Agenda item

To receive a report from Liz Wise, Chief Officer of the Enfield Clinical Commissioning Group (CCG), on the Clinical Commissioning Group Operating and Strategic plans. 

The Board received a report from Liz Wise, Clinical Commissioning Group (CCG) Chief Officer, on the Clinical Commissioning Group operating and strategic plans. 

Graham McDougall, Head of Commissioning, Integrated and Acute Care at the CCG, presented the report to the Board highlighting the following: 

·       All CCG’s are required to develop an operational plan.  Enfield has produced a draft plan to cover the next two years.  Enfield is also involved in producing a five year strategic plan at the North Central London level. 

·       The trajectories in the operating plan are based on 7 key ambitions.  They align with the trajectories in the Health and Wellbeing Strategy, the CCG Operating Plan and the Better Care Fund. 

·       There is a quality premium concerning access to services and recovery rates. 

·       NHS England had asked the CCG to review the trajectories for IAPT (Improving Access to Psychological Theories) and dementia diagnosis in the original submission. 

·       Reporting of medication errors was also subject to a quality premium.  In Enfield reporting would need to increase by 30% to bring levels up to the London average within peer groups.  The CCG have agreed a target to achieve this over two years at 15% at year. 

·       Much relates to the activity of the acute providers, including the need to reduce emergency admissions across the three acute trusts. 

·       The strategic plan is based upon the activity of the five North Central London Boroughs.  It has been put together by a strategic planning group including representatives from all the boroughs. 

·       NHS England has expressed some anxieties about the initial submission.  More detailed work will be needed to address the challenges and the plan will be resubmitted in September 2014.  The boroughs will need to be more creative about how they work together to meet growing demand and the Nicholson Challenge; addressing rising costs at a time of a continuing reduction in the money available for services.

·       Strategic planning is being carried out to try and bridge this gap and structural interventions put in place including value based commissioning based on outcomes.

·       Improving urgent care so that 95% of people are seen within 4 hours is a significant focus.  There are currently issues at North Middlesex but these are being addressed through a tri partite agreement between the five boroughs, NHS England and Monitor.  There is currently an issue delivering elective care within 18 weeks from the point of GP referral.  It will take time before benefits are realised. 

·       The Royal Free Hospital acquisition of Barnet and Chase Farm will enable Enfield to improve clinical pathways and the quality of care for patients. 

·       Primary Care has been reorganised into a four networks across Enfield.  Work is beginning on jointly commissioned integrated services to manage particular populations, such as people with diabetes.  Working at a network level will enable much wider, more effective interventions.

·       Work on the QIPP (Quality Innovation Productivity and Prevention) financial plan to maintain the sustainability of the North Central London groups is continuing.  There is a wide difference between the financial situation of the northern and southern boroughs: Enfield is £20m undercapitalised. 

Questions/Comments

1.               There are difficulties with the operating plan target on medication errors as the expectation is that the number of incidents reported is maximised at the same time as reducing the number of incidents.  Work is continuing with the Barnet, Enfield and Haringey Mental Health Trust (BEHMHT) to achieve this.  The CCG is also working with the provider to obtain specific borough level data.  Enfield CCG is the lead commissioner for the BEHMHT in this area. 

2.               The target in reporting errors will be achieved through better training and changing cultures.  The onus for this will be on the provider who has to make the changes. 

3.               Deborah Fowler advised that Healthwatch England had written to NHS England and the Local Government Association with concerns about adequate public accountability where two or more CCG’s were working together. 

4.               The suggestion that it would be helpful to include an outcomes table and information relating to patients involvement in their own care. 

5.               Reduction in medication errors is a local trajectory. 

6.               Enfield will have its own version of the five year strategic plan, which will disseminate the key trajectories for Enfield.

7.               The risks will be shared among the five boroughs of North Central London, but not the resources. 

8.               Over the 5 year plan there is a shift in responsibility to the individual.  The evidence that this will improve health outcomes is supported by work with patients which shows that outcomes are improved when patients are directly involved in their care.  It will require a change in the approach of clinicians and major workforce redesign.  There is also evidence from work on diabetes including the DAFNE and DESMOND teaching models. 

9.               The 15% medication errors target is challenging, but realistic in order to make it possible for the provider to succeed.  A transparent approach will help ensure that good data is available and improvement recognised.

AGREED

1.               To note the revisions to the NHS Enfield CCG Operating Plan.

2.               To agree the proposed increase in reporting of medication-related safety incidents by 15%, based on NHS England guidance of a minimum expected 10% increase in reporting.

3.               To note progress to date on the development of the North Central London SPG Five Year Plan.