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Hartlepool and Stockton-on-Tees Clinical Commissioning Group

Hartlepool and Stockton-on-Tees Clinical Commissioning Group. Dr Boleslaw Posmyk, Clinical Chair Dr Paul Williams, Stockton-on-Tees Locality Lead. What we aim to do in our presentation. Describe to you: Our journey so far The people we work with and on behalf of

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Hartlepool and Stockton-on-Tees Clinical Commissioning Group

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  1. Hartlepool and Stockton-on-Tees Clinical Commissioning Group Dr Boleslaw Posmyk, Clinical Chair Dr Paul Williams, Stockton-on-Tees Locality Lead

  2. What we aim to do in our presentation Describe to you: • Our journey so far • The people we work with and on behalf of • Our challenges, opportunities and risks • Our plans for improvement • How we do things around here: Our decision making and our leadership

  3. Meet our Team • We are a membership organisation of 40 general practices with devolved decision making to our Governing Body • Our team has a strong clinical focus, bringing together a broad range of skills and experience together with a passion for improving the health outcomes of our communities

  4. Our Journey • Two pathfinder groups – Hartlepool and North Tees • Merged into one CCG (40 General practices) April 2012, with first Shadow Governing Body meeting as a sub-committee of NHS Tees • Rationale for coming together: • Shared vision and values • Similar health needs, levels of deprivation, challenges • Share acute, community and mental health providers • Avoids duplication • More financially robust • Increased pool of clinicians willing to take on lead roles • Small enough to maintain effective practice engagement through strong locality focus and co-terminosity with LAs • Offered potential for synergy and sharing of good practice • Still able to work effectively with neighbouring CCGs especially South Tees

  5. Hartlepool & Stockton-on-Tees CCG Population c285,000 40 General Practices Hartlepool & Stockton-on-Tees CCG Population c285,000 40 General Practices

  6. Meaningful Engagement - Our Stakeholders How we are working “together” Stockton-on-Tees Borough Council Health and Wellbeing Boards Hartlepool Borough Council 40 Member practices Local Safeguarding Children's Boards Commissioning Support Safeguarding Adults Boards / LD partnership Providers Hartlepool and Stockton-on-Tees CCG Public Health Community Groups Patient participation groups Clinical Networks LINks/ Healthwatch NHS Commissioning Board/LAT Other CCG’s/Northern CCG Forum Professional Clinical Leadership Voluntary Sector

  7. Meaningful Engagement – our communities Communication & Engagement strategy Local Events PPGs LiNKs/Healthwatch Scrutiny Forums

  8. Our Health Challenges Rank distribution of electoral wards in various deprivation groups Hartlepool and Stockton compared with England Index of Multiple Deprivation (IMD) 2010 7934 Most affluent wards in England (7567) Ingleby Barwick East 7139 6346 Park (6412) 5553 Electoral ward rank position 4760 3967 3173 2380 1587 793 Most deprived wards in England 1 (17) Town Centre Dyke House (44) Stockton A population of ‘two halves’ Hartlepool A population with little relative affluence

  9. Ingleby Barwick Parkfield & Oxbridge Stockton Centre One of the consequences of differences in risk are differences in outcomes… Life expectancy Men 78 74 69 Women 82 78 74 Life expectancy reduces sharply within very short distances from periphery to centre 9 years for men 8 years for women The starkness of inequalities in health

  10. Our Health Challenges High levels of deprivation Mortality from suicide & undetermined injury; Cancer; circulatory disease; Gastrointestinal disease; and Respiratory disease worse than England mean Levels of health worse than Average Smoking related deaths higher than average Health inequalities Hospital stays for alcohol admissions higher than England average Life expectancy lower than average Healthy eating, smoking & obesity worse than England average High levels of child poverty

  11. Our Plan at a glance J S N A H& WB STRAT EGIES S T R A T E G I C O U T C O M E S Our Vision Reduced inequalities / Improved wellbeing Our Aims commission high quality, sustainable and evidence based services that respond to local need, bring care closer to home and are cost effective work in partnership to reduce health inequalities and improve the health and wellbeing of the population Look for opportunities to innovate, involving users, carers, staff providers and the public in transforming services Our Values Engagement & Patient focus Quality & safety Value, efficiency and affordability Integrity and honesty Courage Accountability Our Work streams Health & Wellbeing Out of hospital care Acute in hospital care Mental Health, LD & Dementia Medicines Management Our Priorities • Address health inequalities • Improve lifestyles • Focus on particular groups i.e. carers and children • Transform community care (TAPs) • Bring care closer to home • Care home management & quality • Improve productivity • Choice & quality • Streamline care pathways • Reduce urgent care attendances • Develop MH/LD • Improve equity • Improve Dementia care • PHBs • Safe, rational and cost effective use of medicines • Reduce variation

  12. Managing Financially Sustainable Position up to 2016 Technical Efficiency Programmes Investments Underlying Cost Pressures Income Shifts £’000s Future planning assumptions are: - Lower Growth - Increase in inflation - Lower Tariff Efficiencies - Increase in demographic demand

  13. Our QIPP Challenge • Benchmarking Tools Utilised to identify outliers • NHS Comparators – emergency admissions, A&E attendances, outpatients per 1000 population • PBMA – identify high spending poor outcomes • PBR Benchmarking – identifies provider performance issues ie new to review ratios • Prescribing EPaCT • Variation in spend on specialities across Tees • Variation across practices • What it told us – increasing activity in acute sector, prescribing above national average, local FTs where not performing to top quartile in some areas, significant variation in referrals, admissions and resource use across GP practices • What we did – • Looked for evidence of effective improvement methods (Kings Fund, National QIPP programme, Institute of Innovation programmes, VMPS/NETs) • Engaged our practices and providers • Developed our QIPP programme around what the benchmarks told us and grouped these against our workstreams, developed our Delivery Plan • Developed our monitoring arrangments

  14. Improving Quality and Safeguarding Improving quality is at the heart of what we do • Safe and tested governance with our systems and processes • Implementation and monitoring of Quality Dashboards • Robust provider Clinical Quality Review Groups • Development of a Quality Assurance Framework for all commissioned services • Embraced Legacy Document – now preparing to receive Quality Handover Document • Committed to driving up quality in primary care - GVISQ Recognising our statutory responsibilities for safeguarding • Working with our Local Authority partners • Executive Governing Body appointment (Nurse) • Supporting our Local Safeguarding Children’s Boards and Adult Protection Committee’s Preparing for the future Sir Robert Francis

  15. Constitutional & Governance arrangements NECS Council of members Locality groups x 2 Hartlepool H&WB Delivery team Governing Body Stockton H&WB Workstreams Governance & Risk Funding panel Audit Remuneration QPF Safeguarding Boards Partnership / QIPP delivery board Quality & Safety Group CQRG

  16. Capacity and Capability Chair GP GB members & locality leads Local NECS Team & Collaborative commissioning Clinical Workstream Leads Chief Officer Designate / Accountable Officer Chief Finance officer Executive Nurse Commissioning development / Deliver Manager Corporate Governance and Risk Officer Head of Quality and Safeguarding (designated Adults safeguarding) Assistant Finance Managers Partnership & Innovations Manager Corporate Office Administrator Designated Nurse Children’s Safeguarding Designated Doctor and LAC lead Partnership Project Officer Admin Support

  17. Risks and Mitigations • Developed different opportunities at all levels of the organisation • Strong relationships, strong governance, high awareness • Clinical Engagement • Improving quality & safety • Economic environment and financial challenge • Hospital Reconfiguration / Momentum • Robust QIPP plans & track record of delivery, preparation, contingency, good governance • Evidence based Clinical mandate, strong relationships with OSC, good public engagement The biggest task is alignment………..

  18. The difference we are making • Highly effective GP, public and other stakeholder engagement • Winner of HSJ National award for Efficiency, Medicines Optimisation • Safer Care NE; Adult safeguarding award • Finalists for Commissioning Organisation of the Year (HSJ); Vision Award – use of data, NE lean Academy; spread of innovation, • Reduced variation in primary care - improved clinical quality • Transformed community services – commissioning for clinical outcomes • Progressing Momentum Pathways to healthcare; redesigning 46 clinical pathways, improving patient experience, reduced length of stay, increasing productivity • QIPP delivery – securing financial sustainability

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