Subject: Meeting: Bedfordshire, Luton & Milton Keynes (BLMK): STP Update NHS Milton Keynes CCG Board Date of Meeting: 23 May 2017 Report of: Maria Wogan, Director of Strategy and Planning Is this document: Commercially Sensitive For the Public or Private Agenda To be publically available via the CCG Website N Public Y 1. SUMMARY This paper sets out an update on progress with the BLMK: STP since the last Board meeting. 2. RECOMMENDATION The Board is asked to note the report. 3. BACKGROUND The CCG continues to engage actively with the BLMK: STP across all of the STP priority areas and cross-cutting workstreams. The CCG s Operational Plan 2017-2019 has been developed to align with the STP vision and priorities and the PMO will manage interdependencies between these plans. Priority updates 1. Priority 1 Prevention Work is already in full swing to embed a culture of prevention across BLMK so we can keep people healthy, improve care and quality and reduce the burden of ill health.
Prevention Champions A region-wide Prevention Steering Group, with nominated Prevention Champions from the STP partners, has been established to monitor, encourage and empower colleagues to work towards improved prevention in the region. They are championing the delivery of new prevention plans across organisations. Falls and Fracture Prevention A fracture liaison service is due to be implemented at Bedford Hospital later in the year to offer specialist support to people who have fallen, or are at risk of falling. This and similar approaches are being discussed by a falls and fraction prevention group which has formed across BLMK. Social Prescribing Using a model currently in practice in Luton, whereby patients can be offered targeted support and navigation to non-clinical services to try and improve their health and well-being, the Priority 1 team have put a business case together proposing an approach to roll social prescribing out across BLMK. This will require investment from the CCGs in MK and Bedfordshire. 2. Priority 2 Primary, community and social care The STP aims to provide better care, closer to home and ensure organisations are working together to improve outcomes for the patients. Commissioners across the BLMK STP have agreed a joint approach to primary, community and social care development based on the following ambitions: Integrated working across the wider health, social care and voluntary community ensuring that our residents and patients receive care from the appropriate service or professional Patients are provided with personalised, coordinated and responsive care nearer to their home The GP remains central to patient care and care planning, supported by the multi-disciplinary team to coordinate care across all elements of the health and social care system GP shared decision making and involvement during transitions between sites of care, e.g. when patients are being discharged from the hospital Clear and timely communication and information flows between health and social care professionals, patients and their families.
A clinical conversation event aimed at GPs took place on 3 May in MK and was well attended by GPs from across BLMK. MK CCG commissioned MKUCS and 111 to provide cover for practices from 5.30pm so that practices could close to enable GPs and other practice staff to attend the event. The feedback from the event will be used to launch the STP s primary care programme and we will provide more details of this programme when it is available. 3. Priority 3 Sustainable secondary care Our three local hospitals play a crucial role in providing care for local people and they are continuing to work closely together to develop a unified service across our three existing hospital sites to ensure services continue to be delivered safely and well. Any proposed changes to hospital-based care will also need to be integrated with, and supported by, new models of care across primary, community and social care. 4. Priority 4 Technology If we are to create integrated models of care and encourage greater collaboration across organisations, we need to transform the way we securely share information. The need for electronic sharing of patient records locally has been recognised as fundamental to achieving many of the goals set out in the STP. A plan has been created for a strategic Shared Health & Care Record and Patient Portal project following a very well attended Supplier Event where six key suppliers presented their ideas and systems followed by discussions with over 70 attendees from across BLMK. 5. Priority 5 System redesign This work is considering how the various components of the current health and care system - prevention, needs assessment, demand management, commissioning, contracting and health and social care supply can work together better, so they create a positive and lasting environment that supports and accelerates solutions emerging from other front-line STP priorities.
In advance of P5 progressing its system redesign thinking too far, the STP programme has been engaging with the leadership teams of individual partners to listen to partners views on how best to proceed with this work. We are pleased to report that we were successful in securing funding from the Sustainability and Transformation Fund for diabetes, mental health 24/7 liaison service and cancer services. CCG staff are working with colleagues across the STP on the implementation plans for these new initiatives. Joint Commissioning Executive The Joint Commissioning Executive between the 3 CCGs will have met four times by the time of the Board meeting. The main focus of the JCE s work is on achieving closer alignment between the work of the three CCGs. STP Engagement STP public engagement activity is currently on hold due to purdah. The CCG is engaged in all elements of STP delivery and the PMO is coordinating this input and provides a weekly report to EMT summarising the outcomes of STP meetings and any actions for the CCG. Alignment of MKCCG Operational Plan and BLMK: STP Following approval of the Operational Plan for 2017-2019 at the CCG Board in January, work is now underway to ensure effective delivery of the key milestones and QiPP initiatives due for completion in Year 1. Rigorous monitoring of delivery is critical as the level of operational and QIPP challenge for 2017/18 is significantly greater than in previous years. Also, delivery of the Operational Plan milestones needs to be accomplished within the context of the longer-term plans of the 5 BLMK: STP workstreams. Therefore to strengthen the delivery of the Operational Plan (including QIPP) the following governance arrangements and PMO support has been put in place: A high level MKCCG Plan 2017-19 has been developed to visually show the key milestones for overall operational delivery. A copy is attached for information. This will be actively monitored through the PMO, with key milestones tracked and reviewed to give assurance for how well delivery of the plan as a whole is progressing. Regular reporting of this, to the
CCG Board, will be given on a quarterly basis with the first report due at the July Board. A QIPP Executive Group (QEG) has been established to oversee delivery of the specific QIPP initiatives contained in the overall plan this group meets every two weeks and all exec directors are core members of the group, with GP Board members attending a meeting once a month. The focus of the group is on ensuring delivery of schemes by resolving any issues, the group is also be responsible for identifying new schemes to meet the QIPP target in 17/18. Programme/project managers are invited to present progress with their schemes and particular attention will be given to implementation that is significantly off-plan. An MK Savings Delivery Group (MKSDG) has been established providing a forum for programme/project managers to report on progress with their projects and receive support from colleagues to resolve any issues/delays with their schemes. It will also be a forum where the PMO and finance teams can report on overall progress, assist with managing dependencies (between CCG projects and with the STP) and consult on new templates/reporting requirements. All programme/project managers are invited to a meeting of this group once a month and a smaller sub-set of the membership meets a second time in the month to ensure momentum on delivery is maintained. Improvements are being made to the reporting of progress on schemes and the PMO has developed new templates for highlight reports, a business case-lite, PIDS and workbooks. The PMO is also responsible for tracking progress against the master plan which will be informed by highlight reports submitted by programme/project managers once a month.
MKCCG PLAN 2017-19 (Including QIPP Delivery - V0.12) Apr- June Q1 17/18 Jul Sep Q2 17/18 Oct Dec Q3 17/18 23/05 25/07 26/09 28/11 23/01 Jan Mar Q4 17/18 27/03 RightCare Clinical Triage Live Cardio / Resp Business Case Community Cardiology Contractual Monitoring Integrated Diabetes Hub Live Hub Live Patient & Provider Engagement Service Redesign with Providers (18 month Proof of Concept) Monthly data returns, light touch changes, review and identify next steps Implementation Integration Preparation Maternity & Early Years LMS Plan Due Stages to be defined Patient Flow Complex Patients/Discharge Urgent Care 111 service DHU go-live 111 go-live review Latest AECU data Proposal due from MKUHFT Agree discharge policy Rapid Response Phase 2 In depth review of AECU data Service Re-design stages to be defined Planning for Urgent & Emergency Care Centre (subject to MKUHFT proposal) stages to be defined Children s Continuing Care & Complex Needs Continuing Healthcare / Personal Healthcare Budgets Go live ED disp. CAS 24x7 service in place High Intensity User Support Pilot 6 months CHC Residential Care Procurement Green 2 CAS Business Case development Discharge to Assess policy roll-out Ongoing monitoring and further development of Integrated Urgent Care Quarterly review of budget 30/06 Dom Care Procurement Appt of provider(s) 30/06 Procurement commences Heart Failure admission avoidance pathway established Discharge to Assess post project review High Intensity User Support Transition to BAU (Subject to evaluation) Quarterly review of budget Ongoing monitoring 31/07 FT Early Assessments Go Live 30/09 Dom Care Go Live following procurement Sept - Change Policy operational 31/10 Provider(s) appointed Quarterly review of budget 31/12 Go Live 31/03 Service users transitioned Clinical Priority Best Value POLV communications & contract changes RMS 100% of referrals & procurement Advice and Guidance Project being defined Prescribing QIPP Board decision re changes Produce Annual Plan 01/06 - Finalise POLV Policy 01/06 - Initiate Comms plan Finalise Procurement Procurement Monthly Monitoring Implementation CQUIN Payment CQUIN Payment CQUIN Payment CQUIN Payment Review progress Review progress Review progress Review progress Dermatology PCOC Service Review & Re-design 30/06 Service Spec Review Care Closer to Home ENT Pathway Re-design Gynae PCOC Service Review & Re-design Service Model Agreement Scoping 2017-19 CPNT plans Ophth : Glaucoma pathway implemented Complete review of Community Paediatric Nursing Team GP Forward View Delegated Commissioning 31/05 Contract Variation & Service Spec 16/05 B.Case Approval 30/06 Comm ENT Nurse in place MH P.Care pilot commences in 4 practices Care Navigation & Signposting Training 30/06 Service Spec Review Implement new service model either via procurement route or with the current provider Brooklands Practice ready GP Access Fund Contract award 3/head projects Procurement process ends Whitehouse B.Case approval Development of GP Federation 30/06 Federation legal entity Mental Health & Learning Disabilities Draft Mental Health Transformation Plan 2017-19 currently under development Delivery of PEP OOA Placements Children & Young People s Mental Health & Wellbeing Local Transformation Plan Refresh of LTP Implement agreed framework C2C Better Care Fund / Partnership Contributions Monthly Monitoring 31/05 Agree plan for joint review (Project stages to be defined) 01/04 AQP Acupuncture decommissioned System Infrastructure Delegated Commissioning Acute Contract Challenge Implementation of SEND Reforms CNWL Patient Transport Service Estates Rationalisation District Nursing Rationalisation of Meds Admin Mental Health PEP OOA Placements Reducing AQP Podiatry End of Life Psychology Continence Services Adult Hearing Service Apr - Review data sharing arrangements Apr - Review out of area issues Board Decision 25/04 30/04 Implement consultation outcome and contractual changes PID under development for transfer of service to SCAS 30/04 Scoping & review of CNWL estates proposal 30/04 Scoping review of HQ Implementation and ongoing review Monthly Challenge process CNWL Bundle 30/06 Proposal Consultation 31/08 Decision re changes 31/08 Stakeholder Engagement\Staff Consultation 01/05 Go Live 01/06 Realign formulary 12/05 Draft contract variation 16/05 Contract Variation Approval at CDG 01/08 Continence Nurse in post (Further stages to be defined) Timelines to be defined (subject to CNWL confirming whether TUPE may apply to the staff in the service) Develop scope for nursing home activation (timeline tbc) 30/06 Provider s Clinical system is upgraded for pathway monitoring Contract Monitoring Process WICU Board Decision 25/04 (Project stages still being defined) IV Service in District Nursing Phase 2 Stakeholder engagement on proposed changes to pathway CNWL Bundle Decision re changes Notice to providers on Commissioning intentions Apr 18 New pathway commences MKCCG Board Dates Contracts Signed Finalise Procurement Decision Required Key Go Live Events Service Decommissioned Procurement Outcome Milestones Monitoring Data Service Reviews