NHS Wyre Forest Clinical Commissioning Group Annual General

NHS Wyre Forest Clinical Commissioning Group Annual General Meeting Tuesday 14 th July 2015, 10. 00 am

Welcome and Introductions Welcome to the second Annual General Meeting (AGM) of NHS Wyre Forest Clinical Commissioning Group

Wyre Forest NHS Wyre Forest CCG commissions services, based on health need, for the local population of 113, 400 people

About us • Operating as a statutory body since April 2013 • A membership organisation comprising of local GP practices • Strong clinical leadership and input • Member practice involvement in priority setting • The voice of local people is integral to service developments, commissioning decisions and assurance processes

Annual Report Highlights 2014/15 Dr. Simon Rumley Chair and Clinical Lead

Successes üReduction in the rate of non-elective admissions üImprovement in the Dementia diagnosis rate üFriends and Family Test results for local providers are significantly above the national levels

Successes üPrimary Care Medicines Optimisation Service üCare Homes Enhanced Service üHigh levels of assurance

Patient Satisfaction ü Highest performing CCG within the area team for overall experience of their GP surgery Base: All those completing a questionnaire: CCG 2015 (1, 766); CCG 2014 (1, 862); National (841, 444) Source: Ipsos Mori , June 2015, GP Patient Survey %Good = %Very good + %Fairly good %Poor = %Very poor + %Fairly poor

Patient Satisfaction ü Confidence and trust in the GP was higher than the national average Base: All those completing a questionnaire: CCG 2015 (1, 746); CCG 2014 (1, 832); National (834, 817) Source: Ipsos Mori , June 2015, GP Patient Survey %Yes = %Yes, definitely + %Yes, to some extent

Patient Satisfaction ü Highest performing CCG within the area team for convenience of making an appointment Base: All those completing a questionnaire: CCG 2015 (1, 732); CCG 2014 (1, 831); National (830, 142) Source: Ipsos Mori , June 2015, GP Patient Survey %Yes = %Yes + %Yes, but I had to call back closer to or on the day

360 Degree Stakeholder Survey Source: Ipsos Mori , 2014/15, 360 Degree Stakeholder Survey

Challenges • Underperformance against the Cancer ‘ 62 day referral to treatment’ target and the ‘two week wait’ targets • Below target for the referral to treatment (RTT) 18 week threshold • The A&E standard for patients waiting less than four hours before being discharged after treatment or admitted into hospital was below target

Questions? Any questions about the Annual Report Highlights?

Patient and Public Engagement Jan and John’s Stories

Jan and John’s Stories https: //youtu. be/2 Fypp 5 PDBa 8

Commissioning Improvements in Quality and Patient Safety Quality Highlights 2014/15 Jo Galloway Chief Nursing Officer

Quality Challenges • Accident and Emergency performance at Worcestershire Royal Hospital • Service sustainability related to the Future of Acute Hospital Services in Worcestershire

Quality Improvements • Quality Assurance Framework strengthened (AQP and Domiciliary Care) • Electronic Care Home Quality Monitoring Tool • Quality Member visits to care homes • Quality ‘Commendation and Concern’ reporting • Culture of Quality county-wide work • Hydration Campaign • Personal Health Budgets

Cdiff Performance • Maintained positive performance • In 14/15 WFCCG had the 12 th lowest number of infections of 211 CCGs • Against objectives WFCCG was one case above threshold which was ranked 84 th best performance. • The Multi-Agency Cdiff Task and Finish Group was awarded Infection Prevention Team of the Year by the Infection Prevention Society Clostridium difficile (Cdiff) 2012/13 2014/15

Safeguarding • On-going support to the Worcestershire Safeguarding Adults Board and Safeguarding Children Board • Development of a safeguarding adults multi-agency communication protocol across Worcestershire. • Improved attendance by GPs at Safeguarding Adult Training (50% increase in GPs attending Level 3 children’s face to face training) • Health partnership safeguarding children communication protocol developed and is being implemented • Supported the development of the Multi-Agency Safeguarding Hub (MASH). • Support to Primary care with the Mental Capacity Act and Deprivation of Liberty Safeguards

Carer Support • Valuing views of carers in quality assurance visits and quality monitoring • Monitor ‘friends and family’ scores • Featured a carer’s story as a patient story to Governing Body and have looked at ways to improve the carer journey and support the carer role • Supported the Dementia Friends initiative • Made pledges attached to the county-wide Carers Strategy and are working in partnership to ensure the Carers Strategy is delivered and meeting the NHS Commitment to carers and the NHS Strategy for Carers

Mental Health and Learning Disability • Multi-agency sign up to deliver Mental Health Concordat • Urgent care (Mental Health) dashboard – commitment to parity of esteem • Quality assurance visits to Mental Health services • Full commitment to Winterbourne View Concordat and Transforming Care agenda • Reductions in use of out of county placements for people with learning disability and / or complex mental health needs • 100% completion of quality assurance checks and individual reviews for people who have required out of county placements to ensure good quality care and minimise lengths of stay • Children and young people - Urgent care protocol developed so that all agencies work in partnership and jointly respond to emergency cases. There is a clear escalation process for complex cases.

Commissioning Quality and Innovation 2014/15 improvement outcomes included: • Greater patient experience feedback through extensions to the Friends and Family Test • Strengthening of systems to identify the needs of people with cognitive impairment including dementia • Better physical health care for people with long term mental health needs and for people with a learning disability • Enhanced education and strengthened management of hydration for patients in hospital, care home residents and the public 2015/16 the Clinical Commissioning Group has agreed to incentivise schemes to: • Continue to support improvements in care for people with dementia and their carers • Support a range of initiatives to enable people to achieve the right care in the right place by creating options for care closer to home in their local communities, improving flow and enabling timely discharge from hospital beds. • Improving health outcomes with a focus on reducing deaths from severe infection (sepsis) and acute kidney injury.

Questions? Any questions on the Quality Highlights?

Finance Highlights 2014/15 Paul Sheldon Chief Finance Officer

CCG Financial Requirements for 2014/15 • Deliver at least 1% surplus £ 2. 94 m • Hold 0. 5% contingency £ 0. 65 m (CCG set target of 2%) • Hold Non-recurrent 1. 0% reserve £ 1. 30 m • Create 1. 5% Strategic Change Reserve £ 1. 95 m • QIPP target – derived locally £ 2. 2 m

Finance Highlights 2014/15 • The financial statements have been prepared in accordance International Financial Reporting Standards (IFRS), as adopted by HM Treasury and detailed in Government Financial Reporting Manual • The full financial statements are included in appendix A of the Annual Report • The annual external audit findings report for 2014/15 can be found at Appendix C, and the external audit opinion can be found as Appendix D

Finance Highlights 2014/15 Statutory Duty Expenditure not to exceed income Revenue resource use does not exceed the amount specified in directions Revenue administration resource use does not exceed the amount specified in directions 2014 -15 Performance Target £’ 000 2, 635 2, 941 132, 083 129, 142 2, 701 2, 473 • Wyre Forest CCG delivered the planned 2% surplus of £ 2. 941 m – remaining within allocation • Remained with Running Cost Allocation • Delivered Quality Innovation Prevention and Productivity programme (QIPP) of £ 2. 2 m

Finance Highlights 2014/15 Key Variances - Surplus / (Deficit) for 2014 -15 £ 2 200 £ 1 399 £ 650 Acute Primary Care -£ 28 -£ 3 357 Community -£ 315 Continuing Care / Local Authority -£ 549 release of contiguency release of strategic change reserve QIPP

Finance Highlights 2014/15 Expenditure for every £ 1 spent by WFCCG Area of Expenditure Acute Primary Care Local Authority/Free Nursing Care/CHC Community Reserves Running Costs £ Acute 0. 53 Community 0. 19 Primary Care 0. 18 Reserves 0. 01 Local Authority/Free Nursing Care/CHC 0. 07 Running Costs 0. 02

Questions? Any questions about the Financial Report?

Reducing Inequalities Making it Happen Innovation Fund Wayne’s Wellbeing Wednesday

Making it Happen – Innovation Fund • A fund that is run in partnership with Wyre Forest District Council and Worcestershire County Council • Looking for innovative ideas that help the CCG to achieve our priorities, reduce health inequalities and meet the needs of our patients • Submitted ideas need to be a new concept

Wayne’s Wellbeing Wednesday • A successful bid was awarded to Wyre Forest Community Housing Group to carry out a healthy lifestyle project in Oldington and Foley Park • Aimed to raise awareness of making positive lifestyle choices and identify the barriers/issues that had a negative influence on health and wellbeing • A recent evaluation of Wayne’s Wellbeing Wednesday indicated the project was popular with residents and had impacted positively on health

Wayne’s Wellbeing Wednesdays https: //youtu. be/Baxp 8 m. EKYLY

Primary Care Medicines Optimisation Service Anne Kingham Primary Care Medicines Commissioning Lead

Why a Medicines Optimisation Service? • Medicines are the most common health intervention • BUT medicines are often not taken as intended, resulting in reduced benefit and waste

Aims of the Service • • To help patients get the best from their medicines To minimise the risk of errors and adverse effects To reduce potential waste medicines To improve support for practice staff e. g. GPs, Practice Nurses, repeat prescription and reception staff

How it works GP practices were required to: • Review discharge medication and contact the patient where clinically appropriate, to ensure they understand the changes to their medication • Undertake medication reviews with patients taking medication likely to cause a hospital admission

What difference did it make? • For one month - 2000 interventions made: • Medication commenced, stopped or changed • Formulations changes • Drug interactions identified • 5% were assessed as potentially avoiding an admission • Direct savings identified as a result of changes made • Wyre Forest CCG spend on medicines is growing at a lower rate than surrounding CCGs

What did patients think? • 67% of patients agreed it was useful to have the opportunity to discuss their medicines • 32% learnt something they didn't know before • 38% have changed the way they take their medicines as a result of the discussions

What next? • The service has been re-commissioned for two years • NHS Redditch and Bromsgrove CCG have used the same model for a new service • Submitted and has been accepted by National Institute for Health and Care Excellence (NICE) as a good practice example in their learning database

https: //www. nice. org. uk/sharedlearning/a-medicines-optimisation-service

Questions? Any questions about the Primary Care Medicines Optimisation Service?

Questions?

Closing Observations Dr. Simon Rumley Chair and Clinical Lead

Thank you for attending