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Kingston Clinical Commissioning Group Commissioning Intentions 2013/14 Kingston Clinical Commissioning Group Kingston Clinical Commissioning Group Commissioning Intentions 2013/14 November 2012 Final Version Submitted

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Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Kingston Clinical Commissioning Group

Kingston Clinical Commissioning Group

Commissioning Intentions 2013/14

November 2012

Final Version

Submitted

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

CONTENTS

1. Introduction 2. Financial Position 3. Better Services, Better Value 4. Long Term Conditions 5. Community Services 6. Mental Health 7. Acute Hospital Services 8. Outpatient Pathway Redesign 9. Maternity and New Born 10. Children 11. Urgent, Unscheduled and Emergency Care 12. Managing Outpatient Referrals 13. Surbiton Health Centre 14. Any Qualified Provider 15. Primary Care 16. End of Life Care 17. Social Care 18. Medicines Management 19. Public Health 20. Innovation 21. Information Appendices 1 Commissioning Priorities Mapped to the Domains in the National Outcomes Framework

2 Commissioning Priorities Mapped to the vision and values of Kingston CCG

3 Overview of Kingston Joint Strategic Needs Assessment 4 Abbreviations

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

1. INTRODUCTION

The 2013/14 Kingston Commissioning Intentions have been drawn up by the Kingston Clinical Commissioning Group (KCCG). They outline the priorities to be taken forward in the coming year to improve health and health services for the population of Kingston. Having developed detailed Commissioning Intentions for 2012/13, it is not our intention to start again from the beginning, but we will build on and refresh the 2012/13 plans, updating them where necessary and incorporating new priorities and requirements where they have been identified. 1.1 Principles Central to development and delivery of our Commissioning Intentions are the following principles; Patient Focused Our first responsibility is to our patients, their carers and to the people and communities of Kingston. We will involve them in the design of services, support them to co-produce systems of care and empower them to look their after own health and help others do the same. We have also adopted a population approach to commissioning with proportionate universalism whereby commissioning resources are spent in proportion to the degree of disadvantage of the local population. Outcomes driven We will measure our success by the improvements we are able to secure in the health of local people and the range and quality of services provided. We will commission health services based on evidence of need, clinical effectiveness, patient experience, and in response to defined local and national strategic priorities, and health inequalities. We will also work towards commissioning based on outcomes achieved by providers and use accurate and timely information to guide commissioning decisions and reduce unwarranted variation in primary, community, secondary and tertiary care services. To help us achieve this we will ensure that all our commissioning priorities support the delivery of the National Outcomes Framework. Appendix 1 shows how the commissioning priorities map to the domains in the National Outcomes Framework. Collaborative As the Clinical Commissioning Group (CCG) is a membership organisation , the GP practices of Kingston who constitute the membership will co-operate to ensure that local service are delivered to the highest standard and that we collectively commission services of high quality, the best value possible and which are responsive to patient‟s needs. To achieve this aim we support the integration of services where appropriate working with Local Authority colleagues and other key partners and put in place we put in place commissioning support that is fit for purpose for us to deliver our commissioning objectives. Integrity

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

We are part of the NHS and will ensure that we uphold its principles and values as reflected in the NHS Constitution. We will demonstrate honesty and integrity in all of our work. We will be thoughtful and transparent in our decision-making and governance. We will be responsible stewards of public money, ensuring that we make adequate provision for adverse times and we will use programme budgeting to assist in choosing areas for commissioning scrutiny. Supportive and Innovative We are responsible to our employees and will support individuals and teams to experiment and succeed, to lead and develop. We will treat people with respect and value diversity. 1.2 Drivers In drawing up the 2013/0214 Commissioning Intentions we have identified the following drivers: Joint Strategic Needs Assessment As with the 2012/13 plans, a core driver for the 2013/14 Commissioning Intentions is the Kingston Joint Strategic Needs Assessment (JSNA). A detailed JSNA was prepared and finalised in 2011. However, the JSNA is an evolving piece that constantly assesses need and is refreshed on a continual basis as new information becomes available. The specific priorities identified from the JSNA are: Mental health

Substance misuse Integration of community health and local authority teams

Medicines management

Managing ambulatory care sensitive conditions (primarily pneumonia and influenza)

Urgent care

Management of outpatient referrals A snapshot of the Kingston profile from the JSNA is attached to this document as Appendix 2. Joint Health and Well Being Strategy In response to NHS reforms and other changes, Kingston now has a Health and Wellbeing Board (HWB) which is a formal committee of the Royal Borough of Kingston Council, with a membership drawn from across statutory public sector bodies and the local voluntary and independent sectors. One of the responsibilities of the HWB is to oversee development of a Joint Health and Wellbeing Strategy for Kingston, and a draft version was published for discussion in June 2012. Local NHS Commissioning Intentions must also take this into account, and the following outlines the main areas in this Strategy: Mental health Older people and people with long term conditions Addressing the needs of socially excluded and disadvantaged communities Children and young people

Better Services, Better Value We will continue to work with colleagues across SW London (SWL) to develop and

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

deliver the Better Services, Better Value (BSBV) programme. The principle aim of the BSBV programme is to shape the future model of health services across SWL to secure both clinical quality and financial sustainability. The main areas of focus for this programme are: Planned Care End of Life Care Urgent, unscheduled and emergency care Maternity and new-born care Children‟s Services Long-term Conditions

The programme is described in more detail in Section 3 of this document. Quality, Innovation, Productivity and Prevention (QIPP) The other main strategic strand that has been taken into consideration during the development of our 2013/14 Commissioning Intentions is the delivery of the QIPP targets. As part of the 2012/13 QIPP, Kingston has a savings target of £10.5m. We will need to continue to maintain these savings through 2013/14, together with an additional savings target for 2013/2014. The value of the net savings had not been confirmed at the time of writing this document. We are currently developing a range of QIPP schemes to meet the 2013/14 QIPP savings target. The QIPP schemes will build on those delivered in 2012/13 and we are therefore anticipating that they will include areas such as: Remodelling of identified patient pathways in community, mental health and elective outpatient services to improve access, choice, health outcomes, patient experience and value for money

Support timely discharge from hospital to the community through integrated health and social care, rehabilitation and reablement services

Development of primary care including urgent care and primary care prescribing

Achievement of best value for individual placements and continuing care

Promotion of public health and prevention though initiatives such as screening, immunisation and healthy living

Delivery by all our providers of national performance and key performance indicators

Dr Naz Jivani Dr Phil Moore

Clinical Lead & Chair (designate) Clinical Lead & Interim Chair (designate)

Kingston CCG Kingston CCG

David Smith

Chief Officer (designate)

Kingston CCG

November 2012

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

2.FINANCIAL POSITION

Kingston has historically demonstrated strong financial management. Since implementing a turnaround programme in 2007/08 we have achieved our financial targets year on year, demonstrating effective use of resources. This has enabled us to be able to invest in key areas to improve services and the long term health of the population. Included within our financial plans to 2015 are the BSBV (Better Services Better Value) assumptions which recognise that a critical component of a sustainable health economy is the necessary acceleration in scale and pace of our locally owned and developed out-of-hospital models of care, along with the required transformation of primary care. These shifts in models of care will enable better services closer to home for Kingston patients whilst delivering net savings in the region of £1.7m in both 2013/14 and 2014/15.

3. BETTER SERVICES BETTER VALUE Clinicians, from hospital and community services and primary care working alongside patient representatives have been leading five clinical working groups to look at the patient journey and models of care in the following areas: Planned Care End of Life Care Urgent, unscheduled and emergency care Maternity and new-born care Children‟s Services Long-term Conditions

The NHS in SW London faces a challenging future: the population is changing; there is increasing demand for healthcare, an ageing population, locally a rising birth rate, people living longer, unhealthy lifestyle choices, long term conditions increasing and higher expectations. There are also health inequalities across the patch and a need to make sure services address variation in need. The NHS needs to change to reflect modernisation in medicine, technology and drug costs. There are also workforce pressures - a need for increasing specialism in clinical roles within the NHS and a shortage of trained staff with not enough senior doctors available round the clock in some of our most vital services. As well as the clinical challenges, the financial challenges for health services are great over the coming years and we need to become more efficient whilst improving the care we provide. SWL‟s four main acute providers will have to deliver £370 million savings each year by 2016/17, a reduction of around 24% in their costs. A further driver is that of improving safety and clinical quality across SWL, with the aim of improving health outcomes for patients within the available resources. In the view of these factors „no change‟ is not an option and some of the possible early solutions suggested by clinicians and discussed by the public as part of the review include:

Having more urgent care centres, providing urgent medical advice in cases that are not life-threatening linked to A&E departments;

Improving urgent care in the community;

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Improving care for very sick children by locating longer-stay hospital beds in specialist children‟s units in fewer hospitals;

Increasing the number of operations that are done as day surgery;

Having a small number of inpatient planned surgery units;

Better treatment in the community for people with long term conditions;

Improving maternity care by making sure senior doctors are present on labour wards 24 hours a day, seven days a week, including exploring the option of achieving

this by consolidating maternity units onto three sites; Considering having more senior doctors at fewer A&E departments.

The next phase of work involves looking at a very broad range of options for the future that are location specific, and making an initial assessment as to which of these options will be financially viable and achievable in the time available. At the same time, the clinicians leading the review have been engaging with local people and stakeholders to get their views on some broad „criteria‟ that decision makers should take account of when assessing these options for service change and exploring which of these criteria are most important to them and why.

4. Long Term Conditions

We are committed to developing and implementing a transformational model of integrated health and social care which we will use as a platform to deliver services for people with long terms conditions in Kingston. The underpinning principles to the approach that we will adopt in commissioning services for patients with long term conditions include: Setting a clear, ambitious and measurable goal to improve the experience of

patients and service users;

Offering guarantees to patients with complex needs with a greater emphasis on well being, prevention of ill health and independent living;

Implementing change at scale and pace; Keeping the needs and perspectives of the individual at the heart of any discussion

and decision about integrated care Simply redesigning care pathways is unlikely to effect the transformational change in health and social care delivery that we are working to achieve. Instead we aim to redesign core processes to create and sustain a multi-disciplinary care delivery system to form enduring partnerships which will drive the quality and cost benefit of the care we need to provide. During 2012/13 we have piloted a number of initiatives to support the improvement in the care of patients with long terms conditions. These pilots will continue in the early part of 2013/14. If evaluation of these pilots shows the services to be effective then the CCG will look to commissioning them as core services during the second half of 2013/14. A summary of the initiatives identified under the Long Terms Conditions Strategy is given below: 4.1 Kingston at Home We are working in partnership with The Royal Borough of Kingston (RBK) to develop an integrated approach to the commissioning and provision of health and social care

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

services, delivering rehabilitation, reablement, residential and nursing home care and home-based services under the umbrella project Kingston at Home. The main aim of the Kingston at Home project is to support the delivery of less bed based care (hospital, residential and nursing homes) and an increase in home based care, whilst also reducing the number of non-elective admissions into hospital. This aim will be achieved by implementing the following initiatives under the Kingston at Home project. An integrated health and social care service model and single point of access for

referrals and into services;

Redesign of social day care services in partnership with Age Concern. 4.2 Prevention and Self Care We recognise the importance of illness prevention and self care in improving the health outcomes and quality of life for people with long term conditions. By investing in this area we will also be able to deliver cost savings in the medium and long term by identifying factors contributing ill-health earlier and helping people to manage their own health more effectively. Examples of the services provided under prevention and self care are NHS Health Checks, Cardiac Rehabilitation and Diabetes Prevention. 4.3 Reduction in non-elective admissions into hospital Analysis of Kingston data shows that non-elective admissions of older people in supported housing (nursing homes, residential care, and sheltered housing) are most often complex and costly. Better care management of this cohort of the population will reduce the frequency and the severity of admissions. There are also particularly high numbers of admissions from older people with dementia living in supported housing which is a further complicating factor in management of these admissions. 4.4 Telehealth We are committed to introducing Telehealth across Kingston which reflects the Department of Health (DOH) policy - 3 million lives. By introducing Telehealth we will be able deliver the following benefits to patients: Improve awareness of their condition;

Increase self management;

Improve the information available for proactive clinical management which can have a significant impact on the number of patients who are admitted to hospital, and when they are admitted to hospital, their lengths of stay;

4.5 Shifting Care Closer to Home The CCG is committed to a fundamental shift of core services from secondary care provision into the community so that patients can access effective and high quality services closer to home. In 2013/2014 will develop a community cardiology service. 4.6 Risk Stratification We are currently working with the Kingston Co-operative Initiative and Richmond CCG to introduce an IT based risk stratification model in both CCGs. This will enable primary care and other services to share patient level information about patients, predicting when they are likely to require increased clinical input and ensuring that services are in place to prevent avoidable admission to hospital. In Kingston, the risk stratification

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

model will also incorporate links with the locally developed shared care record project.

5. COMMUNITY SERVICES Developing services in the community will continue to be a focus for the CCG and we will take this forward in the following areas: 5.1 Admission Avoidance We will build on existing community services delivery and the 2012/13 QIPP projects to commission services that prevent unnecessary hospital admissions and support early discharge from hospital for patients with long term conditions and frail elderly as follows:

nursing support and education into residential and nursing care homes; enhanced occupational therapy services in Kingston Hospital Accident and Emergency (A&E) Department;

community falls prevention service; rapid response alternative care pathways with the London Ambulance Service (LAS)

5.2 Integrated Care

In line with the HWB Strategy to improve the integration of services, we will work in partnership with RBK and Your Healthcare (YHC) - the local provider of community services - to redesign and transform community health and social care services, providing rehabilitation and reablement for adults through the Kingston at Home project. The Project will support the integration of the rehabilitation, intermediate care and reablement services to deliver new service models focussed on enabling the early discharge of patients from hospital and preventing unnecessary hospital admissions. The service model will place greater emphasis on home based care and service delivery. The service transformation and redesign will increase community capacity e.g. enhanced community nursing and therapies workforce and skill mix to deliver improved outcomes for patients, and will result in changes to our community beds requirements informed by the bed modelling project undertaken in 2012/13. The integration will be further facilitated by the joint commissioning of the Kingston at Home model by the CCG and RBK.

5.3 Care and Management of Older People in acute setting

As part of transforming services for older people and those with long term conditions, and to ensure synergy with the Kingston at Home project, the CCG will build on the joint CQUIN between YHC and KHT to commission a reconfiguration of older people‟s services at Kingston Hospital. The emphasis will be on a more holistic approach to the care and management of older people using a Comprehensive Geriatric Assessment tool and a recovery and rehabilitation philosophy to enable older people to regain their independence and return home following an acute illness.

5.4 Stroke Rehabilitation The London Stroke programme evidences Early Supported Discharge (ESD) as significant in improving outcomes for stroke survivors. ESD is a programme of intensive rehabilitation therapies e.g. physiotherapy, speech and language and occupational therapy, delivered up to daily over 2 weeks. Following this initial intensive period the therapy regime reverts to the level of normal community rehabilitation. In 2012/2013 we implemented a CQUIN with YCH to develop a service for stroke

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

patients. Early data shows patients are being referred from stroke units to this community based service For 2013/14 we intend to decommission the Community Neurology Rehabilitation Service (CNRS) currently provided by Hounslow & Richmond Community Health Services. Work is underway to integrate the ESD within a local CNRS. Ultimately the CNRS will develop to manage patients directly from the Hyper Acute Stroke Units (HASU) which would enable patients to be seen in their own homes and reduce hospital cost as fewer hospital bed days would be required. The service will also provide rehabilitation for patients with other neurological conditions.

6. MENTAL HEALTH

We have identified the following commissioning priorities in respect of improving Mental Health Services: 6.1 Improving access and outcomes within a primary care setting To support the refocusing of services towards prevention and early intervention and improved access to dual diagnosis services within a primary care setting. We will deliver the following: Transfer of Payment by Results (PbR) clusters 11 and 12 into the Community

Wellbeing service; Review effectiveness of the newly commissioned Community Wellbeing service

against a range of PbR indicators. 6.2 Personality Disorders (the SUN Project) During 2013/14 we will review the outcomes of the DH funded Service User Network (SUN) project with a view to either prioritise as a commissioning intention or decommission into local community services. With the other SWL CCG‟s who commission mental health services from South West London and St George‟s Mental Health Trust (SWLStGs) we will Review the outcomes and current service model;

Identify service gaps and mitigations;

Complete a wide review of the need and use of personality disorder services. 6.3 Adult of Working age Tier 4 bed provision

In partnership with SWLStGs and the other CCG‟s who commission mental health services from the provider we will develop and agree a SWL strategic approach to deliver future Tier 4 services and reinvestment opportunities for a dynamic community approach (Assertive Outreach / Crisis Team / Virtual Ward model). 6.4 Special Contractual (out of area or specialist) placements We will support the reduction in the level of activity within Tertiary and Specialist services by: Closer management of referrals and review of secondary care pathways;

Improved contracting of these services, with consideration given to SWL contracts where these can deliver better value for money;

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Review and repatriate activity to local/secondary care services if clinically appropriate to do so

6.5 Older Persons Tier 4 bed provision review Working in conjunction with SW London commissioning colleagues we have identified the need to reconfigure Older Peoples Mental Health (OPMH) psychiatric liaison services and their relationship with Tier 4 provision. We will also consider opportunities to provide mental health expertise and / or training to general older people‟s services - such as domiciliary care. During 2013/14 the CCG‟s who commission mental health services from SWLStGs will, in partnership with the provider, develop and agree a SWL strategic approach to deliver future Tier 4 services. 6.6 Review of Older Persons Community Mental Health Services We will review older people‟s community teams and service outcomes to ensure that services are adequately responding to need, reconfiguring or decommissioning services where necessary. We will also review the implementation of the joint dementia implementation plan and performance of memory services. To take this work forward we have set up a Project Board to look at the current model of OPMH services. The recommendations from the Project Board will be sought and reviewed early in 2013/14 and service changes indicated implemented later in 2013/14, with a full year effect in 2014/2015. 6.7 Carers We will agree and implement a plan to support carers where possible using direct payments or personal budgets in line with the Carers Strategy. To support this aim we will take the following actions: Review provision for carers against other health and social care initiatives; Clarify resources and access to dedicated Mental Health carers‟ funding - NHS and Local Authority;

Clarify Key Performance Indicators (KPIs) regarding carers in provider contracts (e.g. percentage of carers assessments);

Identify how much money is spend on carers breaks and the number of breaks to be available within that funding. 6.8 Veterans and their families We will commission mental health services for veterans and their families in line with the Murrison Review “Fighting Fit” (2009). We will work to raise awareness of veterans services with primary and secondary care providers together with ensuring that SWLStG refers appropriately to the London Veteran Mental Health Service. 6.9 Support to Independent Living We will commission accommodation and support services for people coming out of acute mental health services. The length of stay in specialist mental health (Tier 4) provision will be reduced enabling disinvestment in in-patient beds and high cost placements. We will achieve this by: Continuing to evaluate the needs of people in the target group; Identifying a joint strategic approach to meet the needs of this group; Invest freed up resources to support the delivery of accommodation and support

services.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

6.10 Primary Care facing Attention Deficit Hyperactivity Disorder (ADHD) We will increase the commissioning of local primary care facing ADHD services to reduce the current reliance on South London and Maudsley NHS Foundation Trust (SLaM) as a tertiary provider and in line with NICE guidance relating to this service area. We are discussing with the SWLStG Kingston Borough Director the development of a joint commissioning and provider plan to address the current service gap within available current SLaM budget.

7. ACUTE HOSPITAL SERVICES

We will continue to work with our main provider of acute hospital services, Kingston Hospital (KHT), to improve both the quality (improving health outcomes, patient access to and experience of services), and value for money of the services provided. Many of the commissioning priorities we have identified in this document will impact on our acute providers. The priorities we wish to highlight in this section are summarised below: 7.1 System Sustainability Board In 2012/2013 we established with KHT, a clinically lead System Sustainability Board, to address the issues described above in the following prioritised areas: Urgent Care High Cost Drugs Frail Elderly

During 2013/2014 we wish to build on the achievements of this clinical forum to date by continuing the work already under way and expanding the work plan of the group. 7.2 Accident and Emergency See Section 11 7.3 Outpatient Pathway Redesign See Section 8 7.4 Managing Outpatient Referrals See Section 12 7.5 CQUINs (Commissioning for Quality and Innovation) We await national guidance regarding CQUINs for 2013/14, including identification of any that are nationally mandated and the value to be applied. KHT has received information regarding the implementation of the High Impact Innovations will be a CQUIN pre-qualification requirement from April 2013. These are summarised in Section 20 At KHT and YCH there are a number of CQUINs which have been established in the past year. We expect that these will be reviewed and rolled forward if appropriate. The CCG will look at new areas for CQUINs in 2013/14. As in previous years we would wish to work with KHT to ensure that any new CQUIN is well designed and will deliver the desired improvement.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

7.6 Specialised Services

The range of services to be commissioned by the London Specialised Commissioning Group (LSCG) as part of the NHS Commissioning Board is set to be extended in 2013/14. At the time of writing detail of this extension are not available. Information relating to these transfers will be shared with local acute Trusts as it emerges. Throughout we will be working closely with LSCG to ensure that this complex process runs as smoothly as possible and that the governance arrangements e.g. the role of

Clinical Quality Review Groups (CQRGs) is unambiguous and well understood. The impact of this is expected to be that a greater proportion of commissioning of acute services for Kingston residents is likely to be carried out by the LSCG. 7.7 Changes to Tariff In September 2012 the DOH confirmed the changes to tariff to be introduced in 2013/2014 they are:

Chemotherapy– transition to national tariff;

Maternity pathway payment system – to be confirmed;

Unbundled tariff for diagnostic imaging;

A&E tariffs (separate prices for all 11 HRGs); Increase in scope of procedures attracting “Best Practice Tariff” (BPT). In the years up to and including 2012/13 BPT has been applied and modified as summarised in the following table:

BPT 2010-11 2011-12 2012-13

Acute Stroke Introduced Increased price

differential

Further increase in price

differential

Cataracts Introduced and maintained

Fragility hip fracture Introduced Increased price

differential

Further increase in price

differential and expansion

of best practice

characteristics

Day case procedures Gall bladder

removal

12 further

procedures

added

2 further procedures

added; breast surgery

procedures amended and

revision to some day case

rates

Adult Renal Dialysis Vascular access

for haemodialysis

Home therapies

incentivised

Paediatric Diabetes Activity based

structure (non-

mandatory)

Year of outpatient care

structure (mandatory)

Transient ischaemic

attack

Introduced and maintained

Primary total hip and

knee replacements

Introduced and maintained

Interventional radiology 2 procedures

introduced

5 further procedures

added

Procedures in 3 procedures introduced

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Outpatients

Same day emergency

care

12 clinical scenarios

introduced

Major trauma care Introduced

We expect the activity associated with the introduction of new currencies and pricing arrangements to be subject to key performance indicators (KPIs) to ensure commissioners and providers are not exposed to any unintended and unplanned financial risk. 7.8 London Integrated Cancer System

The London Cancer Programme (LCP) will co-ordinate the commissioning of cancer services across London in 2013/14. Key expectations from the LCP are listed below:

• That London providers will play a full part in implementing the model of care for cancer services;

Services will be commissioned from London providers which are active participants in their Integrated Cancer System; • A standard approach to the counting and coding of chemotherapy activity will be introduced from April 2013;

• A pan-London approach to chemotherapy delivery pricing will be introduced from April 2013, if no mandatory prices are set nationally.

8. Outpatient Pathway Redesign We will continue with our programme of providing an increased range of outpatient and diagnostics in community settings. Surbiton Hospital will provide a suite of diagnostic services that will offer GPs direct access, so we expect levels of this activity will decrease at Kingston Hospital. We will seek to agree to an approach to treatment of first outpatient appointment tariffs with our acute provides in line with PbR guidance, where the diagnostic component of the outpatient appointment have already taken place outside of the hospital. In terms of the programme of service pathway redesign for 2013/14 this is currently being finalised. Priorities identified to date include:

8.1 Community Urology Service

During 2011, In partnership with Kingston Hospital Trust, an analysis of outpatient activity and case mix identified a cohort of patients in secondary care whose treatment needs could be better served in community settings by a GP with Special Interests (GPwSI). A pilot focused on male urology symptoms which began in will be evaluated during Q3 of 2012/13 to determine the most effective service model for community urology and make recommendations for the future provision and commissioning of this service. 8.2 Community Neurology Service

A similar pilot to the community urology service is underway for a community neurology service based at Oakhill Medical Centre and Tolworth Hospital. This pilot will also be evaluated during Q3 of 2012/13 to establish the most effective service model for

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

community neurology and make recommendations for the future provision and commissioning of this service. Both the community urology and neurology services include joint clinics involving a hospital consultant to review complex cases. 8.3 Community ENT/Audiology service

From December 2012 an audiologist-led direct access audiology service for adults with a hearing loss under the age of 60 years has been commissioned. This service was developed as a result of a review of Ear, Nose and Throat (ENT) patient flows and utilisation, with a view to exploring the feasibility of developing a community based ENT service. Work will continue on exploring the feasibility of developing a community based ENT service, which will support the shift of activity from secondary care to a community service. 8.4 Community Cardiology

A working group has been established to scope Kingston‟s community cardiology requirements. It is anticipated that elements of secondary care diagnostics and treatment which can be better provided to patients in a community setting, will be identified by the group. The working group will also seek to identify any community service gaps and redesign opportunities within current community cardiology services, to enable these to be taken forward as appropriate.

It is anticipated that a community cardiology service will be established by October 2013. 8.5 Community Gynaecology The CCG is keen to develop community gynaecology service and has progressed this as follows:

Phase 1 - ‘the Ring Pessary’ care pathway Provision of this pathway started in November 2011. On discharge from Kingston Hospital, the woman‟s GP either manages the next routine follow up appointment or refers the woman to KCAS to see another local GP who provides the service. Early data shows the pathway is working well. Phase 2 - Gynaecology clinical pathway redesign

Work is on-going to revise the gynaecology pathway for heavy menstrual bleeding (HMB). A lead GP and Kingston hospital gynaecology consultant have identified improvements to this pathway which could reduce the number of hospital appointments for a woman. It is anticipated that the new community pathway will become operational in early 2013/14.

9. MATERNITY AND NEW BORN

9.1 Screening

We will continue to ensure easy access to screening both antenatally and for new-borns. In respect of antenatal care we will ensure that the 12 week maternity target is met in 2013/14 by working with services to reduce the number of women presenting late and post natally we will ensure accessible support to breastfeeding advice and services.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

9.2 Integrated Community Midwife Team

We will continue to support the Kingston Integrated Community Midwifery Team service model. The community midwifery teams have been co-located within the five Children Centres based in Kingston and provide women with choice and access to maternity services in the community. Under this service model the integrated teams work in smaller and more defined geographical areas with close alignments to each of the Children‟s Centres catchment area and their associated GP Practices. The aims of the Integrated Community Midwifery Team are: To ensure continuity of care for women; To offer and provide choice of type of care and birth; To increase options and flexibility of care delivery at all stages of the care pathway for women;

To improve communications between the hospital and community services especially with regards to vulnerable families and safeguarding children.

9.3 SWL Maternity Network Commissioning of Maternity Services will be the responsibility of CCGs. To prevent Maternity from losing its priority status within CCGs, NHS London (NHSL) has recommended the development of local maternity networks. Networks should be sector-based, aligned to perinatal networks. Sector funding has been identified to set up the SWL Maternity Network and sub-groups. The remit of the Network encompasses commissioning and service development as well as care pathway redesign and work on clinical quality standards. The CCG will be represented on the Network Board by a GP Clinical Lead and a managerial lead.

10. CHILDREN

There is synergy between the Children‟s services that health and the local authority commission and we have consequently appointed a joint commissioner for Children‟s Services and established a Child Health Commissioning Board with RBK to take this joint agenda forward. The priorities for Children‟s Health identified for 2013/14 by joint Child Health Commissioning Board are summarised below.

10.1 Health Visiting

The Health Visitor role is vital to engaging with the most vulnerable and isolated carers with children under the age of 5 years. In Kingston the Health Visiting service has aligned its teams with the geographical area covered by each Children‟s Centre and each centre has a named Health Visitor. We will continue to support this service model by integrating services further with primary care and ensuring the following:

The active encouragement of registration of new families with their local Children‟s Centre; That the Health Visiting Team work closely with the Integrated Midwifery Service particularly with vulnerable families;

The roll out of 2 year olds‟ checks across Kingston to identify concerns and signpost to

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

appropriate services; To ensure on-going guidance, advice and support is offered with regard to carers‟ health –related concerns for a child‟s development.

10.2 Emotional Wellbeing and Mental Health

Ensuring all children and young people have good emotional wellbeing and mental health is vital in ensuring they are able to achieve their full potential. In 2012 a joint review of the service model will be undertaken to ensure: The resilience of children and young people is promoted through good preventative

measures that protect emotional wellbeing and prevent avoidable harm;

Access is improved by creating a clear an accessible treatment pathway for children and young people who develop a mental health problem; Recovery is promoted through an early intervention approach;

Services provided are evidence-based and delivered to a high standard to ensure children and young people have a positive experience of care and support. The recommendations from this review will be taken forward in 2013/14.

10.3 Integrated Disabled Children’s Service

In October 2010 the Disabled Children‟s Service was transferred from Kingston Hospital Trust to the Royal Borough of Kingston to develop an integrated service across health and social care for this group of children, with close links with education services. In 2012 RBK are undertaking a review of the service model to implement enhanced multidisciplinary working. We will consider the outcomes of the review and commission RBK to provide this service in line with the recommendations and evidence of value for money.

10.4 Safeguarding

We will work with RBK to deliver the recommendations made in the recent OFSTED report into Children‟s Safeguarding in Kingston. This will include improvements such commissioning Health Visiting time to support the Single Point of Access (SPA) being introduced that will improve information sharing between all agencies including general practice to ensure there is a prompt and appropriate response to need and risk. We will also look at the current arrangement of sharing a designated nurse resource between YHC and the CCG to establish whether this can continue going forward

10.5 Immunisation

The responsibility for commissioning immunisation programmes transfers to Public Health England. We will want to work with them to ensure that Kingston remains in the upper quartile for all primary immunisations compared to other Clinical Commissioning Groups in London whilst reducing the inequalities in childhood immunisations within Kingston.

11. URGENT, UNSCHEDULED AND EMERGENCY CARE

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

In recent years the number of attendances at KHT‟s Accident and Emergency Department (A&E) has increased year on year. In 2012/13 the number of attendances seem to have stabilised, although it is believed the acuity of patients presenting at A&E has be come more complex. In 2013/14 we will be introducing a number of initiatives that will reduce the number of patients attending A&E, including NHS Single Point of Access (SPA) 111, Surbiton Urgent Care Service (at the new Surbiton Health Centre) and Kingston at Home. Our target is to reduce the total number of attendances at A&E by 10% compared with 2012/13. To support KHT in managing the patients who do attend A&E in the most effective way possible we will be working with the hospital to develop an integrated care model for the management of patients presenting with minor injuries and aliments at A&E. By developing this model we will be able to ensure that patients are treated in the most appropriate care setting for their presenting clinical condition. We are also developing avoidance services to reduce the number of patients being admitted into a hospital bed as an emergency. This is explored in more detail under section 5.1 of this document.

12. MANAGING OUTPATIENT REFERRALS

During 2012/13 our QIPP referral management initiative has been effective in reducing the number of new outpatient referrals being made to hospital services. This has been achieved by effectively triaging patients to alternative services, often in the community, or by supporting their on-going treatment in primary care. A key component of this work is the locally commissioned referral management service KCAS (Kingston Clinical Assessment Service). During 2013/14 we will continue to roll out this work, working with GP practices to identify and focus particularly or outlier referrers and services. We will also work with KHT to reduce consultant to consultant referrals. 12.1 Patient Navigation During 2013/2014 we will explore with Kingston Hospital the implementation of a patient navigation pilot project with a focus on reducing outpatient follow up attendances learning from the successful scheme running in Croydon. The project seeks to remove non-value upcoming clinic lists and test results for patients who can be: a) Discharged b) Rediverted directly for tests/procedures c) Rediverted directly to surgery d) May need to be brought forward due to sinister findings e) Saved a wasted appointment

Patients are identified using clinic sheets, test results and outpatient appointment letters.

The patient navigators will identify suitable, pull the patient files, and ensure test results

are available, review test results using algorithms provided by the consultant and

knowledge they have built during their time leading on service. The Navigators will then

bring these patients files to a virtual clinic, where the attending clinician will review the

Navigators proposals, and make the clinical decision to discharge/divert the patient ot to

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

maintain the original appointment.

The Patient Navigators are responsible for ensuring the patients are discharged

efficiently and correctly.

13. SURBITON HEALTH CENTRE

As part of the redevelopment of Surbiton Hospital a new health facility – Surbiton Health Centre - will be opened in February 2013, comprising of a range of local community healthcare services. The completed development will provide modern facilities designed and operated to enable service providers to deliver an enhanced range of easily accessible, integrated, high quality services in a local setting, a number of which will have been shifted from secondary care. Development of new care pathways enabling more services to be delivered closer to home will offer a better experience and better outcomes for patients. The overall aims are to deliver improved quality (patient experience and outcomes) in a comprehensive and cost effective pattern of services. In line with the facilities opening date in Q4 2012/13 the Surbiton Health Commissioning Sub Committee is undertaking a service commissioning programme for the following services: 13.1 Relocation of existing services

Outpatient services will be relocated from Tolworth into Surbiton and will include: GP with special interest (GPwSI) services dermatology; Independent providers providing NHS services such as ophthalmology; Secondary care providers e.g. orthopaedics; Minor surgery and vasectomies.

13.2 Commissioning new services

An example of the new services to be commissioned, to be provided from the new Surbiton Health Centre include:

An urgent care service; A range of direct access diagnostic services e.g. imaging and ultrasound.

In addition the facility will provide a community base for the community mental health team (CMHT) and Improving Access to Psychological Therapies (IAPT) teams. Providers using Surbiton Health Centre will be required (where they have not already done so) to sign a lease / licence for use of the facility and pay the associated rents.

14. ANY QUALIFIED PROVIDER

We have been contributing to the DH commitment to delivering a phased roll out of extended patient choice of Any Qualified Provider (AQP). In 2012/13 Kingston CCG determined three services for AQP provision from a national „menu‟ of services (developed through public consultation), that can meet the needs of local patients and deliver high quality. The three chosen services are:

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Podiatry - core nail surgery service, Continence - stress incontinence service, and Continuing care.

14.1 Podiatry – core nail surgery

From October 2012 we have commissioned under Any Qualified Provider procurement a podiatry core nail surgery service. Four providers, including the existing provider, have qualified and been awarded a three year contract each, subject to local conditions being met, to provide the service for patients registered with Kingston GP practices.

14.2 Continence – stress incontinence service

We have developed a service specification for a stress incontinence service to be commissioned under Any Qualified Provider. This service will be advertised in October 2012 with the view to contracts being signed by end January 2013, and the service being live from early 2013 offering patients greater choice.

14.3 Continuing Care

We have signed up to the London-wide AQP looking at the tariff charged by residential and nursing homes to the NHS for continuing care patients. This piece of work is being led by the London Procurement Partnership (LPP). During 2013/2014 We will continue to explore other opportunities to use AQP for the commissioning of services

15. PRIMARY CARE

Through the Health and Social Care Act the responsibility for primary care contracting will rest with the NHS Commissioning Board and will not be part of the delegated authority given to Clinical Commissioning Groups. However it has been clearly signalled that CCG‟s will have a role in monitoring and improving quality in primary care (especially GP practices), and primary care plays a central role in delivering many of the goals of improved health and wellbeing in Kingston. The CCG will therefore be supporting the following improvements in primary care throughout 2013/14:

15.1 Primary Care Infrastructure and Estate

We will continue to support the development of the primary care infrastructure and estate (where we have responsibility and delegated resources) to ensure that primary care services are delivered from facilities that meet the needs of a 21st century health service. This is reflected in the development of Surbiton Health Centre. 15.2 Enhanced Services Many of the services that we offer to patients outside of hospital are provided in the community in GP practices and Community Pharmacies via Local and Directly Enhanced Services (LES and DES). The CCG will continue to commission enhanced services from GP practices and Community Pharmacies. We will review the current portfolio and seek opportunities to expand the range of services offered via local enhanced services in line with our commissioning priorities.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

16.

16. END OF LIFE CARE

We will continue to pursue opportunities to work with all providers to deliver an appropriate and continued shift of care closer to home through community based services with the aim of improving end of life care (EOLC) for Kingston patients by

Reducing avoidable admissions to hospital; Increasing choice in preferred place of care and place of death through advance

care planning.

16.1 Coordinate my Care

The Coordinate my Care (CMC) register (provided by the Royal Marsden) will be commissioned during 2013/14 following its implementation during 2012/13. In addition appropriate and effective use of the CMC electronic register of EOLC patients will (where appropriate) be specifically included within provider contracts to maxmise the quality and use of information held on the register. This will be based on audited evidence and will improve communication and co-ordination of services for EOLC patients. We have redesigned the EOLC local enhanced service to reflect the implementation of CMC and put in place local initiatives for our community and Kingston hospital to work with Kingston CCG in improving patient experience of EOLC.

17. SOCIAL CARE

17.1 Personal Budgets

More and more service users are now benefiting from the establishment of Personal Budgets for certain social care services. Within the Learning Disabilities services a Brokerage Team has been established for some time and in response to the outcome of the review of Day Services for People with Learning Disabilities this team was temporarily expanded. For older people and people with physical disabilities support is presently provided by Support and Assessment staff and by the Kingston Centre for Independent Living. Customer consultation indicates that while service users value the choice and independence provided by Personal Budgets they would welcome better information and more choices about how to use their budget. They would also welcome greater support in managing them. From January 2013 a new mixed model of support planning will be in place, which will enable service users to receive support from the Council or from independent sector organisations.

This project will be led by the Executive Head (Adult Services) and will continue through 2013/14.

17.2 People with Learning Disabilities

Kingston CCG will commissions services for People with Learning Disabilities (PLD)

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

jointly with RBK. We will work with the Health Group of the Kingston PLD Parliament to co-produce a local service speciation for PLD health services to encompass local community, mental health, GP practices and secondary care providers. We envisage that at the core of this service specification will be a commitment to provide capacity for annual health checks, health action plans, hospital passports and Your Healthcare Specialist Services. We look to the Health Group of the PLD Parliament to advise any commissioning decisions that impact on PLD healthcare provision and to assure any commissioning plans we put in place.

17.3 Kingston at Home Project

Kingston CCG and RBK will continue to work together to develop integrated services for older people and people with long term conditions through the Kingston at Home Project. This will see integrated commissioning of community and bed-based services, which will offer more help to people to remain at home, reduce admissions and promote independence. This initiative is further explored in Section 4 and Section 5 Long Term Conditions and Community Services of this document.

17.4 Adult Safeguarding

The local Safeguarding Adult‟s partnership Board recognises the need to monitor safeguarding alerts in relation to pressure sores raised from our local care homes. RBK has specifically identified care homes quality monitoring as a commissioning priority. To address this, health and social care representatives are working together to identify the training needs for care homes, improve access to specialist community nursing services e.g. tissue viability, strengthen the contractual requirements with improved reporting and monitoring of commissioned services. These reports will be discussed regularly at the CCG‟s Integrated Governance Committee

18. MEDICINES MANAGEMENT

Effective medicines management requires health and social care professionals, patients and carers to work in partnership and use medicines as one element of a wider treatment pathway. The medicines management commissioning intentions and QIPP plan for 2013/14 build on existing work to drive improvements in quality and efficiencies through effective medicines management. This includes supporting GP practices to choose less expensive drugs with the same active ingredients and other projects to help GPs make clinically effective prescribing decisions which also support value for money. Effective delivery of the QIPP plan is dependent on the medicines management team engaging within the CCG and GP practices in Kingston to identify local priorities and ensure where appropriate any local work is supported by engagement with secondary care colleagues. In 2013/14 the medicines management team intends to:

Further improve prescribing efficiency in primary care through the implementation of a QIPP-focused Medicines Management Incentive Scheme;

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Reduce variations in GP prescribing practice; Enable providers to adhere to safe and effective medicines management practices;

Deliver improvements in area-wide medicines management priorities (e.g. respiratory medicine);

Audit antipsychotic prescribing for people with dementia;

Focus on prescribing efficiencies in primary care for example appropriate generic prescribing where appropriate, through reduced use of and expenditure on „specials‟ medicines; Review medicines in care homes and work with GPs to reduce waste;

Better medicines commissioning within service redesign and pathway development;

Design a framework to improve the control of secondary care use of drugs excluded from PbR for implementation by the Commissioning Support Unit;

Further enhance the development of a joint formulary and shared care guidelines with local providers;

Support providers to improve systems to support safe transfer of information on patient

medication at admission and discharge.

19. PUBLIC HEALTH

The Public Health function will transfer from the PCT to the Local Authority from 1st April 2013. Associated responsibilities will transfer to a variety of organisations, particularly the CCG, Local Authority and NHS Commissioning Board: Cardiac rehabilitation, vasectomy, female sterilisation, abortion services to CCG; Prevention (including NHS health checks), health promotion (including weight management), sexual health, school nursing to Public Health in RBK;

All screening services, HIV services to the NHS Commissioning Board. The CCG recognises the importance of all of these areas and we will work collaboratively with the Public Health team and others to ensure these services are delivered in the most effective way possible for Kingston residents.

The Public Health Priorities identified for 2012/2013, to be maintained through 2013/2014 include:

19.1 Cancer Screening

A range of cancer screening programmes will continue to be commissioned for 2013/14 with specific deliverables as outlined below.

Cervical screening Deliver cervical screening results to women within two weeks Maintain coverage above 70% (women aged 25-49) and above 75% (women aged 50-64) national target. Implement HPV triage and test of cure.

Breast screening Implement age extension to include women 47-73 years of age Introduce surveillance of women with moderate or high risk Maintain coverage above the national target of 70%.

Bowel Cancer Screening

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

Improve uptake to achieve national target of 60%.

19.2 Abdominal Aortic Aneurysm (AAA) Screening

Will continue to be commissioned in 2013/2014 for the male population during their 65th year and, on request for men over 65 years of age. The aim is to improve coverage towards achieving 80% of men aged 65 screened.

19.3 Cardiac Rehabilitation

Coronary Heart Disease (CHD) is a major cause of morbidity and mortality in the UK and in Kingston. We recognise the value of prevention programmes in protecting the health of our people and will ensure that a comprehensive cardiac rehabilitation service is available locally as this will: Reduce the overall risk of dying; the risk of future cardiac events; Reduce the number of hospital readmissions; enhance quality of life and minimise the risk of recurrent cardiac events; Improve the overall health of the patient reducing the risk factors for heart disease.

The Community Cardiac Rehabilitation Team (CCRT) runs two programmes; the first is „Healthy Hearts‟ which is a centre based programme and the second is the „Heart Manual‟ programme which is a home cardiac rehabilitation programme. Both programmes are aimed at patients who have already had a cardiac event as well as those who have not had a cardiac event but would benefit from lifestyle advice, relaxation training and a tailored exercise programme to reduce their risk.

Additionally, the cardiac rehabilitation team is also running a separate programme for people identified to be at high risk of developing vascular disease via the NHS Health Check programme. The main aims of this programme are:

To promote and support a cardio-protective lifestyle using strategies such as motivational interviewing to support individuals in health behaviour change.

To negotiate an individual care plan to empower individuals and support them in behaviour change

To enhance patients‟ quality of life. Work started In 2012/13 in the following areas to improve the cardiac rehabilitation services, and this will be continued in 2013/14: To continue to raise awareness of the local cardiac rehabilitation programme To increase the number of referrals to cardiac rehabilitation programmes from acute and primary care

Commissioning of flexible and innovative models of care across the patient pathways to increase uptake and improve health outcomes

Development of integrated delivery models with cardiac rehabilitation embedded strongly in existing pathways of care to reduce duplication and to improve patient referrals and uptake

Development of care plans to record patient goals prior to attending the course and review progress at intervals during the programme.

Linking the service to the development of the community based cardiology service described in section 8.4.

19.4 NHS Health Checks

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

The „NHS Health Check‟ programme is a national initiative that aims to offer a „vascular check‟ to all people aged between 40 and 74 years, once every 5 years. This universal risk assessment and management programme could significantly increase uptake of preventive interventions already available (such as smoking cessation and weight management), in addition to encouraging individuals to make personal changes to improve their health. The main aims of the programme are to: Reduce the burden of cardiovascular disease in the community by enabling more people to have their CVD risk identified and managed at an early stage of vascular change;

Sustain the continuing increase in life expectancy and reduction of premature mortality that is under threat from the rise in obesity and sedentary living;

Offer opportunity to make significant inroads into health inequalities, including socio-economic, ethnic and gender inequalities.

The NHS Health Check is currently provided in all Kingston GP Practices, three pharmacies located in Hook, Berrylands and Surbiton to ensure targeting of hard-to-reach groups

19.5 Weight Management The objectives set for commissioned weight management services in 2012/2013 will be maintained and further progressed in 2013/2014:

Increase dietetic capacity in GP clinics to provide specialist weight management support in Primary Care in order to provide regular, on-going high intensity support to achieve a clinically significant weight loss of 5-10% (NICE, SIGN, NSF-T2 diabetes & CVD);

Establish a tier 3 MDT specialist adult weight management service for SWL for complex severely obese patients whose weight and comorbidities cannot be managed in Primary Care (possibly on a joint commissioning basis with Kingston, Croydon, Wandsworth, Richmond, Sutton & Merton);

Establish a specialist tier 3 MDT child obesity clinic in Kingston (to include a paediatrician, Dietician, Psychology, Physiotherapy);

Set-up a specialist antenatal Maternal Obesity clinic in Kingston Hospital; Continued provision of the 'Walk Away' programme to prevent patients with impaired glucose tolerance from going on to develop diabetes;

Double “DESMOND” provision (compared to 2011/12 baseline) for patients newly

diagnosed with diabetes and DESMOND PLUS for those patients with established diabetes that

is poorly controlled; Provision of the 'X-PERT' programme for patients with diabetes being managed on

insulin.

19.6 Sexual Health Kingston Integrated Sexual Health Network (KISH) KISH was established in April 2010 with the aim of supporting providers to deliver the agreed service specifications. KISH will continue to be commissioned in 2013/2014 to progress and support the following: The delivery of a 3 tier service model to create better access to services for patients closer to home.

The development of an integrated service for sexual health and reproductive health so

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

patients only have to access one service for similar associated needs The development of common pathways across providers to ensure consistent and high quality services

The development of robust clinical governance for all sexual health service providers across Kingston

Public Health Outcomes Framework (PHOF) Improving Outcomes and supporting Transparency Part 1: A public health outcomes framework for England, 2013-2016.

Locally derived targets of the outcomes framework:

Reducing teenage conceptions by 50% by 2020 from the 1998 baseline rate (based on

Teenage Pregnancy Strategy ending 2010)

Reduce Chlamydia prevalence by 2% among 15-24 year olds by April 2014 by

achieving a diagnostic rate of 2400/100,000 (National Chlamydia Screening

Programme) by embedding the Chlamydia Screening Programme into core services

Halve the proportion of people diagnosed late with HIV by 2015 (the Halve it Coalition –

Gilead Sciences Ltd and British HIV Association - BHIVA) by training primary care

Staff to provide the test

Halve proportion of people living with undiagnosed HIV by 2015 (the Halve it Coalition – Gilead Sciences Ltd and British HIV Association - BHIVA) by training primary care Staff to provide the test

Sexual Violence is an indicator in the PHOF and currently being made into a local target

As well as these outcomes, Kingston is also prioritising the following:

Improving access to a range of contraception for all age groups

Increasing uptake of Long Acting Reversible Contraception (LARC)

Reducing repeat abortions

Termination of Pregnancy Services

To continue to reduce repeat abortions, to improve access to LARC, Chlamydia and

Gonorrhoea screening, and HIV testing from our termination of pregnancy services as

well as to ensure that younger people are directly linked into supportive community

services in order to address their particular sexual health needs (as acknowledged on the

Sexual Health Needs Assessment, 2012).

Vasectomy and Sterilisation Services

To improve access, quality, and governance of the vasectomy and sterilisation services.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

19.7 Self Care

The CCG recognises that self care brings many benefits for the individual in terms of

improved health outcomes and quality of life.

By encouraging self care the CCG is supporting increased personal confidence and self-

reliance, empowering patients to make positive decisions around their health. This will

ultimately remove reliance on seeking clinical advice on managing their health and

reduce unnecessary contacts.

The CCG supports individuals in self care in a number of ways which will be explored

further during 2012/2013. One self care initiative that has been running successfully over

a number of years in Kingston is the Expert Patient Programme. From 2013/2014 the

commissioning of this service transfers to the CCG and we will look for opportunities to

expand the scope of the current service where appropriate.

20. INNOVATION

We are committed to being an organisation that supports innovation in as broad a context as possible. To ensure that this ambition is realised we have identified a clinical lead for innovation on our Governing Body. With their leadership we will be able to promote a culture of continuous innovation.

In line with our culture of localism, engagement and continuous improvement, all innovations (internal or external) deemed potentially relevant to our overarching objectives will be subjected to a continuous process of "sense checking" and feedback by the intended users groups to assess whether they think the innovation makes sense to them and if so what adaptations are required to optimise it for local development. We have in place actions plans for the delivery of the innovation priorities identified by the Department of Health in the 2012/13 Operating Plan. These priorities are summarised below: Child in a chair in a day (childinachair.innovation.nhs.uk) Intra-operative fluid management (iofm.innovation.nhs.uk) Support for carers of people with dementia (dementiacarers.innovation.nhs.uk) Digital first (digital.innovation.nhs.uk) 3millionlives (3millionlives.innovation.nhs.uk) International and commercial (internationalcommercial.innovation.nhs.uk)

During 2013/14 we will continue to work on the delivery of these priorities, expanding the scope of the work to include both local and national priorities as they are identified

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

APPENDIX 1

Commissioning Priorities Mapped to the Domains in the National Outcomes Framework

(NOF)

NOF Domain NOF Overarching Indicators Relevant sections of 2013/14

Commissioning Intentions

1 Preventing people

from dying prematurely

1a. Potential years of life lost from

causes amenable to healthcare

1b. life expectancy at 75 (i) male (ii)

female

4.2

4.6

9.1

19

Appendix 2

2 Enhancing quality of

life for people with long

term conditions

2. Health related quality of life for

people with long term conditions

3

4

8

13

14

17.2

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

17.3

3 Helping people recover

from episodes of ill

health or following

injury

3a Emergency admissions for acute

conditions that should not usually

require hospital admission

3b. emergency readmissions within 30

days of discharge from hospital

3

4.3

5.1

7.2

11

16

4 Ensuring that people

have a positive

experience of care

4a. Patient experience of primary care

(i) GP services (ii) out of hours

services (iii) NHS dental services

4b. Patient experience of hospital care

6.1

6.10

15

17.2

18

19.4

5.3

7

5 Treating and caring for

people in a safe

environment and

protecting them from

avoidable harm

5a. Patient safety incidents reported

5b. Safety incidents involving severe

harm or death

7

18

A general focus running throughout these Commissioning Intentions is on Improving Quality (safety,

patient experience, outcomes), which makes particular contribution in domains 2, 4 and 5 above.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

APPENDIX 2

Commissioning Priorities Mapped to the vision and values of the CCG

"Mission" - For the population of Kingston our task is to:

“NHS-speak” See in particular sections:

11.1 Help you stay as healthy as possible Screening, prevention, promotion,

other public health activities

4.2, 4.6, 5.1, 6.1, 7.8, 9.1, 10.1, 10.5, 13.2, 19

11.2 support you in looking after yourself when you are well and when you are not

Self care, self management 4.4, 10.1, 18, 19

11.3 Make sure the right services are available if you become unwell, and for those services to be safe, effective and provide the good experience you deserve

Assurance of service provision* Unplanned care

3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 18, 20, 3, 4.3, 5.1, 7.7, 11, 13.2, 21.2

Quality+ 4.1, 4.4, 4.5, 4.6, 5.3, 5.4, 6.1, 7, 7.5, 7.8, 9.3, 21.5

11.4 Listen to you, involve you and be influenced by you

Patient and public engagement 4, 6.6, 6.7, 8, 13, 14, 17.3, 20

11.5 Work with you to continuously improve:

- the health and wellbeing of people in Kingston - the support that's available to help people look after themselves - the quality of local health services

Patient and public engagement

4, 6.6, 6.7, 8, 13, 14, 17.3, 20

Public health and inequalities

1.2, 10.1, 19,

Self care, self management 4.4, 10.1, 18, 19

Quality+

4.1, 4.4, 4.5, 4.6, 5.3, 5.4, 6.1, 7, 7.5, 7.8, 9.3, 21.5

11.6 Work with you to reduce inequalities in health across Kingston

Inequalities 1, 19

11.7 Become recognised and respected as the leader of the

health care system in Kingston

Leadership 1, 2, 3, 20

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

"Mission" - For the population of Kingston our task is to:

“NHS-speak” See in particular sections:

12 The CCG will promote good governance and proper stewardship of public resources in pursuit of its goals and

in meeting its statutory duties

Governance 2, 7.7, 21

Values

13.1 Healthier lives for people in Kingston Screening, prevention, promotion, other public health activities

4.2, 4.6, 5.1, 6.1, 7.8, 9.1, 10.1, 10.5, 13.2, 19

13.2 Getting the best possible health improvement and health

care for people in Kingston

Screening, prevention, promotion,

other public health activities Assurance of service provision*

4.2, 4.6, 5.1, 6.1, 7.8, 9.1, 10.1, 10.5, 13.2, 19

3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 18, 20,

13.3 Health services for local people shaped by local people Patient and public engagement 4, 6.6, 6.7, 8, 13, 14, 17.3, 20

13.4 You being able to say "I'm heard, I'm healthier, I'm cared for"

Patient and public engagement

Screening, prevention, promotion, other public health activities

Assurance of service provision*

4, 6.6, 6.7, 8, 13, 14, 17.3, 20

4.2, 4.6, 5.1, 6.1, 7.8, 9.1, 10.1, 10.5, 13.2, 19

3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 18, 20,

We plan to do this by:

14.1 targeting the causes of ill health and premature death Screening, prevention, promotion,

other public health activities

4.2, 4.6, 5.1, 6.1, 7.8, 9.1, 10.1, 10.5, 13.2, 19

14.2 improving the quality, safety and responsiveness of services

Quality+ 4.1, 4.4, 4.5, 4.6, 5.3, 5.4, 6.1, 7, 7.5, 7.8, 9.3, 21.5

14.3 ensuring good quality health services are available and accessible in a timely way

Quality+

Assurance of service provision*

4.1, 4.4, 4.5, 4.6, 5.3, 5.4, 6.1, 7, 7.5, 7.8, 9.3, 21.5 3, 4, 5, 6, 7, 8, 9, 10, 13, 14, 15, 16, 18, 20,

14.4 developing services across health and social care Integration

1.2, 4.1, 5.2, 6.7, 6.9, 9.2, 10.3, 10.4, 17, 18

Notes

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

* + Assurance of service provision and Quality are threads running throughout our Commissioning Intentions. Each separate incidence is therefore not included in

the above table – the sections highlighted are significant contributors to these objective. Quality includes as its core patient safety, effectiveness of provision and

good patient experience of services. It also includes access to and responsiveness of services.

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

APPENDIX 3 Overview of the Population of Kingston for the Kingston Joint Strategic Needs Assessment: Office of National Statistics resident population (2011 census) 160,100

Greater London Authority estimates increase of 2,031 over previous year, made up of 1,304

natural increase and 727 net migration inwards

Population registered with local GPs is greater (190,072 at end March 2012)

There were 2,312 births to Kingston residents in 2011

There has been an increase in births almost every year since 2003, when there were 1794

births

This is partly due to the rise in population, but also increase in fertility rate

There were 1,008 deaths of Kingston residents in 2011

Lower death rate than comparators: SMRs: 100 national, 94 London, 86 Kingston

There has been a decrease almost every year since 2002, when there were 1,306 deaths

Life expectancy now stands at 81.3 years for men and 84.1 years for women (2008-10

figures)

Kingston is in top 4% of LA areas in UK for male life expectancy and the top 11% for female

life expectancy

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14

APPENDIX 4

ABBREVATIONS

AAA Abdominal Aortic Aneurysm ADHD Attention Deficit Hyperactivity Disorder AQP Any Qualified Provider A&E Accident and Emergency BSBV Better Services Better Value CCG Clinical Commissioning Group CDAT Community Drug and Alcohol Team CHD Coronary Heart Disease CMHT Community Mental Health Team CQUIN Commissioning for Quality and Innovation CRNS Community Neurological Rehabilitation Service CSP Commissioning Strategy Plan CMC Co-ordinate My Care DH Department of Health EoLC End of Life Care ENT Ear, Nose and Throat ESD Early Supported Discharge GPwSI GP with Specialist Interest HASU Hyper Acute Stroke Unit HWB Health and Wellbeing Board IAPT Increased Access to Psychological Therapies JSNA Joint Strategic Needs Assessment KCCG Kingston Clinical Commissioning Group KCI Kingston Co-operative Initiative KHT Kingston Hospital Trust KISH Kingston Integrated Sexual Health Network KPI Key Performance Indicator LAS London Ambulance Service LCP London Cancer Programme LES Local Enhanced Service LPP London Procurement Partnership LSCG London Specialist Commissioning Group NHS National Health Service OPMH Older Peoples Mental Health QIPP Quality, Innovation, Productivity and Prevention RBK Royal Borough of Kingston SPA Single Point of Access SUN Service Users Network SWL South West London SWL&StG South West London and St George‟s Mental Health Trust YHC Your Healthcare

Kingston Clinical Commissioning Group – Commissioning Intentions 2013/14