Download Appendix 12 BCCG Schemes Supporting Better

Health… at the heart of life in Blackpool
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Health… at the heart of life in Blackpool
Contents
Appendix 11 BCCG Schemes Supporting Reduction
of Health Inequalities.......................................... 97
Appendix 12 BCCG Schemes Supporting Better
Care Fund Plan .................................................... 98
Appendix 13 Timelines for Implementation ..... 101
Introduction ........................................................... 3
Executive Summary ............................................... 4
............................................................................... 8
Part 1 The Story of Blackpool ............................... 9
Part 2 Foundations for Delivery........................... 18
Part 3 System Vision for Commissioned Services 28
Part 4 Finance and Activity .................................. 46
Part 5 Engagement and Partnership ................... 50
Part 6 Outcomes .................................................. 54
Part 7 Risks .......................................................... 57
Part 8 Governance and Delivery Systems............ 60
Appendix 1 Altogether Now – A Legacy for
Blackpool ............................................................. 66
Appendix 2 Better Care event voting results ...... 68
Appendix 3 Paramedic Emergency Service/Patient
Transport Service Memorandum of Understanding
with Blackpool CCG ............................................. 73
Appendix 4 Paramedic Emergency Services
(PES)Commissioning Intentions Plan on a Page .. 74
Appendix 5 Innovations ....................................... 75
Appendix 6 Blackpool Plan on a Page.................. 76
Appendix 7 Lancashire Area Team Priorities ....... 77
Appendix 8 Blackpool Teaching Hospital POAP... 91
Appendix 9 Blackpool IT Strategy Summary........ 92
Appendix 10 BCCG Schemes Supporting the
Outcome Ambitions............................................. 94
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Introduction
This document is the strategy and plan for
Blackpool Clinical Commissioning Group
(CCG), for the period from 2014/15 to
2018/19. It sets out our strategy for the
next five years, and some of the actions
we will be taking to deliver that strategy.
It is our part of the plan for the whole health and
social care community, aligning with Blackpool’s
Health and Wellbeing Strategy and Better Care
Fund Plan, and is designed to deliver our
collective vision of a happier, healthier
population, with fewer inequalities, and health
services that are high quality, cost effective and
sustainable.
The CCG plan is based on a thorough analysis of
the strengths and weaknesses of the local health
and social care system, and the needs of the
changing population.
It sets out a strategy for moving Blackpool to a
position where it can deliver high quality
standards of health and social care in all settings,
while also delivering financial sustainability.
This plan is ambitious for patients and the public.
It focuses on improving outcomes for older
people, people with chronic diseases and those
suffering from the consequences of health
inequality. It focuses particularly on improving
access to services for these patient groups, in
order to help them avoid unnecessary hospital
admissions.
The plan also recognises the need to improve the
quality of people’s experiences of health and
social care services, and reflects our joint plans
with our commissioning partners in Fylde and
Wyre CCG, NHS England and Blackpool Council.
and ensuring the system works collaboratively in
the best interests of the patient.
All our improvement interventions will contribute
to integrating services more effectively around
the patient – wherever possible pulling services
closer to the patient’s home. Over the next five
years Blackpool CCG and its partners will deliver:
improvements in the integration of health and
social care; improvements in the integration of
people’s physical and mental healthcare; and
closer working between GP practices so that they
can drive the integrations of primary, community,
secondary and social care around the needs of
each patient and their family.
This plan will also result in a significant
improvement in our performance against the key
pledges in the NHS Constitution. This will give
people a much better quality of experience when
they need to use our emergency services or to
have a planned procedure, and will help to
provide better value health and social care
services.
Finally, the plan recognises that we need to do
much of our core business more effectively. In
particular, we have described the steps we will
take to tackle health inequalities, to place more
equal value on our mental and physical
healthcare, to involve the public in our work, to
meet quality and safety expectations, and to
ensure we commission efficient and effective
services.
Dr Amanda Doyle (OBE)
Chief Clinical Officer
Blackpool CCG
This plan focuses on reducing demand,
streamlining and integrating care to deliver
improved quality and greater financial efficiency,
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Executive Summary
Who we are
NHS Blackpool Clinical Commissioning Group
(CCG) represents 24 GP practices and works on
behalf of the people of Blackpool, commissioning
health services for the local community. We also
work closely with our neighbours, Fylde and Wyre
CCG, on healthcare across the Fylde Coast, along
with other local partners such as Blackpool
Council, Blackpool Teaching Hospitals NHS
Foundation Trust and voluntary agencies.
Challenges faced by Blackpool
5.
Blackpool faces many health challenges. It
may be a popular place to visit for millions
of people each year, but unfortunately,
Blackpool is not a healthy place to live. Our
town is one of the most deprived local
authority areas in England, with high levels
of unemployment, deprivation, poor quality
housing and benefit claimants. An ageing
population, low educational achievement,
and the fact that 10% of the population of
172,000 moves into the town for just short
periods before leaving, add to our
problems. These economic factors impact
on the poor health of our population in the
same way that cancer, alcohol abuse and
smoking do.
6.
Life expectancy in Blackpool is the worst in
the country for men and the third worst for
women. Although life expectancy is
improving in the town, it isn’t improving
fast enough, and this is something that the
CCG and its member practices, Blackpool
Council and other stakeholders in the town
are extremely concerned about.
7.
There are a number of priorities that the
CCG is tackling to improve the health and
wellbeing of our town. These include:
Vision
“Together we will make Blackpool a place
where all people can live longer, happier and
healthier lives by commissioning better health
care.”
Principles
1.
Our aim is to reduce health inequalities
through strong, clinically led commissioning
of high quality services that are modern,
truly patient-centred and in the most
appropriate setting.
2.
We are committed to ensuring equality and
diversity is a priority when planning and
commissioning healthcare services for our
community.
3.
 Cardiovascular disease
We will promote safe and effective health
care for our local population.
 Respiratory disease
 Mentalhealth and wellness
Values
4. We will:
 Be honest, open and act with integrity
 Make the safety and quality of the care
we commission our first concern
 Work in partnership with our patients
The future of healthcare in Blackpool
8.
Blackpool CCG, along with other local
stakeholders, realises that continuing to
deliver more care in its current form will
not make the required step-change
improvements in outcomes, variation and
quality that the Blackpool population
deserves. These stakeholders have agreed
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to design and implement a range of patientfocused models, based on solid evidence
from other local health economies. These
will drive improved outcomes and quality
through far more proactive and efficient
care.
9.
To achieve our ambitions for Blackpool, one
of our main aims is to change the way we
manage and treat patients with complex
health needs. These patients often have
recurrent exacerbations of their condition
and are very likely to have frequent
admissions to hospital to be managed.
10.
We intend to reduce the number of these
admissions
by
providing
intensive
management to complex patients within
the primary and community care setting,
based on multi-disciplinary neighbourhood
teams.
11.
The development of neighbourhoods will
comprise groups of general practices,
covering populations of between 20,000
and 40,000 people, associated community
and primary mental health services, and
strong links to third sector services, led and
directed operationally by GPs. The
expectation is that more services will in
future be delivered within these
neighbourhoods. This will enable care to be
‘wrapped around’ the patients rather than
the patients progressing through different
levels and types of care that are isolated
from each other.
12.
13.
Such neighbourhoods will contain sufficient
mental health support, care of the elderly,
community, extended primary care and
third sector services to ensure that patients'
health is maintained at a higher level than
the 2014/15 baseline. Admission to hospital
for unplanned urgent treatment and by
care-managed patients (both social and
health care) will be considered a system
failure
requiring
improved
system
responses to prevent recurrence.
In addition, we will develop 'extensivist'
services, each covering populations of up to
2,000 care-managed patients across several
localities. This will ensure that they are
treated and cared for on a continuous basis
within their homes, which will provide
higher quality, cost-effective care compared
with unplanned hospital admissions. These
services will free up time in the general
practices to be able to develop the
Enhanced Primary Care (EPC) services for
people with long-term conditions and those
requiring episodic interventions and
support.
14.
There will be a shift in neighbourhoods of
primary care working more closely with the
community. Community Orientated Primary
Care (COPC) is an amalgamation of public
health practice with delivery of primary
care, community and social care services.
This will include:
 Reviews of long-term conditions to
inform and educate patients, their carers
and families on choice
and the
management of their conditions
(including relapses etc.).

Involving patient participation groups
and other service users to design, plan
and provide feedback on initiatives.
 Clinicians and non-clinicians, as well as
community representatives, working
together.
 Mobilising additional resources, e.g.
counselling,
employment
advice,
exercise classes etc.
15.
We
believe
effective neighbourhood
working that enables this step-change
improvement will deliver:
 15% fewer unplanned inpatient episodes
taking place within acute hospital
settings by 2019, saving £7m per annum
 A substantial reduction in outpatient
appointments taking place within acute
hospital settings
 10% increase in community and primary
care-based services providing extended
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mental health support, urgent care
services and services for long-term
conditions by the start of 2015/16
21.
 Reduction in harm, serious incidents and
healthcare associated infections.
16. Blackpool faces significant Mental Health
difficulties amongst its population and in the
redesign of services particular attention will
be paid to Parity of Esteem and ensuring that
patients with mental health issues are given
equal opportunity as those with physical
health problems.
17. It is also planned that the implementation of
such services will reduce demand for elective
inpatient treatments such as orthopaedic
surgery. This will be achieved through better
informed decisions using health coaching and
patient decision aids. There will also be a
reduction
in
outpatient
follow-up
appointments.
18. Our five-year strategy anticipates the
rationalisation and sharing
of elective
surgical specialties onto fewer sites across
hospitals in Lancashire. Reductions in
commissioner expenditure will be driven by
cumulative increases in productivity of 20%
over the next five years and efficiency gains in
the hospital sector being delivered by the
rationalisation agenda. The EPC model will
also give general practice more capacity to
manage demand for elective care and other
services.
19.
The CCG also anticipates that the potential
rationalisation of hospitals will be
synchronised to take account of the
commissioning decisions of the Prescribed
Services team.
20.
Development of larger-scale diagnostic
services will be able to respond to the
increased demand for diagnostics from
extensivist and EPC services, support
telemedicine and telecare for out-ofhospital diagnosis and care, and meet the
new technological agenda.
We have fully considered the Francis
Report, the Berwick Review into patient
safety and Keogh Review into high mortality
rates. We will seek assurances that both
existing and new services are providing safe
care, maintaining privacy and dignity, and
protecting the most vulnerable. We will
work with regulators to make sure
recommendations are acted on and that we
will embed a robust quality assurance
process.
Lead commissioning role for
ambulance services
22.
NHS Blackpool CCG has a lead
commissioning role for the North West.
This includes ambulance services and the
NHS 111 service. The ambulance service
contracts are the Paramedic Emergency
Service (PES) and the Patient Transport
Service (PTS). For PES, there is a single,
region-wide contract that covers the 33
CCGs in the North West, provided by the
North West Ambulance Service NHS Trust.
For PTS, following a procurement exercise
in 2012, there are five contracts:
Lancashire, Cumbria, Merseyside, Cheshire
and Greater Manchester. The first four are
provided by NWAS and the GM contract is
provided by Arriva Transport Solutions
Limited.
23.
For NHS 111, there are two contracts
covering the 33 CCGs in the North West.
One is with Fylde Coast Medical Services to
provide the NHS 111 service to Blackpool,
Lancashire North, and Fylde and Wyre. The
other is with NWAS to provide services for
the rest of the North West.
Patient Choice:
24. Blackpool Clinical Commissioning Group
believes patient choice is crucial and should
underpin the delivery of a patient-centred
health service. Choice empowers individuals
to obtain the health and social care services
they need. Providing the public and patients
with high quality information enables them to
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make effective choices that are right for them
and their families. The CCG is committed to
engaging with public and patients and
involving them in our decisions so we can
work in partnership to address the health
challenges facing our community.
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Health… at the heart of life in Blackpool
26.
The Story of Blackpool
.
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Part 1 The Story of Blackpool
Blackpool is a large seaside town located
in Lancashire, North West England. It
covers an area of 13.46 square miles
within the urban area stretching along the
Fylde Coast, and is one of the most
densely populated local authority areas in
the UK.
(less than 2%) move more than three times
a year, and that the age group most likely to
move at least once is young people aged
20-29.
1.3.
Population and demography
1.1.
Blackpool has a registered population of
172,217 and a resident population of
approximately 142,000 (source: Office for
National Statistics, 2012). Each year there
are approximately 1,800 births and 1,800
deaths among the resident population. In
addition to the resident population,
Blackpool sees an estimated 11 million
visitors to the resort each year.
1.2.
The population of Blackpool has a
considerable amount of transience,
including movement within the town.
Transience has been an identified issue in
Blackpool for a long time and a recent data
review has been undertaken to identify
whether there is a reliable quantitative
source of information that can help us
understand this issue. Population turnover
statistics identify that some areas in
Blackpool have extremely high levels of
population inflow and outflow. The MSOA1
that contains South Beach has a population
inflow rate of 193 per 1,000 population,
which is the 65th highest inflow rate in
England. Further analysis of GP register
data suggests a small number of people
Blackpool has a population that is older
than the average for England and Wales. A
larger proportion of Blackpool’s population
is aged 45 and above compared to the
national average. The proportion of the
population aged under 10 and 20-39 is
lower than average (Figure 1).
Figure1
1
Super Output Areas (SOAs) form a geographic
hierarchy designed to improve the reporting of small
area statistics in England and Wales. Middle Layer
Super Output Areas (MSOAs) are designed to have a
minimum population of 5,000.
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Deprivation
1.4.
Blackpool experiences considerable levels
of disadvantage, and in 2010 ranked most
deprived of 354 local authorities in England.
Conversely 46 out of 94 small areas within
Blackpool are among the 20% most
affluent. Blackpool’s relative position in the
national deprivation rankings has worsened
over the last five years, from 24th most
deprived in 2004 and 12th in 2007.
Additionally, in the 2010 indices, Blackpool
ranked 1st for the concentration of
deprivation.
Life expectancy
1.5.
1.6.
Life expectancy is one of the key indicators
of health in a population. Life expectancy
for men in Blackpool is 74 years (2010-2012
figures) and is the lowest in England.
Women can expect to live longer than men;
life expectancy for women is 80. There are
considerable differences in life expectancy
within Blackpool. Men in the least deprived
areas of the town can expect to live nearly
10 years longer than men in the most
deprived areas. Similarly, for women this
difference is eight and a half years. Not
only do people in Blackpool live shorter
lives, but they also spend a smaller
proportion of their lifespan in good health
and without disability.
Figure 22
Figure 2 shows bus routes in Blackpool and
how life expectancy increases the further a
person lives along the bus route away from
the town centre.
2
Source: Office for National Statistics and Blackpool
Council
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Causes of poor life expectancy
Social isolation
1.7.
1.8.
The key causes of shorter life expectancy in
Blackpool are: alcohol-related diseases;
circulatory disease; cancers (especially lung
cancer); accidents and self-harm; and
respiratory diseases (Figure 3). Deaths in
younger people contribute to a larger
proportion of shorter life expectancy, as
more years of life are lost. Infant mortality
rates, particularly among babies aged
between one month and one year, are
currently higher than the national average.
Over the last 10 years, death rates (for all
ages and from all causes) have fallen. Early
death rates have also been falling for the
two most common causes of death –
circulatory disease and cancer – which
jointly make up almost 60% of all deaths.
Although this is good news, death rates in
Blackpool are higher than average and rates
have not been falling as quickly as
elsewhere.
Social isolation is a recognised risk factor for
poor mental and physical health and is
experienced by one million older people in
the UK. Strengthening positive relationships
in later life will help to promote mental
health and wellbeing for all of us. Factors
that contribute to social isolation and
increased risk of mental health problems in
older adults include:
 Decline in social activity
 Deaths of friends and relatives
 Transportation and mobility problems
 Less support due to smaller family size
and living alone.
100%
90%
Circulatory, 20%
Circulatory, 22%
80%
Cancer, 11%
Cancer, 15%
70%
60%
Respiratory, 18%
Respiratory, 22%
50%
40%
Digestive, 23%
30%
20%
Digestive, 23%
External causes, 14%
External causes, 12%
10%
0%
Other, 14%
Other, 5%
<28 days, 1%
<28 days, 1%
Male
Female
Figure 3 Public Health England:
Segmenting life expectancy gaps by cause
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Mental health
1.9.
Although secondary mental health
services work primarily with people
who have severe mental illness, many
of the people presenting in primary
care may have complex problems. A
number of factors have been identified
as having a negative impact on mental
health. These include:
 Being homeless
 Being unemployed
 Being poor
 Having a physical illness
 Having a drug or alcohol problem
1.10. The Marmot Report (2010) described
the role of addressing the wider
determinants of health in improving
health and reducing inequalities, and
the contribution of positive mental
wellbeing to preventing mental illness.
Mental wellbeing includes: subjective
wellbeing (how people feel about
themselves);
social
wellbeing
(relationships etc.); and sense of
meaning or purpose. One of the
greatest predictors of mental wellbeing
is self-perceived overall health.
1.11. According to the North West Wellbeing
Survey 2009, Blackpool has the lowest
average scores for wellbeing in
Lancashire, shown in Figure 4.
Residents who rate their health as very
bad are eight times more likely to have
the lowest mental wellbeing scores
than those with very good overall
health. From the ONS survey of 2011 –
12 Blackpool was in the bottom 5
nationally for public happiness score.
This survey found that where people
live is a crucial factor of happiness.
Figure 4 Warwick-Edinburgh Mental Wellbeing Scale
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Directly Standardised Rate per 100,000 (DSR)
Health… at the heart of life in Blackpool
Mortality from Suicide and Injury Undetermined - 1993 -2012 (Annual trend) - DSR - Aged 15+
60
50
40
30
20
10
0
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Year
ENGLAND AND WALES Males
NORTH WEST Males
Blackpool UA Males
ENGLAND AND WALES Females
NORTH WEST Females
Blackpool UA Females
Figure 5: Joint Strategic Needs Assessment (JSNA) Blackpool
Suicide
1.12. People with a diagnosed mental health
problem are at particular risk. Nationally,
up to 90% of suicide victims have been
reported to have been suffering from a
psychiatric disorder at the time of their
death.
1.13. Figure 5 shows that the rate of mortality
from suicide within Blackpool has remained
consistently greater than that of the North
West and England, particularly for males.
According to the Public Health Outcome
Framework, 6% of the adult population
aged 16+ in Blackpool have self-reported a
low worthwhile score. This is an important
indicator because people with higher
wellbeing have lower rates of illness, and
recover more quickly.
Alcohol and smoking
1.14. Blackpool has some of the highest levels of
alcohol-related harm in the country, not
only from the direct health effects of
alcohol, such as premature death and
chronic
liver
disease,
but
other
consequences such as disorder and
violence. There are an estimated 40,000
Blackpool residents who drink at hazardous
or harmful levels, equating to 28% of the
adult population. Alcohol is a factor in more
than three quarters of domestic violence
incidents and is a major contributing factor
in violent crime. Locally, in 2010/11, 4,806
people aged 16+ had an alcohol-related
hospital admission.
1.15. Smoking is the single most important factor
explaining the difference in death rates
between the most and least affluent areas,
and is a major factor in ill health. Around
400 people die prematurely every year in
Blackpool as a direct result of smoking, and
a further 8,000 will suffer related diseases.
The proportion of people smoking varies
widely between social groups. The highest
rates are seen among the most
disadvantaged groups, where, typically,
three out of four families smoke and spend
one seventh of their income on tobacco.
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and care home settings.
Substance misuse
1.16. Blackpool has an estimated level of opiate
and crack use at least two and a half times
the national average. Injecting drug use in
Blackpool is also estimated to be
considerably higher than average at over
three times the national rate.
Safeguarding
1.17. There are higher numbers of Children that
are Looked After (CLA) in the Blackpool area
that are vulnerable and need access to
preventative and ongoing health care. In
2014 we had 446 children identified.
1.18. There are a high number of vulnerable
elderly people living in their own homes
Healthcare spend in Blackpool
1.19. Blackpool is reflective of nearly all health
systems in that a substantial proportion of
the healthcare budget is accounted for by
relatively few patients, many of whom have
multiple long-term conditions and/or are
elderly/frail.
The increasing proportion of these populations is
further concentrating the healthcare spend,
putting increased pressure on budgets and
requiring health professionals to consider radically
different approaches to delivering effective care.
As shown in Figure 6, 48% of Blackpool’s
secondary care spend is driven by 5,600 patients,
just 3% of the population, of whom 3,700 are
aged over 60.
Blackpool CCG patients and population
Secondary care spend segmentation for Blackpool CCG residents
Cumulative hospital income
Blackpool CCG residents, HES 2011 income
Patient segmentation by hospital spend
Blackpool CCG residents only
Cumulative hospital spend (HES, 2011)
£120m
£100m
£80m
Moderate spend
segment: 12%
population, 40%
spend
£60m
£40m
High spend segment:
3% population, 48%
spend
Further
~103k
Blackpool
CCG
residents
with no
recorded
hospital
interactions
Patient
segments
Cost
breakdown
3%
48%
5.6k
£56m
12%
40%
20k
£45m
Spend
per
head:
£9.8k
£2.2k
£20m
£m
85%
12%
44k using 2o care,
103k not1
£16m
£0.1k
Cumulative patients
Source: HES, 2011
Note: Hospital interactions refers to inpatient, outpatient and A&E attendances during 2011 calendar year. Total spend refers to PbR and non-PbR estimates (where available) for HES
recorded activity. Includes residents of Blackpool CCG postal districts only
1: ~103k registered residents in Blackpool CCG postal districts with no evidence of a hospital interaction
© Oliver Wyman
29
Figure 6
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Health… at the heart of life in Blackpool
Figure 7 looks at Blackpool’s secondary care
spend by age and comorbidity. Not surprisingly,
the elderly (more than 60 years old) are the
largest users of secondary care, but interestingly
the 55% that are comparatively well in this group
account for only 32% of this spend. Therefore, in
the design phase, consideration will be given to
orientating the extensivist approach to elderly/
frail patients in order to provide better, more
proactive, care to those individuals with
comorbidities rather than the total over-60s
population.
Additional Challenges for Blackpool
1.20. In addition to those already described there
are various other challenges that Blackpool
faces in terms of healthcare and its delivery.
These are:
 Achieving Accident and Emergency targets
and the need for system reform to
alleviate this along with pressure on nonelective admissions
 Maintaining 18 week Referral to
Treatment
targets
in
pressured
specialities
 Mortality rates, progress to improve lacks
pace and there is a need to integrate
primary and secondary care to implement
agreed pathways
 Providers being able to meet 7 day
working. A need to reduce ‘low clinical
value’ areas such as Follow up
appointments to facilitate a shift of
resource to 7 day working.
Right Care
1.21. Blackpool CCG has partnered with the Right
Care programme to implement the NHS
Right Care approach. This will focus on
clinical programmes and identify value
opportunities, as opposed to focusing on
organisational or management structures
and boundaries.
1.22. Value opportunities exist where a health
economy is an outlier and therefore will
most likely yield the greatest improvement
to clinical pathways and policies.
Triangulation of indicative data balances
quality, spend and outcome, and ensures
robust assessment.
1.23. In Blackpool, the clinical programmes that
appear to offer the greatest opportunity in
terms of both quality and spending are:
• Circulatory problems (cardiovascular
disease) Cancer and tumours
• Respiratory system problems
• Mental health problems
• Gastrointestinal conditions
1.24. These opportunities are not surprising
when viewed in the context of Blackpool’s
story. The clinical programmes highlighted
could have been predicted when reading
through the challenges we face. The
inclusion of gastrointestinal programmes
may seem surprising, but this focus is due
to numbers of people with alcohol-related
illness. (Appendix 11)
1.25. It is also clear from the work done with
Blackpool Council public health service
colleagues, and evidence from elsewhere,
that the generation of these opportunities
is not necessarily through healthcare but is
more likely to be a consequence of people’s
lifestyle choices. With that said, there is an
incentive for Blackpool CCG to commission
strongly in these areas as the outcomes for
the people of Blackpool are poor.
Informing our strategy
1.26. In developing our strategy for the future,
several sources informed the decision
making process. In addition to the facts and
figures already described, we used the tools
developed by NHS Right Care, including
Commissioning for Value packs and
modelling and comparator tools, including
the NHS Atlases, Outcome Packs (CCG and
local authority versions) and ‘Anytown’
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models. The Staffordshire and Lancashire
Commissioning Support Unit (CSU) have
carried out a diagnostic for Lancashire
CCGs, which cross-referenced all of the
main data sources, including: spend and
outcomes;
Joint
Strategic
Needs
Assessment (JSNA) and local health and
wellbeing plans; and Atlas of Variation. This
was triangulated with the Commissioning
for Value outputs, with significant
correlation and therefore assurance of the
key areas of opportunity to prioritise.
1.27. These have all added greater richness to
our understanding and we continue to work
with Right Care, the Commissioning Support
Unit and public health colleagues to further
develop our understanding.
Key Points – The Story of Blackpool
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Blackpool faces many challenges in terms of health and lifestyles
Population older than average for England
High levels of deprivation
High numbers of Children Looked After
Lowest life expectancy in England for men
Key causes of shorter lives – alcohol; cancer; respiratory disease; self-harm
and accidents
Infant and hospital mortality higher than national average
Social isolation among elderly
Complex mental health problems
High levels of smoking and alcohol-related harm
Opiate and crack use twice the national average
3% of patients account for 48% of hospital spend
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Health… at the heart of life in Blackpool
Foundations for Delivery
.
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Health… at the heart of life in Blackpool
Part 2 Foundations for Delivery
CITIZENS ARE
FULLY INCLUDED
PATIENTS ARE
FULLY
EMPOWERED
• Working closely with
Healthwatch, using
focus groups to
commission services
that patients need in a
way they want
• Personal health care
budgets
• Patient choice
• PPI forum
• Listening events
WIDER PRIMARY
CARE PROVIDED
AT SCALE
MODERN MODEL
OF INTEGRATED
CARE
HIGHEST QUALITY
URGENT AND
EMERGENCY CARE
• In-house pharmacists,
employed by and
based in GP practice
• Hypertension scheme
• COPD scheme
• Atrial fibrillation
• Pulmonary
rehabilitation
• Access to high quality
urgent and emergency
care
• Primary/communitybased services
• Rapid response team
• Mental health single
point of access
• Community IV therapy
service
• Care planning scheme
• EMIS Web clinical
system supports the
above use of
telehealth in care
homes and patients'
own homes
•24/7 urgent care
centre
•GP/Primary care -led
primary cre
assessment unit
•GP/Primary care-led
DVT service
•Established NHS 111
provider with close
collaboration with outof-hours and
unscheduled urgent
care providers
supported by robust
directory of services
•Frequent caller project
PRODUCTIVITY OF SPECIALISED
ELECTIVE CARE
SERVICES
CONCENTRATED
•Working
IN CENTRES OF
collaboratively
EXCELLENCE
across Lancashire
on the Clinical
•Ensuring
Strategy
specialist
•Using support from
commissioned
Oliver Wyman
services are
consultancy to
provided in a way
bring together
that delivers
national evidence
to redesign elective world-class care
provision
for Blackpool
patients
Figure 7
2.1.
2.2.
Blackpool CCG is already working with
partners to create the foundations on
which the new models of care will stand.
We have an impressive infrastructure of
developed primary care premises and a
purpose-built Urgent Care Centre to
support
enhanced
primary
care
establishment and integration.
The CCG has implemented a number of
modernisation initiatives that demonstrate
how it has developed the six characteristics
of a transformational organisation. These
innovations are also the beginning of a
step-change towards the new models of
care, supporting their implementation
(Figure 8). Examples are provided below to
highlight the CCG’s current good practice.
A summary of further initiatives for 14/15
can be found in Appendix 5. These build
on and add to existing initiatives
Citizens are fully included and patients
are fully empowered
2.3.
Expert Patient Programmes: We have
been delivering an expert patient
programme in diabetes for several years,
ensuring that patients have the knowledge
and confidence to manage their condition
and recognise when they need to seek
professional support.
2.4.
Healthwatch and Age UK Blackpool &
District work closely with the CCG to ensure
public engagement (see 5.2, 5.3). We are
also working with advocacy services for
hard to reach groups.
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Health… at the heart of life in Blackpool
2.5.
2.6.
My Breathing Book is a support tool for
chronic obstructive pulmonary disease
(COPD) patients, encouraging better selfmanagement for COPD patients, and care
planning to implement prophylactic
interventions when exacerbation of the
condition is taking place. This results in
better management of symptoms and
improved
patient
confidence
and
experience, and contributes to reduced GP
attendances and hospital admissions.
The CCG is continuing to develop this work
in putting empowered patients at the heart
of their own care. We want patients to be
able to make informed choices with the
right information at the right time.
Wider primary care provided at scale
Blackpool CCG has developed a number of
strategies in primary care.
2.7.
2.8.
Hypertension scheme – Aims to reduce
mortality from cardiovascular disease (CVD)
and to reduce inequalities in mortality
within the population. We targeted the
highest risk groups and hard-to-engage
people aged over 40 years old. This was
achieved through our ‘Altogether Now – a
Legacy for Blackpool’ campaign (see
Appendix 1), involving a range of public
events at non-clinical venues across the
town e.g. football club changing rooms. We
were so successful in raising public
awareness of the importance of managing
blood pressure to prevent ill health that an
additional 15,000 blood pressure checks
were carried out;
2,700 patients were
added to hypertension registers, equating
to 70 cardiovascular events being
prevented and five lives saved over the
period of a year.
COPD scheme – The CCG COPD pathway
has been rolled out, targeting evidencebased
interventions
to
increase
prevalence. We carried out a targeted
campaign in collaboration with the
Altogether Now campaign that, a third of
the way through the project, has resulted in
290 newly diagnosed COPD patients and
reduced non-elective admissions.
2.9.
Pulmonary rehabilitation – For patients at
risk of acute COPD exacerbation, especially
over the winter months.
2.10. Atrial fibrillation – Part of NHS Blackpool’s
CVD strategy, the aim was to raise
awareness, and improve the detection and
management of atrial fibrillation (AF) across
primary care in Blackpool, and support
collaborative stroke prevention work across
Lancashire. In year 1, this resulted in 214
newly diagnosed cases; 74 were diagnosed
in year 2 and 217 in year 3. For every 100
patients identified, 20 strokes are
prevented.
2.11. In-house pharmacists employed and based
in GP practice – The service contributes to
the CCG priorities of extending life
expectancy and people leading healthier
lives, by securing improvements to
medicines management and maximising
health benefits for patients. The scheme
supports national and local outcomes, for
example, the Combined Predictive Model
Scheme (see 2.17) utilising the pharmacists’
skills to contribute to care planning for
high-risk patients.
Access to high quality urgent and
emergency care
2.12. Blackpool CCG led the Fylde Coast
Unscheduled Care Strategy and is already
commissioning elements to support
Extended Primary Care.
Through various workstreams put in place
to implement the strategy, we have:
 Developed a 24/7 single point of access
for multi-agency use, with care coordination and management and access
to patient information via EMIS Web
(information sharing governance) in
place
 A focus on the approach that ‘there’s no
place like home’ for patients already
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Health… at the heart of life in Blackpool
often seen by a GP, nurse or community
matron because of an existing medical
condition that can flare up from time to
time
months of the project it demonstrated a
saving of:
 A Care Co-ordination Service, managed
by the same people who operate the
phone lines for the out-of-hours doctors’
service.
This means that there is
someone to answer the phone 24 hours
a day, seven days a week, to enable
Extended Primary Care to be a reality
 346 emergency department attendances
 Intensively utilised risk stratification
tools (to support the above)
 An integrated 24/7 Urgent Care Centre –
GP primary care, out-of-hours and A&E
services have one gateway reception,
24/7. This utilises NHS pathways used by
NHS 111 operatives and includes the
piloting of NHS pathways face to face
 Invested in information and IT
infrastructure – This is key to the
delivery of wider primary care with
appropriate governance in place. Work
is beginning with social care colleagues
to ensure care co-ordination is seamless
 Enhanced primary care in the Urgent
Care Centre, meaning that patients
requiring rapid access to diagnostics can
be managed more appropriately at
home with the necessary support
packages organised prior to discharge
and therefore not requiring non-elective
hospital admission.
2.13. GP-led Primary Care Assessment Unit –
Enabling rapid access to diagnostics and
assessment where it is likely that the
patient would be discharged within a few
hours.
2.14. GP/Primary Care-led DVT service –
Enabling rapid access to diagnostics to
confirm a suspected deep vein thrombosis
(DVT).
2.15. Frequent Caller project and paramedic
pathfinder – Reducing frequent 999 callers
and non-elective admissions, this links with
the care planning scheme. In the first three
 433 ambulance calls (477 reduced to 44)
 64 mental health admission days
 28 days in Parkwood Hospital Mental
Health Unit
 Total cost saving across the Fylde Coast
£301,000 projected to £1.2m over 12
months.
2.16. The net result of the CCG’s work, with
partners, has resulted in minimal growth in
non-elective demand in secondary care
against a background of national growth in
this sector.
Modern model of integrated care
Risk stratification (Combined Predictive Model
tool)
2.17. In 2011 the CCG developed a bespoke
version of the King’s Fund Combined
Predictive Model (CPM) tool that identifies
patients at risk of unplanned hospital
admission and scores this risk in terms of a
percentage.
2.18. From the evidence, the following factors
have been identified in the achievement of
successful outcomes:
 Accurate case-finding to ensure
interventions target patients with
defined care needs
 Appropriate caseloads to ensure that
patients are receiving optimum care
 A single point of access for assessment
and a joint care plan
 Continuity of care to reduce the risk of
an unplanned admission to hospital
 Self-care to empower patients
manage their own condition
to
 Joined-up health and social care
services, with professionals working to
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Health… at the heart of life in Blackpool
aligned financial incentives and in multidisciplinary teams
 Information systems that support
communication and data that is used
proactively
to
drive
quality
improvements
2.19. The aim of the scheme was to target a
number of disease-specific areas and
provide enhanced care over and above the
core contract. The scheme enhanced the
management of long-term conditions,
leading to improved outcomes, avoided
hospital admissions and better quality care
provided and delivered in the primary care
setting.
2.20. Each practice was encouraged to better
understand their at-risk population and
create care plans, selecting from the
evidence above to better manage these
patients in the community setting and
support patients and their carers to remain
in their usual place of residence.
2.21. Rapid Response team – Aimed at admission
avoidance for people with a diagnosed
health and/or urgent social care need that
can be linked to community care plans. This
involves an integrated expert health and
social care team to provide rapid
assessment (within two hours) and
mobilisation of appropriate support, refer
onwards and signpost to appropriate
services to ensure a positive and effective
patient journey.
2.22. Mental Health Single Point of Access – The
service operates as a single point of access
to all adult mental health services in the
Blackpool locality. This means that patients
are not assessed and amassed by different
teams but are instead assessed once and
signposted to the right service, or, if an
uncomplicated referral, sent straight to the
right service.
2.23. Community IV Therapy Service –Provides a
community-based service for appropriate
patients on intravenous (IV) antibiotics. This
improves the patient’s experience of care
and contributes to reduced non-elective
admissions.
2.24. Frequent Caller Project: See 2.15
2.25. My Breathing Book: See 2.5
2.26. Care Planning Scheme – Provides:
 Single point of access for care plans and
co-ordination using EMIS Web. The
clinical system supports care planning,
the Frequent Caller scheme and the
sharing of key clinical information. Joint
contract monitoring is in place with
Blackpool Council, and the scheme is
successfully
delivering
reduced
admissions and improved quality
 A full care home management team,
working in care homes, starting with
highest non-elective admission rates.
The team are: completing care plans and
offering support and advice on tissue
viability, falls, end-of-life care and
nutrition for patients.
2.27. Health and social care integration. We
have funded dedicated health staff, nurses
and allied health professions (AHPs) seven
days a week, to work in a social care
intermediate care facility. The health staff
are part of the fully integrated team and
proactively rehabilitate and educate
patients in their recovery, so that most
patients go back to their own homes.
2.28. Integrated
approach
to
management. This includes:
medicines
 A ‘pharmacist interface’ post to support
patient issues at the transfer of care and
reduce readmissions
 Joint working with the Local Authority –
a CCG-funded pharmacist post is
currently in place at Blackpool Council –
supporting medicines governance in
care homes to improve medicines
management and
hence patient
safeguarding and outcomes;
(both
quality of life and hospitals admissions)
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Health… at the heart of life in Blackpool
 Workforce development – A long- term
conditions training and education subgroup is supporting partnership working
with the Pharma organisation to develop
skills and competencies to enable
delivery of future service redesign
 Implementation of Blueteq system for
the management of high-cost drugs –
This enables the CCG to have assurance
of
delivery
of
evidence-based
treatments in accordance with National
Institute of Health and Care Excellence
(NICE) and local guidance
 The establishment of a ‘care homes
pharmacist’ role to support medicines
management for patients and reduce
medicines waste aims to achieve cost
savings and improve patient quality of
life measures and outcomes
 A practice pharmacist service level
agreement (SLA) – To focus on national
and local prescribing Quality, Innovation,
Productivity and Prevention (QIPP)
indicators
to deliver quality
prescribing and cost savings
in
 Supporting the development of nonmedical prescribing locally to enhance
the skills in care teams.

To continue work with community teams
and public to reduce the use of
unnecessary antibiotics. The aim being to
locally reduce infections such as C
Difficile.
Blackpool CCG - IT Strategy
2.29. Blackpool CCG has worked with the
Business Support Unit at the CSU to
accelerate the IT strategy to ensure the
foundations are in place to support best use
of technology as the models of care are
rolled out Table 1 (see appendix 9 for more
detail).
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Health… at the heart of life in Blackpool
Table 1
Priority Areas
GP Clinical Systems
Document management
PC Infrastructure
Mobility
Impact

Using a standardised clinical system enabling connectivity between
healthcare systems, allowing clinicians to securely share and access real
time patient information and link into secondary care and out of hour’s
services

Simplified distribution of templates

Search and report tools

DocMan system simplifies workflow processes and GPs will spend less
time on administrative tasks

The EDT Hub will provide a secure, reliable and flexible platform for the
electronic communication of documentation between Secondary,
Primary and Social Care providers

During 2013-14 Blackpool introduced the all in one desktop to each and
every GP’s desk. This provided a richer experience when using unified
communication tools

It provides a platform for the use of voice, video and presence, enabling
the future vision of virtual GP consultations

Clinicians can access the core elements of EMIS Web on a tablet device
anytime, anywhere, making it easier to deliver care closer to home

Potential mobile communications solution while out of the practice (used
in the care homes setting for example, enabling a tablet device to be
present with the patient while the GP remains in the practice)
23
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Health… at the heart of life in Blackpool
foster good health and readiness for
school
Lottery bid applications
2.30. Blackpool CCG, as a partner organisation,
has been very successful in applying for
Lottery funding for our patient population.
We have been successful in two of three
bids. The other is being processed but we
have progressed to the second stage. These
bids will dramatically improve the health
and social care outcomes for our residents
and enhance services across the
community. They will also provide vital
funding to tackle issues in Blackpool that
are much further reaching than healthcare.
A Better Start
2.31. Blackpool has been successful in attracting
£45m funding over 10 years that will be key
to delivering improvement for babies and
young children. It aims to improve life
chances of babies and children through
improved
social
and
emotional
development, nutrition, language and
communication development, and system
change.
2.32. Blackpool’s Better Start shares with all its
partners a responsibility to constantly find
more effective ways of making the Better
Start and public money deliver better
outcomes for our children. This aim has
never been more important than in the
current challenging financial circumstances.
2.33. The committee has committed to the
following:

We will transform the way local services
are delivered, putting children and
families first

Every expectant mum and dad will have
access to high quality antenatal
education

Every new parent will have
opportunities to meet other parents in
safe attractive community spaces

Every new parent will have the
information and advice they need to

Every mum under 20 will be able to
access the Family Nurse Partnership

We will increase access to early help
services for babies in families affected
by drug and alcohol, mental illness and
domestic abuse problems

We will radically reduce the risks of
abuse and neglect of babies

We will become a national beacon for
early child development
Fulfilling Lives
£10m of funding, which has been granted
to Blackpool Council by the Big Lottery
Fund, will enable 24 specially trained
workers, based at a new HQ in Blackpool
town centre, to hit the streets and identify
those in the resort most affected by drug
and alcohol problems, mental illness and
homelessness. The aim of the scheme is to
improve the lives of the most vulnerable
people in the town.
£10m Fulfilling Lives: HeadStart
2.34. Investment will equip young people to cope
better with difficult circumstances in their
lives, preventing them from experiencing
common mental health problems before
they become serious issues. This
investment has been designed with the
help of young people in direct response to
the mental health needs of adolescent
young people. We know adolescence is a
difficult time for many young people: their
experiences in school, family lives, and the
modern pressures of growing up can trigger
problems that could be avoided or reduced
through earlier support. Our funding will
enable work in schools and youth clubs, and
with families, community groups and
charities, to make sure that young people
have a chance to benefit from this all-round
support.
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Health… at the heart of life in Blackpool
Productive elective care
100 Day Pathway Campaign
2.35. The 100 Day Pathway Campaign is a
development that brings together primary,
community and secondary care clinicians
and managers to improve elective care for
the patients of Blackpool. The aims of the
change are essentially to improve patient
quality/satisfaction and the appropriate
spending of public funds on health services
through the development of agreed clinical
pathways and processes grounded on the
Map of Medicine (a national collection of
evidence-based best practice). The
objectives are as follows:
 Reduce inappropriate secondary care
referrals
 Reduce variation between referral
practices
 Improve consistency of referral
information through standardised
criteria
 Reduce interventions of limited clinical
value
 Improve demand management
 Improve inefficiencies due to
inappropriate referrals
 Increase care within the appropriate
setting i.e. primary or secondary care
 Facilitate spend in the right element of
the patient pathway.
From September 2013, the focus moved
towards
implementation
planning.
Blackpool CCG, in partnership with the
Staffordshire
and
Lancashire
Commissioning Support Unit (CSU) and
Blackpool
Teaching
Hospitals
NHS
Foundation Trust, has developed inbuilt
links to the pathways and a clinical content
decision support and referral template tool
within the EMIS Web system. These will be
able to be monitored.
Specialised services concentrated in
Centres of Excellence
2.38. Blackpool Teaching Hospitals NHS Foundation
Trust provides specialist cardiac services
across Lancashire. The trust and local
commissioners work closely with the
specialised
commissioning
team
to
understand the implications, not only for our
population in terms of overall provision, but
the impact on our main provider if major
changes in provision of cardiac services are
proposed.
Altogether Now – a Legacy for
Blackpool
2.39. Altogether Now is a partnership between the
NHS in Blackpool (the CCG and Blackpool
Teaching Hospitals NHS Foundation Trust);
Blackpool Football Club; and Blackpool
Council. It is centred on tackling four
‘Tangerine Targets’. These are:
 Physical activity
 Lifestyle
2.36. The campaign commenced in March 2013
with the development of pathways across
the top 35 elective procedures. All
pathways are based on the Map of
Medicine approach and localised through
clinical discussion and development.
2.37. Tranche one pathways have been
developed and approved through local
governance processes throughout 2013.
 Childhood health
 Mental health and wellbeing
These are the key areas in which reforms
have to be made if the health of people in
Blackpool is to improve.
2.40. Altogether Now was launched in 2010 in
response to a Government directive to NHS
organisations to work more closely with
professional sports clubs in the challenge to
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Health… at the heart of life in Blackpool
improve health. The CCG has capitalised on
the benefits of working closely with this
unusual partner, using the programme to
launch and underpin several of its successful
schemes and as a meaningful way of engaging
with hard- to- reach residents of the town.
wellbeing of people in our seaside town
irrespective of age, race, gender or ability
through increased physical activity and
targeted health messages (for further detail
see Appendix 1).
2.41. The all-age, all-sport, all-inclusive programme
is aimed at improving the health and
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Health… at the heart of life in Blackpool
System Vision for Commissioned
Services
.
27
V6.0
Health… at the heart of life in Blackpool
Part 3 System Vision for Commissioned
Services
Imagine…
Jean is a 74-year-old widow. She moved to
Blackpool 10 years ago to enjoy her
retirement after happy memories from
childhood holidays here. She has lived
alone since her husband passed away last
year. She gave up smoking 10 years ago
but still suffers with emphysema. She also
has type-2 diabetes and arthritis. She is
lonely and becoming increasingly forgetful
and is reluctant to leave the house.
Jean frequently visits her GP but finds it difficult to
remember to discuss all her medical needs in a brief
consultation, often forgetting the important things.
When Jean can’t get to see her GP she calls 999. This
often results in her being taken to hospital and
admitted to a ward. She has to speak to lots of
different healthcare professionals, having to explain
her conditions repeatedly. She often has to wait for
social services before she can go home. The result is
that she spends longer than is necessary in hospital.
When she is discharged there is often a lack of coordination between the hospital, her GP, community
and social care services, resulting in Jean not getting
the support she needs.
Eventually, after several admissions in just six months,
Jean is admitted to a care home…
What if health and social care services were more
joined up?
With a professional responsible for coordinating Jean’s
care needs?
This person meets with Jean, her social worker and her
GP. Jean decides she wants to manage her care at
home with the support of ‘Enhanced Primary Care’. A
care plan is devised to meet Jean’s needs; a copy is
given to Jean and the professionals can access this plan
online at any time.
Jean now gets regular visits from her care co-ordinator,
who supports her to manage her chronic conditions.
When Jean’s condition deteriorates she knows who to
contact and rarely requires an ambulance. On the rare
occasion she’s admitted to hospital, the discharge
process is much quicker, involving a review of her
existing care plan.
Jean’s health and social care is funded from a joint
budget, so the team and her care coordinator can
make the right decisions with all the relevant
knowledge.
Unfortunately, Jean deteriorates. Her coordinator
reviews her plan with her GP and they escalate her
case to the ‘extensivist’ – a clinician skilled in dealing
with patients like Jean who are at high risk of
hospitalisation. After tailoring her care to meet the
deterioration in her physical and mental health, the
extensivist mobilises some telemedicine support to
enable Jean to remain safely at home and de-escalates
her care back to her GP and care coordinator.
Jean has chats with her care coordinator and is also put
in touch with a local charity, which offers a befriending
service, and she goes out to some community groups;
this has made her less lonely and she is no longer
scared to go out.
Jean didn’t need to be admitted to a care home and
now gets the help she needs in her own home
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New models of care in Blackpool
3.1
3.2
 The Extensivist model, which focuses
care on patients with the most complex
needs. We anticipate that this model will
facilitate better management of patients
who may not only have multiple physical
health needs but whose care becomes
more complex due to mental health and
social issues.
Blackpool CCG (with support from NHS
England) has commenced working with
external support on developing new models
of care. This work is based on international
best practice to build on our existing
progress in transforming and integrating
local care delivery (see Part 2). The new
system will be radically different, with
clusters of GP practices working together,
supported by appropriate services (Figure
9),
coordinating
care
in
their
locality/‘neighbourhood’ (Figure 10), closer
to patients’ homes.
An initial stratification of the Blackpool CCG
population on secondary care spend (Part 1,
Figure 6) shows that 3% of the population
account for 48% of the total expenditure.
This establishes that the proposed models
of care would work well for the Blackpool
population. Two main models will be
implemented that aim to care for
Blackpool’s residents.
 Enhanced
Primary
Care,
which,
alongside community and social care, is
centred in neighbourhoods. This will
enable holistic care to be wrapped
around patients who have a single longterm condition that needs to be
managed
and
prevented
from
escalating.
3.3
Both models are founded on identifying a
distinct cohort of patients, who are then
supported by a specific clinical/ social/
therapy-led care model.
The key
component of the care model is clear
patient accountability. All care decisions
are taken by the patient/their carers,
supported by the lead clinician and their
care team. This care team has holistic
responsibility for an individual’s care, acting
Figure 8
29
V6.0
as the co-ordinating point across the local
health and social care system, holding other
individuals/organisations to account with
respect to their patients. This approach is
cohesive with the public health approach of
community-oriented primary care, basing
interventions on community need.
3.4
The neighbourhoods will be based on
groups of GP practices covering populations
of 20,000 to 40,000, and will take account
of health, social care and voluntary
resource and estate available to deliver
seamless and comprehensive care.
3.5
Delivering care closer to home requires
organisation of out- of-hospital care at a
greater scale. But GP practices will remain
at the centre of patient care, providing
routine care near to where patients live,
continuing to promote health and assist
patients in making complex care choices.
They will retain overall accountability for a
patient’s health and co-ordinate care for
people with long-term conditions.
3.6
Figure
10
shows
the
proposed
neighbourhoods and their population size.
In order to assess the appropriate
boundaries of the neighbourhoods, a group
is in place to map all current services in
nursing, allied health professions, adult
social care and mental health (primary care)
and voluntary services against the
neighbourhoods.
Commissioners
are
working with providers to establish the
levels of care at practice/locality level and
the appropriate setting. Integrated/multidisciplinary care teams based in the
neighbourhoods will ultimately provide
Figure 11
9
30
V6.0
seamless care across health and social care
and
the
voluntary
sector
where
appropriate. The current care co-ordination
service will be developed to ensure it
maximises co-ordination of health and
social care.
Extensivist: care model design
3.7
This model is focused on the sickest of the
sick patients; the 3% of our population who
account for 48% of our secondary care
spend (see 1.20 and Figure 6). The model
has several nuanced orientations; some are
medically-led (e.g. for the elderly/frail
population), whereas others are socially
and behaviourally led.
3.8
The Extensivist model is a fundamentally
different way of delivering care. Care is
reoriented around the needs of the patient,
cutting across all aspects of health and
social need: medical, social, psychological,
functional and pharmaceutical. The holistic
care system is designed to ensure early
intervention and, over time, proactive
prevention, breaking the current cycle of
slow, reactive care provision.
3.9
Each patient’s care is led by an ‘extensivist’,
who is responsible for managing a specific
group of about 2,000 patients. They coordinate and deliver disease-specific care
programmes and general intervention
programmes (e.g. end of life care), which
are supplemented by specific specialist
services, either long-term condition (LTC)
related or episodic. Care takes place at
convenient locations for the patient and in
settings designed with their needs in mind,
with significant home care. In this way,
higher levels of compliance with treatment
programmes are typically delivered, which
in turn supports better outcomes and
patient experience.
3.10 This model has significant impacts (Table 2):
 Patient
satisfaction
improves
considerably, e.g. 80% of patients in
other local health economies would
recommend a friend
 By breaking the cycle of reactive
interventions, hospital admissions are
reduced by 25% and outpatient and A&E
attendances decline by 20%
 When hospital admission is necessary,
the length of stay can be reduced by the
availability of rehabilitation care outside
hospital, managed by the extensivist
team
 It will free up capacity in primary care to
deliver a more community orientated
experience (see 3.17-3.20).
3.11 There will be an initial delivery challenge
around identifying individuals with the
interest and appropriate experience to be
successful in the extensivist role. Additional
to this will be: identification and
recruitment of the care team; training and
development support; integration with
current, local, disease-specific pathways
and activities; and sufficient change
management support to establish these
radically new ways of working over a short
time period.
3.12 The CCG has been working closely with our
main healthcare provider to develop a
workforce plan and has process in place in
order to assure Health Education North
West and NHS England that the plan
reflects the needs of the redesigned system
and identifies:

An understanding of clinical models
and priorities

Impact on workforce of the Strategic
Plan and Better Care Fund

The
gaps
between
current
workforce and future workforce
 More effective condition management
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
Descriptions of the type of people
who will be needed to deliver care
in the future

Equality and Diversity impact
assessments on the workforce

Best practice

Areas that can be delivered at pace

Barriers

Delivery of outputs

An OD plan that moves the health
economy for the current situation to
the desired future.

Communication and Engagement
Plan
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Table 2
Clinicians and
other
staff:
Patients:
Other
caretakers:
Extensivist
 Empowered to impact care and
have capacity to do so
Enhanced Primary Care
 Practice to full scope of
license/capability while
expanding system role
 Have greater influence on
patient outcomes through
accountability
 Receive highly personal care
 Gain increased access
 Are engaged in the management
of their conditions
 Become empowered to make
informed decisions
 Receive consistent, higher quality
care in the GP surgery
 Are supported through all phases
of life, including end of life
 Gain comfort that loved ones are
receiving superior care
 Receive whole person
focussed care delivered
by current GP
 Can regularly access care
and have questions fully
addressed
 Work in conjunction with
GP to ensure condition
mgmt./wellness
Enhanced Primary Care (EPC): care
model design
3.13 EPC is a new model of primary care for the
larger group of patients at the level below
those of the Extensivist model in terms of
complexity and need (Figure 6). The target
patients are those with a single long-term
condition, recognising the acuity and
support required varies considerably, e.g.
well-managed diabetes versus severe liver
disease.
3.14 The GP is the accountable professional,
supported by their team, as the responsible
professional for supporting the patient in
maintaining/improving
their
health
condition/status.
The effective coordination of the multi-disciplinary team
surrounding the patient, and their authority
to access efficiently broader health and
social care services, substantially improves
proactivity of care, consistency and access.
This model often requires a networked GP
 Defined role in managing
patient care and
coordination across
clinical resources
model, or alternatives, to ensure timely
access for patients on a 24/7 basis.
3.15 The initial challenge of the EPC model is
‘knitting’ together the key elements of
support services required.
Effective
delivery of this model is heavily reliant on
nurse care manager accountability and
acceptance from other parts of the system
to ensure that access and management of
their patients in other settings reflects the
patients’ needs and acuity. Given the
critical nature of this change, we will
introduce
strong
EPC
governance,
potentially
including
service
level
agreements, to ensure compliance across
the system.
3.16 The benefits of this system are outlined in
Table 2. In addition to the benefits to
clinicians, patients and carers, there is a
benefit to the community by freeing up
primary care resource to promote
‘Community Orientated Primary Care’.
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3.17 Initial programme design is underway
across the Fylde Coast to establish the
relevant workstreams for both the design
and delivery phases, with appropriate
governance structures. Both Blackpool and
Fylde and Wyre CCGs have ambitious plans,
with Blackpool looking to establish its first
extensivist during 15/16. (Appendix 13
timelines)
Community Orientated Primary Care
(COPC)
3.18 The EPC model will also be able to provide
the infrastructure for COPC, which is
another evidence-based public health
approach to tackling the health problems of
a defined community or neighbourhood,
and incorporates population-based and
epidemiological input/data. It ‘marries’ the
best of primary care with the best of public
health, with the primary care practitioner
taking responsibility for the care of an
identified community.
3.19 In Blackpool, this model of working will be
adopted and members of the community
and the wider voluntary, community and
faith sectors will be involved in the design
and implementation of each GP
neighbourhood model. The ethic of service
is to drive community health improvement,
and together neighbourhoods develop and
implement prevention and treatment plans
for their priority areas. The aim is to not
only treat diseases but also to develop
programmes for health promotion,
protection and maintenance.
3.20 Each GP neighbourhood will need to take a
different approach in reaction to the
community’s health needs, strengths and
resources; including whether relationships
have been established between the health
service and the surrounding communities.
3.21 The Extensivist, EPC and COPC models are
key components in pivoting our primary
care services to become more proactive
and
will
either
be
introduced
simultaneously or in quick succession. We
expect the Extensivist model to stabilise the
sickest of the sick with multiple long-term
conditions, and the EPC model to enhance
single-condition management, reducing the
rate of condition progression. Effective
delivery of these models will impact on
activity in secondary care, helping to reduce
the current pressure points, and is likely to
lead to subsequent further redesign in
these areas, supported by additional new
models of care.
Co- commissioning of Primary Care
3.22 In May 2014 NHSE announced a new option
for CCG’s to co-commission primary care in
partnership with NHSE England giving CCG’s
new powers to drive up quality of care,
reduce health inequalities in primary care
helping to sustain local NHS over the next
five years.
3.23 NHS Blackpool CCG believes the cocommissioning of Primary Care Services will
underpin its established Primary Care
development work embedded within its
existing structure.
3.24 Engagement with its constituent practices
to support improvements to the health of
people in Blackpool has been integral to the
development of a number of unscheduled
care schemes delivered in wider primary
care.
3.25 Approval to co-commission services will;
 Achieve greater integration of health
and care services, in particular more
cohesive systems of out-of-hospital care
that bring together general practice,
community health services, mental
health services and social care to
provide more joined-up services and
improve outcomes;
 Raise standards of quality (clinical
effectiveness, patient experience and
patient safety) within general practice
services, reduce unwarranted variations
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in quality, and, where appropriate,
provide targeted improvement support
for practices;
 Enhance patient and public involvement
in developing services, for instance
through
asset-based
community
development;
 Tackle health inequalities, in particular
by improving quality of primary care in
more deprived areas and for groups
such as people with mental health
problems or learning disabilities.
3.26 In summary, NHSB CCG believes that
developing
robust
co-commissioning
arrangements with NHS England (and other
commissioners) is an essential step to
deliver truly integrated services at the scale
and pace required, to meet the local and
national challenges.
local social inclusion resources that we are
going to build around communities.
3.29 The introduction of personal health budgets
and the special educational needs and
disabilities (SEND) agenda will mean
structured joint care planning across
education, health and social care children's
services, which lends itself to joint teams
and pooled budgets. Our aim will be to
reduce duplication of assessment. Families
will have choices, care co-ordination, and
access to telehealth and digital technology.
Most importantly, the families and carers
will feel that services are truly working
together and be able to be very responsive
to enable their child to have the best
possible start in life and aspire to reach
their greatest potential as young people.
We will actively participate in the
safeguarding of children and ensure that
those most in need have ease of access.
Children's services
3.27 To some degree, paediatric services are
already working in an ‘extensivist model’.
Paediatricians can and do treat many
different comorbidities in children without
referring onto tertiary centres unless there
are specialist complex issues. But even
then, the local consultants will be offering
support to these children and families
during their treatment pathway.
3.28 In the future model we will see a more
community-based service with consultants,
paediatric nursing teams, allied health
professions and social care overlaying the
neighbourhood model. The aim is to
support children and families as close to
home as possible, reducing stress for the
children, their parents and carers. Training
on emotional health and wellbeing and
early detection of problems will also mean
more integrated working with child and
adolescent mental health services (CAMHS)
in the community to offer early
intervention and the development of
resilience, transition to adult services and
self-management. This will be linked to
schools and children’s centres, and into the
Mental health services redesign
3.30 As described in 1.9 to 1.13 Blackpool faces
significant mental health issues amongst its
population. Evidence shows that people
with mental health problems have reduced
life expectancy and physical morbidity.
Compared to people without mental health
issues they proportionately

Consume more hospital services
than those without mental health
issues

Use the ambulance service more
frequently

Stay in hospital longer

Are more likely to be classified as an
emergency.

Have more outpatient appointments
3.31 In order to reduce the impact of mental
health issues on both the individual, their
families, carers and the health and social
care systems not only will we introduce a
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series of new improvements as described
but we will ensure that mental health
services are given equal priority to those for
physical health. Patients will experience
parity of esteem in their care helping to
improve their health outcomes.
3.32 Parity of esteem will apply to people of all
ages, and all groups of the population. It
will establish equal access to health and
social care with comparable waiting times,
equitable treatment according to need with
equivalent levels of choice and quality.
3.33 We have introduced memory screening for
our population, so that early cognitive
issues can be detected and healthy
lifestyles advice provided, as well as links
into voluntary sector support and earlier
assessment at memory assessment services
in Blackpool for intervention and
treatment.
3.34 We are expanding specialist mental health
services to cover seven days a week,
helping patients to remain in their own
homes with expert oversight. We are also
commissioning care home liaison support to
assist care home staff in managing more
complex cases. Together with this we are
investing in more dementia advisor and
peer support programmes and training for
carers and patients in coping with
dementia.
3.35 We will have a brand new, state-of-the-art
psychiatric
inpatient
facility
within
Blackpool, due to open in 2015. This will
provide an environmentally friendly facility
for patients to receive their care within the
local area.
3.36 We are also working to enhance adult
community mental health services to
reduce the separate teams so that patients’
care is co-ordinated in a comprehensive
manner. We aim to ensure that all
providers work together and overlay the
neighbourhood teams to ensure that
practices are linked to their own teams of
specialist support.
3.37 We are working with our providers to
redesign the crisis response service to work
more closely with A&E liaison to ensure
timely responses to emergencies.
3.38 We are creating a culture where our
workforce takes a care-co-ordinator role for
the patient/service user, ensuring that the
person’s holistic physical and mental health
needs are equally valued and supported.
Improvements in end of life care
3.39 The Blackpool vision for end of life care is to
ensure that high quality services are
available in hospitals, care homes and all
community settings for all patients and
carers, irrespective of diagnosis, which offer
dignity, choice and support to achieve
preferences in the last year of life.
3.40 Priorities for Blackpool are:
 To increase the number of deaths in the
patient’s preferred place of death or
their usual place of residence
 To improve the quality of the patient
experience at end of life and the
experience of their families/carers
 To develop community care plans in
support of co-ordinated care.
Improvements in cancer care
3.41 The CCG will be working to deliver
improved treatment and access to cancer
services, including:
 Access to diagnostics
 Referral pathways
 GP engagement
Awareness
and
campaigns
in the National
Early
Diagnosis
 Royal
College
of
General
Practitioners/National Cancer Action
Team cancer diagnosis in primary care
audit
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 Clinical
decision
making/decision
support tools, e.g. risk assessment tool,
safety netting
 ‘Cancer Local Implementation team’
developing Fylde Coast action plan for
cancer
 Implementing
national
cancer
campaigns, i.e. bowel screening, lung
cancer
3.47 BTH will continue to provide national
artificial eye services to England.
3.48 BTH will continue to provide level 2
neonatal services.
Unplanned care provision
3.49 The Acute Trust will provide core unplanned (non-elective) services, including:
 Review of breast service referral and
triage process
 A&E
 Reviewing whether to move follow-ups
for stoma care into the community
 Clinical decision unit
Acute Services
3.42 The CCG has worked closely with its main
provider of acute hospital care, Blackpool
Teaching Hospitals NHS Foundation Trust
(BTH). They are integral stakeholders in the
delivery of the new models of care. They
understand the need to shift delivery of
acute services towards more community
orientated working and their plans reflect
this (Appendix 8 BTH Plan on a Page).
3.43 Patients will only be admitted to hospital
when they require acute treatment that
cannot be safely or efficiently provided in a
community setting. The following sections
summarises BTH plan:
General acute based services
3.44 Medical and surgical high dependency
patients will be supported by intensive
therapy unit and high dependency unit
beds.
3.45 BTH
will
establish
a
centralised
rehabilitation service, to which patients can
be transferred following acute medical/
surgical treatment at Blackpool Victoria
Hospital, or can be repatriated to following
surgery/treatment elsewhere in Lancashire.
3.46 BTH will continue to provide elective
cardiothoracic, cardiology and haematology
services for Lancashire and South Cumbria.
 Diagnostics
 Trauma and emergency surgery
(orthopaedics, general surgery, urology,
gynaecology, maternity)
 Paediatric services
3.50 The Acute Trust will support the continued
provision of major trauma services at
specialist centres (Lancashire Teaching
Hospitals NHS Foundation Trust).
3.51 A&E will treat ‘true accidents and
emergencies’. Patients with minor injuries,
or who require a period of longer
assessment, will be treated in a more
appropriate environment.
3.52 A multi-disciplinary clinical decision unit will
be established, to allow a holistic, rapid
assessment by experienced clinicians.
3.53 Elderly patients will be managed in a
dedicated frail elderly unit, with a named
clinician responsible for their care.
Planned care provision
3.54 Core planned (elective) services will be
provided on the acute hospital site, or in an
ambulatory care setting if appropriate.
3.55 Ambulatory care centres will be established
that provide diagnostics, outpatient
services, treatment regimens and minor
surgical procedures in a non-acute setting.
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3.56 Outpatient services will become ’one stop’,
with access to diagnostics, specialist
opinion and pre-operative assessment.
 Have access to information and advice
3.57 BTH will continue to work in partnership
across Lancashire to develop federated
service models wherever this will increase
quality of care, service sustainability or
improve cost effectiveness.
 Develop systems for gaining service
feedback
3.58 Local support for cancer treatment
pathways will be provided, even if the
surgical intervention is undertaken
elsewhere in the region.
Third sector
 Know how to raise concerns about
services if needed
3.61 To enable this we will put in place a range
of support materials and services, including:
 Patient education programmes
 Accessible information
 Shared decision making
 Expert patient programmes
3.59 Mobilising the third sector will deliver a
range of services:
 Comprehensive directories of health,
social and voluntary care services
 Supporting people to stay out of hospital
where their needs can be met in the
community
 Focusing our efforts on the most
vulnerable
 Reducing social isolation by developing
early intervention and preventative
support programmes
 Helping people to better understand
illness prevention in order that they can
take greater responsibility for their own
health through more informed choice
and control
 Educating and enabling people to
recognise the signs and symptoms of ill
health and use more self-care options
Patient empowerment
3.60 A key component in the success of the new
care models is the support and
empowerment of patients to enable them
to:
 Take ownership of their own care and
wellbeing to enable them to live
independently
 Make informed decisions about their
care.
 Live a healthy lifestyle
 Decision support aids
 Key public communication messages
 Clear process for making complaints
Paramedic Emergency Service
3.62 Commissioners recognise a need for whole
system transformation in order to move
towards the healthcare system described by
both the House of Commons Health
Committee’s Urgent and Emergency
Services report (July 2013) and the Keogh
Urgent and Emergency Care Review
(November 2013). Both reports describe
paramedic emergency services (PES) as
having a changed role within an enhanced
system of urgent care – a role where
conveyance to hospital will be one of a
range of clinical options open to ambulance
services. The 2014-2019 Commissioning
Intentions Plan on a Page (Appendix 3)
starts to describe the incremental changes
that will be required over the coming years,
in order to allow PES to become “mobile
urgent treatment centres” (Keogh, 2013).
One of these key required changes is to
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achieve a reduction in conveyance to
hospital.
3.63 The contractual model for 2014/15
encourages a significant step towards the
required strategic change, by incentivising
through CQUIN a reduction in inappropriate
conveyance. This will allow the North West
Ambulance Service (NWAS) to build on the
progress they have already made with
commissioners
over
recent
years,
developing and implementing initiatives
such as the Urgent Care Desk, Pathfinder
and referral schemes into primary care, as
well as targeting frequent attenders, to
name some examples.
3.64 Priority areas for ambulance commissioners
are:
 Conveyancing – Reduce inappropriate
conveyance to A&E, increase use of Hear
and Treat and See and Treat
 Healthcare professionals – Develop
standards to include triage and
eligibility, Priority Type (possible bureau
approach) and engage with GPs
 Avoidable admissions – Support for
people over 75 years old and those with
complex needs, including those in
nursing and care homes
 Outcome measures – Develop a series
of measures for use in year 2 that focus
on impact on the patient.
3.65 A virtual ‘Task and Finish Group’ has been
established, which includes clinical and
managerial representatives from each of
the five county areas.
Specialist commissioning
3.67 As a CCG, we are working with NHS England
to ensure patients requiring specialist care
are treated by the most appropriate
provider. We recognise that there is a need
to change the provider landscape in order
to deliver services designed around patients
and carers, and ensure our specialist
centres are used to treat the most sick.
3.68 National thinking around hospital-based
care has been influenced through high
profile reviews such as the Francis report
into Mid-Staffordshire Hospital, and the
Berwick and Cavendish Reviews. In his
review of hospital services, Sir Bruce Keogh
recommended that serious or lifethreatening care should be delivered from
centres of excellence, with the best
expertise and facilities to maximise chances
of survival and recovery. This has led to
national recommendations moving towards
commissioning of serious, life-threatening
emergency care and rare services from
centralised locations to ensure clinical and
cost efficiencies are maximised.
3.69 Engagement and local knowledge will
inform local strategy development,
ensuring that specialised services will:
 Be commissioned to deliver quality,
better outcomes and value
 Have a qualified workforce to enable
better equity of outcome and access,
and offer sustainable quality against
standards
 Be value for money
 Be based
networks
on
integration
of
care
 Take account of interdependencies and
care bundling.
3.66 The vision for specialist commissioning is to
consolidate and develop sustainable
services based in fewer centres to create
networks of excellence, aligned to research
and innovation.
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Lancashire Area Team and NHS
England North
to ensure that local priorities inform
decisions made by the team and ultimately
benefit Blackpool patients and services
(table 3).
3.70 The CCG works closely with the Area Team
and through them with NHS England North
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Table 3
Summary of Lancashire Area Team priorities
Full narrative found in Appendix 7
Area
Specialised
Commissioning
Primary Care
Direct
Commissioning
Health and
Justice
Priority
Delivery
Mental health
 Develop North West child and adolescent mental
health service (CAMHS) tier 4 system review and
potential procurements
 Review secure mental health
Cancer and blood
 Compliance with NICE improving outcomes guidance
(IOG) standards and any procurements as a result
 HIV commissioning arrangements
Trauma and head
 Adult neuro-rehabilitation services whole care
pathway model, better capacity management
 Major trauma centres – alignment with specification
and co-location (time/distance for required services),
viability of multi-centre model
Internal medicine
 Cystic fibrosis capacity
 Cardiac services – specialised services review, surgery
and devices
 Vascular services – compliance with standards and
reconfiguration and any procurements as a result
 Respiratory services
 Acute kidney injury
 Inherited metabolic disorders
Women and children
 Neonatal services
 Paediatric neuro-rehabilitation
GP out-of-hours services
 Develop a relationship with GP out-of-hours services
Seven-day working




Integrated out-of-hospital
services
 Reduce unwarranted variation in quality and provision
 Collaboration with local communities, partners and
colleagues
 Strategy based on patient and public insight – ‘A call to
action’
Establish integrated system
 Single prime provider
Economies of scale
 Secondary care in-reach
 Mobile diagnostics
Support of Better Care Fund
GP contract changes
Local improvement schemes
Neighbourhood approach
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 Remodelled inpatient provision
Partnership working to achieve
excellence
 Service specifications in line with national guidance
 Local and strategic partnership arrangements
 Commissioning guided by robust health needs
General prison healthcare
 Quality of offender healthcare services improved and
equivalent to those in the community
 All prison health contracts are compliant with NHS
standard contracts
 There are comparable standards of quality and care
across all Area Team area prisons
 Prisoners’ health and social care needs are met
Secondary care
 The need for appropriate escort and bed watches is
reduced by the implementation of alternative access
to services, e.g. telemedicine and prison-based clinics
 Activity and spend on secondary care is reduced and
replaced with care closer to home.
Substance misuse
 Effective offender health substance misuse strategy in
place and being delivered
 Quality of offender substance misuse services
improved
 Substance misuse contracts compliant with NHS
standard contracts.
 Comparable standards of quality and care across all
prisons
Secure children’s homes
 Transfer of NHS-commissioned healthcare completed
 Commission high quality NHS comparable services
within secure children’s homes
 Improved commissioning capability
 Improved high quality clinical governance
 Improved care pathways
Immigration removal centres
 Comparable standards of quality and care as in the rest
of the NHS
Sexual assault services
 Transfer of sexual assault referral centre (SARC)
commissioning to NHS offender health commissioning
as a part of the transfer of police health
commissioning, in partnership with key agencies and
based on NHS standard service specification and
contract
 Improved health and reduced inequalities in
healthcare
 Achieved national roll-out across all Area Team area
police custody suites and courts against a national
service specification and NHS standard contract
 Continuity of care across pathways and back into the
community
 Offender health needs are known and provided for by
appropriate treatment services
Liaison and diversion
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Police custody suites
Public Health
Commissioning
Reduce health inequalities
Key challenges
 Growing population
 Increased demand on
commissioned services
 Increasing pressure on
NHS financial resources, which
will intensify further from
2015/16
 Challenges to improve
coverage and uptake of
disadvantaged groups
 Inequalities in service
delivery
 Increase in patient
expectations
Armed Forces
and Veteran
Health
Patient engagement
Pathway review and redesign
 Offenders are diverted from the criminal justice
system when appropriate
 Effective planning that is aligned to an investment
strategy
 Transfer of the commissioning of healthcare in police
custody to NHS via offender health commissioning
 NHS-commissioned police custody healthcare
 Improved care pathways, through improved access to
wider clinical expertise and integration with wider
community-based services
 Strengthened clinical governance arrangements
 Equity of access to healthcare and a reduction in
health inequality
 Audits to identify groups and areas with low coverage
and poor outcomes
 Assess provider inequalities
 Develop action plans to improve access and coverage
for most vulnerable and deprived groups
 Working with partners towards transformational
change
 Public health, primary and secondary interventions in
place
 Raising awareness of programmes and encouraging
uptake
 Apply principles of ‘Every Contact Counts’ approach
 Driven by health and wellbeing boards
 Engagement programme with serving personnel, Army
and RAF families (including those registered with NHS
GPs)
 Out-of-hours services
 Musculoskeletal, rheumatology and spinal pathways
 Wisdom teeth extraction
 Oversee smooth transition of Ministry of Defence
medically discharged personnel to NHS Continuing
Healthcare (CHC) pathway
Screening and immunisation
 Baseline position to assure atrial fibrillation direct
commissioning population have full access to all
programmes
 Cervical cytology co-commissioner pathway redesign
Veteran health
 Sustainable commissioning of military veteran IAPT
(improving access to psychological therapies) services
 Electronic transfer of medical records
 ‘History relating to Military Service’ Read Code (Xa8Da)
 Wounded, Injured and sick (WIS) health plans
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Collaborative
Programmes
Working in partnership
 Future proofing Armed Forces networks, securing CCG
ownership and leadership
 Delivering on the Armed Forces Covenant
Strategic planning
 Reservist health
 Operation Herrick (Afghanistan) and impact of
cessation of Net Additional Costs of Military
Operations (NACMO) resourcing
 Troop rebasing
Delivery of Lancashire strategic
vision for health and social care
Strategic work programmes
 Shared programmes of work
Healthier Lancashire















Mental health reconfiguration
Dementia reconfiguration
Child and adolescent mental health service
Learning disability
Children – special educational needs and disabilities
Diagnostics/pathology
Operational work projects
Stroke/ TIA (transient ischaemic attack)/vascular
Prioritise strategies
In-hospital care
Out-of-hospital care
Neighbourhood pilots
Public engagement
Digital health
Transparency – ‘Single Version of the Truth’ (see
Appendix 7 Healthier Lancashire)
 Collaborative leadership
Key Points – System Vision





V6.0

Care will be co-ordinated around groups of GP practices
A new breed of clinician called ‘extensivists’ will focus on patients with the
highest need to reduce demand on the primary and secondary care systems
Enhanced primary care will deliver more co-ordinated care, drawing on the
full range of community resources across health and social care
Community orientated primary care will support development of community
assets to meet the needs of their neighbourhood
The strategic direction of Blackpool Teaching Hospitals is aligned, with a
44
smaller acute site with more community-based services
There are planned improvements in mental health, dementia, children’s and
end of life services
Finance and Activity
.
45
V6.0
Part 4 Finance and Activity
4.1
4.2
 £4.1m via NHS England (the CCG has
received this allocation to pass onto the
BCF)
The financial plans for the CCG have been
developed to ensure that the operational
and strategic objectives of the organisation
can be achieved.
The financial approach adopted is as
follows:
 To meet the national business rules of:
achieving a 1% surplus every year;
maintain a 2.5% recurring surplus in
2014/15 and 1% from 2015/16 onwards;
have non-recurring schemes each year
equivalent to the recurring surplus
figures; and maintenance of a 0.5%
contingency fund
 To achieve recurring savings each year
from a reduction in mainly non-elective
activity in acute trusts
 To apply the recurring savings made to
pump prime and maintain new out of
hospital services designed to prevent
avoidable admissions
 To apply non-recurring funding to trusts
that mitigates the full impact of the
income losses arising from the CCG’s
action to make savings
4.3
The main vehicles for the delivery of savings
within acute services will be the plans for
the creation and application of the Better
Care Fund and the development of
techniques as part of the Right Care
approach to effective commissioning of
services.
4.4
The Better Care Fund (BCF) has been
agreed with the partners in Blackpool and
the CCG will be putting £12.4m into the
fund in 2015/16 as follows:
 £1.4m from existing budgets
reablement and carers’ breaks
for
 £6.9m transferred from existing NHS
budgets in 2015/16.
4.5 The source of the budget transfer of £6.9m
is from acute services comprising the
recurring impact of savings planned for
2014/15 of £2.5m with the balance of
£4.4m being further savings made in
2015/16 (£2m) and 2016/17 (£2.4m).
4.6 There is a direct link between the BCF and
the
transformation
programme
underpinning the CCG’s plans. The BCF
provides the catalyst for the development
and funding of integrated community,
primary care and adult social services that
will prevent avoidable admissions and
improve service quality and responsiveness
for mainly older people. The CCG will apply
its general resources to ensure that funding
stability is maintained in acute trusts while
the transition to lower admissions is in
progress.
4.7 The ultimate aim of the CCG is to reduce
non-elective admissions to hospital by 15%
from trend by the end of the strategic
planning period, with a disproportionate
share of the activity changes being
delivered in 2015/16 and 2016/17 to
correspond with the implementation of the
BCF schemes and the financial changes to
follow one year behind each step change in
the activity figures, in order to maintain the
financial stability of providers.
4.8
The CCG’s plans take account of a £1.9m
recurring shortfall arising from too much
money having been taken from the
organisation by specialist commissioners.
The plans assume that in 2014/15 the CCG
will receive sufficient non-recurring funds
46
V6.0
from NHS England to enable the first phases
of the new extensivist and extended
primary care services to be implemented,
laying the foundations for the reductions in
acute activity to flow in 2015/16.
4.9
Table 4 shows the planned activity
reductions in unscheduled care in the acute
sector over the five year timescale,
together with the financial impact; and
‘bridging finance’ to mitigate the impact on
acute providers’ income in the year in
which the activity changes actually take
place (2015/16 and 2016/17 only)
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Table 4
All Providers
Baseline
Demographic change %
Demographic impact
New models of care
All Provider Total
2013/2014
Activity
Cost
(£m)
2014/2015
Activity
Cost
(£m)
2015/2016
Activity
Cost
(£m)
2016/2017
Activity
Cost
(£m)
2017/2018
Activity
Cost
(£m)
2018/2019
Activity
Cost
(£m)
20,245
20,013
18,544
28.3
0.20%
37
0.06
-1,053
-2.0
17,528
26.4
17,528
26.4
0.40%
70
0.11
-1,263
-2.4
16,335
24.1
16,335
24.1
0.40%
65
0.10
-632
-1.2
15,768
23.0
15,768
23.0
0.40%
63
0.09
-632
-1.2
15,199
21.9
32.0
30.8
-
20,245
32.0
-1,469
18,544
-2.5
28.3
Annual Change %
-5.5
-6.9
-6.8
-8.7
-3.5
-4.6
-3.6
-4.8
Cumulative Change %
-5.5
-6.9
-11.9
-15.0
-15.0
-18.9
-18.0
-22.8
Bridging Finance
2.5
2.0
2.4
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Engagement and Partnership
.
49
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Part 5 Engagement and Partnership
Engagement
5.1
5.2
The CCG is currently updating its
Communication and Engagement Strategy
but has worked hard in the first year as an
organisation to raise awareness and consult
with key stakeholders.3
In response to The NHS Belongs to the
People: a call to action (NHS England,
2013),
stakeholders
have
reached
alignment through a series of events.
5.6
We will continue to engage with our
existing patient and service user forums and
provider forums and listening events,
throughout
the
development
and
implementation of plans, to ensure local
outcomes are achieved.
5.7
We will also continue our engagement with
representatives from public and patient
groups in the CCG Patient and Public
Involvement (PPI) Forum.
5.8
Another example of how we have engaged
with the public is during our public
consultation on community hospital
rehabilitation. Having completed extensive
engagement activities, we published and
shared the findings to show the themes
from the consultation (‘You Said’) and how
we had or would be including those
comments in the plan (‘We Did’).
5.9
We will continue to use social media, in
particular Twitter (@BlackpoolCCG; and
@ANBlackpool), to communicate and
engage, as well as our website.
The public
5.3
The CCG believes in not only informing and
engaging the public in commissioning
decisions, but also in feeding back on how
their ideas and suggestions have been
included and implemented.
5.4
Healthwatch Blackpool, as a statutory
partner of the Blackpool Health and
Wellbeing Board, has committed to leading
on the engagement of patients, service
users and the public to inform the
development of plans. The first public
listening event at the end of January 2014
was a success. There was also a
Healthwatch listening event in September
2013, involving 200 members of the public.
The January event was an interactive
session with members of the public and
service users. We captured live feedback on
an electronic voting system (Appendix 4).
5.5
Age UK Blackpool & District has also agreed
to jointly deliver a programme of
engagement and consultation events with
its members to support the further
development of plans.
Clinical engagement
5.10 We have regular CCG GP member meetings
and hold monthly sessions with all our GP
practices. This encourages and captures
feedback on our planning and prioritisation.
We have also developed a newsletter that
the CCG shares with GP member practices
to aid dissemination across practice staff.
We are committed to involving clinicians in
the development of the CCG’s plan and
strategy and will continue to do this
through several workshops and clinical
engagement events.
3
http://blackpoolccg.nhs.uk/publicinformation/strategies-and-plans/
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Other campaigns
5.11 The CCG has also executed several
communication campaigns to improve the
health of the local population. These come
under the partnership banner of
‘Altogether Now – a Legacy for Blackpool’
(Appendix 1).
5.12 As part of this partnership programme, a
health film highlighting the health
challenges that are faced in Blackpool, and
encouraging action from the public to
respond to these challenges is produced
annually. This is played at every Blackpool
Football Club home game to 15,000 fans,
most of whom define the DNA of our
population
5.13 During December and January, the CCG has
worked in partnership with Blackpool
Teaching Hospitals NHS Foundation Trust
and Fylde and Wyre CCG to promote winter
messages to the public. Using the ‘Choose
Well’ brand, the CCG has promoted healthy
living messages, reinforcing to the public
what services are available and appropriate
for which ailments and conditions.
5.14 All key partners continue to be fully
engaged in refining and delivering
strategies via the longstanding Urgent Care
Working Group/Board and the Fylde Coast
Commissioning Advisory Board. Blackpool
CCG, Fylde and Wyre CCG, Blackpool
Council, Lancashire County Council,
Lancashire Care Trust and Blackpool
Teaching Hospitals NHS Foundation Trust
are
working
together
to
ensure
transformational change is delivered.
Better Care Fund
5.15 The CCG has also consulted with other
partner organisations and groups through
the Better Care Fund process in Blackpool,
and used this information to inform our
planning.(table 5):
Table 5
Forum
Date of consultation
Residential Provider Forum
Learning Disability Care At
Home Forum
Generic Provider Forum
Mental Health Partnership
Board
Learning Disability
Partnership Board
Carers Partnership Board
Blackpool Disability
Partnership Board
Public listening event
(Appendix 3)
CCG Governing Body
(public)
Health and Wellbeing
Board
7 February 2014
15 January 2014
6 February 2014
10 January 2014
21 February 2014
15 January 2014
21 January 2014
31 January 2014
14 January 2014
20 November 2013
18 December 2013
15 January 2014
5.16 From these events we agreed to co-design
and implement a range of patient-centric
models, based on solid evidence from other
health
economies,
national
and
international, that will drive improved
outcomes and quality through far more
proactive care. (Appendix 12)
5.17 The starting point for these models is a
detailed understanding of local patient
populations as the basis for evolving patient
segments and subsequently matching
provider delivery models, whether medical,
social or therapy-led, tailored to these
segments. This is a significantly different
approach to patient care and will require
considerable change from the models
currently adopted.
5.18 Local
stakeholders
recognise
that
continuing to deliver more care in its
current form will not make the required
step-change improvements in variation and
quality that our population deserves.
51
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Working with partners
Stakeholder Survey
5.19 The 2014 CCG 360 Stakeholder Survey. This
was the annual NHS England survey
allowing stakeholders to provide feedback
on working relationships with the CCG.
 Out of 28 questions asked of all
stakeholders, Blackpool CCG scored
more highly than the average score
across Lancashire CCGs on 26 questions.
 Blackpool CCG scored more highly than
the average score across all CCGs in
England on all 28 questions.
 Out of eight questions asked where a
comparison could be made with the
2012 stakeholder survey undertaken
during the authorisation process,
Blackpool CCG scored more highly than
the score achieved in 2012 on six
questions.
 Out of the 28 questions asked of all
stakeholders, Blackpool CCG achieved a
positive score of 80% or more on 19
questions.
52
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Outcomes
.
53
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Part 6 Outcomes
6.1
The fundamental purpose of the changes
planned is to enable the people of
Blackpool to live longer, happier and
healthier lives.
6.2
In order to measure our success over the
next five years we have considered the five
outcome domains and seven outcome
ambitions (set out in the NHS Outcome
Framework), and determined improvement
ambitions against each of these, having
considered our current position and
potential impact of initiatives.
6.3
6.4
6.5
Outcome Ambition 1: Securing additional
years of life for the people of England with
treatable mental and physical health
conditions. Blackpool CCG is the 3rd worst
in the country in terms of potential years of
life lost (PYLL) from premature death. The
current rate is 3,019.4 per 1,000
population. The main causes for this are
described in Part 1 The Story of Blackpool,
but in the main are attributable to
circulatory and respiratory disease, cancer
and higher than average infant mortality.
Our ambition is to improve this figure by
10% to 2,717.46 per 1,000 population.
Outcome Ambition 2: Improving the
health-related quality of life of the 15
million+ people with one or more longterm condition, including mental health
conditions. Blackpool is in the lowest
quartile nationally in 2012, having a score
of 66.5 on the standard measure. Our
ambition is to improve this to 70.9 by 2019,
which is a 6.62% change and will make us
consistent with similar demographic areas.
Outcome Ambition 3: Reducing the
amount of time people spend avoidably in
hospital through better and more
integrated care in the community, outside
of hospital. The measure used for this is a
reduction in emergency admissions. We
are aiming for a 15% improvement by 2019,
moving from a 2,622.6 baseline and
reducing to 2,229.
6.6
Outcome Ambition 4: Increasing the
proportion of older people living
independently
at
home
following
discharge from hospital. The measure used
is the proportion of older people (65 and
over) who were still at home 91 days after
discharge
from
hospital
into
reablement/rehabilitation services. Baseline
data is not available for this, however, we
have initiatives in place to make
improvements (as described in Figure 16)
and this will be quantified as part of the
Better Care Fund, in partnership with key
stakeholders at Blackpool Health and
Wellbeing Board.
6.7
Outcome Ambition 5: Increasing the
number of people having a positive
experience of hospital care. The measure
used is the proportion of people having a
positive experience of hospital care.
Currently Blackpool is within the 3rd worst
quartile nationally and our ambition is to
improve to the England average by 2016
and to the best quartile by 2019. Over the
five years this is an improvement of 12.1%.
We aim to maintain a high Friends and
Family Test score locally to at least above
the national average.
6.8
Outcome Ambition 6: Increasing the
number of people with mental and
physical health conditions having a
positive experience of care outside
hospital, in general practice and in the
community.
The CCG is currently
performing in the best quartile nationally
but we will aim for a further 1%
54
V6.0
improvement, reducing from 4.3 to 4.25 on
the measure used.
6.9
Outcome Ambition 7: Making significant
progress towards eliminating avoidable
deaths in our hospitals caused by problems
in care. Blackpool is currently an outlier in
both HSMR and SHMI rates. We will expect
an improvement in the HSMR and SHMI
hospital mortality rates. The baselines have
been drawn from the 2013 KEOGH
mortality Review. We have trajectories for
improvement agreed in 4 areas:
 Stroke
 Sepsis
 Pneumonia
 Cardiac chest pain
6.10 In order to achieve these improvements
planned, a range of initiatives have been
put into place. Many of these are described
in Part 2 Foundations for Delivery and are
listed in Figure 10, along with additional
schemes against the ambitions they impact
upon.
6.11 In order to ensure that continual progress is
made towards achieving these ambitions,
the CCG recognises that it is important to
have good delivery and performance
monitoring systems.
6.12 Each initiative is clinically led by a named
GP to ensure best clinical practice, patient
focus and engagement of other clinicians.
6.13 A named lead commissioner is responsible
for project management and monitoring.
They are supported by information, quality
and contract expertise to ensure that
decisions made are based on full
information and safe practice, and are
contractually sound.
6.14 Progress will be reported back to both
Quality and Engagement Finance and
Performance Committee for quality
outcomes and on an exception basis, formal
quarterly reviews will be undertaken of all
schemes.
55
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Risks
.
56
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Part 7 Risks
7.1 At a recent team development day the CCG
managers considered the content of the FiveYear Strategic Plan and, in light of that,
undertook a SWOT (strengths, weaknesses,
opportunities and threats) analysis of the
CCG’s ability to deliver the plan. The results
are summarised in table 6. Managers
concluded that we are well placed as an
organisation to deliver what is necessary.
Having an awareness of weaknesses and
threats will enable us to put in place systems
that will either eliminate or mitigate many of
the issues.
Table 6
STRENGTHS










A strong vision
‘Do-ers’
Track record of achievement
Good broad clinical engagement
Flexible, ‘can do’ teams
High stakeholder buy-in
Strong public engagement networks
Close working with neighbour CCG
Good relationship with Commissioning Support
Unit – adding value and skills
Simple local system, 1 local authority, 1 trust, 1
CCG
OPPORTUNITIES








To ‘grow our own’ talent to answer challenges
Develop clinical leadership
Fresh workforce not confined by current job
descriptions
Strong IT foundations/infrastructure
Stakeholder buy-in
Altogether Now as a vehicle to support change
and buy-in
Co-commissioning primary care
Developing the CCG Governing Body
WEAKNESSES








Previously, small schemes rather than whole
system
Lack of robustness in project and programme
management arrangements
Business process and systems
Access to data
Pace to achieve (fast)
Lack of capacity
Lack of join-up in IT systems
Provider performance: mortality, Care Quality
Commission
THREATS









Too little resource: financial, workforce
Further system change
National direction/agenda e.g. Better Care
Fund ‘pause’
Development of appropriate workforce
Increasing demand for services
Local provider issues: quality and financial
Long-term plan
Co-commissioning primary care: resource,
implications
Loss of prescribed service at local trust
57
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7.2
There are some risks that are currently
unknown; as they emerge they will be
assessed and mitigated through robust
programme management. (See 8.10
Programme Management)
There are considerable risks involved in a
transformation
programme
of
this
magnitude (table 7). Known risks will be
regularly reviewed and mitigated during the
life of the transformation programme.
Table 7
Risk
Financial
Workforce
IT
Leadership
Description
Affordability of funding new
services and paying for double
running costs by commissioners.
We will need to factor in the
necessity to continue to pay for
existing services on a reducing
basis that is synchronised to the
increase in new services. The
issue of an inability to realise
fixed cost savings, especially if
they are greater than the savings
made by commissioners, is
potentially a show-stopping
factor
An inability to staff more
extensive primary, community
and extensivist services, including
the
specialist
extensivist
clinicians, community specialist
nurses, and GPs. Culture of
ownership/’make every contact
count’
1. Inability to design and
implement secure, common
clinical and social care
systems
across
the
health/social care economy
at the time they are required
by the new services
2. NHS
number
and
information sharing
Consistent
leadership
and
management
capacity
and
capability over the strategic
timescale
Likelihood
3
3
Impact
5
4
Score
15
12
Mitigations
The careful planning to
effectively synchronise the
reduction of existing services
and development of new
services
is essential for
provider stability
Training/workforce
development/co-ordinate
nursing expansion with move
to community-delivered
models/import
international skills/link with
university
Expert review and advice on all
options available
3
4
12
Default positions if IT not
available in timescales
Clear and robust governance
framework that limits any
destabilisation of any key
leadership changes
4
3
12
Carefully planned and agreed
resource
across
all
organisations, with regular
reviews
Buy-in of all organisations to
the plans and timescales
Estate
Opportunities and threats/other
58
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Management
community premises/acute site
utilisation as new model delivers
4
3
12
Governance and Delivery
Systems
.
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Part 8 Governance and Delivery Systems
CCG governance
8.1.
NHS Blackpool Clinical Commissioning
Group (CCG) is a membership organisation
of 24 GP practices across Blackpool. Clinical
leadership is embedded into the working
practice of the CCG, with each GP
member of the Governing Body having lead
responsibility for a particular area of care.
8.2.
Internally the governance systems are as
depicted in Figure 12, with very clear lines
of responsibility and reporting. . The two
CCG committees; Quality and Engagement
and Finance and Performance report
directly to the Governing Body. The
Governing Body has strong links with to the
Health and Well Being Board, strategic
partnerships and full participation with the
local safeguarding Boards.
8.3.
We will continue to monitor and
performance review our providers against
quality indicators within contracts. We will
promote quality through clinical leadership
and stakeholder involvement. We will
monitor and manage the provider
responses and deficiencies in delivery as
identified in the 2013 Keogh Report, 2014
Care Quality Commission (CQC) inspection
report and other peer review reports.
8.4.
We will work in partnership to safeguard
our
local
population
by
actively
participating in both Adult and Children’s
Safeguarding Boards. We will challenge
partners when services are not effective or
unable to improve outcomes.
8.5.
The Health and Wellbeing Board is central
to the development and implementation of
joined-up health and social care strategies,
in particular the Better Care Fund.
dr
Figure 10
60
V6.0
overarching strategy for the provision of
healthcare across the Fylde Coast,
recognising
individual
member
responsibilities for the commissioning and
provision of healthcare, to ensure that
health services are commissioned and
provided in an integrated way, and that
provision of health services is integrated
with provision of health-related or social
care services (figure 13).
Fylde Coast governance
8.6.
The CCG recognises that in order to meet
the scale of the challenges in this plan, the
vision, objectives and implementation have
to align with partner organisations across
the Fylde Coast.
8.7.
The Fylde Coast Commissioning Advisory
Board consists of representatives from the
following organisations:
8.9.
 Blackpool Clinical Commissioning Group
 Fylde and Wyre Clinical Commissioning
Group
 Blackpool Teaching
Foundation Trust
Hospitals
NHS
 Blackpool Council
 Lancashire County Council.
The CEO of BTH has been appointed as the
Senior Responsible Officer and a Fylde
Coast Programme Director will be
appointed for the transformation. The
Programme Director’s governance structure
is evolving but is likely to include an
Executive Delivery Group with clinical and
managerial representation from all
organisations operating across the Fylde
Coast.
(See Appendix 13 Timelines)
8.8.
The Commissioning Advisory Board’s remit
is to co-ordinate the development of an
Figure 11
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61
areas described above, and where we
need to get to, mapped to the
requirements of the CCG Assurance
Framework
Programme management
8.10. The Better Care Fund Plan forms the first
two years of the Strategic Five-Year Plan
and will have six principal workstreams.
Each workstream will have a lead tasked
with developing clear project plans,
ensuring that required actions are
completed against clear timescales. The
leads will be supported by a series of ‘task
and finish’ groups.
 Action planning – identifying the
actions needed to be taken to move
us from where we are to where we
need to be
 Intervention – taking the actions
identified
 Evaluation – measuring what impacts
the actions have had, leading to new
diagnosis and going round the process
again
Current workstreams are:
 Design and delivery
 HR and workforce
 ICT/Shared information
 Finance
 Communication and engagement
 Estates
8.11. Workstream leads will report to the Better
Care Fund Steering Group, which in turn will
report
progress
to
the
Strategic
Commissioning Group on a six-weekly basis.
The Strategic Commissioning Group will act
as the Project Management Board. As the
programme develops, further workstreams
and project groups will be formed as
necessary to ensure delivery (figure 13).
8.14. The Organisational Development Plan 201420154 sets out the diagnosis and action
planning activities within this OD cycle. It
describes how Blackpool CCG will develop
the culture, strategy, structures, systems,
staffing and skills, and leadership to create
a robust organisation and meet the
requirements detailed in the CCG Assurance
Framework. It is a ‘live’ document and will
be regularly reviewed and refreshed
throughout 2014/15.
Organisational development
8.12. Our ability as an organisation to realise
these ambitions is dependent on the
‘health’ of the organisation. In order to
achieve this there is a process of planned
change aimed at continuously improving
the effectiveness of our organisation, and
this is described in our organisational
development (OD) processes and our twoyear Organisational Development Plan.
8.13. Our OD process involves four key activities
within a continuous OD cycle:
 Diagnosis – ongoing analysis and
review of where we are in the six
4
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services to all our
characteristic groups.
Equality and human rights
8.15. The Equality Strategy5 for Blackpool has
been aligned to the key strategic themes of
the plan and is intrinsically linked to the
equality objectives published in April 2012.
8.16. We embrace the duties outlined within the
Equality Act and will ensure we continue to
promote fairness and equity of access for all
patients and service users.
The
implementation of this plan and delivery of
improved health outcomes for all protected
characteristic groups can only be achieved
by ensuring that equality and diversity is an
integral
part
of
our
planning,
commissioning, procurement, monitoring
and review of commissioned services
(Figure 21).
8.17. We will build on existing processes and
systems
to
further enhance
our
effectiveness in understanding and
responding to the needs of our local
protected characteristic groups. As part of
our progress in monitoring against this plan,
we will use the outcomes of our grading
assessment using the National Equality
Delivery System 2. This will support the
CCG’s statutory duties under equality and
human rights legislation (Equality Act 2010,
Human Rights Act 1998) and the Health and
Social Care Act (2012). It requires us to
support:
local
protected
8.19. Our work on embedding equality into
commissioning health services will be
underpinned by engagement with staff and
stakeholders. We believe that engagement
with patients, carers, residents, service
providers and third sector organisations,
and drawing on their expertise, is critical to
shaping services that are personal, fair and
meet the needs of our diverse population.
8.20. In accordance with the CCG’s equality
duties, an equality analysis will be
undertaken on the plan and any issues
identified will be used to update it.
8.21. A full equality analysis will be undertaken
on each of the programmes of work that
are instrumental in delivering the plan, to
ensure that the needs of all local
communities are fully reflected in the
design, planning, implementation and
evaluation of healthcare services.
 Better health outcomes
 Improved patient access and experience
 A representative
workforce
and
supported
 Inclusive leadership.
8.18. This will ensure that year on year we see
improvements in our performance and how
we commission and subsequently provide
5
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Ambulance Services
8.22. Blackpool CCG lead and co-ordinate the
commissioning,
contracting
and
performance management of NWAS/Arriva
but this requires local and county wide
input and support. This is achieved through
comprehensive governance arrangements
which are shown in diagrammatic format at
Appendix 3. These arrangements ensure
local CCGs are kept abreast with ambulance
and 111 matters and provide a conduit for
raising concerns.
8.23. To carry out its lead commissioner role, the
Ambulance Commissioning Team (ACT)
utilises the agreed governance framework
within the Memorandum of Understanding
between NHS Blackpool CCG and the 33
CCGs in the North West (Appendix 3). The
ACT carries out the contract monitoring and
management of the Paramedic Emergency
Service (PES) and Patient Transport Service
(PTS) contracts, and connects with the 33
CCGs via the five County Area Ambulance
Commissioning Groups.
8.24. The Ambulance Strategic Partnership Board
(SPB) is the pinnacle of the governance
framework for the North West Ambulance
Service (NWAS) provided contracts and has
an assurance role for the single PES and the
four PTS contracts. The Ambulance Lead
from each county area is represented on
the SPB. For the Greater Manchester (GM)
PTS contract provided by Arriva Transport
Solutions Ltd (ATSL), the ACT reports
through the GM Ambulance Commissioning
Group, to the GM commissioning
governance framework.
8.25. The lead commissioner role has two
strands: 1) Contract management, and 2)
System modernisation and transformation.
The lead commissioner has worked with
commissioners and providers over recent
years and made good progress in improving
performance and increasing quality and
value for money.
8.26. The SPB maintains the strategic oversight of
all county area reconfigurations, both at
county and CCG level, acting as the Change
Management Board and seeking assurance
that county and local changes translate into
a North West level. A workshop is being
arranged for summer 2014, to begin this
work. Blackpool CCG will continue to
ensure local plans align with the SPB via the
Lancashire Area Commissioning Group.
8.27. A key element of the governance
framework is the Clinical Development
Group (currently being refreshed to include
NHS 111 to progress urgent care system
transformation) and Lancashire has clinical
and managerial representation on this
group. These representatives link back to
the Fylde Coast Urgent Care Board.
Lancashire-wide governance
8.28. The Lancashire Leadership Forum enables
all leaders from health and social care
across the patch to meet and identify
shared issues and priorities. The forum is
made up of the eight CCGs , the five health
trusts in Lancashire, the three upper tier
local authorities, Public Health England, the
NHS England Area Team and Staffordshire
and Lancashire Commissioning Support Unit
(CSU).
8.29. The forum is not an executive body but
works closely with the three health and
wellbeing boards in Lancashire, the
Lancashire CCG Network and the emerging
network of provider trusts. The forum links
to the Lancashire Chief Executives meeting
for local government, academic institutions,
the CSU and workforce partnerships.
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Appendices
.
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Appendix 1 Altogether Now – A Legacy for
Blackpool
Background
Altogether Now – a Legacy for Blackpool is a multi-agency crusade to improve the health, wellbeing and
lifestyle of people in Blackpool irrespective of age, race, gender or ability.
It is a partnership between the NHS in Blackpool (the Clinical Commissioning Group and Teaching Hospitals
Trust), Blackpool Football Club and Blackpool Council.
It was launched in 2010 in response to a Government directive for health organisations to work more closely
with professional sports clubs and individuals in the challenge to improve health.
Fit2Go










Six-week healthy lifestyle education and physical activity programme
Delivered in every Blackpool primary school (30) to Year 4 pupils
Worked with 10,000 children in three years
800 family members involved
Outcomes – 94% increase in physical activity (60 minutes a day)
91% increase in in healthy lifestyle score
Now extended for further three years: 2014-2017
Funded by Blackpool CCG/Blackpool Council public health service/Blackpool Football Club
Community Trust (£100k x 3)
Programme enhanced to include Family Fit2Go with specific course and workbook targeting
parents/carers/family members etc.
Developing plans to extend Fit2Go into high schools targeting teenagers
Altogether Now Community Projects
All of the work of Blackpool Community Trust (the charitable arm of Blackpool FC) is delivered as part of
Altogether Now.
This includes:




Community inclusion projects in areas of high juvenile crime and anti-social behaviour, delivered in
partnership with police. Total participants – 846 engaged since June 2011. Outcomes: first year of
delivery, youth crime reduced by 70% and anti-social behaviour by 50%; 17% reduction in anti-social
behaviour and 20% in youth crime.
Social action programmes for 16 to17-year-old volunteers
Physical activity project for youngsters with disabilities, which will see the formation of Blackpool’s
first disability football team
Dementia project delivered in partnership with Age UK
What’s Your Number? (Hypertension project)

Targeting the traditionally hard-to-reach in the community, away from clinical settings
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



Sessions held in football club changing rooms, on a double-decker bus, in bingo halls etc.
15,000 additional blood pressure tests
2,769 people placed on hypertension register, now receiving treatment
Outcome: prevented 70 cardiovascular events
Teenagers Turning the Tide




High school impact days involving high profile Health Ambassadors and Health Champions
Targeted work tackling Tangerine Targets
Mental health awareness project – involving 10 schools, including sixth form colleges, and Blackpool
Young Carers, in which students researched mental health issues and devised and developed their
own radio and social media awareness campaigns
Outcome: request from school principals and head teachers for Altogether Now to be on the school
curriculum
Altogether Now Community Sports Awards



Annual event launched in 2014
Linking the health agenda to physical activity
Categories including: Community Club; Young Volunteer; Adult Volunteer; Disability Sports; Young
Achiever; and Lifetime Achievement
New Ways of Working







Services for vulnerable/hard-to-reach people in football club changing rooms (e.g. mental health
services and blood pressure testing)
Targeted specific groups through football club’s extensive database
Health checks on football fans (e.g. chlamydia testing)
Targeted health messages on big screen (e.g. Choose Well) on match days reaching average
audience of 15,000 fans
Health information in match day programme
4,000 free community match day tickets as incentives to engage
Engagement/communication using inspirational role models from world of sport
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Appendix 2 Better Care event voting results
This was an event facilitated by Healthwatch to provide a forum to discuss and get feedback on the Better
Care Fund and the CCG’s plan. The responses were collected using a voting pad system following a lively
debate on the subject. Question 1 was a test question.
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Appendix 3 Paramedic Emergency Service/Patient Transport Service
Memorandum of Understanding with Blackpool CCG
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Appendix 4 Paramedic Emergency Services
(PES)Commissioning Intentions Plan on a Page
Key
"High quality care for all, now and future
generations"
PES Ambulance Commissioning Intentions 2014 - 2019:
Plan on a Page
ACG - Area Commissioning Group
BACT - Blackpool Ambulance Commissionng Team
BCF - Better Care Fund
HCP - Healthcare Professionals
HWBd - Health & Well Being Board
PF - Pathfinder Scheme
UCD - Urgent Care Desk
Initiatives
Overarching
What
Region
Where
• Continued Commitment to NW
Ambulance Commissioning
Governance Framework
County
When
Target
UCD
• Continued Commissioner
Support
BY 28/02/2014
PF
• Continued Commissioner
Support
BY 28/02/2014
Workforce
• Commissioners & NWAS establish a
working group & develop a 5 year
plan & then implement
01/04/2014
Cheshire
• Increased use &
sharing of CCPs &
SPNs, Risk and
Stratification
Mersey
• Reduction in AS3
transfers
X 33
CCG's
Governance
31/03/2015
• Include Ambulance agenda on
HWBds
• Commissioners & NWAS establish a
IT & Technology working group & develop a 5year plan
& then implement
Plan:
July 2014
Implementation:
Aug 2014
Plan:
July 2014
Implementation:
Aug 2014
Conveyance
• Reduce conveyance to AED
• Increase Hear & Treat
• Increase See & Treat
10% by 31/03/2015
5% by 31/03/2015
5% by 31/03/2015
HCPs
• Develop standards to include Triage
& Eligibility, Type & Priority (possible
bureau approach) & engage with GPs
31/03/2015
• Connect as appropriate with
Urgent Care Working Groups
Lancashire
31/03/2015
• Develop plans to access BCF &
agree how to release & allocate
system savings
Avoidable
Admissions
• Support for those >75 years & those
with complex needs, including those
in nursing & care homes
31/03/2015
Outcome
Measures
• Develop a series of measures for
use in year 2 which focus on impact
on the patient
31/03/2015
County
Initiatives
• Evaluate 2014/15 county initiatives
& decide whether to roll out across
NW year 2 and/or develop new
county initiatives for 2014/15
Greater
Manchester
• Public
engagement &
communication
• Colaboration &
cultural shift at
county level
• DoS further
development
31/03/2015
Governance
Conveyance
• Reduce conveyance to AED
Workforce
Target
• Access BCF & HWBds
• Continue to implement &
develop the plan (due in yr 1)
Develop
Primary
Care
• Work with NHS England & wider
system colleagues
20%
(from 2014/15
baseline)
Cheshire
Sept 2015
Mersey
To be developed in Year 1
PF
UCD
IT &
Technology
Integration & Safe Care Closer to Home
Operational Plans
BACT, SPB
& County
Leads, X33
CCG's
year 2 : 2015 / 2016
Cumbria
To be set by county ACGs
year 1 : 2014 / 2015
• Ensure local services In place for
NWAS to refer to
June 2014
Continue to explore CCG variability,
building on work done during 2013/14
Target
• PES to be included in local plans
• Continue to implement &
develop the plan (due in yr 1)
• Review alongside the (expected) new service
specification for NHS 111 (giving consideration to who the
provider is at this stage)
• Continue to review
GP
OOHs
• Develop relationship with GP OOHs
Sept 2015
Develop
3-5 Yr
initiatives
• Overarching
• Region
• County
Sept 2015
Conveyance
• Reduce conveyance to AED
Cumbria
Lancashire
Greater
Manchester
Strategic Plan
Years 3 - 5: 2016 - 2019
Target
To be developed by September 2015
50%
(from 2014/15
baseline)
To be developedby September 2015
To be developed by September 2015
Reformed Urgent & Emergency Care System - PES to assess, commence treatments and transfer to Major
Emergency & Specialist Centres, as "Mobile Emergency Treatment Centre", (Urgent & Emergency Care Review: End of phase 1 Report)
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Appendix 5 Innovations
Below is a list of schemes that the CCGs are implementing in 2014/15
 Patient pathway management and education supporting selfcare
 Personal budgets
 Altogether Now




Extended Primary Care Model
Heart failure rehabilitation
Atrial fibrillation (AF) scheme
Diabetes pathway
 Residential and nursing home scheme
 IV antibiotics
 Single point access and care co-ordination




24/7 Urgent care
Frequent caller and housing link worker scheme
Acute visiting service
Children’s assessment unit
 Musculoskeletal (MSK) pathway
 Lancashire-wide service review
 Extensivist Model
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Appendix 6 Blackpool Plan on a Page
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Appendix 7 Lancashire Area Team Priorities
1. Specialised Commissioning
Locally the Specialised Commissioning Team is undertaking consultation to establish their five-year plan.
Within the priorities being consulted on, there is focus on the following.
Mental health

Develop North West child and adolescent mental health service (CAMHS) tier 4 system review and
potential procurements
Review secure mental health

Cancer and blood

Compliance with National Institute for Health and Care Excellence (NICE) improving outcomes
guidance (IOG) standards and any procurements as a result
HIV commissioning arrangements

Trauma and head


Adult neuro-rehabilitation services whole care pathway model, better capacity management
Major trauma centres – alignment with specification and co-location (time/distance for required
services), viability of multi-centre model
Internal medicine






Cystic fibrosis capacity
Cardiac services – specialised services review, surgery and devices
Vascular services – compliance with standards and reconfiguration and any procurements as a result
Respiratory services
Acute kidney injury
Inherited metabolic disorders
Women and children


Neonatal services
Paediatric neuro-rehabilitation
2. Primary Care Direct Commissioning
There is an increasing recognition that primary care will have to change to meet the needs of the population
and the challenges described in this document. Both nationally and locally, general practice and wider
primary care services are experiencing increasingly unsustainable pressures.
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Through the development of the Healthier Lancashire Strategy, part of which includes the Out-of-Hospital
Strategy, we will support these transformational changes in primary care. Across Lancashire we have a set of
objectives for primary care, aimed at improving access, satisfaction, quality and outcomes across medical,
pharmacy, dental and eye care services.
We have agreed locally to a number of key themes to achieve transformational change, including the need
for new models of service delivery. This includes general practice working at scale in neighbourhood teams
integrated with wider primary care and social care services.
Our vision is:
A sustainable model of primary care which delivers consistent high quality outcomes for patients
We will work towards seven-day primary care services at scale by working in neighbourhoods and
integrating with social care services. This will be achieved through support of the Better Care Fund, GP
contract changes, local improvement schemes and our neighbourhood approach.
We are aiming to provide integrated out-of-hospital services to deliver consistently better outcomes for our
patients across the region, by reducing unwarranted variation in the quality and provision of services. To do
this we will work collaboratively and cohesively with local communities, partners and colleagues, ensuring
our strategy is based on patient and public insight to reflect the six characteristics of high quality care set out
in ‘GP – A Call to Action’ (NHS England).
3. Health and Justice Direct Commissioning
Prison healthcare across the North West has previously been commissioned in different ways and this is
reflected in current patterns of provision, which can, in some parts of the area, appear fragmented. Our
vision is to establish an integrated system with a single prime provider responsible for the provision of all
health care within prisons and perhaps across clusters. Eventually we would envisage that we will
commission four to five main contracts.
In addition, given that we are now commissioning across a larger area and as part of a national organisation,
there will be opportunities to take advantage of new economies of scale to work with providers and explore
potential new models, such as, for example, secondary care in-reach, mobile diagnostics or different models
of ‘inpatient’ provision.
We will work together with partners to achieve excellence in Health and Justice outcomes for the North
West:



Ensuring that specifications for Health and Justice commissioned services are in line with national
guidance (e.g. NHS Outcomes Framework, Public Health Outcomes Framework, Securing Excellence)
Supporting local and strategic partnership arrangements
Ensuring all commissioning is guided by robust health needs.
In particular, the expected outcomes of implementing the single operating framework and commissioning
intentions for each of the areas that we cover will see an end state of:
General prison healthcare
•
•
•
Quality of offender healthcare services improved and equivalent to those in the community
All prison health contracts are compliant with NHS standard contracts.
There are comparable standards of quality and care across all Lancashire Area Team area prisons
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•
Prisoners’ health and social care needs are met
Secondary care
•
The need for appropriate escort and bed watches is reduced by the implementation of alternative
access to services, e.g. telemedicine and prison-based clinics
•
Activity and spend on secondary care is reduced and replaced with care closer to home
Substance misuse
•
•
•
Effective offender health substance misuse strategy in place and being delivered
Quality of offender substance misuse services improved
Substance misuse contracts compliant with NHS standard contracts
•
Comparable standards of quality and care across all prisons
Secure children’s homes
•
•
•
•
Transfer of NHS-commissioned healthcare completed
Commission high quality NHS comparable services within secure children’s homes
Improved commissioning capability
Improved high quality clinical governance
•
Improved care pathways
Immigration removal centres (x1 Manchester Airport)
•
Comparable standards of quality and care as in the rest of the NHS
Sexual assault services (x1 Manchester, x1 Lancashire, X2 Merseyside – adult and paediatric)
•
Transfer of sexual assault referral centre (SARC) commissioning to NHS offender health
commissioning as a part of the transfer of police health commissioning, in partnership with key
agencies and based on NHS standard service specification and contract
•
Improved health and reduced inequalities in healthcare
Liaison and diversion
•
•
•
•
Achieved national roll-out across all Area Team area police custody suites and courts against a
national service specification and NHS standard contract
Continuity of care across pathways and back into the community
Offender health needs are known and provided for by appropriate treatment services
Offenders are diverted from the criminal justice system when appropriate
•
Effective planning that is aligned to an investment strategy
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Police custody suites (4 police force areas)
•
•
Transfer of the commissioning of healthcare in police custody to NHS via offender health
commissioning
NHS-commissioned police custody healthcare
Improved care pathways, through improved access to wider clinical expertise and integration with
wider community-based services
Strengthened clinical governance arrangements
•
Equity of access to healthcare and a reduction in health inequality
•
•
4. Public health commissioning
The changing demographic of the population currently experienced is set to continue in the coming years.
More people are living longer and will have a greater call on health services, and the consequences of poor
lifestyle choices will have an impact on the services commissioned. Using the available data sources, the
geographical and topic-specific Joint Strategic Needs Assessments (JSNAs) and local health profiles, the
Lancashire Area Team understands the health inequalities and inequities across Lancashire and has taken
into account the findings from the Marmot Review that stressed the importance of giving children the best
start in life to reduce health inequalities and associated mortality and morbidity, and improve life
expectancy.
There is evidence to suggest that preventative health services have lower coverage and uptake among the
more deprived and vulnerable population groups. For public health programmes that are currently achieving
the Section 7a (public health functions agreement) baseline, the priority for the five-year plan will be to
reduce variation, both locally across Lancashire but also between the Lancashire position and the best
performing area teams in the country. For public health programmes that are currently achieving the
minimum/acceptable standard, improving outcomes, coverage and uptake will be a priority for the
Lancashire Area Team.
Health inequalities. Where relevant, a series of health equity audits should be undertaken for programmes
to identify groups and areas with lower coverage and poor outcomes. This will assist the Lancashire Area
Team to develop an action plan to address health inequalities. The Area Team also requires acute and
community sector service providers to assess inequalities in their services, develop action plans and improve
access and coverage for vulnerable and deprived groups.
The key challenges nationally and locally include:






Growing population
Increased demand on commissioned services
Increasing pressure on NHS financial resources, which will intensify further from 2015/16
Challenges to improve coverage and uptake of disadvantaged groups
Inequalities in service delivery
Increase in patient expectations
Response to the challenges. The public health-commissioned services, in many areas, are dependent on the
services delivered by partners. It is recognised that for any transformational change to take place, public
health primary and secondary prevention interventions must be in place, with awareness raising about the
programmes and encouraging the uptake of these services, and applying the principles of ‘making every
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contact count’ to take advantage of the opportunities to provide a public health intervention; all of which
should be driven by the work of health and wellbeing boards.
5. Armed Forces and Veteran Health Direct Commissioning
On 1 April 2013, NHS England, as part of its portfolio of directly commissioned services, became responsible
for the commissioning of some health services for those individuals who are under the care of Defence
Medical Services (DMS) GPs. This includes serving members of the Armed Forces, their families, veterans and
reservists. Services are commissioned through a single operating model, providing a national approach to
strategic planning and oversight.
NHS treatment for those Armed Forces personnel and families returning from overseas will be
commissioned by the Armed Forces Area Team in which the provider of the care that they receive is located.
In Lancashire there are two Ministry of Defence (MoD) Medical Centres; Preston Fulwood and Weeton.
It is the objective of NHS England to ensure that the commissioning of services is organised in such a way as
to provide the best possible patient outcomes and avoid any geographical or organisational variation that
may have existed previously, while maintaining essential stakeholder relationships.
The model will support commissioners and providers of services to:





Improve patient access
Encourage transparency and choice
Ensure patient involvement and participation
Identify better data to drive improved outcomes and better commissioning
Deliver higher standards and safer care
Services to be commissioned



All community and secondary acute and mental healthcare for families registered with a Defence
Medical Services (DMS) GP, in line with the principles of a common commissioning policy for NHS
England
All non-combat related community and secondary healthcare for serving personnel, mobilised
reservists and families registered with Defence Medical Services (DMS) GPs. These are in line with
the principles of no disadvantage and a common commissioning policy for NHS England, with the
exception of services normally commissioned or provided by DMS, including:
o Inpatient mental health – normally commissioned by DMS from South Staffordshire and
Shropshire Healthcare NHS Foundation Trust
o Community mental health – normally commissioned and provided by DMS
o Community rehabilitation
Certain services commissioned in line with the requirements of the Armed Forces Covenant (which
sets out the relationship between the nation, the Government and the Armed Forces), including:
o Prosthetics
o IVF for those with infertility as a result of injuries on military operations
o Mental health
There are a number of changes expected over the next few years that will impact on the needs of the
Armed Forces. These include:
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


The withdrawal of Armed Forces personnel from Afghanistan
Rebasing of service personnel returning from British Forces Germany
Plans for the increased use of reservists
Based on these changes, the key priorities for commissioning are:








Working in partnership
Information, activity and finance
Contracting
Commissioning for Quality and Innovation (CQUIN)
Quality, Innovation, Productivity and Prevention (QIPP)
Service redesign:
o Alcohol
o Domestic violence
o Discharge/transition management
Service review:
o Wisdom teeth extraction
o Rheumatology
o Dermatology
o Termination of pregnancies
o Continuing healthcare (CHC)
Choose and Book service
6. Collaborative Programmes
By working in partnership across the eight Lancashire CCGs and their partners to enable the delivery of the
Lancashire strategic vision for health and social care, Blackpool CCG is further enabling the overall key
strategic aims.
This is achieved through the delivery of shared programmes of work currently governed through the
Lancashire CCG Network, via recommendations from the Collaborative Arrangements Group (CAG).
However, the proposed model (currently under discussion) for Lancashire Collaborative Commissioning is
represented in the following diagram:
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The key focus areas for the Collaborative Arrangements Group are split into strategic work programmes and
operational work projects. Strategic work programmes are defined above as being at least 12 months in
duration, while operational projects are defined as being initially less than 12 months in duration.
7. Strategic Work Programmes:
Mental health reconfiguration
Our vision for mental health and dementia services across the Lancashire health economy is to ensure
appropriate access and treatment for people with mental health problems and ensure they have timely and
effective help at the right place and right time.
The Lancashire CCGs are undertaking a significant mental health acute reconfiguration in partnership with
Lancashire Care Foundation Trust (LCFT). The new service model aims to treat people with mental health
problems in specialist community mental health teams and reduce the requirement from mental health
inpatient capacity. The CCGs are in the third year of a five-year programme of transition and so far have
achieved £9m of savings of a total £15m due by 2017. The transformation programme will then undergo a
period of evaluation to ensure all outcomes have been met.
The programme began in 2006 with an extensive consultation process on inpatient mental health facilities.
This resulted in the 15 existing inpatient units being reduced to four more appropriate, modern facilities.
Although good progress has been made, there are still challenges, and the main priorities are:

Single Point of Access (SPOA) to ensure that access to mental health services is managed through a
single point; this is currently not functioning well. Over 50% of admission into the acute mental
inpatient services present through accident and emergency (A&E) and are unassigned.
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
Unscheduled Mental Health Care Pathway – There is a requirement to redesign a number of current
teams to introduce one single pathway to ensure better quality outcomes for patients while
reducing duplication.
Dementia reconfiguration
In early 2013 the Mental Health Reconfiguration Programme moved on to look at dementia, and conducted
another public consultation process focused on moving the majority of dementia care closer to home or in
the community. The vision for dementia care across Lancashire is:




Good quality early diagnosis, intervention and ongoing support within dementia-friendly
communities
Living well with dementia in care homes and the community, and reducing the use of antipsychotic
medication
Improved quality of care in general hospitals
Improved quality of care in specialist hospitals.
Dementia inpatient services will now be consolidated onto one site – The Harbour, Blackpool – which is a
brand new inpatient facility, due to open in March 2015.
Although good progress has been made, there are still challenges and our main priority currently is in
Dementia Specialist Community Services. We plan to review the overall implementation of IST and NHL
function in all areas, aligning with integrated neighbourhood team developments and ensuring all gaps are
addressed in 2014/15 through specific transition plans.
Child and Adolescent Mental Health Services
The Lancashire Child and Adolescent Mental Health Service (CAMHS) is in the process of restructuring and
integrating with Lancashire County Council, to provide a comprehensive and consistent service across the
county that meets the nationally set quality standards. This involves a refresh of the strategy, a review of
current services leading to new service specifications and models and the oversight, monitoring and delivery
of eight workstreams.
Our aim with this programme is to: increase access and provide 24/7 services; agree an integrated
CAMHS/psychology service; implement and monitor a local and national reporting system; and provide
developmentally appropriate services for young people over the age of 16.
Learning Disability Programme
The Learning Disability Programme is focused on three main workstreams:
Enhanced support services. We are currently undertaking a review of the enhanced support services
through current and future state mapping techniques. We will be supporting the establishment of a multiagency steering group for the project, allowing us to develop and implement a new referral process and
pathway.
Our main outcomes for this workstream will be:


Development of learning disabilities provider framework
Development of assessment and treatment services at Calderstones Partnership NHS Foundation
Trust
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

Undertake engagement with service users, carers and families
Support the development of a revised provider business model and organisational form
Self-Assessment Framework
Following the recommendations made by the Winterbourne Report, we have identified the need to redesign
our Learning Disability Service to ensure that patient needs are met and improved outcomes are delivered.
To achieve the report’s recommendations, we will put in place systems for ensuring the quality of service
provision. We will do this by:




Revisiting our service specifications and implementing new, seamless service models
Establishing the means of monitoring performance and standards
Agreeing processes to provide links and smooth transition for patients between services
Developing and monitoring an improvement plan.
Children/Special Educational Needs and Disabilities (SEND)
Inequitable service provision across Lancashire has been identified by Ofsted and the Care Quality
Commission, which, as a group of CCGs, we have committed to address. We are therefore conducting a
review of services, which will include the checking of compliance with national standards, and will make
recommendations for areas of potential service improvement.
In addition to the review, we will be looking to implement a single service specification for tier 2 and 3
services and to develop and deliver support for care pathways in and out of services.
Diagnostics and Pathology
As new tests come in, and with an ageing population with multiple conditions, there is a need to rationalise,
determine where efficiency and cost savings can be made, and have agreement around use of tests,
technology and good practice.
The Diagnostics and Pathology Programme looks to reconfigure pathology services, including the laboratory
testing element of the cervical cytology screening programme and pathology diagnostic services in the
community, by developing a service specification for the pathology services that reflects current best
practice.
As part of this programme, we will develop standardised activity reporting and payment for Direct Access
Pathology Services, benchmark practice utilisation of services and undertake review of service provision in
support of the wider Lancashire strategy.
The expected outcomes of the programme are:





Common list of tests across all Lancashire providers with consistency in naming and units of
measurement
Updated specification for direct access pathology
Report on level of variation in use of diagnostic tests across Lancashire
Agreement with providers on the process to address any variation
Agreement with providers of Lancashire-wide disease-specific testing algorithms
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8. Operational Work Projects
Community equipment re-procurement
The CCGs aligned to Lancashire County Council have identified opportunities to consolidate purchasing
power for community equipment services across the area, achieving greater value for money, improved
procurement pathways and quality of service.
This programme will develop, mobilise and monitor a consolidation plan to bring the current service
provision from three providers down to one provider. This will include the specification development,
financial analysis and procurement/framework establishment for the service.
Overall we expect to provide a single, high quality service based on a Lancashire-wide service specification
and contract that ensures value for money through the buying power of a single provider. This will deliver
improvements across the whole service, giving us an increased ability to re-use and re-purpose high cost
equipment as well as develop streamlined pathways for equipment provision.
Stroke/ TIA/Vascular
This programme has been identified as initially less than 12 months in duration on the basis that it is
currently subject to a scoping exercise that will be reported to the Collaborative Arrangements Group in June
2014. It is anticipated that the stroke review will offer a real opportunity to be transformational around
seven-day working and potentially drive major reconfiguration.
The implementation of an abdominal aortic aneurysm (AAA) screening programme is cited as a ‘must do’ in
the NHS Operating Framework, focusing attention on the establishment of specialist interventional centres.
We intend to establish three specialist vascular interventional centres covering the region, linked by a
vascular network. This will, in turn, identify pathways and commissioning issues and priorities for individual
CCGs.
Our stroke/TIA (transient ischaemic attack) review will identify a best practice service model, assess our
current service provision against this and recommend further service improvement or transformation
opportunities to achieve a high quality stroke service for the population of Lancashire.
9. Healthier Lancashire
The commissioners of health services across Lancashire are keen to undertake the development of a Health
and Care Strategy across the county that will build upon the work undertaken by the Lancashire Improving
Outcomes Board and, more recently, the Lancashire Transition Group.
We recognise the need to bring together the shared ambitions of both commissioners and providers from
both health and social care, together with the voluntary sector and other agencies.
It recognises the need to prioritise the strategies across the county based upon our current knowledge;
however, it does not undervalue or underestimate the need for local ownership and implementation. The
strategy (‘Healthier Lancashire’) shall be brought together by the Lancashire Leadership Forum but shall be
shaped and implemented by those organisations allied to it, including the health and wellbeing boards of
Lancashire.
The Healthier Lancashire Strategy is being developed to improve outcomes for the people of Lancashire, and
consists of seven main projects, as outlined below.
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






In Hospital Care: This project is a clinically led assessment of opportunities to improve patient
outcomes through provider collaboration for the provision of specialist and hard-to –recruit-to
services. The three main drivers are improved outcomes, clinical sustainability and financial
sustainability.
Out of Hospital Care: This project seeks to improve outcomes for patients who no longer require an
acute hospital bed but who would benefit from further treatment or therapy delivered in a nonacute setting. The project would seek to provide health and social care support that cannot be
provided in a person’s own home. It will address the longstanding problem of hospitals (physical and
mental health) being unable to discharge patients who require further rehabilitation, therapy or
intermediate care in a timely fashion due to lack of suitable alternatives.
Neighbourhood Pilots: All CCGs are developing a neighbourhood and locality approach for multidisciplinary teams and multi-agencies to work within the community.
The Big Conversation: This will aim to engage the public around why Lancashire’s health and care
delivery needs to be transformed and to support the development of the strategy by engaging with
public and stakeholders.
Digital Health: This is about designing a new digital plan for Lancashire, which will harness digital
technology to: promote wellness and self-care; improve access and efficiency; and offer new ways of
accessing and delivering care.
Single Version of the Truth: This will involve creating a public document that sets out the position for
health and social care in Lancashire for the period 2014 to 2020. It will include information on
money, workforce, health outcomes, service sustainability and estates, and provide background
information.
Collaborative Leadership: This is about finding a collaborative team approach to address this
strategy, work together across organisations and streamline our efforts.
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Local Area Team Plans on a Page: Primary Care Five-Year Strategy 2014 to 2019
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Local Area Team Plans on a Page: Direct Commissioning – Public Health
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Appendix 8 Blackpool Teaching Hospital POAP
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Appendix 9 Blackpool IT Strategy Summary
Priority Areas
GP Clinical Systems
Document management
Impact

GP practices across Blackpool have now been migrated over to the EMIS Web solution under GPSoC. This provides the CCG with a
standardised clinical system platform to build and integrate into other areas of the Health Economy supporting the sharing of
information, which had already made progress thought the use of the MIG (Medical Interoperability Gateway) to link into secondary
care and out of hour’s services. The MIG provides an integration engine, enabling connectivity between healthcare systems, allowing
clinicians to securely share and access real time patient information.

There is also the added benefit of simplified distribution of templates and future implementation of EMIS search and report tools to
aid in data collection, supporting the CCG and GP’s in both data quality and business intelligence services.

Along with the benefits of standardisation onto a hosted GPSoC accredited platform, there are also financial benefits in attracting
central funding under the GPSoC framework. This has reduced local maintenance and support costs previously funded by the CCG
under GPIT, a budget which has seen a reduction of over 40% from the previous 2013-14 allocation.

PCTI’s DocMan system is the standard document management solution used by all practices, it simplifies workflow processes by
easily presenting electronic letters in front of individuals to review, comment, highlight or note simple actions. GPs will spend less
time on administrative tasks, whilst being able to access information from any computer in the practice and be up to date with a
patient’s record instantly.

During 2014-15 this previous initiative by Blackpool will further benefit the CCG by becoming part of the GPSoC framework. As it is
expected that this will pass accreditation mid-year, thereafter be centrally funded and further reduce the pressure on local GPIT
budgets.

There are also plans to implement the EDT Hub during 2014-15 across the Blackpool Teaching Hospitals NHS Trust. This will provide a
multi-directional document transfer platform providing a secure, reliable and flexible platform for the electronic communication of
documentation between Secondary, Primary and Social Care providers.

EDT is able to collect from multiple message streams enabling practices to receive from multiple document sources in the same Trust
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or from neighbouring Trusts. No matter how many streams a practice collects from, all documents are delivered into DocMan. This is
convenient both in practical terms for the clinician and from an audit clinical governance point of view
PC Infrastructure
Mobility

Blackpool has always invested in the use of desktop technology within general practice, and is by far considered one of the most
advanced within this area.

Windows 7 and Office 2010 has been the standard for the last two years in Blackpool, while others are still to migrating over from
the legacy Windows XP product, a versions no longer supported unless through the extended NHS England XP support agreement at
additional cost for those organisations who require it.

During 2013-14 Blackpool introduced the all in one desktop to each and every GP’s desk. This provided a richer experience when
using unified communication tools. This enables communications and enhances productivity through the use of CISCO Jabber. It
provides a platform for the use of voice, video and presence, enabling the future vision of virtual GP consultations as the technology
becomes more familiar to use and governance issues addressed.

With the focus on more agile working and better care closer to home. Blackpool has also initiated a project to look at the benefits of
EMIS Web mobile.

This allows clinicians to access the core elements of EMIS Web on a tablet device anytime, anywhere. With EMIS Mobile you can
view your daily appointments and up-to-date medical records, making it easier to deliver care closer to home.

It also enable the inclusion of unified communications and video conferencing solution using the same technology as on the GP’s
desktop, giving a mobile communications solution while out of the practice. This could also be used in the care homes setting for
example, enabling a tablet device to be present with the patient while the GP remains in the practice.

A capital funding request under GPIT has been submitted to support this initiative should the outcome of the pilot be successful and
supported for full rollout.

We will plan to look to develop this further over the next few years now the infrastructure is in place.
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Appendix 10 BCCG Schemes Supporting the
Outcome Ambitions
NHS
Outcome
Framework 5 Domains
Domain
1:
Preventing people
from
dying
prematurely
7 Outcome ambitions
1: Securing additional years
of life for the people of
England
with
treatable
mental and physical health
conditions
Supporting Schemes
Improvement
Ambition
Circulatory schemes: atrial fibrillation/ 10% improvement
GRASP audit tool, new heart failure from baseline over
pathway, hypertension early detection, five years
early treatment high risk TIAs
3019.4 PYLL per
Respiratory schemes: Revised COPD 1000
population
pathway,
improved
pulmonary reduction to 2717.46
rehabilitation, My Breathing Book
Reductions to:
Alcohol and smoking interventions
Risk
Adjusted
Mental health review, single point of Mortality Index
access, more responsive out-of-hours
service, reduce non-elective admissions
Summary Hospitallevel
Mortality
Early detection cancer waiting times
Indicator
NHS Healthcheck
HSMI & RAMI & SHMI
reductions:
Action plan following Keogh and Care
Quality Commission reviews. Quality Pneumonia
Assurance process
Sepsis
Stroke
Domain 2: Enhancing
quality of life for
people with long-term
conditions
2: Improving the health
related quality of life of the 15
million+ people with one or
more long-term condition,
including
mental
health
conditions
Respiratory and circulatory schemes as Cardiac
6.62%,
listed against Ambition 1
improvement
Revised diabetes pathway
Increased scope
telehealth
and
capacity
of
66.50
baseline
increasing to 70.90
by 2018/19
Community matron focus on long-term
conditions
Patient pathway management and
education programmes
Ac
3: Reducing the amount of
time people spend avoidably
in hospital through better and
more integrated care in the
community,
outside
of
hospital
Specialist wraparound
weight ofmanagement
Seamless
health and
programme
social
care services in the community
15.0
improvement
Improve ambulatory care
2622.60 baseline reduce to 2229.0
%
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IV antibiotic therapy scheme
Domain 3: Helping
people to recover from
episodes of ill health or
following injury
by 2018/19
Risk stratification tool
Respiratory and circulatory schemes
4: Increasing the proportion
of older people living
independently at home
following discharge from
hospital
Care home scheme
Care plans for all care home patients
Development of GP capacity
To be determined
as part of Better
Care Fund work
Telehealth
Community matron focus on long-term
conditions
Seamless wraparound of health and
social care services in the community
Patient pathway management and
education programmes
Reablement services to improve
numbers of patients staying out of
hospital after 90 days
5: Increasing the number of
people having a positive
experience of hospital care
Improving Friends and Family Test
scores to above national average
- 12.1 %
Patient and carer feedback
155.6 baseline reduce to 136.8 2018/19
Privacy and dignity maintained
Abolish mixed sex accommodation
Domain 4: Ensuring
that people have a
positive experience of
care
Acute carers workers
Increase rates of
dementia
screening
and
assessment
Dementia advisors
To reach more people with dementia
and ongoing
support to carers and sufferers
Improved Care Quality Commission
inpatient survey
6: Increasing the number of
people with mental and
physical health conditions
having a positive experience of
care outside hospital, in
general practice and in the
community
Improved patient reported outcome
measures (PROMs)
Seamless
wraparound of health and
social care services in the community
Reduced level of harm from incidents
Development of GP capacity
Improve safety thermometer
Increase numbers diagnosed with
Reduce healthcare
associated
infection
dementia
and provide
ongoing
support
to carers and sufferers
0 MRSA
1% improvement
Reducing from 4.3
to 4.25
Already in
quartile
performance
top
for
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Domain 5: Treating
and caring for people
in a safe environment
and protecting them
from avoidable harm
7: Making significant progress
towards eliminating avoidable
deaths in our hospitals caused
by problems in care
Reduce hospital mortality rates:
Implementation of evidence-based and
effective pathways in secondary care,
Improved coding of hospital conditions,
reduced hospital standardised mortality
ratio (HSMR) and summary hospitallevel mortality indicator (SHMI)
Reduce healthcare associated infections
Implementation of post-Keogh review
actions
Reduced falls with serious harm
Increase near miss reporting
Increase near miss
reporting by 5%
C
Difficile
infection No
more than 28
cases per annum
C Diff - No more
than 43 cases in
community
Increase
near
miss reporting by
5%
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Appendix 11 BCCG Schemes Supporting
Reduction of Health Inequalities
Health Inequality
Circulatory
Supporting Schemes
atrial fibrillation/ GRASP audit tool, new
heart failure pathway, hypertension early
detection, early treatment high risk TIAs,
NHS Healthcheck
Early detection & cancer waiting times
Life Expectancy
Cancers and Tumours
Respiratory
Mental Health
Gastro Intestinal / Alcohol
Revised
COPD
pathway,
improved
pulmonary rehabilitation, My Breathing
Book, Public Health smoking initiatives, NHS
Healthcheck
Mental health review, single point of access,
more responsive out-of-hours service,
reduce non-elective admissions,
Increase numbers diagnosed with dementia
and provide ongoing support to carers and
sufferers, Dementia advisors To reach more
people with dementia and ongoing, support
to carers and sufferers
Working with public Health to reduce
numbers of alcohol related admissions.
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Appendix 12 BCCG Schemes Supporting Better
Care Fund Plan
Planned Projects
Implementation of Electronic
Palliative Care Co-ordination
System (EPaCCS)
Expected benefits


Reduce the number of inappropriate admissions to an Acute
Setting.
All stakeholders involved in the care of the patient will have access
to the patients Care Plan which will include details of medication,
preferred place of Care.
Care plans for all patients who are
identified as End of Life


Reduce the number of inappropriate admissions to an Acute
Setting
Patient Care will be better managed within the Community.
Roll-out of Care Homes Support
scheme



Enhance the quality of care in care homes.
Reduce non-elective admissions from care homes.
Reducing the episodes of end of life care in acute settings.
Review Falls Lifting Service linked
to the Vitaline Pendant Scheme

Reduce the number of Ambulance call-outs and conveyances to
hospital due to falls
Reduce the number of A&E attendances and non-elective
admissions due to falls.
Increase referrals into the Falls Advice and Assessment Service.
Reduce the risk of repeat falls
Reduce the admissions to long term care.
Improve the long term outcomes for older people.
Support people to stay in their own home

Reduce delayed transfers of care.






Implement recommendations of
hospital discharge review
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Review all urgent and emergency
services to assess 7 day availability
and draw up plans for future
commissioning arrangements in
line with recent guidance
Review services for carers and
develop programme for
improvement

Improve patient experience.

Reduce A/E attendance and Ambulance Calls.
Reduce non-elective admissions
Increase numbers of people assisted to manage own long term
condition.





Using existing risk stratification
tools build on the current Care Coordination pilot, broadening scope
to include social care risk factors
and increase the number of people
with an Anticipatory Care Plan

To broaden the scope of existing
999 frequent callers pilot in order
to identify more individuals who
could benefit from a proactive,
person centred anticipatory
approach







Increasing re-ablement capacity to
ensure that it is the primary offer
for the majority of people prior to
receiving a long term care service




Implement the recommendations
from benchmark intermediate care
review to ensure sufficient
capacity within



Improved support for carers
Reduced non-elective admissions
Reduced admissions to long term care.
Reduced non-elective admissions.
Improved self-management of conditions.
Provide information to support development of the models to
support full implementation of Health and Care Strategy
Reduction in calls to 999
Reduction in ambulance conveyances
Reduced non-elective admissions.
Improved self-management of conditions.
Provide information to support development of the models to
support full implementation of Health and Care Strategy
Reduced non-elective admissions
Reduced admissions to long term care.
Reducing demand for long term community based care packages
Increased independence and positive outcomes for individuals
Reduced non-elective admissions
Reduced length of stay and delayed transfers of care
Reduced admissions to long term care.
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




Reducing demand for long term community based care packages
Increased independence and positive outcomes for individuals
Residential Rehabilitation
(Nurse and non-nurse led)
Residential recuperation
Community therapy
In line with Intermediate care
review recommendations to
consider development of plans to
integrate bed and community
based rehabilitation services
Scope the increased use of
telecare / telemedicine and
telehealth

Explore plans to develop an integrated single site for all bed based
rehabilitation services and link to community based therapy.

Using the existing infrastructure pilot virtual GP support to Nursing
homes
Review options to invite providers to the market to have better
support to keep people in their own homes through technology

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Appendix 13 Timelines for Implementation
Overall Detailed Timeline
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High Level Timeline
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