Download Our strategic commissioning plan 2014

Our strategic commissioning
plan 2014-19 – summary
Our part of North Yorkshire is a great place to live and
work, and on average people have better health than
much of England. We are part of this local community,
which in part fuels our strong desire to improve
healthcare and provide services which are safe, cost
effective and meet the needs of local people.
Commissioning services is a complicated task. When we
were first established in September 2012, we created
our first Strategic Commissioning Plan. This covered what
we wanted to do from 2012 to 2017. I’m pleased to say
that we have already made very significant progress
on delivering local improvements against this plan.
However, as always, the NHS has moved forwards and
there are a new range of national developments and
local aspirations we want to address. As a result, our
original five year Strategic Plan was in need of a refresh.
While we have tried very hard to explain and involve
people in our commissioning processes, it isn’t always
the simplest of topics. Our full Strategic Plan is very
detailed, and is available on our website. We wanted
to make sure patients, service users, carers and
professionals have an opportunity to read a shorter
summary version of what we are trying to achieve and
how we are going about it. This is what you’re now
reading.
We are proud to be improving services in Hambleton,
Richmondshire and Whitby, and want to make sure
everyone has the opportunity to understand the
difference we are making and to tell us what you
think. We’d be very grateful for your
involvement in influencing your local
health services – information about
how to do so is on the back page
“We are part of this local community, which in part
fuels our strong desire to improve healthcare”
Dr Vicky Pleydell
Local GP and Chief
Clinical Officer
Who are we?
We are a Clinical Commissioning Group of 22 GP practices serving a population of around 142,000 people. On 1
April 2013, we officially took on responsibility for the planning and purchasing of the vast majority of health services
across our area. These include hospital care, mental health services and community services. We are accountable to
our member GP practices, our patients and the public.
At the heart of all of our plans is our determination to ensure we commission high quality, safe, sustainable services.
We take our duty to improve and monitor safety, quality and patient experience extremely seriously and this will always
be our top priority. We will continue to work hard to ensure our patients and the public have confidence in their local
healthcare system.
Our mission: “To commission first class healthcare which improves the health of
everyone in Hambleton, Richmondshire and Whitby.”
Our vision: weaving together a
tapestry of care services…
In five years’ time, the health landscape will be very different. In fact, it will be so much better. There won’t be a
health landscape anymore; there will be a care landscape. It might be helpful to think of this as a rich tapestry of
services woven together, with lots of different colours and textures. A flexible resilient pattern designed around the
needs of individuals and communities.
The people who live in here make up the core fabric of the tapestry, each a unique thread. They will be able to get
information about services easily and access the care they need simply. People will feel in control of their own health,
the health choices they make about the way they live their lives, and how they choose health and social care. Care
records will be easily accessible and sharing information appropriately will improve care without compromising privacy.
When someone is unwell they will be able to easily access high quality care in the best place: in their own homes, their
own villages and towns. They will only travel further when they need the high intensity help that only an excellent
hospital can provide. Where services are further away than they used to be, it is because that is where a truly excellent
service can be delivered best.
Services - the textures - will be weaved into the tapestry around our communities, strengthening them, and building
strong local groups of employed and volunteer care workers who work together. Excellent mental health, health
and social care services, primary, community care, social care and ambulance
services will be there for day-to-day care and to respond to emergencies. In
times of greatest need those services will pull together to wrap care around the
individual so that they have the best chance of making a full recovery.
Is this ambitious? Absolutely! Nothing like this has been done before, as it has
always been ‘too difficult’. The difference this time is we are committed as a
care community to making it happen.
2 | Our strategic commissioning plan 2014-19 – summary
Our strategic initiatives
1. Transforming the Community System
“A modern model of integrated care”
Working in partnership with North Yorkshire County
Council through the Better Care Fund, our intention is
to strengthen and redesign local community services so
that they are available around the clock, seven days a
week, delivered by health and social care teams working
together, and embracing new technologies and ways of
working.
Key initiatives at a glance:
l ‘Fit 4 the Future’: engagement with
the public to seek their views
l improve capacity and integrate our
reablement and rehabilitation services
l improve fast-track arrangements for
patients at the end of their life
l a new model of integrated community
services in Whitby
l provide better clinical education and
urgent support for care homes
l develop an ‘end of life’ strategy Jane’s story:
Jane is an 80 year old lady
who lives in upper Wensleydale
beyond Hawes. She was
admitted for a routine knee
replacement but unfortunately
developed a chronic infection
in the new joint. She had several
admissions for to ‘wash- out’ her
knee but eventually it was decided
that she would need 3 months
intravenous (IV) antibiotics.
Previously, this would entail a lengthy hospital admission as
Jane was frail and not physically up to the daily 80 mile round
trip to attend for as an outpatient at the Friarage Hospital.
The new IV pilot scheme allows Jane to receive her
antibiotic therapy in her own home or her local GP practice,
supported by her community team. This scheme greatly
improves the pathway of care for Jane and also saves
money for the health economy.
“The highest quality urgent and emergency care”
Mary’s story:
Mary was on a trip down to London from Leyburn to visit her grandchildren.
On her way back from London, there was a problem with the coach, so the
trip took longer than planned. As a result of the long-time Mary was sat still,
she developed a painful, swollen and red left leg. Next morning, she visited
her GP who suspected Mary had a clot in the veins.
Instead of admitting Mary to hospital as she would have been in the
past, he carried out a simple assessment. A quick blood test was done
by the practice nurse. As the test was positive (making a deep vein
thrombosis likely) her GP arranged an urgent ultrasound of her leg veins
for that afternoon and gave her some emergency medication to thin the
blood and prevent the clot spreading.
The result was faxed back that day from the
hospital. Mary was rung by her GP that
evening and advised to continue taking the
blood thinning tablets for 3 months and to
come in for review before she stopped the
medication.
For patients with urgent but non-life
threatening needs, highly responsive, effective
and personalised services will be provided
outside of hospital, minimising disruption and
inconvenience for patients and their families.
More seriously ill or injured patients will be
treated in centres with the very best facilities
and expertise in order maximise their chances of
survival and a good recovery.
Key initiatives at a glance:
l An integrated model for urgent care
services based at the Friarage and as part
of re-procured services in Whitby
l Extended consultant cover in A&E to
ensure 4 hour A&E targets are met
l Community Paramedic Practitioners
l Community defibrillator and
first responder schemes
Our strategic commissioning plan 2014-19 – summary | 3
Our strategic initiatives
2. Children’s Health
Joshua’s story:
Joshua is one year old and has a fever,
headache and vomiting. His GP makes a
diagnosis of likely meningitis and sends
him to James Cook University Hospital. The
hospital is 40 minutes’ drive away. He is given
antibiotics by his GP before he gets into the
ambulance.
He is seen on the Children’s ward by a junior
doctor who is training to be a Paediatrician, and
an experienced trainee paediatrician, treatment is
commenced immediately and the Consultant is called,
who arrives in a few minutes. There are at least two
experienced Paediatric nurses helping to stabilise Josh.
The Consultant is worried about Josh’s breathing so calls for a Consultant
Paediatric Anaesthetist who attends in a few minutes. Together the team
of 4 experienced doctors decide that Josh needs to go to the Paediatric
Intensive Care Unit, which is located on the adjacent ward.
He is moved around to the Unit, cared for by the 4 doctors and two nurses.
Josh has been in hospital for less than one hour.
A ‘whole life course’ care approach
will be adopted, with a strong
focus on early intervention,
especially for our most vulnerable
groups, so that all children are able
to achieve positive lives.
Key initiatives at a glance:
l a new seven-day paediatric
short-stay assessment unit,
and a midwifery-led maternity
unit, at the Friarage Hospital
l improved local autism
assessments
l joint commissioning for
speech and language and
communication needs
l improved care for young people
who deliberately self-harm
l Better care for children with
diabetes, asthma or epilepsy
3. Mental health & dementia
Having a mental health problem increases
the risk of physical health problems, leading
to earlier death rates and higher levels
of chronic disease. We will work with our
partners to ensure people living with mental
health problems have the same levels
of access and outcomes as the general
population.
Key initiatives at a glance:
l Enhanced liaison psychiatry
in the Friarage Hospital
l Reduce out-of-area placements so
patients are treated closer to home
l Improve dementia services through a
collaborative and increase diagnosis
l Develop a strategy to ensure
vulnerable people no longer live
inappropriately in hospitals
Robert’s story:
Robert is 42, married with a young family and a good job. Robert has
bipolar disorder, a mental health condition characterised by periods
of intense depression and periods of hyperactivity and feeling ‘high’.
Robert unfortunately became ill with a short-lasting episode of
diarrhoea and vomiting. He stopped taking his medication and did
not restart, though the viral illness soon settled. His mental state
deteriorated and on a night out in Richmond, the police were called
as members of the public had expressed concern about his behaviour.
He was taken to the Section 136 health-based place of safety at the
Friarage Hospital, (rather than the local police station which was
used previously). There Robert was seen and assessed in a health
environment by trained healthcare
professionals.
A health-based place of safety for
Whitby and district residents is
already commissioned, at Cross Lane
Hospital, Scarborough.
4 | Our strategic commissioning plan 2014-19 – summary
Our strategic initiatives
4. Clinically appropriate planned care
We know that our aging population will affect
demand for planned care as incidences of
musculoskeletal problems and cancer, for example,
increase with age.
We will work with our local providers and GP
colleagues to identify innovative ways to offer
services in GP practices and the community
wherever possible. We will enable more elective
day-surgery and reduced unnecessary follow-up
appointments at hospital.
Key initiatives at a glance:
l a community chronic pain service
l two cycles of IVF for local couples
(centred at the Friarage Hospital)
l pre-operative assessment service
l weight management courses for
people who are morbidly obese.
Jim’s story:
Jim was diagnosed with cancer
of the prostate. He had successful
treatment by the urology service.
He needs to have regular monitoring
of his condition with a PSA (prostate
specific antigen) blood test. Jim has a
busy life and cares for his wife Mary. His
bloods used to taken at his GP practice
and he then went to the hospital for the
results, which was difficult as someone
needed to sit with Mary.
Now stable patients like Jim patients, will be transferred back to
their GP for monitoring of their PSA. If there are any concerns
about the patient’s clinical condition or their PSA results there is
an agreed process for them to be seen quickly by the urologists.
For Jim this means no long journey and no need to arrange a
sitter for Mary.
5. Primary Care Productivity and Development
Elizabeth’s story:
Elizabeth is an elderly lady who had bladder difficulties. She saw a
gynaecologist who felt that pelvic muscle weakness was the cause
of her problem. She was fitted with a ring pessary (a medical
device which provides extra internal support) which significantly
improved her symptoms and quality of life.
Previously, she had to travel back to the hospital every four
months to have the pessary changed. Elizabeth has arthritis, is
widowed and does not drive, so she had to make an inconvenient
bus journey or ask family or friends to take her to the hospital.
HRW CCG has now commissioned all GP practices in the area to
undertake the routine replacement of ring pessaries. This means
Elizabeth can book an appointment with
the practice nurse at her local practice.
We will provide development opportunities
for GP practices to help them improve their
productivity and their integration with the
wider health system, for them to improve
access to care, and to develop a ‘federation’,
which works together to improve services.
Key initiatives at a glance:
l Commissioning out-of-hospital services,
including anti-coagulation monitoring,
deep vein thrombosis diagnosis and
treatment, minor injuries, and many more.
l Improving healing rates of complex wounds
l Improve medicines management
l Reduce clinical variation through
provision of benchmarked information
She will get to know the person who
regularly replaces her pessary, which
will reduce embarrassment, and
she will not have to undertake the
inconvenient journey to hospital.
Our strategic commissioning plan 2014-19 – summary | 5
Our strategic initiatives
6. Long Term Conditions (LTC)
Harold has severe lung problems and
frequently gets short of breath. He
lives alone and when his breathing is
bad, there is no-one to give him advice,
so he dials 999 when he gets frightened.
He attends A&E and goes into hospital
several times a year.
Harold’s GP invited him in to discuss his
present state of health, where Harold was
able to talk about his fears and isolation and
together create a suitable care plan. It was
agreed his GP could discuss his case at the local
community health and social team meeting.
There a local voluntary agency rep suggested Harold was contacted
by a befriending service. Harold now has regular conversations with a
volunteer and regular food deliveries.
Harold can also ring his GP for same day advice if he feels his chest is
worsening. This has helped Harold feel more supported, less alone and
treating his chest early has stopped his chest getting so bad.
We believe effective management and
treatment of LTC, beginning with a much
better understanding of a patient’s
own goals and personal priorities, can
significantly impact on both their wellbeing and utilisation of services.
We will make sure we have effective
systems in place to identify those
patients at-risk, establish comprehensive
disease registers, ensure patients have
personalised care plans and access to
appropriate education.
Key initiatives at a glance:
l Using risk profiling technology
to identify and support the
top 2% of the population
l Diabetes educational programmes
l Personal budgets for patients
receiving continuing healthcare
l Development of health psychology
7. Ill-health prevention
Enabling people to help themselves by taking
increasing responsibility for their health
underpins all of our strategic initiatives. We
want to work with our partners in North
Yorkshire County Council and our District
and Borough Councils to create a culture of
prevention rather than cure, supported by
easy access to community resources.
Key initiatives at a glance:
l Local ‘health trainers’ to motivate people
to make long-term healthy lifestyle choices
l An integrated lifestyle referral programme
l Community navigators to help people
access support and advice near to them
l Extending capacity and improving access
to Psychological Therapies to help people
with stress control, anxiety and depression
l Providing training for carers on how to
better support people to stay safe at home
Deepak is 50 and has struggled with his weight for some time.
He has high blood pressure and his weight is causing problems
with his knee arthritis. He has a condition called impaired glucose
tolerance and is at significant risk of developing diabetes. He has
tried various diets and his GP has referred him to the council gym
for exercise on prescription. Despite these interventions he is still
over-weight with a Body Mass Index (BMI) of 41, which will impact
negatively on his health over the years ahead.
Until recently Deepak’s GP had no option but to continue
encouraging Deepak to lose weight. Soon a local enhanced weight
advice service will be available to help patients like Deepak,
(known as a Tier 3 service). Deepak will be helped by a multidisciplinary team of specialists, which will include dieticians,
physiologist, physiotherapist and an
endocrine physician.
Together they will develop a specific
plan of action with Deepak to assist
him in losing weight.
6 | Our strategic commissioning plan 2014-19 – summary
Our five-year strategic ambitions
We understand that we have a real opportunity to work with the public and our partners to transform services
and improve patient outcomes for the longer term. At its core, this strategic commissioning plan has the delivery
of a series of ambitious outcomes covering the experience, efficiency and impact of patient care.
What do we want to achieve?
Why is this important?
We want people’s experience of
patient care inside and outside of
hospital to be the very best in the
country
We believe patients should
experience the best possible care
wherever they are. We intend to
work with local providers to ensure
we make measurable improvements
in the quality of care received.
How will we measure our progress
over 5 years?
We want to see a reduction in the
average number of patient survey
negative responses of:
l 6% in the hospital survey
l 9% in the GP practice survey
(where we are already amongst
the best in the country!)
We want to reduce avoidable deaths We support the national objective
to eliminate avoidable deaths in
hospitals due to problems with care.
We will make sure we have a robust
quality assurance framework in
place that includes medication error
reporting and presentations of MRSA
and C. Difficile.
We want to reduce the amount of
Caring for older people at home
time older people spend avoidably in enables them to recover more easily
hospital
and maintain their independence in
their own homes for longer.
We want to see a 14% reduction in
avoidable emergency admissions for
conditions amendable to healthcare
in adults and children.
We want to improve the healthrelated quality of life for people with
long term conditions LTC (including
mental health conditions)
We want to see a 6% improvement
in the average health status score
reported by patients with a LTC in
the GP patient survey.
The better we can support people
to self-care, the better will be their
health outcomes over a long period
of time.
We want to improve the productivity We need to deliver the current
of elective care
activity levels but with better
outcomes and less resource
In common with the NHS as a whole,
we intend to achieve a 20% increase
in productivity.
We want to secure additional years
of life for people, particularly those
experiencing health inequalities
We want to see a 17% improvement
in the age and sex standardised
measure of potential years of life
lost for conditions amenable to
healthcare
Better quality services, a focus on illhealth prevention, and greater care
provided in the community should
have a real impact on survival rates
for a range of key conditions.
How you can get involved
We want to fulfil the national ambition that Clinical Commissioning Groups are vehicles which place public,
patient and carer voices at the centre of healthcare services from planning to delivery. During the entirety of this
plan we will therefore take every opportunity to make closer contact with our patients and stakeholders to drive a
new approach to commissioning.
Why not join our Health Engagement Network?
We have set up a Health Engagement Network for local residents who care about the NHS so we can gather your
views, through surveys, focus groups and conversations. We can then help to make services more responsive to
your needs. We will also use the information to help make decisions about planning new services.
You can choose how much you get involved with the Network. We will send everyone around four surveys a
year, but you may also be invited to small focus groups with a few other people to discuss specific issues. We
are always looking at new ways to help people have their say about health services and we’ll let you know all
the ways you can take part.
Please visit our website and click ‘get involved’ to join: www.hambletonrichmondshireandwhitbyccg.nhs.uk
You can also directly contact your Health Engagement Network representatives:
Hambleton – Ken Elliott – [email protected]
Richmondshire – Jane Ritchie MBE – [email protected]
Whitby and surrounding area – Linda Lloyd – [email protected]
We are engaging with and involving local people in many different ways, including:
Professional
Engagement
Network of
interested local
clinicians who want
to help improve
services
A Patient Congress
every four months to
bring together local
people and debate
commissioningrelated matters
We will continue
our ‘Fit 4 the
Future’ engagement
programme to
design a better
future for older
people’s services
We will be an active
member on the
North Yorkshire
Health and
Wellbeing Board to
prevent ill-health
and integrate care
with partners
We will develop a
strong and effective
relationship with
Healthwatch and
listen to their
feedback to help
shape services
Get in touch – and tell us what you think!
We’d really like to know what you think about this Strategic Plan. You can send any feedback through any of the
mechanisms below. If you want to read the full version of the plan, then this can be found on our website. Our
contact details are as follows:
Hambleton Richmondshire and Whitby Clinical Commissioning Group, Civic Centre, Stone Cross,
Northallerton, North Yorkshire, DL6 2UU
 Telephone: 01609 767600
 Email: [email protected]
Twitter: @HRW_CCG
Facebook: www.facebook.com/HRWCCG
8 | Our strategic commissioning plan 2014-19 – summary