5. Does this paper provide evidence of assurance against the Governing Body Assurance Framework?

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1 Item Number: 6.3 Governing Body Meeting: 4 February 2016 Report Sponsor Anthony Fitzgerald Director of Strategy and Delivery Report Author Anthony Fitzgerald Director of Strategy and Delivery 1. Title of Paper: QIPP Plan 2. This Paper is for: Approval Decision Assurance For Discussion X Assurance For Information Only 3. CCG Strategic Objectives supported by this paper CCG Strategic Objective 1 Engage and enable local people to be involved in decisions made about the healthcare we commission 2 Commission services to ensure and improve quality and safety of services X and improve outcomes 3 Achieve a sustainable Health Economy X 4 Deliver our 2 year Operational and 5 year Strategic plan to transform X services 5 Strengthen and develop partnerships to collectively deliver our shared X strategic objectives 6 The continuous development of a strong, sustainable, successful and accountable Clinical Commissioning Group X 4. CCG Values Underpinned in this paper CCG Values 1 Respect and Dignity 2 Commitment to Quality of Care X 3 Compassion 4 Improving Lives X 5 Working Together for Patients X 6 Everyone Counts 5. Does this paper provide evidence of assurance against the Governing Body Assurance Framework? X YES NO x If you answered yes above, please indicate which principle risk and outline 1

2 Principle Principle Risk Outline Risk No 2 3 Failure to reduce and maintain reduction in GP referral levels. 3 1 Failure to deliver effective commissioning within available resources, including the delivery of the Better Care Fund. 3 2 Quality, Innovation, Production and Prevention (QIPP) plans not fully delivered. 4 4 Failure to reduce and maintain reduction in GP referral levels 6 2 The constituent GP member practices do not adequately engage with the CCG in its work plans and programmes. 6. Does this paper mitigate risk included in the CCGs Risk Registers? If Yes, please outline. Ref: Risk No Outline YES FPCC 8 The Performance Dashboard is a Key Control for the risk: Failure to deliver effective commissioning within available resources, including the delivery of the Better Care Fund. YES FPCC 9 The Performance Dashboard is a Key Control for the risk: Quality, innovation, productivity and prevention (QIPP) plans not fully delivered. 7. Executive Summary Harrogate and Rural District Clinical Commissioning Group (CCG) is required to meet a circa 6.5 million QIPP challenge in. The following paper will inform Governing Body of: The QIPP context and links to the CCG Strategic Plan and Sustainability Transformational Plans (STP) Process undertaken for benchmarking and developing QIPP schemes for Where the savings schemes will be concentrated upon in The CCG approach to implementation and the role of partner organisations The CCG approach to measurement and monitoring of QIPP delivery in. 8. Any statutory / regulatory / legal / NHS Constitution implications The CCG has a duty to ensure delivery against the NHS Constitution and to operate within its Standing Financial Instructions. 9. Equality Impact Assessment All services contained within the report have been subject to equality impact assessment. 10. Implications / actions for Public and Patient Engagement N/A 2

3 11. Recommendations / action required Note the contents of this report for assurance on the development of QIPP plans, areas of savings and approach to monitoring and measurement of QIPP in. 12. Monitoring Reports are brought to each Governing Body meeting and also monitored via the Finance, Performance & Commissioning Committee. For further information please contact: Anthony Fitzgerald Director of Strategy and Delivery

4 Quality Innovation Productive and Prevention (QIPP) Plan 1. Executive Summary Harrogate and Rural District Clinical Commissioning Group (CCG) is required to meet a circa 6.5 million QIPP challenge in. The following paper will inform the Governing Body of: The QIPP context and links to the CCG Strategic Plan and Sustainability Transformational Plan (STP) Process undertaken for benchmarking and developing QIPP schemes for Where the savings schemes will be concentrated upon in The CCG approach to implementation and monitoring of QIPP delivery in The role of partner organisations 2. QIPP Context and Strategic Planning The QIPP plan should not be seen as separate to the current 5 year Strategic Plan of the CCG. The individual savings schemes are matched to the overall vision of the CCG and the individual strategic priorities. One of the key enablers within our Strategic Plan remains To create, with our partners, affordable and sustainable health services. In June 2016, the CCG and partners will submit a Sustainability and Transformational Plan (STP) for the next 5 years. The STP is a system led, place based plan which describes how the CCG and partners will deliver the five year forward view for our local population. In particular the STP must describe how the triple aim better health, transformed quality of care delivery and sustainable finances will be achieved. The STP requires all local health and care organisations within the local footprint to take a partnership approach to quality, innovation, productivity and prevention. Work is currently being undertaken on this, building upon the strong system leadership through Harrogate Health Transformation Board (HHTB), the Public Sector Leadership Board (PSLB) and the work underway through the Vanguard. 1

5 The challenge for the CCG in remains the delivery of in year QIPP requirements. An Operational Plan for will be submitted in April 2016 that will describe how the CCG ensures aggregate financial balance. Key to this plan will be reconciling finance with activity, and a particular focus on delivering savings by tackling unwarranted variation in demand and outcomes. 3. Process undertaken for benchmarking and developing QIPP Schemes for The CCG has undertaken an extensive benchmarking and review of evidence exercise to inform QIPP planning for. This has built upon and extended work undertaken in previous years. Integral to this has been the local development of the Right Care approach. The methodology emphasises value in healthcare commissioning. The commissioning and business intelligence teams at the CCG have utilised tools available through Right Care to undertake benchmarking and identify opportunities for value and savings. These have included: The Atlas for Variation in Healthcare Commissioning for Value Programme. Spend and Outcome (SPOT) Tools Public Health Profiles. In December 2015, a Governing Body workshop helped further refine opportunities for value. A series of schemes have been taken forward by the commissioning managers and Governing Body GPs into development of plans for implementation in. In January 2016, the CCG commissioned additional business intelligence capacity from Embed and Dr Foster. This has allowed additional benchmarking tools (particularly focused on secondary care) to be utilised, as well as experience and knowledge of QIPP plans in other CCGs to be drawn upon. 4. QIPP Savings Schemes The QIPP savings schemes in will be focussed heavily on reduction in unwarranted variation in demand and outcomes. There will be a combination of: Part year effect of existing savings schemes New transformational schemes Transactional payment schemes. This work will focus upon 4 specific areas. 2

6 4.1 Elective Demand Activity analysis and comparison work has identified significant variation within elective care on a number of different fronts. This includes referral rates across the CCG practices and the amounts of secondary care activity being undertaken at the acute providers. The elective QIPP schemes in are focused upon diversion of elective activity away from secondary care setting where there is no clinical value in relation to outcomes and patient experience. The schemes will cover: A reduction in Primary Care referrals and subsequent first Outpatient appointments A reduction in direct access radiology and pathology requests A reduction in secondary care outpatient follow ups A reduction in secondary care procedures. These schemes will all be quality assured by clinical leads. The CCG will ensure there are a number of plans that facilitate the above appropriate reductions. These include improved and easily accessible speciality specific guidance and thresholds for GPs prior to referral. This will build upon significant work undertaken with GPs in 2015/16 regarding referral data and information. In there will also be an increased emphasis on Patient Decision Aids (PDAs) and information sharing with patients. This will increasingly link with the preventative agenda being built upon through New Care Models work. will also see an increased collaborative approach to sustainable elective care with Harrogate and District NHS Foundation Trust (HDFT) clinical staff, through the Harrogate Clinical Board (see below), and increasing use of shared advice and guidance. 4.2 Urgent Care There has been a noticeable rise in demand in the CCG urgent care admissions over the last 3 years. Benchmarking has again demonstrated the CCG as an outlier in relation to peers, and distinctive variation across the health system. Local audits and analysis has also shown there are patients inappropriately admitted, and patients who remain on inpatient wards longer than is clinically appropriate. The New Care Models development is specifically aimed at ensuring a: Reduction in Non Elective Admissions by 20% Reduction in Emergency Department attendances by 10%. 3

7 The work in will use national transformational funding to implement Integrated Locality Teams and additional capacity in the community to ensure such reductions. This will be a phased approach in localities, and will also involve development of new pathways of care and integrated use of IT and shared care records. The CCG has also evaluated Better Care Fund (BCF) investment in order to prioritise spend in to schemes most likely to add value and reduce non elective admissions. The CCG has also developed service specifications regarding urgent care services, that define what is expected for a patient receiving an urgent care admission in. 4.3 Prescribing The plan for prescribing will build upon plans and investments made in this financial year. These are again informed by benchmarking such as commissioning for value, adoption and adaptation of initiatives from other CCGs and development of new initiatives in partnership with local providers, all of which benefit from local intelligence through the CCG s Medicines Management Team. The schemes are based upon: Reduction in inappropriate prescribing of drugs. Switching to prescribing of most cost effective clinical appropriate drugs, applicable in both primary and secondary care. Facilitating correct drug choice through intervention and communication of CCG commissioning positions and drugs formulary. System redesign to improve and accelerate access to appropriate CCG commissioned medication in more cost effective model. In year rebate schemes. The schemes will build upon and expand the successful role out of CCG formulary and OptomiseRx across CCG practices in 2015/16. 4

8 4.4. Savings associated with Continuing Health Care (CHC) and out of areas placements The CCG has worked with its Partnership Commissioning Unit (PCU) arm to identify savings schemes within current spend. The following areas are being worked upon: Savings associated with review of long term CHC packages. Review of block contract contracts. Improved mechanisms for commissioning and payments of out of area placements. Savings generated through improved mechanism for ordering of continence products. 5. CCG Approach to implementation and monitoring of QIPP delivery in The CCG has ensured that each individual QIPP scheme has a dedicated commissioning manager and GP lead. For those schemes related to activity reductions (elective and urgent care demand) there will be trajectories for reductions across each pod of activity (eg 1 st Outpatient appointment). For elective care this will be measured and monitored on a speciality basis. Each QIPP scheme will have specific key performance indicators against: Activity reduction Financial spend Quality. The CCG has introduced a QIPP Delivery Group, which is chaired by the Chief Officer and will monitor delivery of the individual plans. The QIPP dashboard and delivery will remain a standing agenda item on Finance, Performance and Commissioning Committee. 6. The role of partner organisations There is an increasing acknowledgment that sustainable financial systems can only be achieved through a joint approach from organisations. The STP will ensure that this commitment to a joint approach is delivered over the next 5 years. However, there is requirement to work with partners in to deliver the immediate QIPP challenge. In this will be ensured by: 5

9 Engagement with Yorkshire Health Network in particular on reduction in elective care demand. Formation of Harrogate Clinical Board with HDFT clinicians and GPs to ensure appropriate elective spend and clinical outcomes. The governance of the New Care Models implementation with the 6 associated partner organisations. Increasing collaboration with voluntary sector organisations regarding alternatives to secondary care. 7. Conclusion The 6.5 million QIPP for is a significant savings challenge for the organisation. The CCG has ensured that work plan and schemes to achieve this link to the existing priorities of the organisation, and are in line with national requirements. The CCG will continue to build upon work with partners to deliver the savings required. Governing Body is asked to: Note the contents of this report for assurance on the development of QIPP plans, areas of savings and approach to monitoring and measurement of QIPP in. 6

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