sentinel Stroke National Audit Programme: SSNAP collects a minimum dataset for every stroke patient Indicators to measure processes of acute care, rehabilitation and care in the community. The aim is to improve the quality of stroke care by auditing stroke services against evidence based standards.

Telemedicine The use of telecommunication and information technologies to provide clinical health care at a distance. It helps eliminate distance barriers and can improve access to medical services that would often not be consistently available in distant rural communities. It is also used to save lives in critical care and emergency situations. Telemedicine concentrates mainly on ‘the cure’.

Telehealth The delivery of health-related services and information via telecommunications technologies. It could be as simple as two health professionals discussing a case over the telephone or as sophisticated as doing robotic surgery between facilities at different ends of the globe. Telehealth is not only about ‘the cure’, but encompasses diagnostics, treatment, prevention etc.

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

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NHS Basildon and Brentwood Clinical Commissioning Group 5 year plan

NHS Basildon and Brentwood Clinical Commissioning Group Phoenix Place, Christopher Martin Road, Basildon, Essex, SS14 3HG 56 www.basildonandbrentwoodccg.nhs.uk