February 2013
Contents
- Introduction – p2
- Background to the Operating Plan for 2013/14 (Joint Strategic Needs Assessment & Joint Health and Wellbeing Strategy – p2)
3. Patient & Public Engagement –p3
4. Financial Overview 2013/14 – p3
5. The Three Themes of the Operating Plan 2013/14 – p3
6. Key Priorities for Wandsworth CCG in 2013/14 Based on the Three Themes – p4
7. PACT (Planning All Care Together)– p4
8. QIPP Schemes (Quality, Innovation, Productivity, Prevention) – p5/7
9. Contracting Process – p8
10. Outcomes Framework and three local measures – p8
11. Glossary – p9
1. Introduction
What are Clinical Commissioning Groups?
‘Clinical Commissioning Groups’are made up of General Practitioners (GPs) who will, from April 2013, have the responsibility for purchasing and designing local healthcare services throughout England. They will do this by ‘commissioning’ or buying health and care services such as;
- Elective hospital care (where patients choose to undergo an operation or procedure under the advice of a doctor)
- Rehabilitation Care (services which help patients to re-learn skills or recover after, for example, a stroke or serious accident)
- Urgent and Emergency Care (Accident and Emergency Departments or Urgent Care Centres for minor ailments and injuries)
- Most community health services
- Mental health and learning disability services
- Maternity services
Clinical Commissioning Groupswill work with patients and healthcare professionals and in partnership with local communities and local authorities. Each CCG will have on their governing body at least one registered nurse and a doctor who is a secondary care, i.e. hospital specialist.
Wandsworth CCG
Wandsworth CCG is focused on its responsibilities to offer the residents of Wandsworth improved quality of care, greater value for money and more choice to deliver a better quality of life and improved life expectancy.
The CCG is committed to an ongoing consultation exercise throughout February and March, to allow patients as full an opportunity as possible to comment and provide feedback, which will then be included into the final Operating Plan document.
2. Background to the Operating plan for April 2013 to March 2014
The Operating Plan for 2013/14 is built on the foundations of the Clinical Commissioning Group’s Commissioning Intentions which we published in November 2012. You can read these on our website at
The Commissioning Intentions, and the Operating Plan for 2013/14 are based on clinical evidence as collected by the local Public Health department within Wandsworth and which are then written as a strategic plan called the ‘Joint Strategic Needs Assessment’ (JSNA). The JSNA informs patients/service users and various organisations of both the present and predicted healthcare needs of the local population of Wandsworth. This in turn forms the basis of Wandsworth CCGs Commissioning Intentions. In addition to the JSNA, the Wandsworth Joint Health and Wellbeing Strategy – summary version as prepared by the Wandsworth Health and Wellbeing Board, selects priorities for action to ensure that actions to improve the ‘health and wellbeing’ of the population of Wandsworth are reflected within the Commissioning Intentions as well as the Operating Plan 2013/14.
The Commissioning Intentions and this Operating Plan for 2013/14 Summary, provide a picture of the main programme of work which we plan to deliver during 2013/2014.
- Patient and Public Engagement
The CCG is committed to an ongoing consultation exercise throughout February and March2013, to allow patients as full an opportunity as possible to comment and provide feedback to us. This feedback will then be included into the final Operating Plan and to make sure that patient views are captured and reflected in the final version.
Wandsworth CCG has set up a Patient Public Involvement (PPI) Clinical Reference Group, chaired by the Board Member for PPI, with whom we are working very closely, to make sure that we engage with patientseffectively. The Operating Plan is also being written in consultation with Wandsworth Borough Council, who will also endorse the plan for delivery.
- Financial Overview 2013/14
Wandsworth CCG has inherited a strong financial position from NHS Wandsworth (the previous statutory organisation for health commissioning).
We plan to deliver a ‘‘Quality, Innovation, Productivity and Prevention’ (QIPP) programme to save £10m (this is 2.5% of our total budget of £391 million). The programme of QIPP initiatives are aimed at improving quality and ensuring value for money within the services we provide.
Wandsworth CCG will be in a position in 2013/14 to make investments in key programmes; there are various proposals on which we are focussing to deliver our investments and some of these are already detailed within the Commissioning Intentions and Planning All Care Together strategy (PACT). We have identified the key initiatives in which we want to invest by using the Joint Strategic Needs Assessment and the Health and Well Being Strategy.
- The three themes of the Operating Plan 2013/14
Wandsworth CCG has developed three themes and agreed these with the Local Authority at the Health and Well Being Board. We believe that thesewill help to address the areas of greatest health needs and ensure that we are targeting resources appropriately, to ensure improved health outcomes for our population.
- Prevention, resilience or self-management– We will work with other organisations to create prevention programmes designed to prevent ill-health, giving people the support, information and encouragementthey needto make the step changes towards a healthier lifestyle. Examples of promoting ‘resilience’include the Expert Patient Programme, which provides patients with information and tools tohelp them improve and manage their own health needs.
- Integration – We will integrate local health and social care services where possible, for example in Children’s Services, so that there is a more joined up approach to service provision which feels ‘seamless’ to the service user.
- Collaboration – We will work with surrounding Clinical Commissioning Groups to share good practice and to make changes where needed to local hospital services. One example of this is the Better Services, Better Value review. To find out more about Better Services Better Value you can go to
6. Key Priorities for Wandsworth CCG in 2013/14 based on the three themes
The Joint Strategic Needs Assessment and the Health and Well Being Strategy identify a number of health needs amongst the populationof Wandsworth. The CCG has worked with the Local Authority to approve a number of initiatives based on these health needs. Initiatives are health programmes or work which we will deliver with partner agencies and the Local Authority to meet the needs of the local health population.
The initiatives have been grouped under the three themes of
- Prevention, resilience or self-management
- Integration
- Collaboration
The initiatives under the three themes will be delivered byfour key ‘enablers’. We’ve used the term ‘Enablers’ to describe how we will help deliver our initiatives, by ‘enabling’ the programme in a variety of ways for example by helping to deliverintegrated services. The four enablers are:
- The ‘Planning All Care Together’ (PACT) programme.
- The‘Quality, Innovation, Productivity, Prevention’ (QIPP) programme
- The contracting process for the commissioning of health services across London, this is the way that we buyor purchase the health services the population of Wandsworth needfor the year ahead
- National Outcomes Framework – The selection and monitoring of key health outcome measures where Wandsworth CCG wants to make an impact in 2013/2014
Please refer to the ‘Commissioning Intentions – Summary for Patients’, pages 5 – 14, for a full list of programmes for delivery, presented as a summary version for ease of access. This document is available on the CCG website and has also been circulated along with this summary.
7. Planning All Care Together (PACT)
Planning All Care Together (PACT) is the strategy through which the CCG will help patients with long-term conditions such as diabetes and heart disease, to live at home longer and within their own communities, rather than having to spend long periods in hospital.
The strategy will bringtogether GPs and other healthcare professionals such as nurses, to design local services based on patient needs. These needs have been described in the Joint Strategic Needs assessment (JSNA).
Examples of some of the work which we are planning within PACT are;
- Increasing the amount of time which GPs spend with the most vulnerable patients to carefully plan the care of their long term condition, such as heart disease.
- Through a falls & bone health project we have invested money in services to help people at risk of falls, to prevent falls and bone related fractures.
- A home visiting service with Pharmacists, for patients who take four or more medicines, this is aimed at helpingpatients to learn how to take their medicines properly and to answer any concerns and provide advice.
- We will also provide patients with more ‘self-management’ courses, these courses will show people how to better manage their conditions better to avoid suffering further complications.
We would like to hear what you think
Over the next few months, we will be developing our 5-year strategy for PACT and we would like to hear your views as patients.
The important elements of the 5 year strategy will be;
- Providing more self management services
- Providing an increased number of Community Nursing services e.g. over extended hours and/or locations
- Providing services which require ‘specialist clinical’ skills, this means where the doctor or nurse has more knowledge about a particular disease or condition, such as diabetes or asthma, closer to the patients home and/or with more regular monitoring.
Please see question 2 about PACT in the ‘Patient Questionnaire’ which is available on SurveyMonkey; the link for SurveyMonkey has been given in the email accompanying this questionnaire and the Operating Plan Summary.
8. Quality, Innovation, Productivity and Prevention (QIPP)
QIPP is the ‘Quality, Innovation, Productivity and Prevention’ national programme which is a large scale change programme for the NHS. It aims to improve quality of care whilst making sure that savings are achieved and reinvested in frontline care services.
Wandworth’s QIPP programme has successfully delivered its target for the last three years and we are aiming to achieve our target for 2013/14.
The table below lists the full QIPP projects, along with a description of each individual project and the relevant category under which this sits.
Table of QIPP Projects and Descriptions
No / QIPP Project / QIPP Project DescriptionPrescribing
1 / Prescribing in Primary Care / A programme to encourage the most cost effective use of medicines. Based on clinical evidence, the medicines management team are working to make sure all medicines are prescribed as effectively as possible. This includes:
- ‘switching’ medicines where more cost effective options are appropriate
- not prescribing where no clinical evidence exists
- increasing prescribing to prevent some health conditions developing
Impact – better use of resources and reduced cost.
Planning All Care Together, PACT
2 / Community Ward / To identify and better support ‘high need’ patients with long term conditions so that they are less likely to need to go to hospital for an emergency or to be admitted to hospital. There is a small increase in outpatient appointments as patients are stabilised.
Impact - emergency attendance and admissions avoided.
3 / GP Referrals / A programme to increase the quality of GP referrals into secondary care and promote the full use of community based services. It is supported through education and training of clinicians, practice based software to present national and local guidance, care pathways and referral templates, and formalised peer reviews with trained practice leads.
Impact – reduce inappropriate GP referrals
4 / Falls and Bone Health Programme / Identifying patients at risk of poor bone health and supports them to promote good bone health, through education, exercise and prescription of medicines. Further support is provided for patients at risk of falling and those who have already experienced ‘falls’ through exercise and balance classes and medication reviews.
Impact – more patients receiving bone health medication and identified as at risk, emergency attendance and admissions avoided.
5 / Admissions avoidance for harmful and hazardous drinkers / A range of secondary and primary care services to help harmful and hazardous drinkers manage their health better, including brief interventions, education for reducing impact of alcohol on pre existing long term conditions and helping hazardous drinkers to engage with health care services.
Impact - emergency attendance and admissions avoided. Reduced bed stay for alcohol dependent patients as a result of better underlying health.
6 / Urgent Care Centre / Setting up an urgent care centre to treat minor conditions and ailmentsat St George’s.
Impact – To avoid patients having to wait for treatment at A&E departments.
7 / Other work for patients with long term conditions / A range of rehabilitation and exercise schemes to help patients manage their long term conditions.
Impact – emergency attendance and admissions avoided and patients treated more appropriately.
Secondary Care
8 / Effective Secondary Care Commissioning / Thorough audits of services to make sure the quality and safety of services is of the highest standards.
9 / High Cost Drugs / Examining the appropriate use of medicines and prescribing within secondary care
10 / London Ambulance, Service (LAS) Alternative Care Pathways / Ensure that the correct pathways are used to refer, treat and convey patients to the most appropriate settings.
Impact – Avoidinappropriateemergency attendance and admissions for patients
Non Acute
11 / Intermediate Care / Alternative and better quality provision of beds for intermediate care.
Impact – better quality provision of care
Mental Health
12 / Mental Health High Cost Placements (including some forensics) / Regular assessments of ‘out of borough’ and high security placements. Patients are reviewed more frequently and their care packages adjusted to suit their changing health and rehabilitation needs.
Impact – Patients are reviewed more frequently to make sure their care reflects their changing health needs in care packages
13 / Mental Health Review / A review of mental health services to make sure services are provided at appropriate levels
Impact – Review of services
14 / Dementia / Through the development of a new dementia pathway, patients will be diagnosed earlier and they and their carers provided with support to make sure their health needs are better managed.
Impact – Improved quality of care for patient and carers, reduced emergency admissions in the early stages of the dementia
Financial
15 / Out of Hours (OOH) call handling / The use of a combined call handler for Out of Hours and 111
Impact – Provide better cover for calls and avoid unnecessary expenditure
16 / Translation Services / Contract tender exercise for the services
Impact – savings and better level of service
17 / Any Qualified Provider (AQP) / Examining use of a variety of providers with the emphasis on improving quality and offering choice to patients
Impact – To increase productivity
Diagnostics
18 / Pathology / A scheme to improve the use of pathology diagnostics though the elimination of unnecessary testing and an increase in appropriate test combinations.
Impact – Better use of diagnostics
9. Contracting Process
The CCG commissioning and contracting round for hospital services where the CCG decides what level of healthcare service they would like to purchase for the local population will be underpinned by;
- Contracting performance standards as set out in the NHS Operating Framework
- The National Outcomes Framework
- Local performance measures particular to Wandsworth CCG which have been added to the contract performance management framework
- QIPP performance targets as measures for contractual delivery
- The financial resources available to the CCG
10. Outcomes Framework
We have been asked to identify three health outcomes, which we will use to improve the health and wellbeing of Wandsworth residents. A ‘health outcome’ is how we measure the changes in health taking place, as a result of the services which we provide. For example by providing ‘Stop Smoking’ services and by having patients on this programme over a given period of time, we hope to reduce some long term diseases such as, lung disease and cancer.
Wandsworth CCG has selected the three local outcome measureslisted below, based on medical evidence and research and having taken the advice of Wandsworth GPs and medical professionals.
Three local outcome measures;
- We will measure the number of Wandsworth registered patients attending ‘Stop Smoking’services, so that we can try to lower rates of serious health conditions such as heart and lung disease.
- We will measure the number of people who are diagnosed by their GP as having Dementia and who have then been referred onto Dementia services. This is for patients who have not been previously diagnosed with Dementia.
- People who have had a fractured hip aged 50+, making sure that their chances of getting another fracture is reduced, by asking them to attend a ‘falls prevention programme’ and other self management coursesto manage their health better. GPs will provide details of the courses as well as a referral.
Wandsworth CCG will be targeting investment in these three areas in 2013/14 – stopping smoking, identifying Dementia, improving bone health - and tracking the progress.
For more information
This document is a summary for patients and the public, the full version of the Operating Plan 2013/14 will be available on the website from 8th April 2013; the link for the website is
11. Glossary of acronyms used in this document
AQPAny Qualified Provider
A&EAccident and Emergency
BSBV Better Services, Better Value
CCGClinical Commissioning Group
EoLC End of Life Care
JSNA Joint Strategic Needs Assessment
LASLondon Ambulance Service
LESLocal Enhanced Service
NHSNational Health Service
PPIPatient and Public Involvement
QIPPQuality, Innovation, Productivity and Prevention
SPASingle Point of Access
SWLSouth West London
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