The future for Luton s primary care services Draft Commissioning Intentions 2013-14
The NHS will have less money to spend over the next three years. Overall, it has to make 20 billion of efficiency savings by 2014-15. Meanwhile, for many reasons, the demand for services is increasing. In Luton, the Clinical Commissioning Group has identified a number of ways we can improve the quality of services through innovation, greater productivity and prevention while keeping to budget limits and this document explains what we plan to do. We hope it will provide a platform for discussion with our providers and the wider public to enable us to refine and improve our services further in the months and years ahead. 1. Introduction 1.1 What is? includes all of the GP practices in Luton. They work together to buy services, review or change services available to the people in their areas. The group s plans for 2012-2015 are set out in the three-year strategy, A Healthier Luton. 1.2 The Clinical Commissioning Group s aims The Clinical Commissioning Group and Luton Health and Wellbeing Board have a joint strategy for 2012-2017, called A Healthier Future 2012-2017. It has three broad goals: Every child and young person has a healthy start in life. Reduced health inequalities in Luton. Healthier and more independent adults and older people. To meet these and to give people in Luton the best, joined-up approach to care, the Clinical Commissioning Group, other NHS bodies, Luton Borough Council, other public services, the voluntary and community sector will all need to work closely together more so than now on commissioning and delivering services. 1.3 Strategic priorities In line with the goals, the Clinical Commissioning Group has pinpointed ten areas which we believe will have the biggest impact: 1. Ensuring a healthy start in life for children and young people 2. Primary and secondary prevention of disease 3. Empowering people to live independently 4. Active management of long-term conditions 5. Improving medicines management 6. Managing planned care and the quality of referrals 7. Improving urgent care 8. Improving the management of people with mental health needs 9. Integrating health and social care 10. Delivering safe, high quality and value for money services 02
1.4 Who is involved? Ten strategic implementation groups (SIGs) have been set up, focusing on a specific area: Long-term conditions Urgent care Mental health and learning disabilities Primary and planned care Children and young people Prevention of illness Prescribing Integration of health and social care Informatics technology and data Value for money Each group will be led by a clinical director and we are encouraging providers and the other people that we work with to be actively involved in them, too. 1.5 Principles for commissioning What is commissioned, how and from whom will be guided by these principles: Ensuring services are based on local need and evidence of what works Involving patients and carers in shaping local services Ensuring that while we provide universal services to everybody, we will also target help towards those families and communities most in need Empowering individuals and supporting self-care increasing individuals ability to improve their own health and wellbeing Making it easier for people to access the right service in the right place at the right time Safeguarding vulnerable children, young people, adults and older people 1.6 Finance The government s Comprehensive Spending Review 2010 predicted minimal growth in the amount of money allocated to the NHS until 2014-15. It places a major challenge on the NHS to deliver 20bn efficiency savings by 2014-15. 03
2. Purpose 2.1 Commissioning plans The draft commissioning intentions set out in this document show how we aim to achieve our strategic goals and improved quality of services through innovation, greater productivity and prevention (QIPP) for 2013-14. They should be considered in the context of the Clinical Commissioning Group strategy A Healthier Luton, the NHS mandate and the Joint Health and Wellbeing Strategy A Healthier Future. The NHS Commissioning Board s Operating Framework for the NHS will also be taken into account. Once finalised, our commissioning plans will be incorporated into the Clinical Commissioning Group s operating plan for 2013-14. 2.2 Commissioning for improved outcomes Our starting point is the health needs of the people of Luton. With the knowledge of our clinicians and the experience and support of our patients, we will build on what works well and change what needs to work better. Our strategic implementation groups plan to commission services to meet a range of outcomes and indicators. They will reflect clinical evidence, guidance, national frameworks and input from providers. A key document here is the NHS Outcomes Framework which will be used to hold the NHS Commissioning Board to account from 2013-14. It has five main areas: 1) Preventing people from dying prematurely 2) Enhancing quality of life for people with long-term conditions 3) Helping people to recover from episodes of ill health or following injury 4) Ensuring that people have a positive experience of care 5) Treating and caring for people in a safe environment and protecting them from avoidable harm National quality and performance indicators that will be monitored in 2013-14, and which all providers should be mindful of, are set out below. 04
2.3 Integrated commissioning A principle of the joint health and wellbeing strategy A Healthier Future is greater integration between the Clinical Commissioning Group and providers. In practice, this means working in partnership, pooled budgets and joint commissioning. The integrated approach is also central to the group s three-year strategy A Healthier Luton and is already embedded in the Luton Health and Social Care Compact Agreement, which commits health and social care to work together and ensure their services are integrated and aligned, as far as possible. 2.4 Commissioning for improved value for money will make it a priority to ensure that the services it commissions are both high quality and excellent value for money. 2.5 Decommissioning services The financial pressure that the NHS and other public services are under demands a big rethink of how we do things. Services will need to be more efficient and some may need to be reorganised. Some services may need to be decommissioned in part or in full. Decommissioning refers to a service that is: Significantly reduced in scope not brought about by lack of demand for example, a key professional may have left and not been replaced, so the service is inevitably smaller Decommissioned in full with no intention of re-commissioning the service from an alternative provider. (Also known as disinvestment.) Where services do need to be decommissioned, the decisions will based on evidence which draws on the views and expertise of clinical and other stakeholders. There will be robust assessments of clinical risk and the impact on equality and diversity. We will consider decommissioning services where: Existing services are not meeting the health needs of the population. For example, the service may be delivered in a location or at a time that may be unsuitable for patients or service changes may be required to reflect developments in medical technology and current standards of care. There is a clear and objective reason for the decommissioning of a service that is based on assessment of the current providers performance, value for money and the need for service redesign to improve outcomes for patients. The original decision to commission the service was made on assumptions that were not realised. The provider cannot deliver the service required and is failing to deliver the outcomes set out in the contract The service is not value for money Benefits to health would be greater if the money was invested somewhere else The service has limited clinical effectiveness or fails to meet relevant quality or safety standards 05
3. Commissioning arrangements From April 2013, how the NHS is organised is changing. Below is an overview of how commissioning responsibilities will be split between, the NHS Commissioning Board and the local authority from April: Luton Clinical Commissioning Group (CCG) Planned care Urgent care (A&E, ambulance, GP out-of-hours) Maternity services Children s healthcare Older people s healthcare Community services Mental health Learning disabilities Abortion Wheelchairs Enhanced services Infertility Home oxygen Infectious diseases NHS Commissioning Board Primary care services (CCG also responsible for improving quality) Community pharmacy Dental Sight tests Specialised services Offender health Armed Forces Public health for children 0-5 Immunisation and screening Sexual assault Local authority Local authority Healthy child programme for school-age children Sexual health Public mental health Physical activity/ nutrition/ obesity Drug and alcohol Tobacco control and stop smoking NHS health checks Falls prevention In addition: For the SEPT mental health contract Bedfordshire Clinical Commissioning Group will be the lead commissioner and Luton CCG an associate commissioner. For the L&DFT acute contract Luton Clinical Commissioning Group will be lead commissioner and Bedfordshire CCG the associate commissioner. 06
4. Commissioning intentions Our draft commissioning intentions, listed by strategic priority, are outlined briefly below. They have been drawn up based on the following criteria: Strategic fit Clinical effectiveness Cost effectiveness Health impact Impact on health inequalities and wider determinants of health Strategic priority 1: Ensuring a health start in life for children and young people Most projects in this category are provided by acute services and community. They include: Reviews of services for children including health visitors, community continuing care, school nursing, paediatric urgent care and phlebotomy (blood collection) Speech and language therapies, audiology services Development of a specialist therapeutic service (trauma, sexually abused) Paediatric rapid response Cancer and palliative care psychology service for children and young people Paediatric sexual assault referral centre (SARC) Strategic priority 2: Primary and secondary prevention of disease Primary care, community services and acute are the main providers of projects including alcohol intervention, stop smoking, weight management, obesity prevention, health trainers and HIV testing Strategic priority 3: Empowering people to live independently Provided by L&D, GP practices and SEPT, this includes services such as adult hearing and wheelchairs (AQP any qualified providers). Strategic priority 4: Active management of long-term conditions Most projects including the integrated community diabetes service, and development of new services such as primary-care led cardiology and chronic disease management are run by sub-acute providers. Risk stratification (the identification of patients at high risk of hospital admission managed in primary care) is run by primary care providers Strategic priority 5: Improving medicines management This category includes: Dietetics Respiratory conditions Diabetes Home care Procurement of wound dressings Providers are in primary or secondary care. 07
Strategic priority 6: Improving medicines management This is one of the largest categories of projects, mainly run by acute providers. It includes: Community hernia service and community eye service Ophthalmology and optometrists Cataract services Community ENT Minor surgery Endoscopy Gynaecology (acute and community providers) Community diagnostics (L&D, GP practice providers) Strategic priority 7: Improving urgent care Provided mainly by acute and community providers, this category of projects focuses on emergency services, such as: Cutting the number of inappropriate attendances by maximising the potential of the 111 telephone service Commissioning an integrated clinical navigator team to pinpoint patients who don t need to be admitted to hospital Urgent care rapid access service and a single point of access, both to cut emergency admissions Integrated discharge review to prevent delayed discharges Communications programme to ensure people access the right services first time to meet their needs Strategic priority 8: Improving management of people with mental health needs Provided by mental health services, community services and others, this category covers a range of projects including: A community service to support older people with mental illness in their own home or a nursing home Expansion of psychological therapies service A review of in-patient rehabilitation services Developing a payment-by-results approach for adult and older people s secondary care Improving crisis and out-patient services Implementing the Luton dementia care strategy New approaches to review and after care for people previously detained in hospital (Section 117) Developing an autism service jointly with Bedford Clinical Commissioning Group Strategic priority 9: Integration of health and social care Projects here, involving all providers in some cases, examine how services can be or are being integrated in areas such as adult community nursing and the carers' breaks service: Strategic priority 10: High quality, save and value for money services This priority focuses on areas such as reducing variation in quality and ease of access to services between Luton general practices, developing new primary care services to ease pressure on the acute sector and value for money in contracts generally. 08