Herts Valleys stakeholder update - February 2017
Here is the Herts Valleys stakeholder update for February 2017.
As reported in our last letter, we have been taking action to bring our expenditure down having been formally placed in ‘financial turnaround’ as a result of our deteriorating financial position.
Part of our strategy has been to establish a new committee of our board – the investment committee – and this is where a group of board members, including local GPs, examines proposed investments to determine the extent of value for money and a return on the investment being made. This includes disinvestment decisions where we need to make savings in areas where there is limited or no added value. The committee considers how we can make best use of our limited resource. Among the committee’s decisions, which will take effect from next financial year, are: changes to contracts with our acute and community providers; changes to some referral arrangements for GPs; new standard specifications for community physiotherapy; revisions being planned for greater ophthalmology activity in the community and more consistency; continued investment in care homes improvement team; and the non-payment to social care of any additional discretionary funding beyond the better care fund – as reported in our last letter.
In terms of this current year, we are now forecasting a year-end position of £8-10 m less than our original target. Actions being taken to meet this revised target (as agreed with NHS England) include: reductions in expenditure on our own running costs; greater scrutiny of payments to providers; reductions in prescribing expenditure; and review of continuing health care cases.
We continue to liaise closely with NHS England and our other partners as we develop plans to meet our financial targets – for this and future years. We need to be mindful of the fact that financial pressures are set to continue in the coming years whilst ensuring the compliance of national standards and improving the health of the local population.
Your Care, Your Future update
The Your Care, Your Future team is holding conversation events about future local health and care services in each of the four areas in west Hertfordshire.
Local GPs from each area are taking centre stage to consider the health needs of the local population and how these needs are best met. This includes outlining plans to transfer a lot of services out of hospitals and instead provide more joined-up health and care services in communities, tailored to local needs. The events are also an opportunity to explain the broader aims of Your Care, Your Future and to update on hospital plans.
Work to transform acute hospital services has reached a significant milestone as the strategic outline case (SOC) for planned hospital developments on the current Watford and St Albans sites has been approved by West Hertfordshire Hospitals NHS Trust board. The SOC also needs approval from Herts Valleys CCG as the commissioner of hospital services and will be considered at our board meeting on 9 March. Once approved, the SOC will go to NHS England and NHS Improvement to determine if we can move to outline business case stage.
Meanwhile work has also started to develop a strategic outline case for a new hospital providing out-patient services in Hemel Hempstead. This work is being steered by a newly formed Dacorum and Hemel Hospital project group which includes patient representatives.
Work to increase local planned, primary and community care services continues. We are working with GP practices to make sure that from 1 April 2017 each care, residential and nursing home will be aligned to a GP practice. This will provide people in care homes with a regular GP, make sure each resident has an annual medical review and ensure that they get the same access to services as if they were living in their own home.
An enhanced community gynaecology service will also be launching in April 2017. New multidisciplinary teams are being established and will be accessible through GPs. This is one of the first services being launched under a new framework in which providers are signing up to co-design and provide joined-up services for patients through a provider collaborative which is based on the national new models of care. In the case of gynaecology services the community provider and hospitals (WHHT, Luton and Dunstable Hospital and the Royal Free) are collaborating to provide a new style service where diagnostic tests and treatments will be combined into one appointment where possible and more patients will be supported locally rather than always having to go to hospital.
Within the next few weeks we will be seeking the views of local people on their experiences of using the range of unplanned, urgent and emergency services in west Hertfordshire. These services include West Herts Medical Centre, NHS 111, minor injuries unit at St Albans, urgent care centre at Hemel Hempstead and A&E department at Watford. The purpose of this is to feed into the work that is being undertaken as part of Your Care, Your Future to develop a future model of urgent care in west Hertfordshire.
Emergency health services across Hertfordshire have been experiencing major pressures during the first weeks of 2017. Accident and Emergency departments have been stretched by the number of patients arriving there as is the ambulance service.
A number of measures have been put in place to help deal with the high number of patients arriving at Watford General A&E department and to support a good ‘flow’ of patients through the hospital. These include: a GP working in the emergency department so that people with minor illnesses that could have been treated within a primary care setting are seen and treated; a ‘queue nurse’ is available to help look after and speed up the transfer of patients from the ambulances to the emergency department and a frailty service is also in operation which allows older people to be assessed more quickly when they arrive in A&E. This has been extended to run six days a week.
These measures are supported by a campaign to encourage people to telephone the NHS 111 service first if they have an urgent medical need. The service provides information and advice about where to go and can dispatch ambulances where necessary. GPs have been encouraged to refer patients to the community rapid response service when that is appropriate for them.
Local digital roadmap
At our January board meeting the CCG signed up to supporting the local digital roadmap (LDR) that is part of the sustainability and transformation plan (STP) for Hertfordshire. It is the digital strategy that underpins the STP and shows how we will use technology for the benefit of patients, service users, practitioners and commissioners. We are now developing timeframes for delivering the various elements of the roadmap which is regularly monitored by NHS England.
One key strand of the LDR is patient empowerment and we will be looking to engage with patient forums in the coming months to ensure that they understand the LDR and also play an active part in helping us use technology to the best advantage of patients.
As well as technology projects, there will also be an underlying project around information governance to ensure confidentiality around data is always considered. This group will also be responsible for ensuring cyber security is considered throughout projects.
You can see the local digital roadmap, as part of the sustainability and transformation plan at www.healthierfuture.org.uk
Delegated primary care commissioning
Towards the end of last year, a ballot was held among our member GP practices in which they voted in favour of delegated commissioning of GP medical services. As a result the CCG has submitted a formal application to NHS England to request this is approved and supported. The outcome of our application will be known in mid-February. If approved, Herts Valleys would take over responsibility for commissioning our 68 GP contractors from April.
This would enable us to design and implement local incentive schemes, general practice budget management and contractual GP practice management.
The benefits of this will be greater local and clinical influence over primary care decision making, improved integration between primary care and other parts of the health system, control of primary care medical budgets, the ability to match local incentive schemes more closely with our strategic intentions and Your Care, Your Future, and the opportunity to improve the quality of primary care.
Integrated personal commissioning
We are one of 15 CCGs in the country who successfully bid with HCC to pilot integrated personal commissioning – a programme that helps give patients a greater say over their own health and social care.
Supported by NHS England this is a joint programme led by CCGs and local government authorities. The pilot aims to simplify and personalise care and improve services for those with complex needs by putting patients in control of their care plan. The programme aims to allow patients to view a breakdown of the services they are using and see how much is spent on each one. If they choose to, they can opt to use that amount of money to choose their own provider (currently only available for social care).
Initially the Hertfordshire pilot will focus on people with complex needs and the programme will also consider how we are improving experiences and outcomes for children and young people, people with mental health conditions and people with learning disabilities. A steering group has been set up with representatives of many ages and from a variety of agencies to help the programme develop and prepare for the future.
We are raising awareness and encouraging people to register with Patient Online. Patient Online enables people to book and cancel GP appointments, renew prescriptions and view medical records via a computer, tablet or smartphone. This means patients not having to visit their local practice or to telephone for appointments.
We have seen an increase in registrations recently. January figures show that most of our practices – 68 per cent - had achieved the minimum of ten per cent registrations. We have been working to promote this across west Hertfordshire so expect to see more progress in the coming months before the deadline in March 2017.
New chief executive
We are pleased to be able to let you know that we now have a firm start date for our new chief executive, Kathryn Magson. She joins us on 16 March and is already busy making arrangements to meet partners, with some of this happening in the run-up to her formally joining us. No doubt you will all get the chance to meet with her in the coming weeks and months.
We hope you have found this information helpful and we will continue to write to you during 2017 to keep you up to date; there is certainly a lot going on.
With very best wishes
Dr Nicolas Small, Chair, Herts Valleys CCG, and
Cameron Ward, Interim Accountable Officer