Contact details

Name of group of GP practices / GP consortium: South Tyneside Clinical Commissioning Group (STCCG)

Lead GP contact details:

Name Dr Matthew Walmsley

Designation Chair of STCCG

E-mail address xxxxxxxxxxxxxx

Telephone number xxxxxxxxxxxxx

Signature of lead GP on behalf of group/consortium

XXXXXXXXXXXXXXXXXXXXXXXXXXXXX

PCT Lead Director contact details:

Name Dr David Hambleton

Designation Director of Commissioning and Reform, NHS South of Tyne and Wear

E-mail address xxxxxxxxxxxxxxxxxxxxx

Telephone number xxxxxxxxxxx

Signature of PCT Lead Director

XXXXXXXXXXXXXXXXXXXXXXXXXXXXXX

GP Practices Group / Consortium details

General practice commissioning consortia pathfinder programme application

2

Number Practices within the group / consortium:

29

Combined Patient population (weighted): 153,896

Brief description of populations served: Approximately 46% of South Tyneside residents live in the most deprived areas of England. Across South Tyneside average life expectancy is 77.8 years which is lower than the England average, this masks differences between men (76.2) and women (80.3) both of which are lower than England (77.9 and 82.0 respectively). Cardiovascular disease and cancers remain the main causes of premature mortality in South Tyneside. Understanding which diseases make up the life expectancy gap for men and women allows us to focus our efforts on making a large impact on tackling these diseases. Risk factors for CVD and cancer are strongly linked to deprivation. Other key challenges, as identified within the JSNA, include:

Coronary heart disease - 7,700 (6%) people from the Borough have a diagnosis of CHD although the true prevalence is estimated to be closer to 6.5% equating to 8,300 people on GP lists.

Hypertension – in 2008-9 although 18.4% (23,700 people) had a diagnosis of hypertension the true prevalence was estimated to be about 32% (41,500 people). This means that a large number of people have hypertension in South Tyneside but have not been diagnosed.

The prevalence of chronic obstructive pulmonary disease (COPD) is high and rising in South Tyneside, being strongly linked to the high levels of smoking in the Borough. In 2008-9 there were 4,700 people aged 16+ with COPD (3.6%) although the true prevalence was more likely to be 5.6% (7,200 people on GP lists).

3

Local Authority Practice Code

Practice name Practice list size (weighted) at 1.4.11

Number of GPs (wte)

South Tyneside A88001 Dr Vinayak & Partner 3111 2

South Tyneside A88002 Dr Sandbach And Partners 12622 9

South Tyneside A88003 Dr Muchall & Partners 11679 10

South Tyneside A88004 Dr Dias & Partners 8970 4

South Tyneside A88005 Dr Haque & Partner 4512 2

South Tyneside A88006 Dr Craig & Partners 8708 5

South Tyneside A88007 Dr Bhalla & Partners 9266 6

South Tyneside A88008 Dr Perrins & Partners 6274 5

South Tyneside A88009 Dr Thorniley-Walker And Partners 6541

5

South Tyneside A88010 Dr McManus & Partner 3297 3

South Tyneside A88011 Dr Nixon 2707 2

South Tyneside A88012 Dr M Brady 6141 3

South Tyneside A88013 Dr Gallagher And Partners 11761 10

South Tyneside A88014 Dr Kulkarni 2677 1

South Tyneside A88015 St George Medical Practice 3999 3

South Tyneside A88016 Dr Simpson And Partners 7436 5

South Tyneside A88020 Dr Chander 2051 1

South Tyneside A88022 Dr Burns & Partners 7561 4

South Tyneside A88023 Dr Cervenak & O'Neill 5112 2

South Tyneside A88024 Dr Vis-Nathan 1813 2

South Tyneside A88025 Dr Dowsett & Partners 5359 2

South Tyneside A88601 Dr Curry 2372 1

South Tyneside A88603 The Park Surgery 2983 3

South Tyneside A88608 Dr Vis-Nathan 4326 2

South Tyneside A88611 Chichester Practice 2751 6

South Tyneside A88613 Dr Zaidi & Partner 4187 3

South Tyneside A88614 Dr N E Win 2072 1

South Tyneside Y00915

The Trinity Riverside Practice 3425

7

South Tyneside Y02999 Jarrow GP Practice 183 3

Total

153896

112

Proposed date for group to start commissioning: 1st July 2011

4

Please describe how the group/consortium will work and the scope of commissioning activities to be undertaken to benefit patients. (This will include, for

example, the organisational structure, the management arrangements and the working arrangements with the PCT during the transition)

Our Vision South Tyneside Clinical Commissioning Group (STCCG) strongly believes that commissioning services for the local population must be clinically led to achieve the changes which are required in the shorter and longer term, from cultural\behavioral shifts in our local systems to ensure sustainability and financial balance, through to the better management of patients within primary and community services, taking preventative approaches. The South Tyneside JSNA and ISOP act as strategic drivers for our work in improving health services. We cannot achieve this alone and are already developing close alliances with partners such as the PCT, South Tyneside Council, South Tyneside Foundation Trust (STFT) and local patient groups. Networks are being developed with neighbouring clinical commissioning groups, so that discussions around future commissioning systems are joined up and so that best practice can be shared. We are committed to the achievement of QIPP and - for the purposes of this bid – will focus on medicines management, reductions in elective and non elective activity, through the commissioning of effective pathways, whilst ensuring services deliver quality and value for money. We believe the added value in GP commissioning to be that in general practice we know our patients best, so we are well placed to understand their needs and influence changes in primary care behavior. At the heart of our vision is the development of a robust infrastructure for GP commissioning in South Tyneside which will be enabled via our Council of Practices, of which each practice is now a member. Through this we will make a difference by constructively challenging the status quo, developing systems for peer review to improve the quality of primary care, pulling together to work in a more co-ordinated way to achieve our goals; an early example is current work to harmonise the Local Incentive Scheme (LIS) objectives with QP QoF indicators, which in turn will link to pathfinder objectives.

Organisational structure The executive board began on 1st April 2011 comprising 6 members (3 GPs and 3 Practice Managers). Acknowledging the need for additional clinical input, a new structure has been designed (diagram 3). The governance arrangements (diagram 2) show how STCCG will link and work with the PCT, as well as our relationship with constituent practices. Diagram 1 illustrates the role of STCCG in taking responsibility for delivery of this pathfinder bid, as well as continuing to advise and influence a broad range of commissioning activities across the PCT. Moving forward STCCG will be accountable for more of these commissioning activities. The structure of STCCG has been organised around the principles of ensuring delivery of pathfinder objectives, whilst advising and influencing the broader commissioning agenda, two roles which will merge over time.

Scope of pathfinder delivery – decision making & delegation

from PCT

Commissioning activities outside of pathfinder – advisory &

influencing

Decision making will be via Pathfinder sub Committee of statutory Board. This circle will increase in size as GPCC takes on increasing responsibility over time

Decision making will be via existing PCT routes. This circle will decrease in size as the PCT delegates increasing responsibility to GPCC over time. The Chair attends the PCT Commissioning Executive Team\RRI Board meeting and will attend the statutory Board. The GPCC Clinical Governance lead is a member of the

Quality, Patient Safety and Clinical Governance Committee.

Diagram 1 Scope of commissioning as at July 2011

5

Board members have specified roles; job descriptions and role outlines have been created. We recognise the need to increase the number of GPs engaged in STCCG, so a range of clinical delivery roles have been identified to support elected members in the delivery of pathfinder objectives; this will also ensure critical clinical input into commissioning developments outside of the scope of our pathfinder bid. We are currently planning recruitment to these clinical support roles. Additionally we have successfully attracted a new GP elected member via a nomination process on which we have worked jointly with the LMC. We are in the process of writing to all GP practices to gain a mandate for the new GP member and anticipate welcoming her to the Group from 1st July 2011. Governance documentation is being drafted building on that produced by NEAG. This includes a Consortia Constitution, Pathfinder Committee Terms of Reference and associated GP Consortia Conflicts of Interest Policy. Public and Patient Involvement Our plans for the above are at three levels:

- Corporate level (S Tyneside GPCC Board) - Service re-design level - Practice level

At corporate level, one Board member has allocated responsibility for oversight of PPI and will be working closely with the PCT Involvement Manager. By the end of October 2011, we will have asked each practice to identify a patient representative to take part in a Patient Involvement Group, which will help to inform our planning and commissioning activities. We will also utilise the PCT’s existing “Reading Group” to whom we will send information around involvement activities by post or email. At service level, engagement and consultation around re-design or implementation will take place directly with service users or service user representatives. At a practice level, patients will be able to influence decision making through Patient Participation Groups or Forums. We would anticipate that practices will participate in the new 2yr DES which aims to promote the proactive engagement of patients in seeking their views through the use of effective patient reference groups and to publish the outcomes of their engagement and views on the practices own websites. We further plan to encourage those practices that currently do not yet have a PPI group of a practice website to do so by using some of the DES payments Management arrangements STCCG’s management support is supplied by the PCT’s Commissioning Development Unit (CDU) for South Tyneside which provides dedicated resource to STCCG. We are also working with the wider PCT to identify additional support, including medicines management team through a link prescribing advisor, organisational development, business intelligence, governance, as well as finance and contracting.

Scope of STGPCC (July 2012 – for authorisation readiness)

Future decision making will be carried out by the Committee of STGPCC as it takes on increasing responsibility over time

Scope of pathfinder delivery – decision making & delegation

from PCT

Commissioning activities outside scope of STGPCC

Diagram 2 Scope of future

commissioning

Key

Green Box – Statutory Role Amber Box – Non Statutory Role currently but will have statutory role in the future Green Line – Formal accountability between layers Amber Line – No formal accountability but communication between the two will be required

Statutory Board for South Tyneside

Primary Care Trust

PCT

(Current decision making)

South Tyneside GPCC Pathfinder

Committee (new)

South Tyneside GPCC Executive

Committee

Council of Members

South Tyneside Practices - Members

Hebburn and Jarrow Locality Group

South Shields Group

(North Area)

South Shields Group

(South Area)

Scope of decision making linked to scope of pathfinder. Consists of elected members & non elected members (PCT Execs incl DoF & non Exec) & those in attendance eg DPH.

Elected members. Detail around operation and Powers set out in draft Constitution.

Nominated Member lead from each practice. Focus on priorities, relationships, networks and developing collaboration. Draft constitution exists.

Members of Consortium - practices holding a contract GMS. PMS APMS.

Locality groups (peer review, challenge, QoF QP and Local Incentive Scheme planning). Focus on priorities, relationships, networks and collaboration at local level.

Diagram 3 Governance

overview

7

Matthew Walmsley, Chair

(GP)

MH & LD

John Tose (GP) Joint Vice Chair

Clinical lead Planned Care

(pathfinder)

Colin Bradshaw (GP)

Joint Vice Chair Clinical lead MM, Nursing Homes

(pathfinder) & Clinic.

Governance

GP Board Member Member nominated–

to start 1.7.1 Currently obtaining

mandate from practices 1

Clinical lead Urgent

Care (pathfinder)

Irene McConnachie Practice Manager

Board Lead for LTCs

Ros Whitehead Practice Manager

Board Lead LIS/QoF Comms &

Engagement (Practices)

Marion Slater Practice Manager

Board Lead for PPI & Comms

Pathfinder delivery (GP)

Clinical Support – Planned Care

Pathfinder delivery (GP Clinical Support

– Nursing Homes (Medicines

Management support from PCT)

Pathfinder delivery (GP) – Clinical

Support: Urgent Care

Clinical Support (GP)

LTCs

Clinical Support (GP)

MH & LD

Board level role

Clinical delivery & support

Blue font denotes vacancy-recruitment in progress

Diagram 4 Executive Committee Structure (elected members)

May change subject to national requirements

8

Scope of commissioning STCCG have identified priorities linked to QIPP which are of strategic importance and which will require engagement with key partners and stakeholders; we feel that GP commissioning can add value and make more difference in these areas than the PCT could in acting alone. The scope of our commissioning activities is described below, with detail addressed in the QIPP section. An indicative total of around £190m for services commissioned will transfer to STCCG, and additionally £27m for medicines management. Day to day responsibility for service areas will be agreed, with an initial indicative amount of £42m, and over time this will increase in % terms. This will be aligned with PCT’s scheme of delegation and standing orders. To be authorised, the Commissioning Group will need to go through due and proper processes. Improving primary care For our priority areas, we have linked our Local Incentive Scheme (LIS) for 2011\12 with pathfinder objectives and QoF QP indicators to maximise the potential for change at practice level; our plans include peer review, working in identified localities to challenge pathways, existing behaviours and to make changes across South Tyneside through reductions in unwarranted clinical variation to improve primary care services. This critical principle will cross cut the scope of all our commissioning activities as shown in Diagram 5. Further detail is outlined in the section on Supporting Practices and Leadership.

Urgent Care – A&E attendances, Emergency Admissions and Walk in Centres & Minor Injury Units A significant rise in emergency admissions and A&E attendances at South Tyneside Foundation Trust has increased pressure in the system and we see this as an opportunity to take ownership of the problem and review current issues with a view to setting ambitious targets to make required system improvements in the short and longer term. By doing this we will seek to reduce urgent care activity in a hospital setting and achieve identified savings, reducing South Tyneside PCT’s contribution to the Transformation Fund. We will undertake specific work; including reviewing pathways and relationships to understand the effectiveness of WICs and MIUs across South Tyneside. We will look to bring services which are fragmented across health and social care together to work in a more integrated way, to avoid patients falling through gaps, where the default position is emergency care in hospital, through appropriate management of patients in Primary and Community services. We will work jointly with the Local Authority through the Health and Wellbeing Board; our early work plans include work around Urgent Care. The Chair has regular meetings with the Children’s and Adult Director of Social Services to facilitate joint working.

Urgent

Care

Planned

Care

Nursing

homes

Medicines

Management

Improving primary care

Pathway re-design

Diagram 5

Alignment of goals &

cross cutting themes

QoF

QP

LIS

QIPP

Alignment of goals in

general practice Pathfinder goals & cross cutting themes

Diagram 5

Alignment of goals &

cross cutting themes

10

If successful, STCCG will assume responsibility, via the Pathfinder Committee, for decision making around pathfinder urgent care issues from 1st July. Financially, this will include indicative sums of £5m for A&E and £37m for emergency admissions, representative of around 24% of the overall commissioning budget which is anticipated will transfer to STCCG in future. Medicines Management Historically prescribing costs have been the lowest per head of population in the SHA, in the last few years these costs have increased, and are now running at the SHA average. We believe this trend can be reduced by cutting back on growth through the delivery of cost effective prescribing and aligning guidance jointly across primary and secondary care. The Board has established a lead clinician for prescribing and the Consortium has strong links to the PCT Medicines Management Team through a linked Prescribing Advisor; practices are supported by a designated practice pharmacist. Whilst our prescribing group is well established, clinically led, with representation on the FT Drug and Therapeutic Committee, we are keen to develop this further by creating a joint Primary/Secondary Care medicines committee, ensuring our formulary is effective across all providers. This board will make key decisions around prescribing and will develop a South Tyneside wide formulary. By 31 December 2011, STCCG will assume responsibility for an indicative prescribing budget of around £27m via the Pathfinder Committee; by this date, STCCG will have taken on 37% of the overall anticipated total commissioning budget. Planned Care The planned care work stream aims to review a range of planned care services and reform where necessary through service re-design and/or contractual levers ensuring existing and newly developed pathways are monitored to ensure appropriate use of services. We have identified Diabetes, MSK and wider speciality work around new to review ratios as the initial targeted work plan for the group to deliver.

For Diabetes the aim is to reduce unnecessary and preventable secondary care activity to improve the care for patients and to support diabetes care being delivered in the most appropriate setting.

For MSK a training programme will be delivered for all practices to be able to deliver joint injections in practice which will be underpinned by education for clinicians around appropriate use of the existing MSK pathways in South Tyneside.

The group will be working closely with secondary care to agree a reduction in unnecessary OP follow ups for an agreed list of procedures in general Surgery and Gynaecology which will be in place by March 2012. It will also work to agree appropriate new to review ratios for a minimum of 3 clinical specialities based on national best practice levels.

Overall we will be working to improve the quality of GP referrals and reduce any unnecessary referrals, working in partnership with secondary care. The initial areas selected for the pathfinder bid will encourage close working relationships between practices, GPwSI and Secondary Care to review pathways to move as much care safely into the community. We will utilise existing infrastructure to best effect and will play a key role in the PCT’s Planned Care Programme Board. We will be looking to reduce health inequalities by ensuring that those who are on disease registers are effectively managed, and will look to identifying those who are not on disease registers and therefore not receiving structured care. The total planned care budget for South Tyneside is approximately £46m and STCCG will assume responsibility for this indicative sum, via the Pathfinder Committee, by April 2012. Nursing Homes We will aim to improve quality of care in nursing homes through initial review of services for patients at end of life and will commission changes; we will seek to reduce numbers of emergency admissions to hospitals from nursing homes and reduce any overreliance on GP out of hours services; we will also explore the potential for

11

delivering different models of general practice care to nursing homes. Following our initial work around EoLC patients in nursing homes, we will review pathways of planned care for patients in nursing homes with complex conditions, to ensure care is delivered in a way which avoids inappropriate emergency admissions. We will utilise existing PCT infrastructure to best effect and will work jointly with the Local Authority. By April 2012, STCCG will have assumed responsibility for an indicative sum of £7m relating to Continuing Healthcare and Funded Nursing Care. By April 2012, this will be representative of 100% of the overall PCT commissioning budget which it is anticipated will transfer to the clinical commissioners. Supporting Practices STCCG will use available levers, such as QoF QP indicators and the Local Incentive Scheme (LIS) to work with practices around the achievement of pathfinder. In terms of success to date, we held a very successful launch event with our practices in May. This was extremely well attended and the commitment of local practices in working with our Board was clear. An outline of the draft Constitution - which provides the grounds rules between the STCCG and the Council of Practices - was shared and agreement reached in principle. Critical local issues around urgent care, planned care and medicines were discussed and we shared the focus of the LIS for 11\12; practices also agreed to a document which sets out a clear Dispute Process. We are currently developing interfaces for communicating with practices and whilst we already have a regular “round robin” email circulations, we are working with the PCT to further develop our website (South Tyneside Information Portal); this will provide a key interface with all our practices and will be a way to share developments, plans and resources. Our aim for clinically commissioned services for the local population is to ensure that all GPs are engaged. Following the success of the launch, further events are planned with the Council of Practices and plans are being made for further meetings to take place in three locality groups (Jarrow and Hebburn; South Shields – north; South Shields – south). Within these groups practices will aim to support each other, developing systems for peer review, working together in a more co-ordinated way. This way of working will align the QIPP agenda with general practice at local level via the Local Incentive Scheme (LIS) and through our influence in the pathways chosen for the QP QoF indicators, supporting peer review activities through the three locality groups. Specific work at practice level will be supported by the use of the Business Intelligence Reporting Tool (BIRT+) system in practices which will utilise the clinical dashboard (system to support practices in identifying areas for action, e.g. previous day’s A&E attendances at patient level) and give practices the most up to date information available to manage demand and appropriate use of the services available. The tools will also support the reduction of health inequalities through identification of patients in different at risk category groups. Working with PCT during the transition STCCG acknowledges that the PCT cannot devolve accountability and welcomes the PCT’s commitment to delegate agreed responsibilities through amendment of its governance arrangements by creating a Pathfinder Committee, which will sit as a Committee of the Statutory Board. Elected members of STCCG will be joined on this Committee by a non Executive member of South Tyneside PCT, the Director of Finance, the Director of Commissioning Development, as well as the Director of Public Health. This will ensure a rounded approach for assurance purposes during the transition. In effect this will mean that STCCG will be established as a committee of the PCT and will be governed by clear terms of reference, up until the point at which there is a legal framework which allows us to assume authority and accountability for statutory commissioning functions, subject to authorisation. The Chair/Vice chair of STCCG are members of the PCT Commissioning Executive Team, working with the PCT in making important commissioning decisions and working to ensure smooth transition through to April 2013. We are working closely with the PCT around alignment of staff and the development of commissioning support functions for the future. The latter is also the subject of joint discussions between the three Clinical

12

Commissioning Groups in SoTW; we are committed to the development of a SoTW CSU and to maintaining commissioning capacity and capability in the local system. As part of the transition, we would aim to be authorisation ready by July 2012 and authorised by March 2013. Day to day responsibility for service areas will be agreed with the PCT. This will be aligned with PCT’s scheme of delegation and standing orders. Whilst the detail around delegation of budgets is under discussion broadly our expectations are as shown in diagram 6, below:

Pathfinder

deadlines

Pathfinder

submission

17/06/2011

STGPCC

Authorisation

Ready

STGPCC is

authorised

Budget areas

Timeline Jun-11 Jul-11 Aug-11 Sep-11 Oct-11 Nov-11 Dec-11 Jan-12 Feb-12 Mar-12 Apr-12 May-12 Jun-12 Jul-12 Mar-13

Budget

responsibility

37% budget

(circa £69m)

50% budget

(circa £113m)

Acute / Associate comm and CHC / FNC

(£104m)

23% budget (£42m)

100% budget

(circa £217m)

Implementation of pathfinder bid and preparation for authorisation

A&E / Emergency Admissions (£42m)Medicines management

(£27m)

Community Services

(STFT) - (£25m)

Mental Health (NTW) -

(£19m)

Organisational development With OD support from the PCT we are currently working on our OD plan. Early activities have included a Board Away Day to review initial working arrangements and further work is planned to further develop our brand, vision and values. We are maintaining a keen awareness of emergent authorisation criteria, around which we will be developing our OD plan by autumn 2011. As we move into delivery of pathfinder we will be engaging in other areas of commissioning, for example in late summer we will be working with the PCT to take a more significant role in the contract round for 2012\13; this is just one example around how our role will grow and as set out earlier, we are working with the PCT to plan this transition. Diagram 7, overpage, sets out how we intend to move forward in our development. The cornerstones around our development as a Board will be as follows:

Developing a sustainable clinical structure to ensure clinical capacity: eg, through recruitment to the clinical delivery layer in our structure and recruitment of new GP Board member

Leadership development: eg, skills analysis and development for Chair and Vice Chair via NE Leadership Academy programme and personal coaching sessions

Governance: eg, ensuring that appropriate systems and processes are in place for fair and transparent decision making at all levels, via NEAG governance workstream

Making local connections: eg Programme of local network development in place via Chair, includes one to one meetings with senior leaders in partner agencies and provider organisations

Patient involvement & engagement: through our Council of practices we will work to ensure a standardised approach to PPI, developing a Patient Reference Group for STCCG as part of this

To develop our commissioning competencies, we have used the programmes outlined in the ISOP as a guide. Our commissioning development programme will run throughout 2011\12 and will involve learning from and working with colleagues in the PCT, around important areas of commissioning. Further development activities for 2012\13 will be captured in our emerging OD plan.

Diagram 6

13

Diagram 7 – Moving forward : STCCG’s anticipated engagement in the overall commissioning agenda

2011\12 –commissioning development programme

ISOP Programme\functional area

Q1 Q2 Q3 Q4

Urgent Care

Planned Care

Medicines Management

End of Life Care

Contracting (via contract round 12\13) including CQUIN

PPI

Long Term Conditions

Staying healthy (NHS Health Checks, obesity, alcohol, smoking)

Cancer

Mental health (adult)

CAHMS

Children (Care of sick & injured children, child health & maternity)

Continuing Healthcare and Funded Nursing Care

Sexual health

Managing risk We have identified a number of risks and mitigating actions. These will be formally monitored via the Pathfinder Committee though for areas of high risk (e.g. urgent care) representatives of STCCG will work closely with the PCT through ongoing regular dialogue to ensure that risks are effectively addressed and escalated.

Risk identified Mitigating actions

South Tyneside financial situation urgent care activity

- Board member role with oversight for urgent care - Clinical lead\pathfinder delivery role for urgent care in GPCC structure - Chair on PCT Commissioning Executive Committee, ensures GPCC fully

aware of and contributing to discussions\decision making - DoF member of Pathfinder Committee - Pathfinder priorities QIPP aligned

Small population equates to availability of lower funding (clinical leadership and development monies)

- Board and delivery structure designed and fully costed for the year 11\12 in line with pathfinder bid

- Working closely with PCT to maximise resources, avoid duplication

Clinical resources – low numbers of clinicians on Board & potential risk to delivery

- Election ongoing for additional board member - Clearly defined roles at Board level - Flexibility in clinical delivery structure to ensure pathfinder priorities have

appropriate levels of clinical support

Viability of STCCG as an entity in future

- Working together with SoTW GPCCs and PCT to develop a shared and sustainable commissioning system for the future, from which STCCG will be able to draw its future commissioning support

14

Local GP leadership and support

Please describe evidence of existing local GP leadership and support (or how this will be achieved if this is not in place) Leadership and evidence of support The Executive Board began on 1st April 2011 comprising 6 members who had taken part in a nomination process, delivered via the LMC with the approval of its members. Subsequent to nominations, to gain a mandate the LMC advised all practices of the outcomes of the process by letter and addressed the issue at a meeting of the LMC. We have successfully attracted an additional GP Board member, whom we anticipate will start on 1st July, subject to these arrangements being mandated by practices. The three practice managers on the Board are considered to be a strength, all bringing significant experience in practice based commissioning (PBC), having been on previous boards. They will act as a key conduit with practice manager colleagues across the locality and one practice manager Board member is chair of the South Tyneside Practice Managers’ Committee, which has significant influence in general practice business in South Tyneside. The three GP Board members are experienced in practice based commissioning, having sat on PBC Boards and they have experience in the reform of pathways, two members having previously sat on former PCT Professional Executive Committees. Board members are actively demonstrating a commitment to their personal development and leadership skills, with two GP members now engaged in a North East leadership academy programme. We feel this mix brings a positive blend of clinical focus, leadership skills and commissioning competencies. The Council of Practices is at the heart of our plans for effective GP commissioning in South Tyneside, its governance arrangements having been embraced by its constituents. We held a launch event in May which was well attended, with Board members taking the opportunity to present on national policy, key local challenges, as well as the structure of the board and vacant positions. Information was shared around the current financial situation including significant concerns regarding increasing emergency activity. Practices contributed in three peer review locality groups (previously mentioned) to discussions around progressing the urgent care agenda and other aspects of our pathfinder. Feedback from groups is reflected in this bid.

Local authority engagement Please describe evidence of existing local authority engagement (or how this will be achieved if this is not in place) Representatives of STCCG meet regularly with the Director of Children’s and Adult Services - discussions have taken place around STCCG’s development, its pathfinder objectives and joint working, wherein it is agreed that a senior LA representative will be invited to attend Pathfinder Board meetings to ensure a LA perspective. LA colleagues are supportive of the priority areas we are seeking to address and all acknowledge the scope and opportunities for joint working to make improvements across the health and social care economy in South Tyneside. Particular opportunities are presented through the development of the new Health and Well Being Board (H&WBB) arrangements which will commence in June 2011, South Tyneside Council being an early implementer site. The Chair of STCCG is a member of the H&WBB and a priority area already identified for the Board’s early attention is around Urgent Care, clearly linking the H&WBB agenda with STCCG’s pathfinder bid. It is also agreed that the PCT and Local Authority will have a 6-month stock take meeting to discuss progress with the ISOP including RRIs (QIPP) and GPCC Chairs will join this; this demonstrates our commitment to working with the PCT and LA around the broader agenda.

15

As part of STCCG’s Chair’s induction, meetings are taking place with the Council Chief Executive and the Council Leader to develop networks and cement relationships, however, the Chair has already met these individuals more informally. Additionally, the Director of Public Health (a joint PCT\Local Authority appointment) is a non elected member of the Board, ensuring links around with Public Health issues. South Tyneside Council have provided a letter indicating their support of our application.

Delivery of the local quality, innovation, productivity and prevention (QIPP) agenda

Please provide evidence that the group / consortium has taken greater responsibility and involvement in the QIPP agenda During Q3 and 4 of 2010/11 we asked practices to review activity on BIRT and submit end of year reports showing work carried out to analyse practice level emergency admission activity. Following this the Board reviewed recurrent themes and identified solutions to be taken forward in 2011/12 as part of pathfinder. We have also developed strong links with the South Tyneside Urgent Care Network, which is using these findings as the basis for an urgent care action plan for 2011/12. It is our intention that a Board member of STCCG will chair and take a lead role in the urgent care network. STCCG have been influential in the commissioning of an outreach pain clinic in the community at Cleadon Park PCC, providing quality care closer to home. Before this was established patients had to leave the borough to attend secondary care facilities outside South Tyneside. STCCG, supported by the PCT and clinically led by a GP from South Tyneside, have been looking to reform the model of service provision for patients with a range of skin diseases who are currently referred to hospital for diagnosis and treatment, by developing and implementing an intermediate level of care in a community setting, which integrates with secondary care. This will involve the provision of a new consultant-led multi-disciplinary dermatology assessment and treatment service based in South Tyneside which will provide patients with rapid access to assessment and treatment for the most common dermatological conditions outside a hospital setting. We aim to complete the development of this service in 2011. South Tyneside GPs were at the heart of the development of an innovative intermediate assessment and treatment service for MSK conditions. This service has reduced outpatient appointments at secondary care and patients are now seen in a community setting. In April 2011 representatives of STCCG met colleagues from North East Primary Care Services Agency (NEPCSA) to plan alignment of QoF QP indicators with LIS 11\12, key principles being that practices will not be paid twice for the same activity and that STCCG will influence and guide pathways chosen by practices for QoF QP, to ensure alignment with pathfinder objectives. LIS 11\12 is being designed in such a way that practices must achieve QoF QP as a baseline, before then going on to work on LIS objectives, which will draw on baseline work, but will require the achievement of specific practice level objectives (e.g. % reduction in A&E attendances and 0-1 LoS emergency admissions) The draft LIS was shared with practices at a launch event in May and was well received. In summary, QoF QP, LIS 11\12 and STCCG pathfinder objectives will work in harmony and will be co-dependent, ensuring that all practices have clear responsibilities in making commissioning improvements in South Tyneside.

16

Please describe proposals to contribute to the QIPP agenda in your locality The overall scope of our pathfinder bid is set out earlier; this section draws further on those areas which link to QIPP and illustrates how we plan to track our progress:

Measures of success - KPIs

Urgent Care

Take on leadership of South Tyneside Urgent Care Network (UCN) to drive urgent care reform in South Tyneside on a multi agency basis by July 2011

Completion of review of urgent care pathways (but not to duplicate work already carried out) to understand:

o effectiveness of: WIC\MIUs in South Tyneside, o effectiveness of FT “front of house” arrangements (new ACS pathway), o arrangements for emergency admission via A&E, o evaluation of new Acute Care team o how well services on the pathway integrate, in particularly primary and community services o delivery of peer review activities in locality groups around urgent care issues, to include

emergency admissions, A&E attendances - through peer to peer challenge to achieve best practice and change behaviours

Above work be driven via UCN. As a result we will identify changes which will achieve:

o Reduction in emergency admissions by 544 by 31 March 2012 o Reduction in A&E attendances by 10% by 31 March 2012 o Achievement of savings of £1.34m by 31 March 2012

The above figures have been modelled down to practice level and will form part of the detailed work being carried out at practice level towards achievement of the pathfinder KPIs. All of the above will contribute to a reduction in South Tyneside’s contribution to the Transformation Fund. The Health and Well Being Board will also play a fundamental role in addressing urgent care issues and STCCG will play a key role in this, ensuring critical links with the LA and across the system.

Planned Care

Reduction in unnecessary diabetic related new\review OP referrals by 10% within 18 months and a reduction of diabetic related emergency admissions by 5% in 18 months

Practices to use new WHO criteria for diagnosis of Type II DM and thereby reducing unnecessary Oral Glucose tolerance tests (OGTT) by 25% [decrease in OGTT for people with an HbA1c>6.5%]

Pathfinder

LIS 11\12

QoF QP indicators

Diagram 5 Alignment of goals:

co dependency of work streams at GPCC and practice

level

17

with the aim being most OGTTs being carried out in primary care, with a subsequent reduction of secondary care activity by March 2012

Increase GP musculoskeletal referrals going to intermediate CATs to 60% by March 2012 with a decrease to 40% (or less) going to orthopaedics

Implement training programme for primary care clinicians around delivery of joint injections which will be in place by October 2011, this will include engagement of GPs and education around appropriate pathway for joint injections and wider MSK conditions in South Tyneside

To ensure that joint injections are carried out in the most appropriate setting for patients by increasing capacity in primary care services by 10% by March 2012 and use of the intermediate service appropriately as an alternative to secondary care

Reduction in unnecessary OP follow ups in General Surgery and Gynaecology for an agreed list of procedures by March 2012

Work with secondary care to agree appropriate new to review ratios for up to 3 potential clinical specialities by March 2012 based on agreed best practice

Medicines Management

Joint Primary and Secondary Care Medicines Management Committee by Sept 2011

Agreed formulary in place and fully effective across providers by Dec 2011

Practices identifying and reviewing areas of cost savings by 30 June 2011

Scriptswitch in place across South Tyneside practices by Dec 2011

Practices signing up to using the identified formularies, identifying waste. These areas will include SIP feeds and wound dressing formulary. From Dec 2011 onwards

Growth, currently at 4%, to be reduced by at least 10% (this may depend on major external influencing factors) March 2012

Nursing Homes

Delivery of commissioning action plan, worked up jointly with the LA, for 2012\13, based on evaluation and review activities carried out in 2011\12 with a pilot cohort, which will look to:

Develop and commission a different model of primary care services for nursing homes in South Tyneside for implementation during 2012\13; we will explore options in aligning specific homes with specific practices, with an emphasis on improving planned care delivery.

Increase in uptake and use of Advanced Care Planning, partial delivery (cohort) in 2011\12 and phased roll out to all nursing homes during 2012\13 to achieve 100% uptake

Increased uptake and coverage of nursing homes staff trained, partial delivery (cohort) in 2011\12 and phased roll out to all nursing homes during 2012\13 to achieve 100% uptake

Increased uptake and use of palliative care registers in general practice (a complete register available of all patients in need of palliative care / irrespective of age)., including MDT meetings on 3 monthly basis as routine, partial delivery (cohort) in 2011\12 and phased delivery during 2012\13, 2013\14 across all nursing homes and practices in South Tyneside.

The pilot cohort of nursing homes will be identified by comparing each home’s emergency admission rates during the past 12 months, on a basis which is proportionate to the number of nursing beds in each home. Outliers will be targeted in our early work via the pilot cohort.

Please complete and return to Richard Barker, Director of Commissioning Development at North East Strategic Health Authority richard.barker@northeast.nhs.uk