Annual General Meeting 20 September 2018 1
Welcome Dr Debbie Frost, Chair, Barnet CCG 2
Housekeeping No fire alarm is planned today. If you hear the alarm, please make your way outside Please turn your mobile phones off or put them on silent The toilets are on this floor 3
Running order Who we are and what we do Working together Challenges we are facing Highlights from 2017-18 How we performed in 2017-18 Plans for 2018-19 Financial performance Questions and answers 4
Who we are and what we do WORKING TOGETHER CHALLENGES WE FACE Kay Matthews, Chief Operating Officer, Barnet CCG 5
Who we are and what we do Our role is to plan and buy health services and ensure these are of good quality and value for money Drugs prescribed by General Practitioners Mental Health & Learning Disability services Primary Care services delegated by NHSE What services do we commission? Planned hospital care Urgent & emergency care (including out of hours services) Most community services Maternity services 6
We don t commission services on our own we commission strategically with others STP Sustainability & Transformation Partnership where it makes more sense to work together with the 5 CCGs, Health Providers & LAs across Barnet, Camden, Enfield, Haringey & Islington eg opening a women s psychiatric intensive care unit Health and social care/ children services where we would want to jointly commission eg community equipment contract LA CCG Health services which are just for Barnet Just eg ophthalmology redesign Engagement with the public Co-design with clinical experts, health providers & patients THE OUTPUTS OF ALL OF THIS COMMISSIONING IS ATTRIBUTED TO THE CCG 7
Our community is changing 52% of 0-4 year old children are from Black, Asian and Minority Ethnic Groups 387,800 Resident population 50,308 The increase in Barnet population before 2030. That s equivalent to the size of Canterbury. 402,748 Registered with a GP Between 2017 and 2031 the population of Golders Green is expected to rise by 121% and the population of Colindale by 115%. 8 We need to plan for these changes and ensure our health services meet the needs of our population
Challenges Children and young people In Barnet: Nearly 1 in 5 children are overweight or obese in reception year (2017) Children under 5 are the fastest growing age group that attends A&E Nearly 1 in 3 children are overweight or obese in year 6 (2017) 4700 children and young people between 5-16 are estimated to have mental health problems
Challenges Adults In Barnet: Life expectancy for both men and women is higher than the England average but there is still a 6.5 years gap between men and women who live in Burnt Oak and Hampstead Garden suburb Life expectancy in Barnet is high but people live later life in poor health On average people in Barnet live 18 years of their life in poor health Because our patients are living longer CHD and Stroke are our number 1 cause of death and our mortality rate from cardiovascular disease for older people age 65 and over is significantly higher than London and England 64-67 years Healthy life expectancy 82 years Average life expectancy 85.2 years 50 60 70 80 90 100 On average, people in Barnet live 18 years of their later life in poor health
Challenges What we need to do Address health inequalities Address these changing demographics Whilst continuing to ensure we are providing our patients with the best quality of care within the NHS financial constraints
Quality and Performance in 2017-18 Highlights from 2017-18 Dr Debbie Frost, Chair of Barnet CCG 12
Quality The golden thread in everything we do Quality involved in all aspects of projects & improvements Quality Safety Clinical effectiveness Patient experience Working with RFL to reduce number of Never Events One of the few CCGs to achieve CHC Quality Premium thresholds Involving more young people in procurement 13
Performance in 2017-18 Key performance highlights include: Maternity The CCG is in the top quartile of best performing CCGs in England for maternal smoking at delivery and choices in maternity services. Dementia The CCG is in the top quartile of best performing CCGs in England for dementia care planning and post diagnostic dementia support. The CCG also has a good dementia diagnosis rate compared to the England average. 14
Performance in Cancer The CCG came top in the country for improvement in one year survival rates for Cancer 15
Last year you said you wanted and we did 16
Last year you said you wanted and we did You said you wanted: A permanent primary care team, with named managers for each practice, who did practice visits One email address you could contact them on Barnet CCG Primary Care Team barccg.barnetccgprimarycare@nhs.net 17
Last year you said you wanted and we did You said you wanted more district nurses and we: Undertook a review of CLCH services Diverted 1m funds to District Nurses by decommissioning the Barnet Integrated Locality Team (BILT) Invested an additional 783K in Last Phase of Life care, of which a proportion will be diverted into District Nursing All CLCH redesign aligned to CHIN developments This new enhanced District Nursing service will start from the new year 18
Last year you said you wanted and we did You said you wanted a wound care pathway We commissioned additional wound care activity from CLCH to support primary care. For moderate, complex and specialist wounds This pathway will also be supported by digital technology. This means: GPs can take photos and send them to this service for advice/ treatment plans This service can take photos and send them to the acute tissue viability service for more complex wound advice This is expected to start from Spring 2019. We will write to you with more details once these are finalised. 19
Last year you said you wanted and we did You wanted us to develop more clinical pathways and integrate it onto EMIS We will trial this in the new urology pathway Integrated onto EMIS 20
2017-18 highlights Dr Debbie Frost, Chair, Barnet CCG 21
2017-18 highlights Finchley Memorial Hospital At Finchley Memorial Hospital we opened: Adams Ward A breast screening suite A CT scanning suite 95% of this space is now leased 22
2017-18 highlights A successful winter We worked really well as a system and had a successful winter Barnet Hospital one of top performing Trusts in London for ambulance handover times 38,000 additional GP appointments created through extended access Achieved lower DTOCs (delayed transfers of care) than trajectory week on week Set up discharge to assess teams to get patients out of hospital on time Flu jabs in primary care 23
2017-18 highlights Ophthalmology Service Procured a one stop shop ophthalmology service. The service starts 1 October 2019 Service starts 1 October 2018 All criteria and further information will be published on the GP Intranet 24
2017-18 highlights Barnet Dementia Hub launched 25
2017-18 highlights CAMHS improvement Overall circa 1.4m additional investment per year in Children and Young Peoples Mental Health and Wellbeing The mental health access target for 17/18 of increasing access by 30%. Barnet exceeded the target of 30% and reached at least 32% which is the best CYP MH Access rate across North Central London Launch of online counselling support 7 days per week, up to 11pm at night (Kooth) with numbers of users increasing month on month and 98% of users recommending Kooth to their friends. The development of the Resilient Schools Programme in partnership with London Borough of Barnet Public Health Department as part of the additional investment being targeted at CAMHS 26
Sustainability and Transformation Partnership - Highlights COMMITMENT AND ENGAGEMENT Together we have developed our partnership to deliver improved health and wellbeing, transformed quality of care delivery and sustainable finances across primary, community and acute care. WOMEN S PSYCHIATRIC INTENSIVE CARE UNIT Following investment of 1million by Camden and Islington Foundation NHS Trust, this unit ensures that women requiring intensive care are not placed out of area as a first response to their crisis and need for intensive care. INTEGRATED URGENT CARE We are one of the first areas to launch the new integrated urgent care model. This means that mental health patients can now ring 111 and be transferred directly to a crisis team for advice and support. CANCER Improving our cancer services. 27
Sustainability and Transformation Partnership - Highlights CANCER Improving our cancer services MENTAL HEALTH Giving mental health services equal priority to physical health services. DEVELOPING TRANSFORMATION PLANS ONCE Making the best use of our resources and ensuring we coordinate initiatives across NCL (where appropriate) to have maximum impact on patients lives and reduce service duplication or variation. PRIMARY CARE STRATEGY In December 2017 work began to develop a primary care strategy for the North Central London CCGs. The strategy will provide further detail on our vision for primary care and its role in improving health and wellbeing outcomes for patients. Work is underway to develop the strategy with health and care partners and there will be 28
Primary Care highlights Dr Charlotte Benjamin, GP member, Barnet CCG 29
2017-18 highlights 96% of GP practices rated good by the CQC 30
2017-18 highlights GP extended access We have made it possible for residents to access GP services 8am-8pm, seven days a week through extended access31
2017-18 highlights Major expansion of the care and health integrated networks (CHINS) 32
Barnet CCG s focus for 2018-19 Kay Matthews, Chief Operating Officer, Barnet CCG 33
Barnet CCG s focus for 2018-19 Business plan 34
Financial performance 2017/18 Matt Backler, Deputy Chief Finance Officer, Barnet CCG 35
Financial performance 2017/18 Financial Performance and QIPP Statutory Duties (1) Target Actual Achieved m m (Y/N) Expenditure less than income 543.2 545.0 N Revenue resource within limit 541.2 543.0 N Running costs within limit 8.7 8.2 Y (1) There are a number of other statutory duties around capital and specified matters none of these are relevant to the CCG in 2017/18 and all were considered achieved. Increased levels of acuity and patient numbers in 2017/18 saw unprecedented cost pressures placed upon the CCG budgets which resulted in an in-year deficit of 1.8m. However: This included an unavoidable 1.8m cost resulting from medicine price increases due to national shortages; The CCG continues to have an accumulated surplus position ( 3.9m) 12.8m (71%) of the targeted 18.1m QIPP programme was achieved. 36
Summary of expenditure Main areas of pressure where in acute contracts in particular urgent and emergency care Continuing care experienced material pressures Remain commitment to meeting the parity of esteem objectives in mental health 37
Looking ahead 2018-19 Financial Plan and Risks The 2018/19 revenue resource limit is set at 556.1m and the CCG has a financial control target of a 0.2m surplus. The QIPP target has been set at 18.9m (3.4% of the resource limit). The programme will continue to focus on delivering transformational savings through collaboration across the North Central London STP. The level of risk in 2018/19 is greater than previous years due to rising costs and patient numbers and it will be another challenging year to deliver the plan. The plans also include reaffirming Barnet s commitment to meeting important spending targets such as the 2018/19 Mental Health Investment Standard (MHIS) and Primary Care General Practice Transformation support. 38
Thank you Questions? Email: barnet.ccg@nhs.net Tel: 020 3688 2299 www.barnetccg.nhs.uk 39