Update on NHS Central London CCG QIPP schemes NHS Central London CCG has identified circa 11m for QIPP during 2013/14. Commissioning Intentions approved by the governing body included transformational change QIPP schemes aimed at improving the quality of care while achieving efficiency savings. The purpose of this report is to provide the Delivery Programme Board with an overview of the schemes and to outline progress. It is intended that the paper will demonstrate how we are delivering each scheme and communicate current issues in order for the group to agree an action plan going forward. Table 1 shows the current QIPP plan whilst Appendix A provides the overview and update. Table 1 QIPP Plan by Domain Source: Updated QIPP Overview, version 15 April 2013 Page 1 of 8
Appendix A: QIPP Scheme analysis Scheme and lead Key milestones Benefits Current Status Governance Wellwatch, Rosalyn King Project: Wellwatch is a telephone-based Case Management Service for patients with one or more long-term conditions. Change: Although an established service, Wellwatch will deliver a considerable increase in activity in 13/14 amounting to 7,200 patient plans. Wellwatch Business case and tender waiver approval (pending approval) 7,200 patient plans -455 NEL admissions - 1.1M net saving Business case and tender waiver to be presented at next investment group (16 th June) for approval Operational problems have been encountered Number of care plans produced are below forecast target Community matron has been released from post due to performance issue so no team lead currently in place Management of the PRS service through bi-monthly CCG/CLH contract F&P sub-committee Primary Care Plus, Rosalyn King Project: PC+ will deliver a service that enhances mental health services in primary care settings. Change: PC+ comprises a single point of access, assessment tool, PC+ team and a development in counselling services to support patients from secondary community care to primary care. A Mental Health project manager appointed (complete) Plan to rollout to all 36 practices by December 2013 (complete) Discharge template agreed with secondary care providers. KPI s established (complete) 171 discharges from particular MH clusters (FYE) -407 referrals to secondary care (FYE) - 1.2M net saving Business case has been approved Operational problems have been encountered New programme manager has been appointed Rollout of the service has been delayed due to an amendment of GP Single Assessment Tool to link with QOF Target rollout across central locality anticipated by end of June, subject to rollout pilot sites Management of the services through a dedicated Special Interest Group (SIG) F&P sub-committee Page 2 of 8
Scheme and lead Key milestones Benefits Current Status Governance Cardiology, Alan Keane Project: The community cardiology contract is an existing service to provide high quality, accessible, consultant led cardiology services in the community. Change: This savings plan aims to increase productivity through marketing and capacity management. Status: Community cardiology contract will now sit beside the larger Imperial contract and be monitored by the CSU. Formal contract end date is Sept 2013 with option to extend. Scoping exercise with WLCCG to explore expansion / redesign of service. Scoping exercise with WLCCG to explore expansion / redesign of service (May 2013) -1,065 cardiology OP attendances - 210k net saving Contract management of the existing Community Cardiology Service has migrated over to the CSU Updated service specification has been produced in partnership with WLCCG Regular Cardiology service review led through Imperial contracting team Management of the PRS service through bimonthly CCG/CLH contract CCG/CSU contract Integrated Health and Social Care Redesign (HSCC), Rosalyn King Project: Rapid Response and Hospital at Home services will be integrated into the wider health and social care intermediate care services. The Team will use a single assessment process across health and social care and will consist of a multi-disciplinary workforce of social workers, nurses and therapists. Workshop on 24 April to identify key milestones -654 NEL admissions - 1.3M net saving Teams have been aligned to GP practices Workshop held on the 24 th April agreed new single referral form 2 items being discussed at next meeting Management of the PRS service through bimonthly CCG/CLH contract Status: HSCC s are currently in post liaising with GP s, community providers, social care and patients. Workshop scheduled for 24th April to review current referral pathways and determine how providers can integrate with Wellwatch. Attendees will include clinical leads and community / voluntary / social care providers Page 3 of 8
Scheme and lead Key milestones Benefits Current Status Governance Inter-Practice Referrals, Rosalyn King Project: Introduction of an inter practice referral service that will facilitate and promote collaborative working between practices in managing patient need. Status: Allocation of specialities in terms of activity and cost cannot be detailed at this time due to the scoping work which is required. Prescribing, Chris Corfield Project: Managing and reducing prescribing costs through: Use of alternative brands at lower unit cost Using Eclipse software to identify the most valuable related savings opportunities in each GP practice Identification of suitable specialities to be included in scheme (April 2013) Adoption of agreed methodology for confirming GPwSI status (April 2013) Development of appropriate contractual framework (July 2013) Agreement and sign off from participating GP practices (September 2013) Internal testing of Eclipse software (ongoing) Rollout (Q1) -1408 OP attendances - 100k net saving Identification and development of specifications to begin latter part of May Resource issue has been raised as a risk - 650k net saving Eclipse software has been approved and will be rolled out to GPs following internal review Rebate schemes have been identified and 2 signed off with more anticipated Reporting to TRG / CCG Programme Board Highlight report of progress to be developed and presented to the CCG Programme Board Reduce medicines related harm. Page 4 of 8
Scheme and lead Key milestones Benefits Current Status Governance Outpatient Referral Standardisation, Rosalyn King Project: PRS is an existing service which manages routine referrals. Also, work continues with our internal peer review programme to promote collaborative working. Existing community contracts will further be utilised or, where necessary, re-tendered. PRS Business case and tender waiver approval (pending approval) Review of locality action plans and sharing of best practice (April 2013) Increase in referral management threshold - refer back to primary care or redirect to community services (April 2013) Rolling programme of procurement (ongoing) -1,408 OP attendances - 100k net saving Business case and tender waiver to be presented at next investment group (16 th June) for approval Operational problems have been encountered Changes in the operational procedures and staff illness has resulted in a backlog of unprocessed referrals As at 10 th May, 946 appointments were outstanding with 417 being within KPI target of 5 working days Management of the PRS service through bi-monthly CCG/CLH contract During April, as part of emergency measures to reduce backlog, patients were not contacted by telephone; all appointments confirmed by letter Implementation of policy to re-route referrals back to own GP when appropriate has not been introduced Community MSK Dr Goodstone is reviewing the existing MSK service specification Page 5 of 8
Recommendation for the future to be presented at May TRG Procurement may take 6-9 months Community Dermatology Dr Maniera and Dr Mintz have provided input for Community Dermatology service specification Service specification to be modified and business case developed for TRG recommendation Procurement may take 6-9 months Diagnostics, Rosalyn King Project: 1. To reduce the number of unnecessary direct access diagnostics requested by GPs. 2. Maximise bundled tariffs including those in the community through block contracts. 3. GP education These programmes are managed by the CLH Patient Referral Service. PRS Business case and tender waiver approval (pending approval) - 250k net saving PRS provide a fundamental role in managing direct access diagnostics See Outpatient Referral Standardisation, current status CCG TRG sub-committee Abortion Services, Alan Keane Project: Introduction of an AQP for Abortion Services across NW London. This will deliver savings through a single pricing schedule for all providers. The CCG is seeking additional information on this scheme which is being implemented across all NWL CCGs - 50k net saving AQP procurement process has finished Contracts require finalising before implementation It has been questioned whether the savings will be achieved; decision required as to whether it remains a QIPP scheme CCG TRG sub- committee Page 6 of 8
Scheme and lead Key milestones Benefits Current Status Governance End of Life Care, Sharon Yepes-Mora Project: Introduction of a LES for Coordinate My Care, to maximise uptake within Practices and ensure Patients receive the best possible death. The LES will deliver savings based on more coordination of care with patients wishes being communicated to all providers therefore reducing non-elective admissions. Circulation of the new LES to practices and Locality Co-ordinators to support sign up (May 2013) -139 NEL admissions (for cohort of patients in the last 6 months of life). Phased Q2-4, no reduction in Q1. - 350k net saving Coordinate My Care LES to be launched week commencing 12 th May CCG TRG Community contract efficiencies, Contract Leads Project: To achieve better cost and value of care. Change: To achieve efficiencies through contract negotiations. Conclude contract negotiations (April 2013) - 3.6M net saving Negotiations have concluded Information provided by collaborative PMO reflects shortfall of 598k TBC Acute contract efficiencies, Contract Leads Project: To achieve better cost and value of care. Change: To achieve efficiencies through contract negotiations. Conclude contract negotiations (April 2013) - 1.9M net saving Negotiations have concluded with exception of ICHT Paediatric planned care, Alan Keane Project: To deliver service improvements and consequent efficiencies in maternity care. Change: To decommission the existing non-recurrent funding commitment and for providers to continue delivering the services. Conclude contract negotiations (April 2013) - 580k net saving In progress and awaiting the conclusion of negotiations with Imperial Page 7 of 8
Scheme and lead Key milestones Benefits Issues and risks Governance A&E, Rosalyn King Project: To improve emergency care services by supporting patients to receive urgent care in a primary care setting. Change: Target practices which have the highest A&E attendances, extended primary care services, UCC tariff renegotiation, WellWatch, Intermediate care for the homeless, a CCG behavioural change programme. Evaluation of winter initiatives funding - GP Walk in Development of business case for extended opening (May 2013) - 250k net saving Locality team are auditing the top 7 practices for A&E attendance (after the 2 homeless practices) Results will determine individual action plans for each practice linked to their practice plans Mental Health, Contract Leads Project: Improve contract efficiency and productivity to achieve better cost and value of care. This includes shifting setting of care, reduce out of area placements and additional efficiencies Change: Contract negotiations Conclusion of contract negotiations - 833k net saving Negotiations have concluded Information provided by collaborative PMO reflects full delivery TBC Children s Services, Alan Keane Project: A one-off benefit of changes in after-school activity. Confirmation of budget reduction from children s team (April 2013) - 20k net saving Awaiting confirmation of delivery from Children s team Change: Contractual contribution not required Page 8 of 8