D R A F T Croydon Clinical Commissioning Group Prospectus 2013/14 Longer, healthier lives for all the people in Croydon (Version TL) 1
Contents Foreword from the chair 3 Introduction 4 Who we are our Governing Body 5 The health services we commission on your behalf 6 Our vision for Croydon 7 The challenges we face 8 What are we doing to address our challenges? 9 Have your say and get involved 10 Transforming health services in Croydon 11 Our transformation strategy explained 12 Our transformation plans 14 Delivering our transformation programme 16 Improving safety and quality through our transformation programme 17 The NHS in England organisational changes explained 18 2 Contact us 19
Foreword from the Chair Welcome to the NHS Croydon Clinical Commissioning Group Prospectus. We hope you find this publication informative and engaging. Above all we want to help you understand us better and the part we play in commissioning (buying) health services to help the people of Croydon to live longer, healthier lives. Clinical Commissioning Groups (CCGs) put local health experts doctors and other health professionals in charge of local health services. From now on GPs, who best know the needs of their patients, take the lead in deciding what health services are needed locally. NHS Croydon Clinical Commissioning Group (Croydon CCG) is a new organisation, driven by local GPs who are committed to redesigning health services in Croydon to improve care for our patients and ensure better use of resources. We face some tough challenges. Croydon has areas of deprivation in the north and the east of the borough. We have a relatively young population. However, the latest projection suggests that the number of people aged over 85 will also increase, by two thirds by 2029. As the population ages, so we can expect to see more people with one or more long-term conditions. We know that both the very young and older people rely more on health services, so Croydon CCG is anticipating a rise in demand for services in the coming years in a tough economic climate. We also need to address the variations in the quality of health services provided in Croydon. These changes combined with our financial challenge mean that we are going to have to work hard with our patients, partners in health care, the voluntary sector and Croydon Council to make sure that we can deliver high quality, safe health services, efficiently and effectively for all the people in Croydon. Tony Brzezicki Tony Brzezicki, CCG Chair 3
Introduction The way the NHS is organised changed significantly this year (see page X for more information). On 1 April, Croydon CCG became responsible for commissioning (buying) and paying for many of your local health services. It is our role to ensure that we buy the best services with the money we have been been given. We have a budget of just over 400 million to commission a wide range of local health services, including hospital services such as outpatient appointments, urgent and emergency care. We are a membership organisation, made up of all 61 general practices in Croydon. This means that it is your local GPs, who best know your needs, are now in the driving seat in deciding what health services are needed. MAP TO BE INSERTED 4 We serve over 360,000 people across the very diverse borough of Croydon. As doctors, we came together to put patients first and improve health services in Croydon. We want to improve local health services and empower patients and communities to take more responsibility for improving their health. To achieve this, we will work alongside other health practitioners from nursing, pharmacy and secondary care and local partner organisations, such as Croydon Council and the voluntary sector. Where our GP practices are located
Who we are our Governing Body Dr Tony Brzezicki Clinical Chair Fouzia Harrington Director of Governance and Quality David Hughes Lay Member, Finance Dr Agnelo Fernandes Assistant Clinical Chair Chair Dr Dev Malhotra GP Member Stephen Warren Director of Commissioning Amy Page Chief Nurse Helen Pernelet Lay Member, Vice Chair, Integrated Governance and Audit Committee, Patient, Public Engagement Hanna Miller Executive Director, Adult Services, Housing and Health, Croydon Council Paula Swann Chief Officer Dr Jonathan Norman Secondary Care Consultant Dr Mike Robinson Director of Public Health Croydon Mike Sexton Chief Financial Officer 5
The services we commission on your behalf We have a budget of over 400 million to commission a wide range of health services for Croydon residents. Urgent and emergency care This includes NHS 111, urgent and emergency care, ambulance services and GP out of hours services. Planned hospital treatment This includes a range of non-emergency planned operations and procedures. Community health services This includes for example, speech and language therapy, continence services, wheelchair services and home oxygen services. Other community based services This includes additional services provided by GP practices. Rehabilitation services This includes hospital and community rehabilitation services, linking with Croydon council providers to ensure a joined up approach. Children s healthcare services This includes a range of healthcare services for children. Maternity and new born services This will include increasing early access for women to maternity services, improving midwife to mother ratios and increasing health visitor ratios. Mental health services This includes care in an inpatient setting at a time of crisis or support in the community to help service users manage their conditions. NHS continuing healthcare NHS continuing health care is a packed of care provided outside hospital for people with an ongoing healthcare need. Learning disabilities services This includes a full range of services on a needs basis. 6 Infertility services This includes fertility treatment for couples who cannot conceive naturally.
Our vision for Croydon We are ambitious in our aims for the people of Croydon. Our vision is longer, healthier lives for all people in Croydon. We want to: increase healthy life expectancy for everybody in Croydon support children and young people to achieve their full potential Ensure every patient receives a positive experience of care We will do this by working with the diverse community of Croydon, our providers and stakeholder, using our resources wisely, to transform and provide safe, effective, high quality, patient centred services. increase people s independence by helping them understand their condition better, giving them greater choice and encouraging them to make decisions about their care with their healthcare professional We aim to: Help people to look after themselves better, avoid illness where possible and, if they do become ill, by putting them at the centre of their care we will hep them to manage their conditions better When care is needed, we will make sure that we provide the right care in the right place at the right time. This may not always be in hospital; it may be at the GP surgery, in a community clinic or, making the use of modern technology, in the patient s own home Provide safe care care that is of the highest quality, regularly monitored 7
The challenges we face We face some tough challenges. Croydon has areas of deprivation in the north and the east of the borough, and ill health comes with that deprivation. Life expectancy is 9.5 years lower for men, and 5.2 years lower for women in the most deprived areas of Croydon, with circulatory diseases, cancers and respiratory diseases causing the majority of excess deaths that make up this gap in life expectancy. Croydon has a relatively young population, with the fifth highest proportion of children aged 0-19 in London. The number of births is expected to rise by around 10% in the next five years. However, the latest projection also suggests that the number of people aged over 85 will also increase, by two thirds by 2029. As the population ages, so we can expect to see more people with one or more long-term conditions. We know that both the very young rely more on health services, so Croydon CCG is anticipating a rise in demand for services in the coming years. Our financial and quality challenge Croydon CCG has inherited a substantial financial deficit, and the need to improve service quality in some areas. Croydon has historically received less money for health than it spends. We need to reduce expenditure by 37 million by 2016. We have a planned spend of 426 million against a budget of 406 million. We are currently proposing a 19.9m deficit plan for 2013/14, against a budget of 406m and planned spend of 426m. NEED TO SPEAK TO MIKE S The current health care systems will not meet this challenge. And they do not they give people the choice they expect in today s society, nor the support they need to manage their own health. 8
What are we doing to address our challenges? We know that we have a difficult task ahead, but we have a clear and credible plan to meet this challenge. Our Transformation Programme, which is explained in detail later in this publication, sets out how we will reshape services to meet the needs of Croydon, delivering high quality care within available resources. We are already making progress on our financial challenge, having made x m savings in 2012-13 and achieved breakeven. Quality and financial sustainability are equally important and we are committed to tackling both without having a detrimental effect on either services responsibly. This means, for example, asking your pharmacist for advice rather than going to the doctor, and only going to the Emergency Department if it s a very serious or life threatening incident. If we can help people to take better care of themselves, we can take better care of resources and ensure that high-quality services are there when and where people need them. Understanding and listening to people s views are a key part of our commissioning role. We want to hear what people think of the services they have used and the services we as a community need in the future. We are working closely with everybody with an interest in health in Croydon to maximise resources and promote better health for people in Croydon, within tight financial constraints. How you can help us We cannot do this alone. We need to work with all our stakeholders our patients, the public, local health providers, GPs, the local council and the voluntary sector. Most important of all we need the support of the people of Croydon to care for their own health and use local health 9
Have your say and get involved We are committed to communicating and engaging with local people in Croydon, the wider health and social care community and our local stakeholders to maintain trust and confidence in services for which we are responsible. We want local people to get involved and help us make the right decisions about health services in Croydon. There are a number of ways you can personally have your say in the services we provide. Currently we are putting plans in place to facilitate your involvement as follows: Patients, service users and the public can pose questions to the panel about local health services and bring feedback and views for discussion at the forum. Dates, times and venues will be advertised on this website in due course. Our website We welcome your feedback and you can give this any time via our website (www.croydonccg.nhs.uk/haveyoursay/pages/ feedback.aspx) Practice Participation Groups (PPGs) PPGs are made up of volunteers from a GP practice population who meet regularly with the practice manager and/or GPs from their surgery. They advise on how services offered by their practice can be improved and help make sure the patient experience is as good as it can be. For more information about your local PPG contact your GP practice manager. Quarterly Patients Forum 10 An open meeting hosted every three months at a public venue for questions and discussions about health services. A panel of CCG members, including the Governing Body Lay Member with responsibility for patient and public engagement, will be present at the forum.
Transforming health services in Croydon Over the next X pages, we will set out our ambitious plans for transforming health services in Croydon. Our Transformation Strategy and Programme will help us to achieve our vision for healthcare in Croydon, our organisational objectives, outcomes and priorities 11
Our transformation strategy explained Croydon faces major change in the coming years. Current health trends, changes in the make-up of our local population, variations in the quality of health services in Croydon and the need to make the best use of our resources mean that we must transform the way services are delivered. The principles that drive our transformation strategy are prevention, self-care and shared decision making. We want people to be active partners in their health. We want to transform the way we deliver services, putting patients at the centre of their care, feeling empowered to manage their own health, with less need to go to hospital and receiving more and better care closer to home. 12
Our transformation strategy explained Our transformation strategy aims to ensure: Increased emphasis on self-care and shared decision making We help people to feel empowered to look after themselves and their families better by making healthy lifestyle choices to prevent ill health where possible The key priority areas for transformation are highlighted in the diagram below. The seven transformation strategy priority areas If people do become ill, we put patients at the centre of their care, helping them to better manage their conditions Right care in the right place at the right time We deliver the right care in the right place at the right time. This may not always be in hospital; it may be at the GP surgery, in a community clinic or, making the use of modern technology, in the patient s own home Safe care Care patients receive is safe and of the highest quality and is regularly monitored A positive experience of care for every patient People know what services to use and when; that they are involved in decisions on their care and treated with respect and dignity. 13
Our transformation plans Objective We will Prevention, self care and shared decision making Improve patient s life expectancy and quality of life by helping them to look after themselves better, avoid illness where possible and, if they do become ill, to get the best care Help people to feel empowered to look after themselves and their families better by making healthy lifestyle choices to prevent ill health where possible Put patients at the centre of their care, helping them to better manage their conditions Help patients better understand their condition and treatment options so that they and their health professional can reach a healthcare choice together Objective We will More convenience and control for patients, with primary (GP) Harness the local expertise of our GPs by planning our services around six area-based GP-led networks to target services where they are Primary and Community Care and community services delivering more care closer to where people live. needed most by identifying: Areas of deprivation The types of ill-health common in the area People who are vulnerable, such as those with a mental health diagnosis People who need additional support, such as those with a learning disability, older people and children Objective We will The right care in the right Ensure more care is planned, reducing emergencies and ensuring care 14 Planned Care place high quality services, with more care delivered closer to people s homes. is more convenient, accessible and a better use of resources Transfer services which can be delivered out of hospital into community settings. improving access and convenience for patients
Our transformation plans Objective We will Urgent care To reduce the reliance on Urgent Care services by improving access in Primary and Community Care and helping patients use services more appropriately Work with patients so they know which services to use and when best to use them Work with primary and community services, such as GP practices, pharmacies and other services, to improve access and ensure that they respond to patients needs Objective We will Making best use of medicines To support people to get the best benefit rom their medicines cut the amount of medicine wasted each year Work with our GP Practices, pharmacists and nurses so they can help people understand why they have been prescribed their medicines and feel able to raise any concerns Raise awareness of the best use of medicines and how to reduce waste Objective We will Long-term conditions Help people maintain their independence and keep as well as possible for as long as possible. Educate people about their condition so they understand the triggers that make them ill and are better able to look after themselves Help patient to minimise the impact of their condition on their day-to-day lives and avoid the need for emergency treatment Objective We will Children and young people Support children and young people to achieve their full potential. Help ensure the best possible start for in life for children by improving maternity services and increasing the number of midwives Work through the geographical networks, so that local GPs and health workers can identify and respond to local needs ensuring access to the most appropriate care 15
Delivering our transformation programme GP Networks Delivering our transformation programme will be challenging. To ensure that GPs are at the heart of the programme, we have developed six geographical networks of local GPs in Croydon. Each network has a GP Clinical Lead and is supported by a range of commissioning and public health functions. GPs understand their patients needs and are in the best position to know: Pharmacy First services providing advice on minor ailments Shared care including community matrons, district nurse and health visitors Where the pockets of deprivation are in their communities The prevalence of ill health among their patients Who their vulnerable patients are (including those with a mental health diagnosis, people with a learning disability, older people and Older People and Children and Families needing additional support How health resources are utilised within their local areas The six GP networks will lead on commissioning decisions for Croydon as well as delivering services tailored to the needs of their specific areas. These will include: Primary care services (eg GP practices providing a comprehensive range of services) 16 Prevention services
Improving quality and safety through our transformation programme Quality will remain at the heart of everything we do. Croydon CCG s aims is to commission health services that are safe, that employ best clinical practice and offer information to inform patients choice in how, when and where they receive their health care services. We believe that by embedding performance and quality improvement in our commissioning processes and communicating and engaging with the public and patients who use our commissioned services, Croydon CCG will listen to patients concerns and take appropriate action. This is critical to ensuring effective and responsive care. In the way that we work, Croydon CCG will embody the principles of accountability, putting the patient first in everything we do. Our performance and quality programme will ensure: You are seen as quickly as possible Your experience of health services will be improved Healthcare acquired infections are reduced (for example MRSA and C difficile) 17
The NHS in England organisational changes in summary On 1 April 2013, major organisational changes to the NHS were implemented.to deliver the ambitions set out in the Health and Social Care Act. Locally, clinical commissioning groups made up of doctors, nurses and other professionals will buy services for patients, while local councils formally take on their new roles in promoting public health. Health and wellbeing boards will bring together local organisations to work in partnership and Healthwatch will provide a powerful voice for patients and local communities. Most people won t notice any immediate difference to how they get the care they need: they will still contact their GP when unwell, or their local council with ongoing personal care needs, and they will continue to receive healthcare free at the point of need just as before. However, some important underlying changes are being made to how the health and care system is run. These changes are about giving local communities and patients more say in the care they receive and doctors and nurses more freedom to shape services to meet people s needs, to improve the quality of the support, care and treatment we all receive. How health and care organisations will work locally Clinical Commissioning Groups (CCGs) are made up of doctors, nurses and other professionals who use their knowledge of local health needs to plan and buy services for their local community from any service provider that meets NHS standards and costs these could be NHS hospitals, social enterprises, voluntary organisations or private sector providers. This means better care for patients, designed with knowledge of local services and commissioned in response to their needs. Health and wellbeing boards in every area ensure that services work together to respond to communities needs and priorities. They will involve people and community organisations, including elected representatives, in deciding what services the community needs this will inform CCGs and local authorities when they commission services. Local Healthwatch, which are represented on health and wellbeing boards, give patients and communities a voice in decisions that affect them. Local Healthwatch will report their views and concerns to Healthwatch England so that issues can also be raised at a national level. 18
The NHS in England organisational changes in summary How health and care organisations will work locally (continued) Local Councils commission care and support services and have a new responsibility to protect and improve health and wellbeing. They use their knowledge of their communities to tackle challenges such as smoking, alcohol and drug misuse and obesity. Working together with health and care providers, community groups and other agencies, they prevent ill health by encouraging people to live healthier lives. How health and care organisations will work nationally NHS England supports NHS services nationally and ensures that money spent on NHS services provides the best possible care for patients. It funds local clinical commissioning groups to commission services for their communities and ensures that they do this effectively. Some specialist services will continue to be commissioned by NHS England centrally where this is most efficient. Working with leading health specialists, NHS England brings together expertise to ensure national standards are consistently in place across the country. Throughout its work it promotes the NHS Constitution and the Constitution s values and commitments. Public Health England provides national leadership and expert services to support public health and works with local government, the NHS and other key partners to respond to health protection emergencies. How the interests of people using health and care services are protected As the new system brings more freedom for those who plan, commission and provide services, new and existing health and care regulators will safeguard the interests of patients and the wider public. The Care Quality Commission (CQC) measures whether services meet national standards of quality and safety, ensuring that people are treated with dignity and respect. Healthwatch England works as part of the CQC. Monitor protects and promotes the interests of people using health services by making sure that NHS services are effective and offer value for money. Licensing providers of health care will be one of the main tools Monitor will use to do this. 19
Contact us Croydon Clinical Commissioning Group TBC TRANSLATIONS TO BE ADDED HERE IF AVAILABLE/ POSSIBLE Patient Advice and Liaison Service (PALS) Tel: 0800 4561517 (Monday - Friday 9am-5pm) If no-one is available to take your call please leave a message on the answer phone and we will ring you back. Email: SLCSU.Complaints@nhs.net Fax: 0203 049 4173 Media queries Tel: Email: TBC TBC Feedback We welcome your feedback and you can give this any time via our website (www.croydonccg.nhs.uk/haveyoursay/pages/ feedback.aspx) 20