Hartlepool and Stockton-on-Tees Clinical Commissioning Group

Dr Boleslaw Posmyk, Clinical ChairDr Paul Williams, Stockton-on-Tees

Locality Lead

What we aim to do in our presentation

Describe to you:• Our journey so far• The people we work with and on behalf of• Our challenges, opportunities and risks• Our plans for improvement• How we do things around here:

Our decision making and our leadership

Meet our Team • We are a membership organisation of 40 general

practices with devolved decision making to our Governing Body

• Our team has a strong clinical focus, bringing together a broad range of skills and experience together with a passion for improving the health outcomes of our communities

Our JourneyTwo pathfinder groups – Hartlepool and North Tees

Merged into one CCG (40 General practices) April 2012, with first Shadow Governing Body meeting as a sub-committee of NHS Tees

Rationale for coming together:• Shared vision and values• Similar health needs, levels of deprivation, challenges• Share acute, community and mental health providers• Avoids duplication• More financially robust• Increased pool of clinicians willing to take on lead roles• Small enough to maintain effective practice engagement through strong

locality focus and co-terminosity with LAs• Offered potential for synergy and sharing of good practice• Still able to work effectively with neighbouring CCGs especially South Tees

Hartlepool & Stockton-on-Tees CCGPopulation c285,00040 General Practices

Hartlepool & Stockton-on-Tees CCGPopulation c285,00040 General Practices

Meaningful Engagement - Our Stakeholders How we are working “together”

Hartlepool and Stockton-on-

TeesCCG

Stockton-on-Tees Borough Council

Local Safeguarding

Children's Boards

Safeguarding Adults Boards / LD partnership

Community Groups

Clinical Networks

Other CCG’s/Northern

CCG Forum

Professional Clinical

Leadership

Voluntary Sector

NHS Commissioning

Board/LAT

LINks/Healthwatch

Patient participation

groups

Public Health

Providers

40 Member practices

Health and Wellbeing Boards

Hartlepool Borough Council

Meaningful Engagement – our communities

Communication & Engagement strategyLocal EventsPPGs

LiNKs/HealthwatchScrutiny Forums

Our Health ChallengesRank distribution of electoral wards in various deprivation groups

Hartlepool and Stockton compared with EnglandIndex of Multiple Deprivation (IMD) 2010

Electoralwardrank

position

StocktonA population of ‘two

halves’

HartlepoolA population with

little relative affluence

1

1587

793

2380

5553

4760

6346

7139

3967

3173

7934

Most deprived wardsin England

Most affluent wardsin England

Park (6412)

Dyke House (44)(17) Town Centre

(7567) Ingleby Barwick East

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

England Stockton Hartlepool

51 to 100%

11 to 50%

0 to 10%

The starkness of inequalities in health

InglebyBarwick

Parkfield& Oxbridge

StocktonCentre

697478

747882

Lifeexpectancy Men

Women

Life expectancy reduces sharplywithin

very shortdistances

from periphery to centre

9 years for men

8 years for women

One of the consequences

of differences in riskare differencesin outcomes…

Levels of health worse than

Average

Health inequalities

Smoking related deaths higher than

average

Healthy eating, smoking & obesity

worse than England average

Hospital stays for alcohol admissions

higher than England average

Mortality from suicide & undetermined injury; Cancer;

circulatory disease; Gastrointestinal disease; and

Respiratory disease worse than England mean

Life expectancy lower than

average

High levels of child poverty

High levels of deprivation

Our Health Challenges

Our Vision

Reduced inequalities / Improved wellbeing

Our Aims

Our Values

Our Work streams

Our Priorities

commission high quality, sustainable and evidence

based services that respond to local need,

bring care closer to home and are cost effective

work in partnership to reduce health

inequalities and improve the health and wellbeing

of the population

Look for opportunities to innovate, involving

users, carers, staff providers and the public in transforming services

Engagement &

Patient focus

Quality & safety

Value, efficiency

and affordability

Integrity and

honesty

CourageAccountability

Health & Wellbeing

Out of hospital care

Acute in hospital care

Mental Health, LD &

Dementia

Medicines Management

• Address health inequalities

• Improve lifestyles

• Focus on particular groups i.e. carers and children

• Transform community care (TAPs)

• Bring care closer to home

• Care home management & quality

• Improve productivity

• Choice & quality

• Streamline care pathways

• Reduce urgent care attendances

• Develop MH/LD

• Improve equity

• Improve Dementia care

• PHBs

• Safe, rational and cost effective use of medicines

• Reduce variation

STRATEGIC

OUTCOMES

J S N A

H&WB

STRATEGIES

Our Plan at a glance

Income ShiftsTechnical Efficiency

ProgrammesUnderlying Cost Pressures Investments

Managing Financially Sustainable Position up to 2016

Change in Recurrent In-

come

Additional Costs from In-

flation

Expected CQUIN

Payments

Efficiencies from Tariff

Efficiencies from Non Tar-iff Contracts

and Prescrib-ing

Demographic & Demand

National Local-20000

-10000

0

10000

20000

30000

40000

50000

60000

70000

Future planning assumptions are:- Lower Growth - Increase in inflation - Lower Tariff Efficiencies - Increase in demographic demand

£’00

0s

Our QIPP Challenge• Benchmarking Tools Utilised to identify outliers

• NHS Comparators – emergency admissions, A&E attendances, outpatients per 1000 population

• PBMA – identify high spending poor outcomes• PBR Benchmarking – identifies provider performance issues ie new to review ratios• Prescribing EPaCT• Variation in spend on specialities across Tees• Variation across practices

• What it told us – increasing activity in acute sector, prescribing above national average, local FTs where not performing to top quartile in some areas, significant variation in referrals, admissions and resource use across GP practices

• What we did –• Looked for evidence of effective improvement methods (Kings Fund, National QIPP

programme, Institute of Innovation programmes, VMPS/NETs) • Engaged our practices and providers• Developed our QIPP programme around what the benchmarks told us and grouped these

against our workstreams, developed our Delivery Plan• Developed our monitoring arrangments

Improving Quality and Safeguarding

Improving quality is at the heart of what we do

• Safe and tested governance with our systems and processes

• Implementation and monitoring of Quality Dashboards

• Robust provider Clinical Quality Review Groups

• Development of a Quality Assurance Framework for all commissioned services

• Embraced Legacy Document – now preparing to receive Quality Handover Document

• Committed to driving up quality in primary care - GVISQ

Recognising our statutory responsibilities for safeguarding

• Working with our Local Authority partners• Executive Governing Body appointment

(Nurse)• Supporting our Local Safeguarding

Children’s Boards and Adult Protection Committee’s

Preparing for the future

Sir Robert Francis

Council of members

GoverningBody

Remuneration Audit QPF Governance &Risk

Fundingpanel

Locality groups x 2

Delivery team

Workstreams

HartlepoolH&WB

StocktonH&WB

Partnership / QIPP delivery

board

Quality & SafetyGroup

SafeguardingBoards

CQRG

NEC

SConstitutional & Governance arrangements

Capacity and Capability

Local NECS Team &Collaborativecommissioning

Chair

Chief Officer Designate /Accountable Officer

Chief Finance officer

Corporate Governance and

Risk Officer

Commissioning development /

Deliver Manager

Executive Nurse

GP GB members &

locality leads

Clinical Workstream

Leads

Assistant Finance Managers

Head of Quality and Safeguarding

(designated Adults safeguarding)

Designated Nurse

Children’s Safeguarding

Designated Doctor and

LAC lead

Partnership & Innovations

Manager

Partnership Project Officer

Corporate Office Administrator

Admin Support

Risks and Mitigations• Clinical Engagement

• Improving quality & safety

• Economic environment and financial challenge

• Hospital Reconfiguration/ Momentum

• Developed different opportunities at all levels of the organisation

• Strong relationships, strong governance, high awareness

The biggest task is alignment………..

• Evidence based Clinical mandate, strong relationships with OSC, good public engagement

• Robust QIPP plans & track record of delivery, preparation, contingency, good governance

The difference we are making• Highly effective GP, public and other stakeholder engagement • Winner of HSJ National award for Efficiency, Medicines Optimisation• Safer Care NE; Adult safeguarding award• Finalists for Commissioning Organisation of the Year (HSJ); Vision Award –

use of data, NE lean Academy; spread of innovation, • Reduced variation in primary care - improved clinical quality• Transformed community services – commissioning for clinical outcomes• Progressing Momentum Pathways to healthcare; redesigning 46 clinical

pathways, improving patient experience, reduced length of stay, increasing productivity

• QIPP delivery – securing financial sustainability