Chorley and South Ribble Clinical Commissioning Group (CCG) and Greater Preston CCG Annual General Meeting (AGM)
A look back at 2019/2020 and plans for 2020/21 Welcome to our first virtual AGM
Welcome Denis Gizzi Chief Officer Dr Lindsey Dickinson Chair and Clinical Leader, NHS Chorley and South Ribble CCG Dr Sumantra Mukerji Chair and Clinical Leader, NHS Greater Preston CCG Katherine Disley Chief Finance and Contracting Officer Agenda
• Welcome and Introductions – Denis Gizzi
• A reflection of 2019-20 – Dr Sumantra Mukerji and Dr Lindsey Dickinson & Denis Gizzi, Chief Officer
• Our financial performance – Katherine Disley, Chief Contracting and Finance Officer
• Our plans for the future – Dr Sumantra Mukerji and Dr Lindsey Dickinson & Denis Gizzi
• Questions and close – All
Who we are Chorley and South Ribble CCG and Greater Preston CCG are GP-led membership organisations
We plan, arrange and buy a range of health and care services for people who live and work in our local areas
We work closely together, sharing an executive team and staff body, as well as strategic and operational objectives Our vision and values
Our shared vision is to ensure equal and fair access to safe, effective and responsive health and care for our communities that represent value – now and in the future The services we commission • Primary care – delegated responsibility from NHS England
• Planned hospital treatment, diagnostic tests and appointments
• Urgent and emergency care
• Mental health services
• Services for people with learning difficulties
• Maternity and new-born care
• Children’s healthcare
• Community health (for example, specialist and district nurses, speech and language therapy, rehabilitation) Partnership working
An integrated care system (ICS) has been developed across Lancashire and South Cumbria. This is supported by five local integrated care partnerships (ICPs), of which central Lancashire is one.
Working in partnership, the ICS has now developed a draft strategy and a set of priority pathways for improvement, to enable the streamlining of care that patients across the whole of Lancashire and South Cumbria receive. Partnership working
The central Lancashire ICP brings together our key partners and providers. These include: • GP practices/Primary Care Networks • Lancashire Teaching Hospitals NHS Foundation Trust • Lancashire and South Cumbria NHS Foundation Trust • Local authorities • North West Ambulance Service • Independent providers • Third sector providers The challenges we face
With higher than average levels of conditions such as heart failure, chronic obstructive pulmonary disease (COPD), obesity and depression across both CCG populations increasing patient need is leading to an increasing demand on services, and funding that isn’t keeping pace.
Both CCG areas have a growing and ageing population. Whilst great news, this does provide a challenge in keeping up with providing services for increasingly complex needs.
To overcome these challenges, we have been continuing to work with a range of health and social care partner organisations to join up care and develop real solutions that enable us to transform the way services are commissioned.
Covid-19: our response March 2020 saw healthcare change across the country. ‘Business as usual’ was deprioritised and pandemic response was at the forefront of activity.
The CCGs major incident response plans were implemented and the NHS entered a ‘command and control’ structure.
In central Lancashire, this structure was led by the ICS. The CCGs mobilised resources at pace to support NHS partners and our patients.
Staff were involved at all levels in managing and supporting the pandemic response.
We could not have achieved any of this without the support of patients, the voluntary and faith sector and the generous donations from individuals and local businesses.
THANK YOU!
Supporting our patients and workforce
The CCG workforce has been working remotely since March.
Through Microsoft Teams and a range of other digital platforms, work has continued and staff have been support with a range of wellbeing opportunities and daily internal updates.
Public CCG and GP practice communications channels such as the website, social media and text messaging services have developed to provide the latest information and support from a trusted source.
Supporting our partners
Primary Care Assisting in the rollout of digital solutions to enable services to continue remotely.
Supporting in the provision of ‘hot and cold’ sites across Primary Care Networks to enable the continued safe face-to-face treatment of patients when needed
Creating a PPE distribution line for practices who were unable to source the required equipment
Daily communications bulletins – sharing the range of national and regional guidance and directives
Online support for practices to help guide patients
Care homes Creation of regulated care group to provide oversight of the system and ensure that covid-19 and wider safeguarding issues were swiftly identified and supported, including the safe discharge of residents from hospitals.
Creating a PPE distribution line homes who were unable to source the required equipment.
Staffing support for homes experiencing challenges.
Daily communications bulletins to support the sharing of vital information.
Hospital services CCG staff were seconded to the hospital integrated discharge team to support the flow of patients through the hospitals; getting people to the best place of care as quickly as possible.
Central Lancashire wide clinical reference group established, including CCG clinical leads, to help aid clinical decision making and pathway discussions during the pandemic.
PPE and testing
PPE
Challenges in the distribution of Personal Protective Equipment (PPE) to NHS services was widely covered during the early period of the response to Covid-19.
A team of CCG staff were deployed to support the sourcing and distribution of PPE to local services.
Testing
Once again in the news, the ability to test patients and staff has been a challenge since the start of the pandemic.
The CCG has been supporting primary care and care home colleagues to access appropriate routes to testing and continue to support the public through advice and guidance.
Our achievements
Denis Gizzi
→Improving quality, access and care →Monitoring patient care →Keeping you safe →Involving you
Improving quality, access and care Pathway redesign
The WHIN programme focusses on developing and redesigning pathways to provide effective, timely and high quality services and support as close to a person’s own home or community as possible. Developing Primary Care Networks
In July 2019, all our GP practices became members of one of nine Primary Care Networks (PCNs), working together to provide care for small local populations.
Each network will have a core integrated multi-disciplinary team of professionals ‘wrapped around’ it. This will increase joined-up working, with the aim of providing much more support in the community. Roles planned for 2019-21
Clinical pharmacists Social prescribing link workers First contact physiotherapists Physician associates Pharmacy technicians Community paramedics Occupational therapists Dietitians Chiropodists / podiatrists Health and wellbeing coaches Care co-ordinators Mental health practitioners Social Prescribing
• Each primary care network now has a social prescribing link worker responsible for delivering social prescribing.
• They work with local voluntary sector organisations to support communities and individuals.
• Regional and local social prescribing groups have been set up to share learning, and support teams to create the best opportunities for patients. The Haven Monitoring patient care We are committed to working together with our providers including in acute settings, primary care, care homes and in the community in order to provide consistently high- quality healthcare that is personal, effective, and safe – care that respects patients’ dignity and is delivered with compassion.
With increasing demand and ever-tighter budgets, the NHS is under pressure to improve health outcomes, deliver quality services and make good use of resources. Keeping you safe We have a statutory duty to make arrangements to safeguard and promote the welfare of children and young people, and to protect adults who may be at risk of abuse. Effective safeguarding depends on multi-agency working to ensure all vulnerable people are protected and remain at the centre of care.
We have been working with partners to respond to the legislative changes which see Local Safeguarding Children Boards being replaced by Safeguarding Children Partnership Arrangements.
We led on the development of a Mental Capacity Act (MCA) Training for Trainers framework to support health and care staff to follow their statutory duties.
The GP Safeguarding Lead / Champion Framework has continued to deliver workshops shaped by learning from Safeguarding Adult Reviews, Serious Case Reviews and Domestic Homicide Reviews.
In partnership with the Lancashire Multi-Agency Safeguarding Hub a new information sharing pathway with primary care was launched in November 2019. Involving you
We continue to make sure that patients are at the heart of everything we do. There are many ways that the public can get involved:
In 2019/20, patients have worked with us on many service developments, including:
• Harmonising several clinical policies • The Our Health Our Care programme • Reviewing elements of urgent care and emergency services Being a well run, financially sustainable CCG Katherine Disley Chief Finance and Contracting Officer
→Financial reports →CCG Governance →Our Constitution How we spend your money
Chorley and South Ribble CCG and Greater Preston CCG met the financial targets this year. These were to:
Achieve operational financial balance Remain within the cash financing limits Pay 95% of all creditors within 30 days of receiving their invoice
CCG Governance
Governing Body members Member practices
Each CCG has a Governing Body, To help give local GPs the which ensures that the CCG has the power, on behalf of their right arrangements in place to perform patients, to influence decisions effectively, efficiently, and that need to be made about local economically, with good governance health services, all our local GP and in-line with the CCG constitution. practices are members of either Chorley and South Ribble CCG The Governing Body leads on setting or Greater Preston CCG. vision and strategy, approves commissioning plans, monitors performance, and provides assurance on strategic risks. The CCG Constitution
• Our Constitution sets out the arrangements that we have put in place to help us to deliver our vision; to discharge all of our legal obligations and to engage with our members, our patients, and our community and other key stakeholders and partners to achieve this. It describes the Group’s governing principles; the rules and procedures that we have established to ensure probity and accountability in the day to day running of our organisation; to ensure that decisions are taken in an open and transparent way and that our patients’ and public interest always remain central to our goals.
• Our Constitution applies to all of our members; to our employees and to anyone who is a member of our Membership Council; the Groups Governing Body, its committees, joint committees, sub- committees or anyone else acting on behalf of the Group.
• NHS Chorley and South Ribble CCG and NHS Greater Preston CCG hold separate Constitutions.
• The Constitution for both NHS Chorley and South Ribble CCG and NHS Greater Preston CCG can be found here https://centrallancashireccgs.nhs.uk/documents/our- polices/organisational-policies
• The CCGs fully engage all member representatives in proposed changes and feedback for each constitution annually, both in correspondence and at the regular Membership Council meetings. All significant proposed changes to the constitution requires a formal vote and approval by each Membership Council.
• Membership Council representatives are invited to attend the CCGs Annual General Meeting.
Our priorities for the future Denis Gizzi, Dr Sumantra Mukerji, Dr Lindsey Dickinson
→Impact of Covid-19 on services →The future of care →Our Health Our Care →Looking ahead
We are yet to see how services will be affected in the short, medium, and long term – but as commissioners, we remain dedicated to supporting all partners and our patient population.
We are certain that we will overcome the challenges we are facing thanks to the positive relationships forged in 2019/20, the solid foundations laid in planning and delivery of services, and the dedication of all staff.
Future of services in Covid-19
Phase 3 planning and beyond As the country navigates through the next stage of the Covid-19 pandemic, the NHS has started reintroducing services that had been paused.
As a CCG we are working with partners to shape these services and make sure our patients receive safe, high quality services they can access in a timely way.
Further phase 4 planning guidance is expected towards the end of 2020 to support our work and new and innovative solutions are being introduced.
The future of care: digital
Digital innovation has been key in supporting the continued delivery of NHS services. The implementation of a Digital First approach in GP practices has seen a number of developments including:
• The roll out of Doctorlink - which allows automatic digital front door triage and, where appropriate, the referral of patients to alternative services.
• Video consultation training and supply of necessary equipment.
• The introduction of ‘Advice and Guidance’ (A&G), a web-based tool which allows GPs and other clinicians working within primary care to seek help from specialists within secondary care.
Whilst face-to-face services continue to be offered where appropriate, patients and clinicians are now seeing the benefits of access to services at the touch of a button.
The future of care: NHS 111 First
NHS organisations across central Lancashire are starting work to implement the new national NHS 111 First programme.
NHS 111 First is part of a national integrated programme to improve outcomes and experience of urgent and emergency care.
To keep patients who are thinking about attending an emergency department safe and allow them to maintain social distancing, they will be asked to contact NHS 111 first. The service will then book them into a time slot in an emergency department or at the most appropriate local service for the patient.
It is due to be launched in central Lancashire in November 2020
Our Health Our Care (OHOC)
2019-20 has seen us continue progressing the OHOC programme, looking the transformation of local in-hospital services for future sustainability and better patient outcomes and experiences
Following lots of engagement with local clinical leaders and staff who work in our services, we have developed and refined our clinically led options for change
This work has been incorporated into our pre-consultation business case – the formal document which must be developed and submitted to NHS England/Improvement for consideration
The pandemic created a delay in this submission and review process, but we are hopeful that this will recommence imminently and remain committed to a public consultation.
Looking ahead 2019/20 saw us continue to develop our plans for working in new and innovative ways with our health and care partners, in central Lancashire and the wider Lancashire and South Cumbria area.
The emergence of new thinking in a post-pandemic NHS landscape has further supported the aims for a new way of working:
Integrated Care Partnership (ICP) Work is ongoing to embed a new Governance Structure for the ICP. This will more clearly enable working collaboratively and in partnership. To support this, the ICP board recently reviewed and approved a proposed operating model and work is now underway to mobilise this.
Integrated Care System (ICS) CCGs across Lancashire and South Cumbria have been asked to consider proposed plans to create a single CCG to represent the whole ICS area. This was paused due to Covid-19 pandemic and a CCG membership vote did not take place. Work has now resumed on the proposal of a single CCG formation and how this might progress. Thank you Any questions?
Chorley and South Ribble CCG Greater Preston CCG Chorley House Lancashire Business Park Centurion Way Leyland Lancashire PR26 6TT
01772 214232