The NHS outer north east London commissioning cycle

The NHS outer north east London commissioning cycle 2012/13 – 2014/15 Jane Gateley Director of planning and delivery

Contents • • Requirements London time lines Design principles Roles and responsibilities NHS outer north east London (NHS ONEL) approach The NHS commissioning cycle NHS ONEL resource plan and time line

Planning for 2012/13 – 2014/15 What is required? • Three year plan • Build on existing plans for 2012/13 – 2014/15 - more detail on how QIPP initiatives will be delivered workforce - strengthened financial, activity, and work force analysis • Enable PCTs to meet their strategy planning requirements and cover all elements of healthcare to be commissioned • Provide pathfinders with CCG level plans that can be used as part of their authorisation process (Jul – Dec 2012) • Need to align with Operating Plan cycle 12/13 What should be provided? • • • overview of local health economy vision for local commissioning areas for improvement description of initiatives that will be implemented to deliver vision based on JSNA and priorities identified in Joint Health and Well Being Strategy What format should plan take? Key elements: • Exec summary • Vision and strategic goals • Approach • Case for change • Key priorities • Opportunities (current and new) • Enablers • Delivery impact • Sustainable commissioning • Implementation

Timeline for planning cycle

Design principles • Strategic plans will be developed with the relevant partners and maximise the opportunity to increase clinical engagement in strategic planning • Cluster chief executives will be held to account for delivering plans on time • There will be clear leadership and lines of accountability within a cluster for the production of each element of the plan, especially where pathfinders have received delegated responsibilities • Pathfinders should engage in developing the whole commissioning strategy plan, and own their local commissioning strategy plan • Clusters will support pathfinders in developing their local commissioning strategy plans • HWBs must be engaged early in the development of plans and must endorse relevant elements of the plans before they can be formally agreed • What can be done once across London, should be done once across London including the London-wide strategic priorities endorsed by the GP Council. Through its assurance role, NHS London will facilitate the identification of pan -London strategic priorities • Plans will develop and further substantiate existing four-year PCT cluster plans and as such be clear where they are building on existing plans • Learning from previous planning processes will be considered throughout the process by all • Strategic planning will be aligned with and feed into the operating planning process for 2012/13 • NHS London will continue to provide ongoing assurance over the planning process and of the plans themselves to report to DH

Roles and responsibilities Stakeholder Responsibility Pathfinder Leading the development of local commissioning strategy plans and contributing to the development of the overall cluster plan, including engaging with neighbouring pathfinders and providers Emerging Health and Wellbeing Boards Engaging in the development of plans for their local populations, promoting and supporting integrated approaches to commissioning and provision and reviewing and endorsing plans where they meet the needs and priorities identified in the JSNA and Joint Health and Wellbeing Strategy as part of finalising plans Local Authorities Working with pathfinders / clusters in developing the case for change aligned to the JSNA and participating in the development of joint commissioning strategies PCT clusters Supporting pathfinders in developing their plans, contributing to the NHS CB elements of plans and ensuring the delivery of cohesive plans to the agreed deadlines London Specialised Commissioning Group Developing elements of the plans related to the specialised services they currently commission Providers Working with commissioners to ensure triangulation of commissioner and provider plans NHS London NHS CB Team NHS London Supporting and monitoring the production of the NHS CB elements of plans, making sure they can be brought together to form a single shadow plan for the NHS CB in London Working alongside commissioners to provide assurance that plans are developed in line with the agreed design principles, that content is developed to the necessary standards and that plans can be consolidated to derive a pan-London financial and service position.

NHS ONEL approach • Meet with each CCG to discuss local approach in early September • Use NHS commissioning cycle as an enabler for matrix working (see next slide and detailed resource plan and timeline) • Begin implementation from mid September • Communicate/engage partners • Submit approved plan that meets authorisation requirements by end of November • Signed contracts in place by end of February • Joint implementation plans in place with trusts by end of March

NHS ONEL approach: use the NHS Commissioning Cycle based on principles …. Plan, Execute, Manage 1. 2. 3. 4. 5. 6. 7. 8. Assess needs: through a systematic process, understanding of the health and health care needs of the PCTs resident population. Describe services and gap analysis: reviewing the services currently provided and based on needs, defining the gaps (or over provision). Deciding priorities: given a list of desirable actions, using available evidence of cost effectiveness and based on robust and defensible ethical framework, prioritise areas for purchase. Risk management: understanding the key health and health care risks facing the PCT and deciding on a strategy to manage it. Strategic options: bring together all the available information into a single strategic commissioning plan that outlines how the PCTs will deliver its core objectives (including those of the SHA and DH). Contract implementation: put those strategic plans into action through contracting. Provider development: (including care pathway redesign and demand management): support provider improvements or introduce new providers to deliver the services required (including setting up demand management systems and designing new care pathways). This includes supporting providers in decommissioning of services where appropriate. Managing provider performance: monitor and manage the performance of providers against their contracts, especially against KPIs Lead: Jane Moore Output: Prioritised JSNA for each borough Lead: Conor Burke Output: Service and gap analysis Lead: Conor Burke Output: Commissioning intentions Lead: Jane Gateley Output: Risk assessment of plans Lead: Jane Gateley Output: Commissioning Strategy Plan Lead: Conor Burke Output: Signed contracts and SLAs Lead: Conor Burke Output: Joint implementation plan Lead: Conor Burke Output: Performance reporting

Current opportunities • Opportunity 10 • Primary care discharge facilitation adults • A&E discharge team • Rapid Response – PELC/NELF • Surgical hot clinics • Model for urgent/UCC utilisation • SPA/111 Do. S • Ambulatory care

Opportunities – future priorities? • O 10 What would a good urgent and emergency care service look like? “A good urgent and emergency care service is the range of healthcare services available to people who need medical advice, diagnosis and or treatment quickly and unexpectedly. People using services and carers should expect 24/7 consistent and rigorous assessment of the urgency of their care need an appropriate and prompt response to that need. ” Dr Agnello Fernandes – August 2011 Key principles No confusion of what to do, who to call or where to go 999 immediate life threatening calls NHS 111 Electronic Directory of Service A joined up and co-ordinated system 24/7 rapid response team ICM LTC management Eo. LC Reablement

Opportunities future priorities cont’d Safe responsive and a high quality service Improved patient access to urgent same day GP appointments High quality responsive out of hours service Multi professional urgent and emergency care workforce MH services located in EDs Out of hours services co-located and integrated with urgent care services 24/7 social care response service Safeguarding the young and vulnerable Child protection and adult safeguarding will be statutory responsibilities Patient and public involvement Improved public education and marketing or urgent and emergency care services Patient representation on the Boards of Commissioners

Next steps A “good” CSP will be developed and tested with: • • • All GP practices Patients and public Clinicians including secondary care Providers Health and well-being boards Local authorities

High level timeline Key milestones CCG workshops completed Leads CCG/ONEL CSP lead Month Early October CCG template issued to cluster leads and CCGs ONEL CSP leads Early October First cut information provided by cluster leads and BDs/cluster leads Mid October Initial engagement with Las CCG/BDs During October Joint engagement event patients CCG/ONEL Comms lead Mid October 1 st cut CCG plans issued CSP cluster lead End October Joint CCGs alignment/assurance event Final draft ONEL CSP incorporating CCG plans CCGs/ONEL Exec CSP lead Early Nov Mid Nov HWB presented with final draft plan CCG/Borough Directors Mid November CCG sign off via Joint CCC/local CCCs? CCGs Mid-Nov Board sign off Submission to NHSL assurance process ends/final plan sign off Board CSP cluster lead CCG involvement required 17 November 30 November TBC December