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Stakeholder letter June 2017

Dear colleague,

In this letter we provide you with an update on our work here at Herts Valleys CCG. We hope you find it useful.

Financial position

As reported in previous correspondence, our financial position deteriorated considerably during last year and we were placed in formal financial turnaround by NHS England. Our year-end position was that we did manage to meet the NHS England revised target – this was £14.6m off the original plan. This shortfall carries forward into this current financial year and we now have a savings target agreed with NHS England of £38m. It is our expectation that we need to actually identify £45m to allow for some possible slippage.

Clearly, finding and implementing savings of this magnitude is a considerable challenge and must be a key focus for all of us here at Herts Valleys CCG. Our approach has a number of elements and started with a forensic examination of spend across all areas. Our savings will come from doing a range of things, such as: making some contractual changes with providers; reviewing pathways and commissioning  services in different ways – community rapid response is one such example; reviewing thresholds for certain treatments of limited clinical effectiveness; and looking at what  treatments and services we might need to restrict access to. We are also implementing a programme of savings internally to reduce our own expenditure on running costs.

We have had conversations with all our key providers and partners about our financial recovery plans; this is not something we will do alone but rather we are determined to work collaboratively to achieve our financial targets. We will also be initiating a public engagement programme to explain our financial challenges to local people and to get feedback from them on those proposals that might impact on them. This programme will launch towards the end of June and we expect to be doing this in partnership with East and North Hertfordshire CCG. 

CCG 360 Survey

This annual survey, commissioned by NHS England, asks for feedback from our GP member practices, local NHS providers, partners and patient representatives. The survey was carried out in February and we have now received our results which will be published in full alongside all other CCGs’ outcomes, by NHS England at the end of June.

A number of themes emerge from the results and we are working up actions to address the issues that arise. These are being incorporated in the overarching improvement plan (see below). In summary: we had a good response rate of 64% - the highest we have achieved and higher than the national average; there was a drop in ratings generally, although on many topics we still do well in comparison with national and other averages; the areas where ratings have deteriorated are around: leadership, people’s confidence that we can deliver on our plans and people’s support for our plans.

Our member practices continue to score clinical leadership highly and to say that they understand our financial position and its implications. Public engagement also continues to be a strength overall and scores on confidence in raising service quality issues have improved and are higher than the national average.

Many thanks to those who contributed to this feedback; we will send a link to the full results when they are published.

Improvement plan

In response to the financial pressures and the need to make some changes to meet our challenges, we have produced a draft improvement plan and submitted this to NHS England. It has been approved by our board. This is the plan that sets out how we will address the issues that have contributed to our current financial position and it covers a wide range of areas. Much of the focus is on meeting the series of recommendations made following a review commissioned by NHS England and conducted by Deloittes. This means doing things such as making changes to governance arrangements; creating closer links between localities and the CCG; and strengthening some of our internal functions, such as contracting and business intelligence. The plan also addresses specific issues raised by the results of the 360 degree stakeholder survey. Implementation is already underway and the executive team are monitoring progress regularly.

Community navigators

Our community navigator scheme continues to take significant numbers of referrals from across health and social care and the scheme is highly valued across west Hertfordshire. Last month the scheme was the overall winner of the Hertfordshire High Sheriff Award for 2017. This was in recognition of the partnership working between Hertfordshire County Council, Herts Valleys CCG and the voluntary sector. It also recognised how the scheme is ensuring that vulnerable people from across Herts Valleys are now accessing the support they need within their community.  As a result of winning this award the scheme was presented with a small amount of prize money which will be used to resource a small number of patient participation groups to work with local voluntary sector providers and their GP practice to develop a volunteer- led model of community navigation.

Rapid response service  

We have recently undertaken an evaluation of the multi-agency rapid response service which operates in much of west Hertfordshire to provide rapid assessment to people over 65 in order to prevent emergency hospital admissions and A&E attendances. The evaluation considered other community services that rapid response links into such as community nursing and therapy services, community navigators, the rapid assessment unit at St Albans City Hospital and the Dacorum Holistic Healthcare Team

As a result, we have asked HCT to work with our GP federations to redesign the community nursing and therapy services to better support older people. At the same time, each of our locality GP federations will be developing a specification for an enhanced service that is specifically tailored to the locality and provides quick access to avoid emergency admissions.

We expect changes will be introduced on a phased basis over the coming months prior to October 2017.