GOVERNING BODY MEETING in Public 26 September 218 Report Title QIPP Individual Schemes Highlight Report Appendix A QIPP Individual Schemes Highlight Report
Appendix A Financial Performance Report Month 5 as at 3 August 218 Scheme Highlight Report
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Elective PbR Schemes - RAS, Right Care & PLCV Planned - 46, 47, 615, 1,545, YTD 346,65 316,85 266,5 615, 1,545, QP/218/1,4 & 12 Total YTD 13,33 83,33 83,33 83,33 83,33 83,33 83,33 83,33 83,33 83,33 83,33 83,37 93, (615,) 13,33 83,33 83,33 83,33 83,33 - - - - - - - 346,65 346,65 - - - - - (83,33) (83,33) (83,33) (83,33) (83,33) (83,33) (83,37) (583,35) 961,65 Elective PbR Schemes - RAS, Right Care & PLCV Performance Project QIPP Clinical Exec Lucy Price Lucy Price Dr Daniel Harle 1,8, 1,6, 1,4, 1,2, 1,, *Implement a referral assessment service which comprises of three elements: a healthcare IT platform, a specialist triage service, a nd an appointment booking s ervi ce. *Improve the quality of referral information, reduce GP clinical variation, and ensure that patients are provided with the right care and at the right time. *Enable improved patient choice of provider, with supporting information *Provides learning to the referrer through specialist advice and guidance *Ensure a consistent approach, based on best practice, is taken in commissioning services of "limited value" 8, 6, 4, 2, Anticipated benefits *% reduction in waiting times for specialist procedures *reduction in variation between high/low referring GPs *% increased number of patients seen appropriately *% increased number of patients being offered appointments in a timely manner *% reduction in referrals across all specialties identified (Cardiology, Gastroenterology, General Surgery, Ophthalmology, Orthopaedics, and Paediatrics) *The scheme reflects savings across the health economy and the high risk reflects the potential for gain share arrangements with providers under block contract *The following specialties are now live: Cardiology, Gastroenterology, General Surgery, Orthopaedics, and Paediatrics. *Additional work is currently being carried out in collaboration with NHS England and other CCG's to refine the referral proccess in relation to Ophthalmology. Once a process has been developed and put in place, it will support capacity within primary care and will enable the specialty to go live within this service.. 28/9/218 Lucy Price Obtain feedback from triagers, collate results 28/9/218 Lucy Price Circulate online GP / Practice Staff Survey, collate results 29/1/218 Lucy Price Develop case study to include performance and evaluation of the Referral Assistance Service to date including options post end of pilot phase (31/3/19) 5/11/218 Lucy Price Draft case study and stage 3 project report to be presented to November PMG 14/11/218 Lucy Price Draft case study and stage 3 project report to be presented to November Finance Committee 3/1/219 Case Study and cover paper to be presented to January Governing Body outlining options (inc. preferred option) post end of pilot phase Page 2 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) High Cost Drugs (Biosimilars) Planned - 35, 16, - 51, YTD 212,5 137,5 16, - 51, QP/218/2 Total YTD 42,5 42,5 42,5 42,5 42,5 42,5 42,5 42,5 42,5 42,5 42,5 42,5 51, - 42,5 42,5 42,5 42,5 42,5 - - - - - - - 212,5 212,5 - - - - - (42,5) (42,5) (42,5) (42,5) (42,5) (42,5) (42,5) (297,5) 212,5 High Cost Drugs (Biosimilars) Performance Project QIPP Clinical Exec Andrea Lunt Lucy Price Dr Graham Duce Alex Mitchell 6, 5, 4, 3, 2, 1, * To maximise the potential QIPP opportunity that the introduction of defined biosimilars PbR excluded drugs offers as alternative safe and effective options to the currently used parent originator products * To deliver a total annualised QIPP opportunity of 5, *Cost savings opportunity *Improved monitoring and controls *Cross system working cultivating Capped Expenditure Programme principles which will encourage a change in culture * It is anticipated the scheme will deliver. Concerns are that higher number of new patients commence in year. undermining savings from existing patients switches * Pace and timescale for project /change to be delivered will depend upon successful clinical engagement and patient education. * Medicines Management Team will be working closely with clinicians to agree protocol 31/5/218 Andrea Lunt Engagement with key stakeholders to discuss and agree principles, gainshare, monitoring and timescales for the introduction and completion of a managed program for each identified biosimilars. 31/5/218 Andrea Lunt Develop and agree prescribing commissioning policy for introduction of the identified biosimilars. 31/1/218 Andrea Lunt Update formulary and clinical pathways to include biosimilars and denote as the locally preferred options 31/1/218 Andrea Lunt Develop and agree Blueteq templates to support the implementation and monitoring. 31/1/218 Andrea Lunt Communication to all providers to ensure they are aware of the new policy/pathway and what the key changes are. Page 3 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Stroke (Recurrent, Block) Planned - 68, - - 68, YTD 68, - - - 68, QP/218/3 Total YTD 68, - - - - - - - - - - - 68, - 68, - - - - - - - - - - - 68, 68, - - - - - - - - - - - - - 68, Stroke (Recurrent, Block) Performance Project QIPP Clinical Exec N/A N/A N/A Alex Mitchell 7, 6, 5, 4, 3, 2, * Negotiate improved settlement for funding of hyperacute stroke care at Stockport FT bringing CCG into line with peer commissioners * Significant savings with no service reduction. * Improved clinical pathway compliance * Savings have been realised for 218/19. There is further opportunity for savings on inpatient stroke stay on further development of early supported discharge 1, 1/4/218 Alex Mitchell Contract agreed at target value. Length of Stay already below target. Page 4 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Stroke (Non-recurrent, Community Rehab) Planned - 291, - - 291, YTD 134,843 256,16 - - 391,3 QP/218/5 Total YTD - 26,42 26,42 59,753 22,25 36,59 36,59 36,59 36,59 36,59 36,59 36,62 391,3 1, - 26,42 26,42 59,753 22,25 - - - - - - - 134,843 134,843 - - - - - (36,59) (36,59) (36,59) (36,59) (36,59) (36,59) (36,62) (256,16) 34,843 Stroke (Non-recurrent, Community Rehab) Performance Project QIPP Clinical Exec Jacki Wilkes Anita Mottershead Dr Sarah Oliver Fleur Blakeman 45, 4, 35, 3, 25, 2, 15, 1, * Robust discharge process for patients who require long term placement * Commissioned integrated community stroke rehabilitation service including in-reach services to patients in an intermediate care setting * Review of the repatriation process/agreements to improve flow * Improved clinical outcomes and recovery for stroke survivors * Improved experience for patients/ families through care closer to home * Timely discharges through integrated health and social care processes * Reduction in length of hospital stay for patients who have experienced a stroke * Reduction in excess bed days 5, * QIPP opportunity for 18/19 represents block arrangements in the stroke contract with Stockport NHS Foundation Trust (see 3) * The business case is in progress to commence early supported discharge service from quarter three * QIPP opportunities for 19/2 for both hyper acute and community stroke services are a potential benefit of this project. * Discussions around stroke tariffs assuming significant reductions in lengths of stay are already in progress. 29/7/218 Jacki Wilkes Business case to Governing Body for review of options and decision regarding preferred option 6/8/218 2/8/218 3/9/218 1/1/218 15/1/218 Cheryl Cooper Commence procurement activities (i.e. first procurement discussion / meeting, development of the timeline, etc) Cheryl Cooper Bidder / meet the market engagement event Cheryl Cooper Place notice on to Contracts Finder and CCG website Cheryl Cooper ITT Bidder Response Deadline Cheryl Cooper Review of Bidder submissions, undetake evaluation / marking process 31/1/218 Cheryl Cooper Return to Governing Body with update of preferred provider Page 5 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) CHC (Care Sourcing) Planned - 723, - - 723, YTD 476,25 846,75 - - 1,323, QP/218/6 Total YTD 6,25 6,25 6,25 26,25 35,25 12,96 12,96 12,96 12,96 12,96 12,96 12,99 1,323, 6, 6,25 6,25 6,25 26,25 35,25 - - - - - - - 476,25 476,25 - - - - - (12,96) (12,96) (12,96) (12,96) (12,96) (12,96) (12,99) (846,75) (123,75) CHC (Care Sourcing) Performance Project QIPP Clinical Exec Karen Smith Kevin Valentine Karen Smith Alex Mitchell 1,4, 1,2, 1,, 8, This scheme applies across Cheshire and Wirral (5 CCG's) * To review the current backlog of 377 Complex care reviews recorded as out of date; with 21% over a year out of date since the last review was completed. * To review the current backlog of 241 CHC reviews recorded as out of date, and 2% of these are more than a year overdue. * To review the financial value of complex care packages to ensure value for money savings 6, 4, 2, * Expenditure grew 13.3% between 214/15 and 215/16, and by 14.7% in 216 The finance teams have estimated the do-nothing scenario for 218/19 will see expenditure growth of 7.4%.The proposed programme will act to slow the financial burden that will accompany the growth in our older population and those living with long term conditions. * Contain anticipated growth of cost of care packages to growth of 7.4% * The CCG's ability to contain financial growth in CHC is key to achieving meeting its financial target * Improved review process should ensure that changes in need are identified in a more timely fashion * Individuals are unhappy with the outcome of a review leading to increased complaints. 1/3/219 Kevin Valentine Review the health outcomes for each patient to determine that the commissioned package of care is safe, high quality, evidence based, sustainable and affordable. 1/3/219 Kevin Valentine Systematically challenge the elements of the care package and ensure all alternative care package options have been considered including care closer to home. 1/3/219 Kevin Valentine Systematically challenge the cost of the elements within the care package through robust contract interrogation and contract negotiation. Page 6 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) GP Prescribing - Formulary Management Planned - 85, 25, - 1,1, YTD 458,35 391,65 25, - 1,1, QP/218/7 Total YTD 91,67 91,67 91,67 91,67 91,67 91,67 91,67 91,67 91,67 91,67 91,67 91,63 1,1, - 91,67 91,67 91,67 91,67 91,67 - - - - - - - 458,35 458,35 - - - - - (91,67) (91,67) (91,67) (91,67) (91,67) (91,67) (91,63) (641,65) 458,35 GP Prescribing - Formulary Management Performance Project QIPP Clinical Exec Janet Kenyon Lucy Price Dr Graham Duce Alex Mitchell 1,2, 1,, 8, 6, 4, 2, * To ensure financial stability, the CCG and its constituent practices need to ensure cost-effective prescribing and manage overall prescribing costs. It is not the intention to reduce prescribing costs at the expense of patient health. To use multiple strategies to contain prescribing cost including promotion of self-care, over the counter medicines policy, and working with prescribers on cost effective use of medicines. * Improve patient care through regular monitoring of medicines in the local formulary and cost effective prescribing. * Practice and peer group level incentive scheme designed to maximise and appropriately reward clinical effort in delivering quality improvements and patient reviews. * Maintain and where possible enhance levels of adherence to local formulary * Improve patient care, health outcomes and resource utilisation. * Rewards achieving an overall budgetary target * Sufficient budgetary control to release incentive payments * Safe and best practice compliant prescribing * Full benefits are dependant upon timely actions by prescribers and may also be subject to external factors such as pricing being adequately managed across the NHS 3/7/218 Janet Kenyon Practice prescribing budgets agreed and NHSBSA advised - (Indicator is on Shedule) 3/7/218 Janet Kenyon Prescribing of generic pregabalin and de-prescribing of Antioxidant vitamins and Lutein is complete in all practices. The Executive Prescribing Committee will assess achievement in July (Indicator on Track) 3/8/218 3/8/218 Janet Kenyon Eclipse Live Red Alert Safety messages have been circulated to practices for the first time; there were 1 alerts circulated across the 3 CCGs. (Indicator on Schedule) Janet Kenyon Practices have been supplied with the data for polypharmacy and high does opiods; work is in progress (Indicator on Track) 3/8/218 Janet Kenyon Proposal for adoption of the NHS England guidance on Conditions for which over the counter items should not routinely be prescribed in primary care to be discussed at the Executive Prescribing Committee 3/9/218 Janet Kenyon Inhaler projects are progressing; on track for completion by end of Sept 218 Page 7 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Running Costs Planned - 275, - - 275, YTD 114,6 16,4 - - 275, QP/218/8 Total YTD 22,92 22,92 22,92 22,92 22,92 22,92 22,92 22,92 22,92 22,92 22,92 22,88 275, - 22,92 22,92 22,92 22,92 22,92 - - - - - - - 114,6 114,6 - - - - - (22,92) (22,92) (22,92) (22,92) (22,92) (22,92) (22,88) (16,4) 114,6 Running Costs Performance Project QIPP Clinical Exec Sammy Brown Mohamed Hussain N/A Alex Mitchell 3, 25, 2, 15, 1, 5, * To release non recurrent( one off) savings associated with the Running Cost Budget. by minimise duplication across Cheshire budgets * Delivery of non-recurrent savings to support ECCCG in delivering its financial plan for 218/19 and achieving its financial control target. * Key component of delivery of expected savings against the financial control target agreed with NHS England. * Internal value for money investment will run alongside Pan Cheshire development 1/7/218 Sammy Brown Prepare forecast expenditure, including vacancies for the year based on robust assumptions and release any savings when comparing the expenditure to the total available resources for running costs. 31/3/219 Sammy Brown Continually review forecast as the year progresses to ensure the forecast outturn remains accurate. Page 8 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Primary Care Commissioning Planned - 2, 2, - 4, YTD 127,794 72,21 2, - 4,4 QP/218/9 Total YTD 16,67 16,67 16,67 38,892 38,892 38,892 38,892 38,892 38,892 38,892 38,892 38,85 399,998 (2) 16,67 16,67 16,67 38,892 38,892 - - - - - - - 127,794 127,794 - - - - - (38,892) (38,892) (38,892) (38,892) (38,892) (38,892) (38,85) (272,23) 127,797 Primary Care Commissioning Performance Project QIPP Clinical Exec Sam Podmore Mohamed Hussain N/A 45, 4, 35, * To release non recurrently (one off) savings associated with the Primary Care Budgets or other allocations which can not see associated investments be realised in year. 3, 25, 2, 15, 1, * Delivery of non recurrent savings to support ECCCG in delivering its financial plan for 218/19 and achieving its financial control target. * Comparison of actual expenditure compared to available funding. * Critical component for delivery of financial control target agreed with NHS England. * Final settlement in relation to GP Pay Review Body not yet reached so expenditure can not yet be finalised. 5, 1/7/218 Sam Podmore Prepare forecast expenditure for the year based on robust assumptions and release any savings when comparing the expenditure to the total available resources (recurrent / non recurrent / bf accruals) for primary care. 31/3/219 Sam Podmore Continually review forecast as the year progresses to ensure the forecast outturn remains accurate. Page 9 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Third Sector Grants Planned - 55, - - 55, YTD 12,22 42,78 - - 55, QP/218/1 Total YTD - - - 6,11 6,11 6,11 6,11 6,11 6,11 6,11 6,11 6,12 55, - - - - 6,11 6,11 - - - - - - - 12,22 12,22 - - - - - (6,11) (6,11) (6,11) (6,11) (6,11) (6,11) (6,12) (42,78) 12,22 Third Sector Grants Performance Project QIPP Clinical Exec Karen Burton Mohamed Hussain N/A 6, 5, 4, 3, 2, 1, * To perform a value for money review of the existing 3 rd sector grants and make a collaborative decision on whether to proceed with reallocating funding for 18/19, with clinical and patient representative input in the decision making process. * Ensure any commissioning investment is targeted at schemes delivering value for money. *Aligned commissioning with Local Authority. * Potential reputational risk should any 3rd sector grants be ceased which is mitigated by patient involvement in the decision making process * Impact to other services to be considered as part of the commissioning decision making process * Review in progress. Outcome currently not finalised. 3/4/218 Karen Burton Hold engagement session with patient representative 3/6/218 Karen Burton Decision to proceed / not proceed with ceasing funding for identified 3rd Sector Grants - decision going to June Executive Committee Page 1 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Audiology - Recommission Service Planned - - - 75, 75, YTD - - - 75, 75, QP/218/11 Total YTD - - - - - - - - - - - - - (75,) - - - - - - - - - - - - - - - - - - - - - - - - - - - 75, Audiology - Recommission Service Performance Project QIPP Clinical Exec Lucy Price Lucy Price Dr Gareth Morelli 8, 7, 6, 5, 4, 3, * The current audiology service has not been reviewed for some time in terms of quality, efficiency and cost effectiveness. Therefore in light of the release of new NICE guidance due out in May; hearing loss in adults assessment and management, it is timely to undertake an in-depth review to ensure we are meeting the needs of the Eastern Cheshire population and achieving the best value for money. * Improved service specification and service efficiencies * Improved clinical outcomes and patient experience * Reduction in cost / resources 2, 1, * Review needs to take place of the current clinical quality, patient experience and cost behaviour of the service in order to set appropriate targets for the future service. * New contracts must be in place by the 1st March 219. Needs attention 2/8/218 Lucy Price Review the service specification (Inc. Stakeholder engagement) 27/8/218 Lucy Price Development of the business case (Inc. impact assessments) 3/9/218 Lucy Price Business Case to Programme Management Group, and Finance Committee outlining commissioning options for new service provision 19/9/218 Lucy Price Present service specification to the Clinical ership Committee for review 26/9/218 Approval to proceed with preferred option to Governing Body 27/9/218 Lucy Price Commence procurement activities (i.e. first procurement discussion / meeting, development of the timeline, etc) Page 11 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Winter Schemes Funding (BCF / ibcf) Planned - 25, - 5, 75, YTD 14,15 145,85 25, 25, 75, QP/218/13 Total YTD 2,83 2,83 2,83 2,83 2,83 56,55 56,55 56,55 56,55 56,55 56,55 56,55 5, (25,) 2,83 2,83 2,83 2,83 2,83 - - - - - - - 14,15 14,15 - - - - - (56,55) (56,55) (56,55) (56,55) (56,55) (56,55) (56,55) (395,85) 354,15 Winter Schemes Funding (BCF / ibcf) Performance Project QIPP Clinical Exec Niall O'Gara Niall O'Gara N/A Fleur Blakeman 8, 7, 6, 5, 4, 3, 2, 1, * Secure additional funding for Winter schemes from Better Care Fund (BCF) and /or Improved Better Care Fund (ibcf) to cover estimated Winter cost pressure of 75k. * If successful, the scheme will release 75k of committed funds to support CCG financial position. * Replacement funding stream rather than change in service meaning that services required to support urgent care over winter period will be maintained. * Initial 26k of funding agreed by BCF governance group from core BCF budget * Meeting DTOC target is the overarching target for BCF and other winter funding sources for 18/19 * Budget discussions for BCF dependant on in year evaluation of the value schemes * Whole system benefit from reducing admissions for long term care March 219 Jo Williams / Niall O'Gara Re-distribution of BCF/iBCF funds to Winter Schemes following 1718 end of year prioritisation progress and continuous evaluation of schemes from BCF governance group. Page 12 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Intermediate Care Planned - - - 45, 45, YTD - - - 45, 45, QP/218/14 Total YTD - - - - - - - - - - - - - (45,) - - - - - - - - - - - - - - - - - - - - - - - - - - - 45, Intermediate Care Performance Project QIPP Clinical Exec Bernadette Bailey Mohamed Hussain Dr Mike Clark Fleur Blakeman 5, 45, 4, 35, 3, 25, 2, 15, 1, 5, * Identify the longer-term commissioning plan for community beds within Eastern Cheshire from 219 onwards * Whilst plans above are developed increase the 218/19 availability of community care, including community beds, in order to provide safe and good quality care in people s homes or as near to home as appropriate in community settings. * Procure cost effective care placements * Alignment, joint working and longer term integration of Social Care teams, Intermediate Care, Re-ablement and other services that are integral to the care communities * Projected financial saving * Meeting better care funding savings * The longer term initiative s a CEP project with the main provider who currently provide bed based intermediate care * If winter pressures are higher than projected there may be a requirement to increase purchasing of community capacity. * Critical component for maintaining patient flow from admission to discharge * Understanding current patient demographic in order to commission appropriate level care in the future Needs attention 12/6/218 Bernadette Bailey Draft mandate reviewed by the Programme Management Office in June 13/6/218 Bernadette Bailey Draft mandate reviewed by the Finance Committee Bernadette Bailey Needs attention Plan to implementation - 22 Page 13 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) External Income to offset GP5YFV Planned - - - 3, 3, YTD - - - 3, 3, QP/218/15 Total YTD - - - - - - 5, 5, 5, 5, 5, 5, 3, - - - - - - - - - - - - - - - - - - - - - (5,) (5,) (5,) (5,) (5,) (5,) (3,) - External Income to offset GP5YFV Performance Project QIPP Clinical Exec Dean Grice Mohamed Hussain N/A 35, 3, 25, 2, * Within the budget for 218/19 3 per head has been included in the planning guidance for investment in transformation in Primary Care. This has been included in CCG budgets ( 624k). In parallel NHS England have launched a regional fund for the development of practice networks which has some cross over. When the CCG Governing Body approved budgets it was recognised that if NHS England were financially supporting transformation in Primary Care then it may not be possible to find the range of viable schemes/capacity that would offer value for money for full local investment of the 3 per head. 15, 1, * The benefit of this approach is that it both supports maximising investment into the local Primary Care system whilst protecting the local health economy finances 5, * Maintain close working relationships with NHS England regarding budget flows * Maintain transparency with member practices via CCG Governing Body on investment decisions * Understand the impact of CCG compliance / non-compliance with each GP5YFV activity 31/3/219 The CCG is offering support to practices in developing their PCN Development Fund bids as well as liaising with NHS England regarding other potential funding sources e.g. previous use of ETTF funding. 31/3/219 Continue to seek external funding opportunities Page 14 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Quality Premium Planned - - 35, - 35, YTD - - 35, - 35, QP/218/16 Total YTD - - - - - - 58,33 58,33 58,33 58,33 58,33 58,35 35, - - - - - - - - - - - - - - - - - - - - - (58,33) (58,33) (58,33) (58,33) (58,33) (58,35) (35,) - Quality Premium Performance Project QIPP Clinical Exec Julia Curtis Dave Forrester N/A Sally Rodgers 4, 35, 3, 25, * To make improvements to the quality, outcomes, of services we commission and reduce any inequalities by improving access/outcomes * Utilise Quality Premium to help resolve serious quality failures * We ha ve to publish an explanation of how we plan to s pend the funding * Potential to generate in excess of one million pounds ( 5 per head of population) * We can use the QP payment to pay organisation/s to deliver the improvements. 2, 15, 1, 5, * Improved quality of service(s), outcomes and inequalities for the patients/population of Eastern Cheshire * Improved access to services * Early Cancer Diagnosis (17%) * GP Access and Experience (17%) * Continuing Healthcare (17%) * Bloodstream Infections (17%) * Mental Health (17%) * Demand Ma nagement Right ca re (CVD/AF) (17%) A1 - Type 1 A&E attendances (NEW) (5%) A2 - Non elective admissions with zero length of stay (NEW) (5%) B - Non elective admissions with length of stay of 1 day or more (NEW) (5%) Maximum 2 month (62-day) wait from urgent GP referral to first definitive treatment for cancer (5%) The number of patients on an incomplete pathway not to be higher in March 219 than in March 218 (5%) * Clear understanding with NHS England local office of progress against targets and payment gateways including A&E trajectory * Good track record of performance against clinical indicators 31/8/218 Jacki Wilkes Mental Health Redesign and Consultation 31/3/219 Jane Stairmand Needs attention Right Care CVD/AF 31/7/218 Dean Grice GP Access Procurement 31/3/219 Karen Burton Emergency demand planning ORG 31/3/219 Tracey Wright Cancers diagnosed at early stage 31/3/219 Karen Smith NHS Continuing Healthcare (NHS CHC) 31/3/219 MMT Reducing Gram Negative Bloodstream Infections (GNBSIs) and inappropriate antibiotic prescribing in at risk groups Page 15 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Dermatology - Recommission Service Planned - - 5, 2, 25, YTD - - 5, 2, 25, QP/218/17 Total YTD - - - - - - - - - - - 5, 5, (2,) - - - - - - - - - - - - - - - - - - - - - - - - - (5,) (5,) 2, Dermatology - Recommission Service Performance Project QIPP Clinical Exec Sally Williams Dr Mike Clark 3, 25, 2, 15, *Re-commission the Dermatology Service following the notice of termination from the existing provider * As part of the Cheshire East Acute Sustainability work there is the opportunity to explore alternative models of care and provision * Projected cost saving of 25k from recommissioning at bench marking of tariff pricing without any subsidy * Sustainable clinical model for residents of Eastern Cheshire 1, 5, * Market management key to successful reprocurement as local market intelligence indicates likely to be low uptake from providers and there may be transitional costs * Location of future service requires careful consideration * Current provider has served notice * Service specification to be redrawn taking into account future needs and capacity 3/5/218 Sally Williams Frequent meetings between existing provider and commissioner with open communications of information. 3/5/218 Sally Williams Alternative arrangements being put in place for existing patients 25/7/218 Outlined options paper presented to Governing Body 28/9/218 Sally Williams Considerations to be looked in to for a longer term solution to be put in place. Page 16 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) HCP Transformational Funding Planned - - - 72, 72, YTD - 72, - - 72, QP/218/18 Total YTD - - - - - - 12, 12, 12, 12, 12, 12, 72, - - - - - - - - - - - - - - - - - - - - - (12,) (12,) (12,) (12,) (12,) (12,) (72,) - HCP Transformational Funding Performance Project QIPP Clinical Exec Mohamed Hussain Mohamed Hussain N/A Alex Mitchell 8, 7, 6, 5, 4, 3, * Receipt of external funding form NHS England / HCP to offset system transformation. * If received, it would support ECCCG meetings its 218/189 planned deficit of 15m and subsequent achievement of the CSF. *Critical component of the CCG meeting the deficit controlled total 2, 1, 31/3/219 Alex Mitchell Engage with NHS England concerning previous discussions / proposal that indicted additional external funding could be provided to offset the 72k contribution. Page 17 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Individual CHC and Complex Case Review Planned - - - 25, 25, YTD 14,167 145,837 - - 25,3 QP/218/19 Total YTD - - - 83,333 2,833 2,833 2,833 2,833 2,833 2,833 2,833 2,833 25, (3) - - - 83,333 2,833 - - - - - - - 14,167 14,167 - - - - - (2,833) (2,833) (2,833) (2,833) (2,833) (2,833) (2,833) (145,833) 14,17 Individual CHC and Complex Case Review Performance Project QIPP Clinical Exec Sue Milne Kevin Valentine Karen Smith Alex Mitchell 3, 25, 2, 15, * A reduced number of patients being cared for outside of Cheshire and Wirral * Individuals being settled into the community, where they and their family would like them to live, through community alternatives to inpatient care. * Further services being commissioned strategically rather than via individually funded packages of care. * Further services being provided by health and social care rather than private providers. * Increased quality of care. * Reduced cost of care. 1, 5, * Delivering value for money by delivering value for money by commissioning support packages locally within the Cheshire East geography. * Improving patient experience by bringing care closer to home * Planned to contain high levels of growth in demand through improved commissioning processes * Timescales critical to realise full scale of QIPP benefits. Some dependencies on external partners e.g. housing services * Management of messages to patients and families are key to success * Best practice bench marking hampered by multiple data sources 31/1/219 Sue Milne To identify joint commissioning opportunities across Cheshire and Wirral for Complex Care community provision 31/1/219 Sue Milne Review and support Communication plans developed by the Working Group 31/1/219 Sue Milne Commission jointly on wider footprint to meet the needs identified by the Working Group 31/1/219 Sue Milne Work with health and social care providers to adapt existing contracted services to meet patient needs 31/1/219 Sue Milne Co-produce and sign a system mandate to prevent wherever possible further patients being placed out of area. Page 18 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) CHC - Responsible Commissioner Review Planned - - 35, 1, 45, YTD 26,428 539,57 - - 799,998 QP/218/2 Total YTD 29,17 29,17 29,17 145,837 27,81 77,8 77,8 77,8 77,8 77,8 77,8 77,9 799,998 35,1 29,17 29,17 29,17 145,837 27,81 - - - - - - - 26,428 26,428 - - - - - (77,8) (77,8) (77,8) (77,8) (77,8) (77,8) (77,9) (539,57) (89,573) CHC - Responsible Commissioner Review Performance Project QIPP Clinical Exec N/A Kevin Valentine N/A Alex Mitchell 9, 8, 7, * To ensure that the CHC service has a robust process to validate the Responsible Commissioner arrangements prior to approving packages of care. 6, 5, * The key benefit is financial in that ECCCG would only commission packages for which it is the responsible commissioner. 4, 3, 2, * Complexity of cases may challenge timescales in identifying responsible commissioner * In-house team developing expertise in this area through exploring cases in 16/17 and 17/18 * Maintenance of safe placement of patients is key 1, Ongoing CHC Team Process is already embedded within the CHC service which is reviewing each case. Page 19 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Contract Monitoring Planned - - 5, 75, 125, YTD 2,85-29,15 75, 125, QP/218/21 Total YTD 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,13 5, (75,) 4,17 4,17 4,17 4,17 4,17 - - - - - - - 2,85 2,85 - - - - - (4,17) (4,17) (4,17) (4,17) (4,17) (4,17) (4,13) (29,15) 95,85 Contract Monitoring Performance Project QIPP Clinical Exec Sally Williams N/A 14, 12, 1, 8, 6, 4, 2, * Standard counting and coding checks e.g. correct GP registration * Targeted checks on counting and coding changes * Compliance with local policies (PLCV) * Projected financial saving * Accurate data to assist with achieving financial savings * Track record of saving between 1-26k through contract monitoring processes over the last 3 years * Number of valid contract challenges should decrease over time as contract data becomes more accurate 3/5/218 Contract monitoring checklist agreed with team (defining priorities) 3/5/218 Allocation of analyst resource to undertake standard data queries, and documented process for raising queries/monitoring responses 3/5/218 Standard process for following through contractual adjustments (either where evidenced or where providers do not comply with requirements) 3/5/218 Recording mechanism for savings compared to queries raised. Page 2 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) PLCV - Contract Compliance Planned - - 5, 75, 125, YTD 2,85-29,15 75, 125, QP/218/22 Total YTD 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,17 4,13 5, (75,) 4,17 4,17 4,17 4,17 4,17 - - - - - - - 2,85 2,85 - - - - - (4,17) (4,17) (4,17) (4,17) (4,17) (4,17) (4,13) (29,15) 95,85 PLCV - Contract Compliance Performance Project QIPP Clinical Exec Sally Williams N/A 14, 12, * Compliance with local policies (PLCV) 1, 8, 6, 4, * Projected financial savings * Contribution to RTT target due to clinically optimise patient flow * Opportunity to fully implement local policy with consistency across local clinicians * Opportunity will reduce over time as compliance increases 2, 3/5/218 Contract monitoring checklist agreed with team (defining priorities) 3/5/218 Allocation of analyst resource to undertake standard data queries, and documented process for raising queries/monitoring responses 3/5/218 Standard process for following through contractual adjustments (either where evidenced or where providers do not comply with requirements) 3/5/218 Recording mechanism for savings compared to queries raised. Page 21 of 22
NHS ECCCG Governing Body Meeting IN PUBLIC 26 September 218 QIPP Programme (218-19) Transactional Other (Schemes Under 25K) Planned - - - - - YTD 2,75 - - - 2,75 QP/218/23 Total YTD - 2,75 - - - - - - - - - - 2,75 2,75-2,75 - - - - - - - - - - 2,75 2,75 - - - - - - - - - - - - - - Transactional Other (Schemes Under 25K) Performance Project QIPP Clinical Exec Various Lucy Price N/A Alex Mitchell 3, 2,5 Vodafone Mobile Phone Contract * Provide better value for money and more security for mobile phones and related communication devices. 2, 1,5 1, 5 * Cost savings - Phone and data bill for 217-18 = 5,655 - Estimated for 218-19 under new contract = 3,36 - Annual savings on existing contract = 2,295 - Annual savings with the inclusion of Airwatch security = 1,455 * Improved security the addition of Airwatch security on devices, will allow the remote wiping of devices and limitations on the type of apps that can be loaded, to optimise device integrity. * Maintain watch on small contracts throughout the year for other opportunities 31/5/218 Mike Purdie Implement a new contract with single tariff Page 22 of 22