QIPP 2019/20 UpdateCPPEG 08/07/19

Sally MacKinnon,

Director of Transformation, Planning & Delivery

Overview

For 2018/19, Camden CCG delivered QIPP of £23.85m, representing 91.7% of the total QIPP target of £26m.

For 2019/20, the CCG has a QIPP plan of £18.5m gross QIPP, with a net QIPP of £14.97m.

In addition, the CCG’s overall financial plan also includes a deficit of £4.8m.

Just over half of the QIPP plan (£9.6m) relates to Acute – primarily transformational schemes seeking to shift acute activity into primary or community care settings.

The remaining £8.9m relates to non-Acute – primarily contract efficiencies and corporate savings.

The majority of QIPP initiatives are not new, with work having started in 2018/19.

Key QIPP priorities, as set out in subsequent slides, are captured in the CCG’s Business Plan for 2019/20.

19/20 QIPP Plan Summary

19/20 Plan

(Gross)

19/20 Plan

(net)

% of plan

(gross)

Acute

Health & Care Closer to Home 1,693,826 1,608,026 9%

Urgent & Emergency Care 2,372,231 2,275,631 13%

Planned Care 2,992,400 2,656,611 16%

Acute Efficiencies 2,491,869 2,491,869 13%

Acute sub-total 9,550,326 9,032,137 52%

Non-Acute

Mental Health 1,216,947 816,947 7%

Primary Care Other 750,000 150,000 4%

Community (Children's/Adults) 1,989,824 489,824 11%

Continuing Healthcare 1,389,000 1,389,000 7%

Corporate 3,631,000 3,091,000 20%

Non-Acute subtotal 8,976,771 5,936,771 48%

Total identified QIPP 18,527,097 14,968,908 100%

2019/20 QIPP Plan Summary

QIPP Priority £ Range

Urgent & Emergency Care

Planned CareHealth & Care Closer

to HomeAcute Efficiencies Community Mental Health Primary Care Other CHC Corporate Total Gross

> £1m £3.97m

£500k - £1m

£7.47m

£250k - £500k

£4.80m

< £250k£2.29m

Total Gross £2.37m £2.99m £1.69m £2.49m £1.99m £1.22m £0.75m £1.39m £3.63m £18.53m

Pipeline

Pri

ori

ty

STP Rapid Response

Integrated Care

Locally Commissioned

Services

Acute Workstreams Non-Acute Workstreams

QIST

Rehab Pathway

Sutherland Ward

Primary Care Prescribing

Acute Prescribing

Adults CHC –Local

Corporate Efficiencies

Estates

CSU Contract Efficiencies

CNWL Transformational

Stretch

BCF Efficiencies

Whittington SLT

SLT Funding

Alliance Reward Grant

MH Risk Share

AAOT

REST Service

TAP Contract

Crisis Houses

ED Demand Management

Care Homes & Care of the Elderly

Pathway

Contracts Review

STP EBICS 4 – LCW &

Back Procedures

UCLH UEC Tariffs

Evergreen Ward

Virtual Fracture Clinic

STP Stroke ESD

Falls

STP Simplified Discharge

STP Integrated Urgent Care

STP LPoL

UCLH PAU

STP High Intensity Users

(RF)

Gastro Nurse

IPS

CKD & Hypertension

STP Teledermatology

Dermatology DES

STP Urology

STT Lower GI (NCL)

STT Lung Cancer (NCL)

STP EBICS 3

qFIT (NCL)

MSK

STP Advice & Guidance

LAS

Wound Care

STP Pathology

UCLH Patient Transport

Outpatient Transformation

Sleep Apnoea

QIPP Priorities: system view

4

Simplified discharge pathways

Integrated Care Services

Rapid Response

Care Homes and Care for the Elderly

Integrated Falls Pathway

Last Phase of Life

CHC

Locally Commissioned

Services

QISTS

Clinical Advice & Guidance

Teledermatology

Dermatology DES

Pathology

Urology

Integrated Paediatric Service

qFit

ED Demand management

EBICS

Outpatient Transformation

High Intensity Users

QIPP Pipeline

5

The schemes below are currently in development as part of the QIPP pipeline

Complex Wound CareExploring if more care for complex wounds should be available within the community inorder to improve patient care and outcomes and reduce secondary care activity

A business case is in development, drawing on a primary care audit to establish thecurrent practices and inform the potential requirements for the service.

Outpatient TransformationWorking jointly with providers to deliver outpatient transformation with the aim toreduce face-to-face outpatient appointments by 30% over the next 5 years

A UCLH Transformation Board will be established in July to develop a plan for bothshort term opportunities and longer term strategy

Sleep ApnoeaEstablishing a community clinic for obstructive sleep apnoea supported by a virtual MDTwhere results can be reviewed in order to reduce waiting times, improve patientexperience and realise system-wide efficiencies

A business case is in development for a Camden wide proof of concept.

Patient and public engagement

6

CCCG priorities are

discussed annually with

CPPEG

CPPEG Reps attend short life groups (e.g.

PMS and MSK) to develop

commissioning changes

CPPEG Reps hold positions within

committees reporting to Governing body

CPPEG reps report progress/status at CPPEG operational meetings of groups/committees they

attend

CPPEG reports disseminated to GP

PPGS through newsletter, displayed via public website and

social media

Examples of patient and public engagement in QIPP initiatives

• STP Last Phase of Life

• STP Evidence Based Interventions and Clinical Standards

• Simplified Discharge

• Rapids

• ED Demand Management / IUC

• Integrated Care

• Integrated Falls Pathway

• Teledermatology

• Integrated Paediatric Service

• Care for the Elderly (as part of wider Public health engagement on Older Adults)

• Universal Offer

Patient engagement overview

Specific examples

7

Initiative You Said… We Did…

Simplified Discharge

Admissions Avoidance

(RAPIDS)

Through work we commissioned with Healthwatch

Camden service users of Discharge to Assess and

Rapid Response said that there was a lack of clarity

of who was doing what and when things were going

to happen with these services

This patient feedback helped us inform our review of CNWL services which helped us decide how we wanted to

shape our community service provision in the future. Outcomes of the review were presented at CCPEG

meetings. We will be reviewing the action plan CNWL have put in place to address the issues raised by this

feedback.

Falls Admission Patients flagged that they wanted to know more

about the falls services Camden commissioned.

Patient representatives were invited to attend a falls workshop in January where it was flagged that the falls

pathway is fragmented and that communication of the services could be significantly improved.

A Falls Stakeholder Group will be held which will include a patient representative. This will ensure that the

patient voice is part of the design of a coherent falls pathway and that the communications and engagement

plan will be accessible from a patient-level.

Integrated Urgent Care CPPEG members raised the need to ensure patients

knew how to access the extended access service

which provides additional GP appointments out of

hours

We supported the provider to develop a high profile communications campaign to ensure patients knew how

they can access the extended access service, resulting in higher utilisation rates for the service.

Dermatology Patients wanted to have stronger involvement with

the design and mobilisation of the Teledermatology

service

Two patient representatives sit on the Dermatology Implementation Working Group where they ensure patient

opinions are considered with the design and mobilisation of the Teledermatology model. They have also helped

with the production of patient information and a patient evaluation of the service.

Integrated Care Teams Patients wanted more information on what integrated

care is and how they can shape the integrated care

model.

We attended CPPEG public meetings to present key messages about integrated care. The CPPEG chair also

sits on the Adult Integrated Care Partnership Group to ensure that the patient views are directly influencing care

for adults with complex needs.

Universal Offer

Development and

QISTS

CPPEG members raised concerns that money is not

diverted from direct patient care in general practice to

support the development of the neighbourhoods and

federations

We attended CPPEG meetings to discuss this further and provide assurance that the money saved through the

changes to the payments will be reinvested in new primary care services which better support moving activity

from secondary to primary care. This meant that there would be no reduction in the amount spent on patient

facing services.

Integrated Paediatric

Services (IPS)

Parents said they wanted to be able to access high

quality care for their children in their GP surgery as

well as for hospitals to have better links with their GP

We have developed the IPS which triages children so they are seen in the right place first time and bringing

paediatric consultants into GP clinics so they get the right kind of help quickly and appropriate for their needs.

The joint GP and paediatric clinics were developed in line with advice and support from Camden CCG’s Parent

Advisory Board.

Questions and discussion

• Are there other initiatives which would benefit from patient engagement?

• Are there particular priorities you would like to hear more about at future meetings?

• Any other views?