NHS Dorset Clinical Commissioning Group Strategy 2013-18 Supporting people in Dorset to lead healthier lives 1
Weymouth and Portland Borough Council
WELCOME Supporting people in Dorset to lead healthier lives This strategy sets out the high level ambitions and principles that will govern the NHS Dorset Clinical Commissioning Group from 1st April 2013. We are delighted that the NHS Dorset Clinical Commissioning Group has been successfully authorised and is now fully established as a statutory body. We are looking forward to building on the robust legacy inherited from the former NHS Bournemouth and Poole Primary Care Trust and the NHS Dorset Primary Care Trust including the strong relationships with partners and providers. The shadow organisation has already been actively engaged in the development of the local Health and Wellbeing Boards with the Local Authorities in Dorset. As we continue our work to help people in Dorset to lead healthier lives, this collaboration will become increasingly more important as we continue to explore opportunities to commission services together and to work innovatively to develop a more integrated approach to the delivery of services. We have been commended on the strength of our leadership, particularly in relationship to the active role and value that our lead clinicians have bought to the organisation and the work that we do. It is our intention to ensure that this continues to be one of our core strengths. We will continue to support and develop our strong capability in both our clinical and executive leadership and in our staff to enable us to meet the challenges of redesigning healthcare services to provide appropriate care aligned to our strategic principles of: designing services around patients; preventing ill health and reducing inequalities; ensuring sustainable healthcare services; enabling care closer to home. We are very much looking forward to leading this new organisation into the future and to building on existing relationships and forging new alliances that will encourage a truly collaborative and responsive approach to meeting the healthcare needs of the people in Dorset. Dr Forbes Watson Chair, NHS Dorset Clinical Commissioning Group Tim Goodson Chief Officer, NHS Dorset Clinical Commissioning Group 3
INTRODUCTION We are the third largest Clinical Commissioning Group (CCG) in terms of population and second largest in financial terms in the country. We consist of 100 member GP practices which are grouped into 13 geographical localities serving a total registered population of around 766,000. All our practices are members of the CCG and have signed up to our constitution. This sets out the governance arrangements for our organisation, how we will meet our responsibilities and how we will achieve our ambition. It describes the key processes for decision making, ensuring transparency and managing conflicts of interest. A copy of the constitution can be found on our website www.dorsetccg.nhs.uk. We cover the same geographic area as the three local authority boundaries of Dorset County Council, Bournemouth Borough Council and Borough of Poole. Dr Forbes Watson Chair Dr Paul French East Bournemouth Locality Dr Blair Millar Dorset West Locality Paul Vater Chief Finance Officer Tim Goodson Chief Officer Dr Richard Jenkinson Christchurch Locality Dr Andy Rutland Poole Bay Locality Chris Burton Consultant Member 4
Supporting people in Dorset to lead healthier lives Dr Jenny Bubb Mid Dorset Locality Dr Rob Childs North Dorset Locality Dr Colin Davidson East Dorset Locality Dr Karen Kirkham Weymouth & Portland Locality Dr Carol Linnard North Bournemouth Locality Dr Chris McCall Poole North Locality Dr Patrick Seal Poole Central Locality Dr Christian Verrinder Purbeck Locality Piers Wilde until end of May 2013 Central Bournemouth Locality Teresa Hensman Lay Member David Jenkins Lay Member Mary Monnington Nurse Member 5
OUR PROFILE Dorset GP practices serve a population of around 766,000 living in sparsely distributed rural areas and within the urban conurbations of Bournemouth, Poole and Weymouth. Overall the population of Dorset enjoys relatively good health with a higher life expectancy than the England average. However there is variation in life expectancy between those in the most affluent and deprived areas, with a gap of over 10 years in men and 5 years in women. Dorset CCG locality boundaries Gillingham Shaftesbury Salisbury The population has increased across Dorset over the last 10 years, in particular the numbers of older people. The high number of older people across Dorset poses a significant challenge for the health and social care system as this is the area of greatest need. Yeovil WEST DORSET Lyme Regis Bridport POOLE COLLABORATIVE Poole Bay Poole Central Poole North Crown copyright and database rights 2013 Ordnance Survey 100051207 Sherbourne NORTH DORSET Weymouth MID DORSET Dorchester Weymouth Portland Blandford Forum Bere Regis PURBECK EAST DORSET Wimborne Minster Poole Swanage BOURNEMOUTH AND CHRISTCHURCH COLLABORATIVE North Bournemouth Central Bournemouth East Bournemouth Christchurch Ringwood Christchurch Bournemouth Dorset CCG age structure 2011 85+ 85-84 75-79 2011 males Dorset 2011 females Dorset 2011 England 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 10 8 6 4 2 0 2 4 6 8 10 percentage of population 6
OUR STRATEGY 2013-18 Supporting people in Dorset to lead healthier lives Our mission, aims, values and strategic principles have been developed through wide consultation and engagement with stakeholders and partners across Dorset. OUR MISSION Supporting people in Dorset to lead healthier lives As leaders and using our clinical understanding we will drive continuous improvements in services throughout Dorset to support people to lead healthier lives for longer. Strategic principles Services designed around patients Preventing ill health and reducing inequalities Sustainable healthcare services Care closer to home OUR AIMS Are to be an organisation that: is trusted and builds confidence in our public, patients and stakeholders; challenges and encourages its partners, members and staff to drive improvements in services and performance; values its staff and membership and is a great place to work; uses resources effectively and efficiently; has a local focus but doesn t lose sight of the bigger picture. OUR VALUES caring collaborative courageous honest responsive responsible Six clinically led commissioning programmes Maternity, reproductive and family health General medical and surgical Cardiovascular disease, stroke, renal and diabetes Musculoskeletal and trauma Mental health and learning disabilities Cancer and end of life 2013/14 annual delivery plan initial priorities Improving dementia diagnosis and services Reducing avoidable emergency admissions Reducing preventable deaths 7
THE NATIONAL ENVIRONMENT The Department of Health has issued a mandate to the NHS England which sets out the objectives for the NHS and highlights the areas of health and care where the government expects to see improvements. Through the mandate, the NHS will be measured, for the first time, by how well it achieves the things that really matter to people. The objectives in the mandate are also at the heart of NHS England s approach to CCG authorisation as CCGs will be expected to secure the best possible outcomes for the patients and communities they serve within available resources, by securing improvement in local health services. Providing safe care Helping people live longer The NHS Outcomes Framework sets out the five domains that the Secretary of State for Health will use to assess the progress of the NHS in improving patient outcomes: preventing people from dying prematurely; enhancing quality of life for people with long-term conditions; helping people recover from episodes of ill health or following injury; ensuring that people have a positive experience of care; treating and caring for people in a safe environment and protecting them from avoidable harm. We will be accountable to NHS England for ensuring that services to the people of Dorset are improved in relation to these outcomes. experience better care Making sure people Helping people recover from episodes of ill-health or injury Helping people manage their ongoing physical and mental health conditions Source: http://mandate.dh.gov.uk/ (Department of Health) 8
UNDERSTANDING LOCAL CHALLENGES Supporting people in Dorset to lead healthier lives DEMOGRAPHIC AND HEALTH NEEDS ECONOMIC QUALITY COLLABORATION AND INTEGRATION PATIENT CHOICE AND INSIGHT increasingly elderly population; people living longer with long term conditions; increasing number of older people living alone and becoming vulnerable; variation in life expectancy; mortality from preventable deaths. deliver quality, innovation, productivity and prevention within budgets; deliver continuous service improvements and efficiency savings; reduce the amount of money spent on avoidable admissions and re-admissions to hospital; reprofile the spends within different sectors of healthcare to reflect the need to provide care closer to home. meeting the rights of our public and patients as set out in the NHS Constitution; deliver improved outcomes for people as set out in the NHS Mandate and NHS Outcomes Framework; ensuring that the providers of healthcare services understand and deliver services that meet and exceed the standards and quality of care required. promote, support and participate in collaborative working with other commissioners of health and social care services and ensure that the complexities of the system do not detract from the ability to work effectively together; consider innovative solutions to encourage integrated patient centred services. ensure that developments in the healthcare system continue to afford the patients right to choice; ensure that effective and respectful listening mechanisms are put in place and that appropriate actions are taken as a result of what is heard. Joint Strategic Needs Assessments (JSNAs) for the area are produced in conjunction with the locality authorities within Dorset and are available on Dorset CCG website (www.dorsetccg.nhs.uk). These assessments are used to inform us and our local authorities about the potential health needs of the population. 9
LOCAL HEALTH AND WELLBEING Our health and wellbeing strategies are produced by two health and wellbeing boards, one covering Dorset County Council and one covering the Boroughs of Bournemouth and Poole. We have been fully involved with the development of these strategies. The strategic priorities that have been identified by these health and wellbeing boards are: BOURNEMOUTH AND POOLE HEALTH AND WELLBEING STRATEGY reducing inequalities; promoting healthy lifestyles and preventing ill health; working together to deliver early intervention, high quality care and better value. DORSET HEALTH AND WELLBEING STRATEGY people live in environments that support their health and wellbeing; people, families and communities are enabled to live healthy and fulfilling lives; people with increased risk of poor health are identified early on and are supported to prevent premature problems developing; people living with long-term health problems avoid complications and maintain a good quality of life. We have developed our own strategic principles which reflect our local knowledge, the things that matter to our patients, and the needs of our local population: DORSET CLINICAL COMMISSIONING GROUP STRATEGIC PRINCIPLES SERVICES DESIGNED AROUND PATIENTS Ensuring access to and high quality integrated care that meets the needs of local people in their community to achieve excellent outcomes for everyone. PREVENTING ILL HEALTH AND REDUCING INEQUALITIES Improving the health and wellbeing of our communities through working with our partners to improve the health of everyone and to address the main causes of illness and death. SUSTAINABLE HEALTHCARE SERVICES Develop a thriving, financially viable health economy delivering safe care and a number of high quality service providers. CARE CLOSER TO HOME Work with our providers and partners to change the way health and social care are provided to ensure that where appropriate care is delivered as close to home as possible. 10
RECOGNISING OUR OPPORTUNITIES Supporting people in Dorset to lead healthier lives LEGACY ECONOMIES OF SCALE CLINICAL LEADERSHIP AND ENGAGEMENT ORGANISATIONAL DEVELOPMENT IN HOUSE COMMISSIONING SUPPORT SERVICES strong and dynamic locality working; active membership - all 100 practices signed up to constitution; strong and meaningful relationships; healthy financial position; strong legacy of public and patient involvement and engagement; health networks aligned to clinical commissioning programmes; strong shadow year of development. co-terminosity with county of Dorset and local authority boundaries; doing things once across Dorset where appropriate; opportunities to test pilots within a locality; resilience; succession planning and skill mix; learning from each other; influence. GP led clinical commissioning programmes; commissioning organised around healthcare pathways and service improvement and outcomes; strong clinical and executive leadership; clinical leadership of wider portfolios such as provider relationships and contract management, learning and development, stakeholder engagement, health and wellbeing boards. development of ambitions; continued development of strong clinical leadership; retained skills; streamlining of policies and procedures; locality development into patient insight and feedback; strategic and integrated partnership development; continued development of clinical commissioning skills; CCG recognition as national leader. collective understanding and ownership of organisational mission, aim, values and behaviours; joined up delivery; organisational memory; local knowledge; shared learning - matrix working; responsive to local needs; enables a locality focus; enables focus of clinical time on value add activity. 11
HOW WE WORK Our Governing Body comprises the Chair of the CCG, the Chief Officer and Chief Finance Officer, GP leads from each of the 13 localities in Dorset and its lay members (a secondary care doctor, a nurse, a lay member with responsibility for audit and quality and a lay member with responsibility for patient and public involvement). The Governing Body has three committees as shown in the diagram below: NHS Dorset Clinical Commissioning Group Governing Body Clinical Commissioning Committee Audit & Quality Committee Remuneration Committee Localities - 13 Clinical commissioning programmes Key GP practices - 100 GPs Governing Body and committees CCG members Clinical commissioning 12
ORGANISING FOR DELIVERY Supporting people in Dorset to lead healthier lives We have embedded the concept of the commissioning cycle within our organisational design and the way we work. At the centre of the commissioning cycle and at the heart of everything we do is patient and public engagement, involvement and good communications. The commissioning cycle Manage quality and outcomes Health needs assessment Prioritisation and work plan development We will work in four directorates, each of which is led by an executive director. These directors will be held accountable by the Chief Officer. The directorates are: quality; service delivery; finance and contracting; engagement and development. Manage performance and demand Stakeholder engagement and communications Current service review Tim Goodson Chief Officer Contracting and mobilisation Securing the services Service redesign and planning Paul Vater Chief Finance Officer Suzanne Rastrick Director of Quality Jane Pike Director of Service Delivery Charles Summers Director of Engagement and Development 13
CLINICAL COMMISSIONING PRIORITIES The commissioning of healthcare is organised within clinical commissioning programmes (CCP). These programmes are led by GP clinical leads and include a number of multi-disciplinary members who bring together their knowledge and expertise to prioritise what needs to be done and to redesign and implement service improvements. The programmes include commissioning managers, secondary care medical and clinical staff, GPs, and specialist advisors in areas such as quality, procurement, business intelligence, engagement and finance. In addition to this other stakeholder groups will be involved and consulted as services are designed or redesigned. This will include the patient, public, carers and potential providers of services. Dorset CCP chairs We have a number of key priority areas that are applicable to all clinical commissioning programmes and these will be managed within the programme structure by dedicated teams. PAN PROGRAMME PRIORITIES Dr Karen Kirkham Maternity, reproductive and family health Dr Richard Holmes General medical and surgical Dr Craig Wakeham Cardiovascular, stroke, renal and diabetes review and redesign urgent and emergency care services; community services review; continued implementation of person centred and integrated care. Dr Chris McCall Musculoskeletal and trauma Dr Ros Maycock Mental health and learning disabilities Dr Lionel Cartright Cancer and end of life 14
Supporting people in Dorset to lead healthier lives Some of the key priority areas that we will be working on over the next few years are shown below. Maternity, reproductive and family health Dr Karen Kirkham General medical and surgical Dr Richard Holmes Cardiovascular, stroke, renal and diabetes Dr Craig Wakeham Musculoskeletal and trauma Dr Chris McCall Mental health and learning disabilities Dr Ros Maycock Cancer and end of life Dr Lionel Cartright review and design children s and young peoples end of life and palliative care services; review and implement pan Dorset pathways of care for maternity services as an integral part of implementation of the maternity tariff; review community paediatric services and pathways of care for chronic diseases in children. develop comprehensive community services for common conditions so that patients can access care closer to home; review, design and deliver new models of care across a number of priority areas to improve patient outcomes; develop referral management approaches for the CCG to ensure right care and right place for patient treatment. develop a balanced approach to the treatment of cardiac disease to improve outcomes for patients ensuring a balance between medical, surgical and interventional management; secure sustainable 24/7 services for stroke and Transient Ischaemic Attack (TIA) patients; further develop the community based model for diabetic patients, including the prevention of long term complications, so that more people can access their care closer to home. develop a comprehensive community based musculoskeletal service; embed the new approach to the management of chronic persisting pain and extend to other areas; ensure we maximise patient outcomes from elective surgery. reconfigure older peoples mental health services to deliver best outcomes and further embed integrated learning disability services; embed models of integrated care for people with dementia; improve primary care mental health services including access to psychological therapies. improve survival for patients with cancer by focusing on earlier diagnosis; ensure effective palliative care is available for all patients; develop and utilise holistic and supportive approaches alongside cost effective new technologies. 15
ENGAGEMENT Engagement is at the heart of everything we do and we are committed to meaningful external and internal engagement to help shape services and improve health outcomes for the population of Dorset. We will build on the existing systems and structures to strengthen and develop robust approaches to communication and engagement across the CCG and CCPs, this will include developing our links with patients, public, partners, providers and other stakeholders including Healthwatch and Health and Wellbeing Boards. We have adopted the principles of the engagement cycle as a model for our work to ensure that there is effective, robust and meaningful engagement with all our stakeholders, either directly through our existing networks and contacts, indirectly through our voluntary sector partners or through Healthwatch Dorset or in partnership with colleagues in local authorities or Health and Wellbeing Boards. 16
FINANCE Supporting people in Dorset to lead healthier lives Our total annual commissioning budget is approximately 915m. The planned percentage share of expenditure in different healthcare areas and in running costs in our first year is illustrated below: Our challenge is not only to ensure that the services commissioned are sustainable but that they also continue to improve within the budget available and support us to achieve our strategic principles. 12% 3% 2% 6% Acute services 484m Mental health services 108m Community health services 94m 2% 10% 12% 53% Continuing care services 57m Primary care services 21m Prescribing 110m Operating plan requirements and reserves 23m Running costs 18m 17
CONTINUED ASSURANCE Supporting people in Dorset to lead healthier lives We will be required to provide in-year assurance to NHS England that we are able to secure safe and sustainable services for patients. NHS Constitution The framework for assurance will include the elements shown in the diagram. The quality of services within the local healthcare providers will be a key aspect of this assurance as it reflects the NHS Mandate objectives to make sure people experience better care and to provide safe care. Our priorities are: establish robust working arrangements with all our partners; develop our own engagement network building on the support and commitment of local people; support clinical programmes to ensure effective patient and clinical involvement; ensure that patient insight and feedback is captured to help influence commissioning decisions; embed the key principles of the engagement cycle across the organisation to ensure consistent implementation; develop effective and robust reporting for our membership and our public to illustrate how the views of local people have influenced our commissioning decisions and made a difference; Quality and service NHS outcomes framework Assurance Stakeholder engagement Organisation capacity Finance build relationships with our local communities and stakeholders to support meaningful engagement in our work and in our commissioning activities. 18
FOR FURTHER INFORMATION NHS Dorset Clinical Commissioning Group Vespasian House, Bridport Road Dorchester DT1 1TS Telephone: 01305 368900 Email: feedback@dorsetccg.nhs.uk Our website: www.dorsetccg.nhs.uk Twitter: @dorsetccg USEFUL LINKS: NHS England www.england.nhs.uk Dorset County Council www.dorsetforyou.com Bournemouth Borough Council www.bournemouth.gov.uk Borough of Poole www.poole.gov.uk Dorset Clinical Commissioning Group 2013