Annual Report Summary 2016/17 1
NHS Sutton CCG Summary Annual Report 2016/17 CONT ENTS 3 Who we are and what we do 3 Our vision 4 Welcome from our Chair 5 Clinically-led commissioning 7 How we spend your money 8 Working in strategic partnership 10 Our progress this year 13 Our performance 14 High quality services 14 Commissioning for equality 15 How we use patient feedback in our planning 16 How to get involved 2
WHO WE ARE AND WHAT WE DO NHS Sutton CCG is a clinically-led organisation responsible for commissioning and monitoring the quality of healthcare services for the population of Sutton. We commission hospital, community, mental health and GP services to meet the needs of over 200,000 people. OUR VISION As doctors, nurses and other healthcare professionals, we work together to put patients first and improve health services in Sutton. Our vision is to commission high quality healthcare that meets the physical and mental wellbeing needs of our population, through joint working with health and social care organisations. During 2016/17, in consultation with CCG staff, GP members and practice staff, we reviewed and refreshed our vision and values to make sure that they continued to reflect where we are going as an organisation. And these are the values that guide our work: Innovative we use the creativity of our membership, staff and stakeholders to continuously improve Professional we act with consistency, responsibility and transparency Compassionate we actively demonstrate care and compassion for others Collaborative we work in partnership to make a difference The refreshed vision statement is: ACHIEVING T HE BEST AFFORDABLE HEALT H AND WELLBEING FOR T HE PEOPLE OF SUT T ON 3
NHS Sutton CCG Summary Annual Report 2016/17 WELCOME FROM OUR CHAIR The NHS is facing unprecedented demand and a challenging financial climate. Against this, NHS Sutton CCG continues to deliver good, high quality health services, meeting most national and local performance targets in 2016/17. This was reflected in NHS England s most recent assessment of us as a Good CCG in July 2017, which is an improvement from last year s rating of requires improvement. We have been nominated for a number of national awards. Firstly, the Sutton Uplift mental health service was nominated for a Health Services Journal Services Redesign award in November 2016. The Sutton Homes of Care Vanguard was a finalist in the Skills for Care Accolades 2016/17, and two primary care schemes, the CCG s Patient Education Events and Help Yourself to Health, were finalists in the Patient Experience Network National Awards. We were also delighted that the CCG was assessed as Good for delivery of its statutory obligations for patient and public involvement, following assessment of the work undertaken in 2015/16. Our dementia care and Improving Access to Psychological Therapies Services have met some key national targets for the first time. This means that people with dementia and those in emotional distress are getting the right care and support as early as possible. Meanwhile our main provider of acute mental health services, South West London and St. George s Mental Health Trust, moved from Requires Improvement to Good in its latest CQC inspection, which is reassuring for patients who need a higher level of support. Our Sutton Homes of Care Vanguard programme, or red bag programme, has continued to support our care homes to deliver better care so their residents have better quality of life and need less hospital care. The programme has attracted regional and national attention, with elements being rolled out across parts of London and elsewhere in the country. This is the first year that NHS Sutton CCG has taken on delegated responsibility from NHS England for commissioning GP services for our local population. Our Primary Care Strategy sets out how we will offer better access to GP services and deliver the vision for primary care articulated in the NHS Five Year Forward View. In April 2017, four of the six CCGs in south west London (Kingston, Merton, Richmond and Wandsworth) came together to form the South West London Alliance, which Sutton will formally join in April 2018. Working with colleagues across a broader area will enable us to improve healthcare and make services more sustainable in the longer term. At the same time NHS Sutton CCG will continue to have a local focus, listening to your feedback and ensuring we deliver the right services for Sutton s population. Dr Jeffrey Croucher Clinical Chair, NHS Sutton Clinical Commissioning Group 4
CLINICALLY-LED COMMISSIONING We are a clinically-led membership organisation bringing together all 25 GP practices across 26 sites in Sutton into one commissioning organisation. We are made up of three geographically-based localities, each with a GP lead who is also a member of our Executive Committee. Our local clinicians work together to plan and commission health services for Sutton, enabling us to focus on the quality and clinical effectiveness of the services we commission more than ever before. The three localities are: Carshalton Sutton and Cheam Wallington OUR LOCAL CLINICIANS WORK TOGETHER AS A MEMBERSHIP ORGANISAT ION 5
NHS Sutton CCG Summary Annual Report 2016/17 GP PRACT ICE SIT ES Sutton and Cheam locality Carshalton locality Wallington locality 1 2 3 St Anthony s Hospital 9 Rose Hill St Helier Hospital 4 5 11 6 Beddington Park 10 Cheam 14 15 13 Sutton 7 Carshalton 20 21 22 Wallington 12 16 17 19 8 23 24 26 25 18 Sutton Hospital 1 Faccini House Surgery 15 18 Benhill & Belmont GP Centre 2 Bishopsford Road Medical Centre 16 Grove Road Practice 3 Green Wrythe Surgery 17 Mulgrave Road Practice 4 Hackbridge Medical Centre 5 Chesser Surgery 19 Beeches Surgery 6 Wrythe Green Surgery 20 Park Road Medical Centre 7 Sutton Medical Centre 21 26 Manor Practice 8 Carshalton Fields Surgery 22 Maldon Road Surgery 23 Wallington Family Practice 9 Well Court Surgery 24 Shotfield Medical Practice 10 GP Centre Dr Brennan/Dr Mukta/Dr Longley 25 Wallington Medical Centre 11 12 Cheam Family Practice 13 Robin Hood Lane Health Centre (Dr Seyan) 13 14 Dr Grice and Partners 6
HOW WE SPEND YOUR MONEY NHS Sutton CCG spent 270.5 million in 2016/17. Of this 266.4 million was spent on commissioned health services and 4.1m (or 1.5% of total resources) on running costs. From 1st April 2016, the CCG was responsible for commissioning primary care (GP) services, and this is included in the above. An analysis of expenditure is shown below: Hospital care Mental Health and Learning Disability services Community Services Primary Care Prescribing Running Costs Other Programme Expenditure 144.0m 25.8m 37.0m 29.0m 24.0m 4.1m 6.6m 2016/17 FINANCIAL PERFORMANCE The CCG met all its financial targets for 2016/17. Specifically: The CCG achieved its target surplus The CCG operated within its running cost limit The CCG met its cash targets The CCG operated within its capital limits The CCG met the requirement to pay suppliers (of health and non health services) promptly Further details are available in the full Annual Report and Accounts 2016/17 on the CCG s website. Looking forward, there is no doubt that the NHS faces very significant financial challenges and this will also apply to NHS Sutton CCG. The CCG has developed an operating plan going forward that meets NHS business rules, but carries a high degree of financial risk, which the CCG plans to manage and mitigate. NHS Sutton CCG s Governing Body is committed to keeping the CCG on a sustainable financial footing so that we can continue to commission the best available affordable services. 7
NHS Sutton CCG Summary Annual Report 2016/17 WORKING IN ST RAT EGIC PART NERSHIP UPDAT E ON T HE SOUT H WEST LONDON SUSTAINABILIT Y AND T RANSFORMAT ION PART NERSHIP AUGUST 2017 The Sustainability and Transformation Partnership for SW London, which includes the NHS and local authorities is currently refreshing its strategy. Since the publication of the SW London STP document in November 2016, we have held a series of public engagement events and more in-depth conversations with our stakeholders. As a result, the STP programme board is now updating its approach and primary focus. We want to strengthen the focus on keeping people healthy. Getting involved earlier, as soon as vulnerable people start to become ill at home. We want to stop people from becoming more unwell and give them the right support at home so that they don t need to be admitted to hospital. We know that being in hospital can in some cases lead to either a reduction in people s independence, or even getting an infection. If people do go to hospital, we want to get them home, so they can recover more quickly in their own bed, with the right care and support. To achieve this focus on keeping people well, the SW London STP recognises that a local approach works best. The NHS working jointly with Local Authorities and local people within boroughs, will plan care based on people s health and care needs from local communities upwards. We want to move the conversation on, to be about planning and delivering care in these four health and care partnership areas: Kingston/Richmond Sutton Croydon Merton/Wandsworth We will also be working with our partners in Surrey, and London borders. By the end of November these health and care systems will have reviewed the feedback from local people over the last 6 months, analysed their local data and identified their challenges. They will then set out how they plan to work together to improve services for local people, and be clinically and financially sustainable into the future. We will now take advice from the local stakeholders and build on engagement to date to involve local people in planning services going forward. If any proposals would mean significant change, the statutory organisations would of course consult local people, with advice from our Overview and Scrutiny groups in each area, and our Health Watch partners. In November 2017, we will publish an updated and refreshed strategy document that will consolidate this view and strengthen our major focus on working together in local health and care partnerships, to keep people well and out of hospital. 8
SUT T ON LOCAL T RANSFORMAT ION BOARD To realise the vision set out in the STP, Local Transformation Boards (LTBs) are being set up across SW London. Membership includes NHS commissioners and providers, local authorities, voluntary sector and patient representatives. This work will also identify those services that need to be considered at south west London level. As part of Sutton LTB s work, NHS Sutton CCG and Epsom & St Helier University Hospitals NHS Trust are working with the London Borough of Sutton and our GP Federation, community and mental health providers to achieve integrated health and social care, which places individuals at the centre of their care. We have developed a business case for a new alliance-based provider organisation Sutton Health and Care which will enable people to stay healthier at home for longer, prevent or reduce hospital admissions and support people to manage their own health and wellbeing. The provider alliance would be accountable for driving the integration of services and achieving good patient outcomes. In the shorter term, the alliance will look to reduce A&E attendances and unplanned admissions to hospital, by focusing on care and support for the 8% of Sutton s population who have complex or unstable long-term conditions. The longer term aim is to develop an accountable care system offering preventative, integrated healthcare, with equal focus given to self-care and prevention, as to urgent and emergency care interventions. HEALT H AND WELLBEING BOARD Sutton s Health and Wellbeing Board (HWB) enables good partnership working between the local NHS, the London Borough of Sutton and the wider community. It considers matters relating to the provision of public health services and the commissioning of adults and children s services across health and social care. You ll find more details about our partnership working in the full NHS Sutton CCG Annual Report and Accounts, available on our website. 9
NHS Sutton CCG Summary Annual Report 2016/17 OUR PROGRESS T HIS YEAR The following four projects demonstrate how we have made significant improvements to patients experience of health services in Sutton. INCREASING ACCESS T O PRIMARY CARE In 2016/17, NHS Sutton CCG worked with Sutton s GP Federation, Sutton GP Services Limited, to extend access to GP appointments outside normal working hours. Since April 2017, Sutton GP practices patients have been able to book evening and weekend GP and nurse appointments, available 6.30pm 8pm Monday-Friday and 8am 8pm Saturday and Sunday. The extra appointments were initially provided at Wrythe Green Surgery, Wrythe Lane, with a second site at Old Court House Surgery, Throwley Way, added in July. This means that patients can now access 2000 more GP and around 1800 more nursing appointments each year across both sites. GP appointments are pre-booked along with a range of nursing services including dressings, with further services to be added including smear tests. Patients book appointments by calling their normal GP surgery during opening hours. Uptake has been high, with nearly 90% of available appointments booked, higher than the London average (70%). Feedback from patients has been excellent, with an early user commenting, I was pleased to be able to get an appointment quickly. I am extremely likely to recommend the service to friends and family, if they need similar care 10
HELPING PEOPLE T O HELP T HEMSELVES Two schemes aiming to improve patient experience in Sutton were among six finalists in the Access to Information category of the Patient Experience Network National Awards, held in March 2017. The nominations for the CCG s Patient Education Events and Help Yourself to Health highlighted the excellent work done by NHS Sutton CCG staff and their partners in reaching out to local people to help them take care of their own health. The Patient Education Events supported GPs to help their patients proactively manage their healthcare. A series of sessions about long term conditions, children s care and health in older age, were delivered across Sutton, in partnership with colleagues across general practice, pharmacy, community services and many others. Over the year, around 1,000 patients attended 11 events and 34 short talks, with overwhelmingly positive feedback from attendees. Help Yourself to Health is a 6 week interactive educational course for Sutton s Tamil, Urdu and Polish communities, delivered by Health Advocacy Workers speaking those languages. The programme improves knowledge and access to services, removes barriers, and reduces health inequalities, as historically these groups have experienced poorer health and greater barriers to accessing services. Course content, materials and tools are flexible and respond to the groups needs and capabilities, with 90% of participants completing the course. SUT T ON INT EGRAT ED DIGITAL CARE RECORD Over the past year, the CCG and the London Borough of Sutton (LBS) have been working together to further develop Sutton Integrated Digital Care Record (Sutton IDCR), which will enable health and social care professionals to share records for the benefit of residents registered with a Sutton GP. The Sutton IDCR enables information from GP and adult social care records to be shared with local Urgent Care, Accident and Emergency, mental health and community health services. The system makes information exchange safer, quicker and more accurate, accessible by health and social care professionals, which in turn should lead to better patient outcomes. Information is only accessed from the Sutton IDCR after patients have confirmed their consent to their record being accessed. Patients can choose to opt out from the ICDR. We will be enabling GP out of hours services to access the IDCR, and developing data feeds from Sutton Community Health Services and St Helier Hospital. Sharing information between GPs and Urgent Care could save up to half a day in time and/or prevent a hospital admission in comparison to when information is requested over the phone. For example, staff in St Helier A&E are able to see patients up to date medical history and test results from the GP patient record, avoiding delay and duplication. 11
NHS Sutton CCG Summary Annual Report 2016/17 SUT T ON HOMES OF CARE VANGUARD Following selection as a national Vanguard in 2015, Sutton Homes of Care continues to work with local partners in health, social care and the voluntary sector, and with local care homes, to improve safety and quality of services for residents. In 2016/17, the streamlined, integrated care provided through the hospital transfer pathway (known as the red bag pathway) reduced residents length of stay in hospital by four days, saving approximately 183,000 a year in running costs and minimising the time care home residents stay in hospital. The Red Bag travels to hospital with care home residents needing emergency care, and contains standardised information about their health, medical conditions and their medications, as well as their personal effects. This enables them to receive quick and effective treatment and to be discharged promptly with the minimum personal disruption. The initiative has been adopted in two other care home Vanguards: Wakefield, and East and North Herts; as well as sites across London and nationally. A further project has addressed the difficulties care homes face in finding time to release staff for training. Care homes can also face high staff turnover, so formal training may not be the best way to educate and empower staff. To combat this, Sutton Homes of Care produced a series of resources to provide staff with up-to-date information about appropriate referrals and best practice. Posters and reference cards were developed along with training films and e-learning packages to address key issues like dehydration, sepsis and falls. The low-cost resources have led to better decision-making by care home staff, improving health outcomes for the residents as well as significant benefits for the wider health economy, reducing ambulance callouts and A&E attendances. For more information on our progress in 2016/17, please see our Annual Report 2016/17 (page 19 onwards). 12
OUR PERFORMANCE The CCG is committed to commissioning health services that are safe, to maintain or improve quality, and offer information to inform patients choice on how, when and where they receive health care services. We have a range of performance measures by which we judge whether we have delivered what we set out to do see from page 32 in the full Annual Report. In 2016/17 NHS Sutton CCG worked with member practices and providers to ensure we met most performance targets, meaning that we are delivering safe, effective care for the people of Sutton. Epsom and St. Helier achieved the four hour A&E national standard, with over 95% of patients attending A&E being seen within that time. We exceeded the standards for referral to treatment within 18 weeks for planned care. We met the cancer waiting time standards (other than that for treatment following screening within 62 days) meaning people with suspected cancer are getting prompt diagnosis and treatment, which leads to better outcomes. The success of the Sutton Uplift service for psychological therapies and wellbeing means we met the challenging national target for access to psychological therapies. We also met the national target for dementia diagnosis, from October 2016 onwards, meaning that more people with dementia are being offered the care and support they need. We know that we need to work with our partners and providers to improve in a few other areas where we ended the year just below national standards, including diagnostic test six week maximum waiting times and category A ambulance call response times. It should be noted, however, that the London Ambulance Service has faced very severe pressures throughout the year with ever increasing volumes of calls. The improved performance and better outcomes for the Sutton population were reflected in NHS England s assessment of the CCG as Good for 2016/17, an improvement from the previous year. This was due to all the hard work and commitment of our local healthcare providers, our GP practices and commissioners over the last year. 13
NHS Sutton CCG Summary Annual Report 2016/17 HIGH QUALIT Y SERVICES The underpinning aim of all our plans is to commission good, safe services that provide a positive experience for our patients. Quality, along with prevention, productivity and innovation, is vital for the commissioning of sustainable services for our community. Quality is a key driver for minimising health inequalities, promoting equality and diversity and raising the life chances and wellbeing of our population. We expect quality to be central to all of our commissioned services, whoever provides them. By ensuring that the quality of care is good, we will ensure that the outcomes for patients are the best they can be. We measure quality through the following three domains (see page 46 of Annual Report for further detail): Patient Experience Clinical Effectiveness Patient Safety We monitor the performance of our providers and ensure that Sutton residents receive the best possible healthcare. Performance is managed primarily through contract monitoring meetings, urgent and planned care working group meetings and clinical quality review group meetings, which report into the relevant committees of the CCG s Governing Body. COMMISSIONING FOR EQUALIT Y For the third consecutive year, NHS Sutton CCG implemented the Equality Delivery System (EDS2) as part of its programme to reduce inequalities. The EDS2 is a performance monitoring tool which allows CCGs to assess their equality performance annually on four domains: patient access and outcomes, staff experiences and leadership commitment to equality and diversity. The following services were reviewed in 2016/17 to assess patient outcomes and access (Goals 1 and 2 of the EDS2): Children s Speech and Language Therapy Services and Continuing Healthcare. As a result, the following improvements have been identified: The Children s Speech and Language Service has been promoted among practitioners likely to make referrals, such as school nurses and health visitors, and guidance has been developed to ensure vulnerable children have special consideration The Continuing Healthcare Service has developed fact sheets to be given to applicants at multi-disciplinary team meetings to clarify their understanding of the assessment process, and we have improved monitoring of domiciliary agencies. 14
HOW WE USE PAT IENT FEEDBACK IN OUR PLANNING Patients and local people are at the centre of our decision-making and we work in partnership with individuals, patient representative groups, families and carers to deliver our vision of high quality, accessible services that tackle inequalities and respond to personal needs. We believe that effective public participation and patient engagement is delivered through organisation-wide ownership. As such, it is a core competency requirement across our senior management team, clinical leads and membership practices, and forms part of our strategic objectives. NHS England conducted a review of our annual patient and public engagement for our statutory obligations on the collective duty to involve and of our individual duty for April 2015 to March 2016. The result of their assessment was GOOD for both parts. NHS England acknowledged we have a good understanding of our local population and prevalent health conditions. Examples of good practice include the community services procurement and the care home vanguard. We have a good awareness of the benefits of self-management to patients and we have delivered excellent engagement around health and social care integration. We have continued to work with local stakeholders throughout 2016, targeting communities we hear less from, to ensure timely meaningful engagement informs the planning, commissioning and evaluation of local services. 15
NHS Sutton CCG Summary Annual Report 2016/17 HOW T O GET INVOLVED We want to hear from you and there are lots of ways you can get involved. Go along to your GP practice patient participation group (PPG). For more information, please ask at the reception of your GP practice. Representatives from each PPG attend our Patient Reference Group. The group provides patients with a forum for dialogue with us and helps deliver an effective patient voice. Our Governing Body meets regularly in public. You are very welcome to attend these meetings to find out more about what we do and the decisions we make about local health services. Dates are advertised on our website www.suttonccg.nhs.uk Email or write to us. Follow us on twitter @NHSSuttonCCG FOR MORE INFORMAT ION ON HOW YOU CAN GET INVOLVED VISIT www.suttonccg.nhs.uk/getinvolved NHS Sutton Clinical Commissioning Group Priory Crescent Cheam Sutton Surrey SM3 8LR 020 3668 1200 sutccg.office@nhs.net www.suttonccg.nhs.uk If you would like to read our full Annual Report and Accounts for 2016/17 and a comprehensive glossary of terms please visit our website: www.suttonccg.nhs.uk/publications 16