Chair's blog: 2016 – New year, new approach to improve patient care
A New Year message from CCG Chair, Dr Jonty Heaversedge
The New Year is a good time to reflect on our progress over the last 12 months, and our plans for the year ahead. 2015 was a challenging year for the NHS – both locally and nationally. In Southwark our population continues to increase at a pace that outstrips many other parts of London, demand for most services is up, and providers of healthcare in our area are experiencing exceptional financial and work pressures.
Without exception the entire Governing Body of the CCG is acutely aware of the strain this places on everyone working in this context to deliver high quality care to our residents. What is inspiring, though, are the many examples of dedicated professionals doing all they can to support patients to achieve the best possible outcomes – often despite of, rather than because of, the way the system is organised around them.
I believe there is good reason to be optimistic about the future but this will require a radical change in our approach to the way we plan and deliver health services locally, and at a south east and pan London level.
We have already made significant progress in Southwark and there is much to be proud of. Some of our key achievements in 2015 include:
Building sustainable general practice
We know that local GPs and practices are finding it increasingly challenging to meet the needs of local people within existing structures and funding. Over the last 12 months, our two GP federations have been working to provide a range of services to benefit patients. Practices have secured funding through Southwark and Lambeth Integrated Care (SLIC) to trial new services including the recently launched Care Navigation pilot, which aims to better coordinate patient care and reduce pressure on general practice. Delivered in partnership with Lewisham and Southwark Age UK, one aspect of the pilot involves the appointment of individuals who work in the community to support older people to maintain their independence, safety and wellbeing. The other element involves training practice and pharmacy staff to become care navigators to help people to access the right support at the right time.
Together with Guy's and St Thomas' Charity we have invested in developing our GP federations to ensure that general practice has a strong future, and giving all Southwark residents high quality, accessible primary care services.
More GP and nurse appointments through the Extended Primary Care Service
Establishing the Extended Primary Care Service (EPCS) has been one of our most significant achievements. We listened to the views of patients, clinicians and other local stakeholders and heard that people often find it difficult to get an appointment and find the health system confusing, and that variability in quality and patient outcomes alongside increasing demands on services were a significant concern.
In response we developed the EPCS, which is open from 8am to 8pm, 7 days a week, delivered from two sites in the borough. To date over 14,000 additional GP or nurse appointments have been delivered through the service and 95% of patients surveyed would recommend the service to friends or family.
Agreeing our plan for the future: Southwark's Five Year Forward View
Last year we developed a new five-year shared strategic vision with Southwark Council. It's an ambitious plan, which describes a very different approach to commissioning and providing services in Southwark. This isn't something we have been asked to do; rather it is our attempt, in the context of a challenging environment, to lead the system locally and achieve improved outcomes; better value; and sustainable high quality service provision for local people. We will achieve this through:
a population-based approach to commissioning, focussed on cohorts of people with similar needs, rather than particular provider institutions
incentivising closer working between healthcare and voluntary sector organisations
commissioning on the basis of outcomes rather than activity
focusing more on behaviour change and early intervention to prevent people becoming unwell in the first place
enabling more patients to take control of their care
supporting the development of Local Care Networks - connecting up health, social care and voluntary sector services around the patient
making it easier for people to access support and treatment out of hospital and reducing health inequalities across the borough.
Work has already begun on turning this plan into action, with the intention that some of the first new contracts to support this change will begin in 2017/18.
Establishing an innovative GP fellows' scheme
We recruited six young doctors across Lambeth and Southwark to the innovative Southwark and Lambeth Population Health Improvement Fellowship scheme. This initiative is intended to support the on-going education and developmental needs of newly qualified GPs, aid recruitment and retention of GPs in both boroughs and enhance the quality and consistency of primary care services for our local populations.
The scheme is the first of its kind and will play an important role in the development of Community Education Provider Networks (CEPNs) linked to our emerging Local Care Networks in Lambeth and Southwark, unifying service and education within the new models of integrated care that we are developing across both boroughs.
CQC visits to Foundation Trusts
Whilst our vision for 'tomorrow' is essential if we are to create a local health and social care service fit for the future, it is equally important that we focus on 'today'. The CQC this year completed visits to each of our local foundation trusts. We are awaiting the report for Guy's and St Thomas', King's College Hospital was rated as 'Requires Improvement' overall, and more recently South London and Maudsley NHS Foundation Trust (SLaM) has achieved a 'good' overall rating with some services rated as 'outstanding'.
In our work with King's we regularly see positive examples of good performance, best practice and innovation across the Trust, and we play an active role as commissioners in working with them to build on these strengths. Over the course of the next year we will continue to work with King's to secure improvements in areas identified by the CQC.
Performance – achievements and challenges
You will be aware of the continued prominence this year of NHS performance in the national media. A&E, referral-to-treatment (RTT), and cancer waiting times in particular, have attracted a significant amount of attention. As the commissioner of these services for Southwark residents, we are responsible for ensuring that all of the providers we commission deliver services in line with national waiting time standards.
Meeting national performance requirements has been, and still remains, a huge challenge for both King's and Guy's and St Thomas'. We are working with local hospitals and other partners to implement actions plans to improve performance where necessary.
We have also achieved a number of national performance standards this year. The number of patients admitted as inpatients onto mixed-sex wards has all but been eliminated locally, and rates of MRSA infections in acute setting are similarly low (only one case to date in 2015/16). The most recent quarterly data shows that 96.5% of Southwark patients referred with suspected cancer are seen within two weeks; and of those diagnosed, 97% began their first treatment within 31 days. This has been achieved in Southwark because providers and commissioners have worked together to ensure these standards are consistently met.
The health of local finances
The CCG has achieved a good financial position so far for the financial year 2015-16. However, local NHS providers have had a challenging time in 2015-16 with regard to their financial positions and this is likely to be reflected in the CCG's budget plans for 2016-17, as we respond to the increased demand on our resources across the system.
The recently published Planning Guidance from NHS England indicates a national commitment to additional resource for primary care and a Transformation Fund – a significant part of which will support those hospitals that are in financial deficit, such as King's. The allocation of this funding has yet to be agreed; however it is clear that any resources available will only be released to health and care systems that are willing to work differently and develop new models of care as described in the national Five Year Forward View.
It is increasingly clear that in order to address the challenges we face we need to improve communication and collaboration, share ownership of problems and co-produce solutions with patients and our partners across the health and social care economy. Our local Forward View in Southwark reiterates our commitment to working with partners across south east London through our regional strategy Our Healthier South East London.
Our close relationship with our nearest neighbours in Lambeth also continues in 2016. The Southwark and Lambeth Integrated Care (SLIC) programme will enter a new phase as the programme transitions into a new Strategic Partnership across both boroughs. We will work together as commissioners and providers in the local system to implement changes at a bi-borough scale that support the population-based approach to service delivery we have described in our Forward View.
Devolution and early action
You may have recently read reports regarding a 'health devolution agreement' for London. The aim of the agreement is to devolve decision-making on health and social care services to local leaders and give people more control over decisions that affect their lives.
Southwark is not participating in one of the five 'devolution pilots' across London but we will learn from them, and build on an already close collaboration with our local council through the Southwark Health and Wellbeing Board.
To support and advise the work of the Health and Wellbeing Board last year we commissioned a report on early action. The Southwark and Lambeth Early Action Commission report Local early action: how to make it happen aims to make preventing harm the driving force behind local policy and practice.
The report recognises that most local problems share the same underlying social and economic causes and that the best way to prevent them is to change systems. The commission acknowledged the good work already going on to promote early action across Southwark and Lambeth and made some key recommendations that will inform the work of the Health and Wellbeing Board and the CCG in the year ahead.
Mental health and parity of esteem
It is pleasing to report that almost 80% of all Southwark residents thought to have dementia are now known to the NHS. This means they can access the treatment and services they need to improve their quality of life as they live with the condition.
Improving Access to Psychological Therapies (IAPT) services in Southwark also continued to see record numbers of patients last year, meaning that hundreds more people with anxiety and depression have received treatment compared to previous years. However, we know there is room for improvement. Next year will see significant changes to psychological services in Southwark. In 2015 we concluded a tendering exercise for the provision of IAPT services in the borough. Under a new contract, which goes live from April 2016, our IAPT service will enhance their support to local people by increasing the range and number of locations from which therapies are provided; and extending opening times to include weekday evenings and Saturdays.
Co-commissioning of general practice
Last year saw a significant shift in our role as a CCG in relation to general practice. Following an extensive engagement process with our membership we moved into a co-commissioning arrangement with NHS England (London). The decision to become more involved in the commissioning of general practice has led us to carefully review our governance structures and conflict of interest policies to ensure that we are able to make objective decisions with NHS England about how general practice is commissioned.
This new way of working presents an opportunity. By bringing together the funding for the whole system in this way, there is more scope to shift available resources to the most cost-effective parts of the care economy and deliver better value for local people.
I am optimistic that, with a lot of determination and effort, we can achieve our ambitious plans, deliver better care to patients and ensure that clinicians' working lives are fulfilling and sustainable.
I wish you all a very happy and healthy 2016.