Bracknell Ascot CCG
Transcript of Bracknell Ascot CCG
Bracknell & Ascot CCG
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• General Practice ‐ 136,163 registered patients in 15 GP practices (see map below)• Independent Contractors ‐ 24 Dental practices, 9 Optometrists and 19 Community Pharmacists• Acute Providers ‐ Services are commissioned from the following providers with % of their activity assigned to
Bracknell and Ascot CCG:• Frimley Park Hospital Foundation Trust – 11.7%• Heatherwood and Wexham Park Foundation Trust ‐11.4%• Royal Berkshire Foundation Trust ‐ 4.4%• Mental Health/Community Trust ‐ Berkshire Healthcare Foundation Trust.• Local Authority ‐ This CCG's registered patients live in 4 different upper tier Local Authorities. The CCG's main LA is
Bracknell Forest. 81% of the CCG's population live there.
Bracknell & Ascot
1. a)Forest End Medical Centre ‐ Balfron Practiceb)Forest End Medical Centre ‐ Birch Hill
2. Binfield Practice3. Boundary House Surgery4. Crown Wood Medical Centre5. Easthampstead6. Evergeen Practice7. Gainsborough Practice8. Great Hollands Practice9. Green Meadows Surgery
10. Heath Hill Surgery11. Kings Corner Surgery12. Magnolia House Surgery13. a) Ringmead Surgery ‐ Great Hollands
b) Ringmead Medical Practice ‐ Birch Hill14. a) Sandhurst Group Practice ‐ Sandhurst
b) Sandhurst Group Practice ‐Owlsmoor15. a) Waterfield Practice ‐ Warfield Medical
Centreb) Waterfield Practice ‐Waterfield Surgery
Federation and Collaboration
• Bracknell and Ascot CCG works locally to respond to health needs and with Federation partners to:
• share resources• improve quality • manage financial risk• maximise influence on providers • Collaborative Commissioning Forum: around Frimley system with North East Hants, Farnham and Surrey Heath
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CCG Executive MembersWilliam Tong Chair GP
Jackie McGlynn Board Member GP
Martin Kittel Board Member GP
Rohail Malik Board Member GP
Alan Webb Board Member Accountable Officer
Sally Kemp Board Member Lay member Governance
Glyn Jones Board Member Bracknell Forest Council Rep
Karen Maskell Board Member Lay Member PPI
Andrew McLaren Board Member Secondary Care Clinician
Sarah Bellars Board Member Nurse Governor
David Williams Board Member Director of Commissioning, East
Eve Baker Board Member Chief Finance Officer
Key Facts About Us
As one of the first organisational development approaches, included working with members and stakeholders the following were developed for the organisation:
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Vision and Values
The CCG’s
Vision is:
The CCG’s Values are:
To commission local outcome based, cost‐effective services for the health benefit of our population now and in the future.
Always being dignified, respectful, open and honest
Being innovative and evidence based
Putting the needs of our population at the centre of everything we do
Being a strong, dynamic passionate team
Being responsible for delivering a sustainable future.
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Our Principles
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Mortality
The percentage of deaths from all cancers was statistically above national in Bracknell Forest at 29.57% compared to 27.71% nationallyIschaemic heart disease in males and females and colorectal cancer in males were the three most common causes of death in 2010Heart disease is the single most common cause of all premature death and the risk is highest in the most deprived wards.The stroke prevalence rate is lower than the England average but is expected to increase as a function of the ageing population
Causes of ill health
Compared to England Stop Smoking Services uptake on smoking cessation is lower in Bracknell. Ischaemic heart disease in males and females and colorectal cancer in males were the three most common causes of death in 2010Heart disease is the single most common cause of all premature death and the risk is highest in the most deprived wardsThe stroke prevalence rate is lower than the England average but is expected to increase as a function of the ageing population
Unequal Outcomes
The rate of depression in general practice registers (12.5%) was above national in 2011‐12 (11.2%)Childhood vaccination uptake is variable and support is needed to vulnerable familiesRepeat rates of domestic abuse are falling but continue to be a priorityAmong those presenting to drug treatment 81% were using opiates and 7% cannabis. Cannabis remains the most common among young people ‐ a rise in mephedrone use is of local concernThose with learning disability do access health checks and screening services but reporting needs to be improvedIn common with other CCGs in Berkshire East stroke emergency admissions are slightly above national
Population Health Needs - JSNA
Male life expectancy is above the England average and rising but there is a gap of 6 years between the most and least deprived wards
Women’s life expectancy is above the England average and rising but there is a gap of 2.2 years between the most and least deprived wards
Ranked 291/326 local authorities in terms of the index of multiple deprivationCompared nationally Bracknell & Ascot CCG has no areas of deprivation in the fifth quintileMost deprivation is experienced by people living in Wildridings and Central, Great Holland's North, Priestwood and Garth and Old Bracknell (ONS, 2010)Highest rates of child poverty in Great Holland's North ‐ above the England average (24.6% compared to 21.3%) with Priestwood and Garth close to the England average at 20.7%.Highest rates of older people living in poverty in Priestwood and Garth and Crowthorne
Deprivation
Life Expectancy
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Bracknell & Ascot JSNA HeadlinesAgeing population with impact on long term conditions
Early intervention for children and families in need
Health checks
Mental health to include CAMHS. depression, dementia
Recommission a holistic sexual health and teenage pregnancy service
Alcohol
Reduce domestic abuse, sexual abuse and violent crime
Smoking cessation
Bracknell & AscotPriority Needs 2012
Housing
Stroke prevention
What are our commissioning priorities?
• Promote healthy lives and self care• Better management of Urgent Care and Long Term Conditions
• Reducing inappropriate clinical variation and getting performance to top decile
• Manage within bottom decile allocation• Strong focus on managing contracts and quality
Commonalities between Joint Health and Well Being strategy and Commissioning Themes
Whilst not all of the JHW priorities are shown in the CCG commissioningplan there is considerable overlap at the theme and individual project level
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Challenges in Local Health System
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Response to our Challenges
The CCG has one of the lowest resource allocations compared to the national average
The CCG has high utilisation of hospital services as shown by Better Care better Value indicators – with particular emphasis on outpatient utilisation and elective care procedures
The previous PCT strategy was based on four programmes:1.Improving Access to Services2.Preventing Crisis Providing Support3.Joint Commissioning4.Staying Healthy
The Strategy set challenging targets of delivering top decile performance in elective and non elective care through reducing variation in practice and implementation of the best practice
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Health Service Utilisation
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Area Q4 11/12 Q1 12/13 Q2 12/13
NHS Berkshire East
Per 100,000
rank Per 100,000
rank Per 100,000
rank
Outpatients 6453.32 16 5852.58 11 5450.53 5
Emergency admissions
465.48 85 382.63 60 353.73 54
Managing surgical thresholds
82.86 58 62.71 21 73.64 35
System - East Berkshire CCGs Benchmarking -Improvements In Year
The CCG approach has been to strengthen engagement with in primary care to understand the activity and identify clinical leaders to enable the CCG to achieve the productivity opportunity presented within these indicators and agree QIPP targets for elective and non elective activity. The CCG has various demand management and community schemes to continue to support this trend of improvements to achieve national average
• Referral Management challenges – Better Value, Better Care benchmarking with the understanding that the CCG are high referrers and yet in the bottom decile for funding which is not sustainable. Target 115 referrals per 1,000 weighted patients
• Illustrate clinical variation in elective referrals – Year End 2011/12 report per 1,000 weighted population in across member practice
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Primary Care – Clinical Variation
Non elective unexplained variation – CCGs agreed benchmark based on QIPP output to 62 admissions per 1,000 weighted patients
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Primary Care – Clinical Variation
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Prescribing Budget Spend 2011/12 Budget 2012/13 % variance Forecast outturn (Sep)
Bracknell & Ascot £14,969,866 £15,123,470 ‐5.8% £14,244,329
The CCG/practice budget is set using the DOH tool kit so that it reflects:•The population needs•Ensure spend was in line with budget for 11/12, •Deliver QIPP and improvement in quality through QOF•Manage the clinical and financial impact of new medicines in the market and those coming off patent in year.
Challenges to the prescribing budget are :•Price changes•NICE/other clinical guidelines•Provider prescribing formulary differences•Patient outcomes
Primary Care - Prescribing
• Percentage of BACCG acute activity split by provider at M10 12/13
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Provider % activity
Frimley Park 34.7%
Heatherwood & Wexham Park 34.5%
Royal Berks 16%
Acute sector market share
Targets have been established for the mandatory targets on IAPT and Dementia
Local priorities have been agreed for:•Increasing satisfaction with GP Services•Increasing people feeling supported to manage their condition•Improving PROMs for hip replacement•These priorities have the full support of member practices. Work is ongoing to identify a meaningful local target for the hip PROM improvement.
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QUALITY PREMIUM AND LOCAL INDICATORS 13/14
Number of people
diagnosed
Prevalence of dementia
% diagnosis rate
2013/14 645 1389 46.4%
2014/15 780 1418 55.0%
The number of people who receive psychological therapies
The number of people who have depression and/or anxiety disorders (local estimate based on Psychiatric Morbidity
Survey)
Proportion
2013/14 1642 13420 12.2%
Target area Baseline Target
Satisfaction with GP Services
87.3% 88.3%
People supported to manage their condition
66.2% 67.2%
• Action plan taken to March 2013 Governing Body• Working in collaboration across Berkshire with 6 UAs / 7 CCGs
• Register of in‐patients (14) completed Feb 2013• Work still underway to identify ALL people with Learning Disabilities and Mental Health problems placed in a NHS funded Placement and complete reviews
• ALL welfare reviews to be undertaken by March 2014
• Action plan will be agreed and put in place to ensure future monitoring and compliance
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RESPONSE TO ‘WINTERBOURNE’REPORT
• Berkshire East CCGs had a briefing on the emerging issues from Mid‐Staffs in July 2012 to inform emerging plans and approach to quality monitoring
• Federated Quality committee is well established and acts to triangulate quality issues and concerns routinely, and acts on findings eg unannounced visit to A&E departments
• Robust recovery plans where concerns have been proven eg HWPH maternity
• ‘clinical concerns’ email collects member concerns and is used to identify trends which are addressed with providers and outcomes fed back
• Provider obligations to comply with recommendations will be driven through contracting process by CCGs and CSU for 13/14
• Strong clinical leadership on CCG Governing Body including local nurse as well as nurse governor
• Long established patient representation at member forum (GP Council) • Governing Body will consider formally their public response to the Francis
report at a future meeting
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RESPONSE TO ‘FRANCIS’ REPORT
Bracknell and Ascot’s Vision
“To commission local outcome based, cost effective services, for the health benefit of our local population now and in the future”