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NHS Buckinghamshire Clinical Commissioning Group Annual

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NHS Buckinghamshire Clinical Commissioning Group Annual Buckinghamshire Clinical Commissioning Group Annual Report 2020/21 1 | P a g e Contents FOREWORD Page 3 OVERVIEW Page 4 PERFORMANCE REPORT Page 7 Importance of Clinical Leadership Page 9 ACCOUNTABILITY REPORT Page 29 Corporate governance report Page 29 Members report Page 29 Statement of Accountable Officer's responsibilities Page 40 Governance statement Page 42 Remuneration and staff report Page 58 Remuneration report Page 58 Staff report Page 64 Parliamentary accountability and audit report Page 67 Independent Auditor’s Report Page 68 Committee Attendance tables Page 73 Terms (Glossary) Page 74 ANNUAL ACCOUNTS Page 76 2 | P a g e Foreword from Clinical Chair It is my privilege to introduce the third annual report for NHS Buckinghamshire Clinical Commissioning Group (BCCG) for the year 2020/21 The headline story for the year has of course been the COVID-19 pandemic and the challenges it has created for our front-line services, our communities and each individual in Buckinghamshire. As with last year’s annual report, I would like to start by acknowledging the keyworkers in health and social care who worked with enormous energy and stamina to serve our population throughout the year under the most demanding of circumstances. The challenges presented by COVID-19 have been the greatest since the inception of the National Health Service. The way that those challenges have been met is a tribute to thousands of individuals in Buckinghamshire who have worked or volunteered as part of hundreds of organisations, big and small throughout the county. Health and social care services have adapted in a remarkable manner, innovating in ways that may have taken years months or years in normal times. I have huge admiration for the way that primary, community, secondary and the emergency care services have responded to the considerable challenges that each have faced, coping with pressures that are unprecedented. I am grateful to our CCG staff who have worked tirelessly and flexibly to ensure that the services available have met the needs of our residents in Buckinghamshire and the 48 GP practices that constitute the membership of our organisation for their continued support. As a CCG we remain aligned to the NHS Long Term Plan, working closely with our Primary Care Networks to develop community-based services that are responsive to the needs of the communities they serve. The work that the PCNs have done as part of the highly successful COVID-19 vaccination programme deserves particular mention as on several occasions it has attracted national media and ministerial attention. We anticipated the move towards greater integration as signalled in the Government White Paper (Integration and Innovation: working together to improve health and social care for all) published in February 2021. We are increasingly aligned with our colleagues in Berkshire West and Oxfordshire CCGs and as part of the Buckinghamshire, Oxfordshire and Berkshire West Integrated Care System (BOB ICS). We have further intensified our focus on the wider social determinants of good health, working closely with our local communities, Public Health and Buckinghamshire Council to empower more of the Buckinghamshire population to live a greater proportion of their lives in good health. A particular success in this regard has been the work that has been done, most notably in Wycombe and Aylesbury to increase COVID-19 vaccination uptake in different communities. We aim to learn from this success and build upon it in future endeavours. I hope that you find the annual report informative, and I wish you all well for the year ahead. Dr Raj Bajwa, Clinical Chair, NHS Buckinghamshire CCG 3 | P a g e Overview from Dr James Kent, Accountable Officer No one could have predicted the extraordinary year that has passed; the COVID-19 pandemic has been all consuming and has touched each and every one of us in one way or another. My condolences to those who have lost loved ones; in the NHS we share in the sadness of those who have suffered a loss. In response to the pandemic, NHSE/I was given legal directions over the CCG 1 commissioning functions by the Government in order to direct health services to meet the emergency needs, each system established an incident structure reporting to NHSE/I SE Region and the normal financial regime was adjusted so the majority of providers were on block funding. During the pandemic health and social care organisations made rapid changes to how services operated, the infection, prevention and control measures that were in place, and other adjustments made to ensure all patients with COVID needing hospital treatment could be treated. Much of primary care and outpatients moved to on- line with face-to-face contacts restricted to where essential to reduce the risk of spreading the infection. Changes also included introducing telephone triage in primary care so that GP practices talk to all patients on the phone first. Many patients have been provided with advice, care and prescribed treatment without needing to visit their practice. For patients with the relevant technology, hospital appointments have been available using video conferencing so they can see, as well as speak to a doctor or healthcare practitioner. BHT has undertaken 758 video appointments and Oxford Health 170, plus 165,228 telephone appointments have taken place at BHT. Primary care carried out over 1.2 million telephone consultations in 2020/21; more than doubling of the 483,069 carried out in 2019/202. New services were also brought online quickly to support people throughout the pandemic such as the 24/7 mental health line across Buckinghamshire and Oxfordshire; these services were set up in April 2020 and continue to support people young and old to access the advice and support they need for their mental health and emotional wellbeing. GPs worked quickly to set up dedicated clinics (‘hot hubs’) for patients with suspected COVID- 19 to manage the risk of transmission from patients needing non-COVID related care GP practices introduced remote pulse oximetry service for COVID positive patients in at-risk groups; these measured a patient’s blood oxygen levels and could alert clinicians to possible problems without the need for the patient to attend an appointment outside their home. Some non-urgent services were stopped for a period of time during the first and then second waves of COVID to focus on treatment of patients with COVID-19 and to prioritise people with urgent care needs; this included some screening and routine referrals for hospital care. At the same time, mostly due to lockdown, referral levels also fell significantly. Services were re-started after both waves as soon as possible but for some the new ways of working through COVID have been maintained where these were felt to be better for patients. However, the infection controls and social distancing measures has meant we were not fully back to pre-COVID levels of planned care activity end March 21 though we will aim to exceed this as we move through 21/22. COVID-19 will continue to have profound impacts as we begin to reset the health system over the coming year and work our way through the backlog of patients who require non-urgent but necessary care and treatment. We recognise that this has led to an increase in the numbers of Buckinghamshire patients experiencing long waits for treatment as shown in the table 1 https://www.gov.uk/government/publications/the-exercise-of-commissioning-functions-by-the-nhs- commissioning-board-coronavirus-directions-2020?utm_source=fe01c604-789a-453e-90cb- 16dd1c965200&utm_medium=email&utm_campaign=govuk-notifications&utm_content=immediate 2 https://digital.nhs.uk/data-and-information/publications/statistical/appointments-in-general-practice 4 | P a g e below: Number of patients waiting Number of patients waiting at at 31st March 2020 31st March 2021 Total number of patients waiting 32,861 38,495 Over 18 weeks for elective treatment 7,428 16,877 Over 52 weeks for elective treatment 13 6,106 Over 62 days for cancer treatment 171 79 (BHT) Our response to the first phase of COVID-19 ensured that services, staffing and capacity could meet demand. Since that time, we have learned a lot; the Incident Control Centre (ICC) across the BOB ICS that was set up during Wave 1 was made more resilient with a greater number of staff for Wave 2 and this continues to be a conduit for cascading information, alerts and requests for action between NHSE and the three CCGs / place responses. The incident centre also facilitated and co-ordinated mutual aid requests for personal protective equipment (PPE) during the first wave in particular as well as other equipment. At the end of 2020, the Government announced approval of the Pfizer BioNTech vaccine against COVID-19, followed by approval for the Oxford AstraZeneca vaccine early in January 2021. Well before the announcement, plans were underway across the BOB ICS for the roll-out of the vaccination programme, starting with our most vulnerable population. Vaccinations started in the BOB area on 7 December 2020 at the first hospital hub in Oxford, followed swiftly by our GP-led local vaccination service across all three places on 14 December. Since then, more than a million vaccinations have been administered to the population of the BOB ICS 3, with three quarters of those delivered by primary care. A huge thanks to the thousands of people across the NHS, local authorities and volunteers who have contributed to this success. We are concerned that health inequalities have increased during the pandemic; we have addressed this head on through the vaccination programme with local health and care teams undertaking a range of communication, outreach and pop-up clinics to ensure good vaccination coverage in harder to reach groups.
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