Welcome

Housekeeping

• Please turn your mobile phones off or put them on silent.

• No fire alarm is planned today. If you hear the alarm, please make your way outside.

• Toilets are available at the back of the main room

Aim of today

• To update you on the development of Enfield CCG

• To inform you about our key plans and priorities over the coming year

• To build relationships with our key stakeholders and our local population

• To give you the opportunity to get more involved in Enfield CCG

Today’s agenda

We will start with some presentations:• About Enfield CCG• Our Commissioning Strategy and QIPP plans• Update on Healthwatch Enfield

Then we will have an opportunity for you to ask questions.

We will break for some food and refreshments at 6pm.

At 6:30pm we will ask you to take part in some workshops on our key strategic plans.

Listening to you

Your feedback is important to us today. We want to work closely with our stakeholders and our local population in developing our plans for the future.

We would like you to get more involved in the CCG. You can:• Attend a Governing Body Meeting• Join your GP practice’s Patient Participation Group• Sign up to our mailing list• Volunteer to help us improve services for local patients• Visit our website www.enfieldccg.nhs.uk for more information

We will ask you to fill in a feedback form about today’s event and we will make a report available in a few weeks time summarising everything we have discussed.

About Enfield CCG

Presentation by

Dr Alpesh Patel and Liz Wise

About CCGs• Clinical Commissioning Groups (CCGs) were created as part of the

changes set out in the Health and Social Care Act 2012.• CCGs are led by GPs and are intended to improve clinical leadership in

commissioning. • Every GP practice is now a member of a CCG and have signed up to a local

constitution.• All CCGs have recently been through a vigorous authorisation process led

by the NHS Commissioning Board which tested their ability to:- commission services- manage the funding - improve quality, reduce inequality and deliver improved outcomes for our patients within the available resources

• During the authorisation process, we were working in shadow form with our PCT cluster NHS North Central London. PCTs closed on 31 March 2013.

• We have been authorised and on 1 April 2013, Enfield CCG became the new statutory body responsible for planning and com missioning health services for patients in Enfield

Vision, mission and goals

Our Vision• We are committed to commissioning services that improve the health and

wellbeing of residents of Enfield borough through the securing of sustainable whole system care

Our Mission • Local clinicians working with local people for a healthier future.Our Strategic Goals• Enable the people of Enfield to live longer fuller lives by tackling the

significant health inequalities that exist between communities• Provide children with the best start in life• Ensure the right care in the right place, first time• Deliver the greatest value for money for every NHS pound spent• Commission care in a way which delivers integration between health,

primary, community and secondary care and social care services

“Local clinicians working with local people for a healthier future”

Enfield CCG’s locality approach

• Population 2012: 312,000 (source: ONS)

• Ethnically diverse: 154 languages spoken in Enfield schools

• Coterminous with Enfield Council• 54 GP practices• 3 main local providers:

Barnet, Enfield and Haringey Mental Health TrustBarnet and Chase Farm Hospitals North Middlesex University Hospital

Governing Body sub committees: chairs and membership

Understanding our challenges

• Scope and complexity of clinical service and organisational change across all three main providers

• Long history of an unsustainable system and scale of financial recovery

• Pace of leadership and organisational development of the CCG

Quality and safety: putting patients at the heart of everything we do

We will strive to improve the quality within our commissioned services through highly effective

clinical leadership

Maintaining quality during strategic changes

• Scope and complexity of clinical service change acr oss all three main local providers

• Barnet Enfield Haringey Clinical Strategy• Clinically supported• Secretary of State approved: A&E, Maternity and Planned Care

changes, enabled by:• Primary Care development strategy and• Integrated Care Programme

• FT related organisational change :• North Middlesex University Hospitals • Barnet and Enfield Mental Health Trust, including Enfield Community

Health Services • Barnet and Chase Farm Hospitals with Royal Free Hospital NHS FT

How we are making a difference

What motivates us to lead clinical change for membe r practicesand patients?

• Connecting practices together in new and different ways through primary care development networks signposting earlier opportunitiesto improve health and reduce outcome inequalities

• Getting the books back in balance through sustainab le, clinically-led re-design and re-shaping the provider landscape to work more productively, by integrating high quality care with and for patients

• Seeing patients increasingly as partners in their o wn care with their practices by involving them more in lifestyle, self care, treatment and re-design decisions

Sustaining two way accountabilityInvolvem

ent of Mem

ber Practices

Informing – named representativesKeeping all Member Practices up to date on proposed or planned changes e.g. through Locality Leads, Protected Learning Time,, CCG Newsletter, CCG Website, Patient Participation Groups, Clinical Network Leads.

Working in Partnership – clinically led changeMember Practices involved in decision making re: structure and governance arrangements and the planning and development of services. Locality Leads holding Locality Group meetings bi-monthly.

Consulting – locality and clinical networksGaining views of the practices and patients, e.g. through Locality Group meetings, Protected Learning events (PLTs),

Our Health Challenges

Dr Shahed Ahmad, Joint Director of Public Health

THE CHALLENGE•Very high levels of poverty and child poverty•High rate of childhood obesity•Large gap in life expectancy•Life expectancy for women in Upper Edmonton the worst in North Central London•Blood pressure control still below national average

THE GOOD NEWS•Best improvement in Year 6 childhood obesity rates in London•Improvement in blood pressure control•Best improvement in life expectancy in North Central London

Our health challenges

Children living in poverty in north central London

Child poverty - August 2007

1560017120

18555

24485

27050

0

5000

10000

15000

20000

25000

30000

Camden Islington Barnet Haringey Enfield

Enfield has amongst the highest rates of childhood obesity in the country

Obesity by local authority• Reception 4th worst nationally 14.4% • Year 6 – 5th worst nationally 25.1%

Position in EnglandLeast deprived (38)Worst 10% (72)Worst 25% (37)Worst 50% (34)

Obesity in children aged 10-11 years

Our health needs

Life expectancy: female

Our health needs

Life expectancy: male

Causes of the life expectancy gap in Enfield

Causes of Life Expectancy Gap in Enfield

Approaches to tackling health inequalities: systematic and sustainable

2010 2015 2020 2025

Gestation from Input to Outcome

A

B

C

Short Term- Treatment of already existing

conditions or risk reduction in people

already at high risk of developing the major

causes of morbidity

Medium Term - Lifestyle approaches.

Long Term - Addressing Wider

Determinants of Health.

Approaches to tackling health inequalities: commissioning for best outcomes

Health and wellbeing strategy

Moving to Public Health Excellence

A healthy start for every \child

Narrowing the gap

Healthy lifestyles Healthy places

Strengthening partnerships and capacity

•Childhood obesity •Immunisation•Infant Mortality•Teenage Pregnancy

•Cardiovasculardiseases•Cancers•HIV•Screening

•Smoking•Physical Activity•Healthy eating•Obesity•Alcohol•Healthy Ageing

•Healthy Parks•Temporary accommodation

•Healthy Enfield•Health is everybody’sbusiness•Health in every policy•Making every contact count

Health and Wellbeing strategy priorities

Improvement in controlling blood pressure and cholesterol levels

2008/09 149th

2009/10 134th

20010/11 110th

CHD 6 National Ranking for Enfield CHD 8 National Ranking for Enfield

(1st being the best and 152nd the worst)

Source: Informational Centre

2008/09 141st

2009/10 128th

20010/11 121st

Largest Percentage improvement in AAACM for males in NCL cluster 2008-2010

0%

2%

4%

6%

8%

10%

12%

14%

Barnet Islington Camden Haringey Enfield

Commissioning Plan2013 – 2016

Richard Quinton Director of Finance and Commissioning

39.2 13.5

6.51.3

20.7

-5

0

5

10

15

20

25

30

35

40

45

Opening RunRate Deficit

2012/13

QIPP Saving Other RecurrentSavings &

Contingency

Other Non-RecurrentBenefits

Non RecurrentSupport via

NCL Risk Pool

£m Deficit

£m Surplus

Trajectory of Financial Position 2012/13

£2.8m Surplus

Trajectory of financial position 2012/13

19.2

5.9

9.0

1.76.3

15.4

11.1

7.6

5.92.1

0

5

10

15

20

25

30

35

40

45

£m Deficit

Trajectory of Financial Position 2013/14

Route to achieve balance 2013/14

Planned Break-even

Route to achieve balance 2014/15

8.0

4.0

12.0 00

2

4

6

8

10

12

14

Run Rate B Fwd2014/15

New Pressures QIPP Deficit Year End

£m Deficit

Trajectory of Financial Position for 2014/15

Acute

Non-acute

Prescribing

Other

Budget £m

Acute 265.9

Non-acute 87.2

Prescribing 38.7

Other 7.9

Finance summary

Our commissioning plansS

take

hold

er E

ngag

emen

t

Mandate Preventing People

from dying

prematurely

Enhancing the quality of

life for people with long

term conditions

Helping people recover

from episodes of ill

health or following injury

Ensuring people have a

positive experience of

care

Treating and caring for

people in a safe environment

and protecting them from

harm

JHWS

Key

Themes

Narrowing the gap –

reducing Health

inequalities

Healthy lifestyles, healthy

choices

Healthy places Healthy places

ECCG

Strategic

Goals

Enabling the People of

Enfield to live longer

fuller lives by tackling

significant health

inequalities

Commission care in a way

that delivers integration

between health and

social care

Ensure the right care, in the right place, first time

Healthy Starts – Improving child health and providing children with the best start in life **

Deliver the greatest value for every NHS pound spent

ECCG

Commissioning

Intentions

Prevention Primary

Care

Integrated

Care

Clinical and

cost

effectiveness

Children

and young

people

Mental

health

Enfield Transformation Programme

Prevention,

Early Diagnosis

and Primary

Care

Integrated Care

for Older People

Unscheduled

Care

LTC

Management

Maternity,

Children and

Young People

Mental Health

and CHC

PREVENTION AND

EARLY DIAGNOSIS

Helping people to

stay well and

identifying those

who are unwell

early

PRIMARY CARE

Improving access

and reducing

variations in

quality of care and

patient experience

Joining up Health

and Social Care to

support Older

People and people

with Long-term

Conditions (LTC)

Delivering more care locally and helping

people to stay out of hospital

Understanding

the needs of the

population and

commissioning

effective and

efficient services

for people with

Mental Health

needs

Joining up Health

and Social Care to

support children and

young people

Clinically effective and safe services

Patient centred – a good patient experience

Most effective use of NHS resources

Delivering our commissioning plans (1)

Enfield Transformation Programme

Prevention,

Early Diagnosis

and Primary

Care

Integrated Care

for Older People

Unscheduled

Care

LTC

Management

Maternity,

Children and

Young People

Mental Health

and CHC

Projects:

Anti Coagulation

DVT

Home Oxygen

Review

Diagnostics

Primary Care

Programme

Projects:

MDT Case

Management

Admissions

Avoidance/ESD

Falls

OPAU

Community

Services Review

Projects:

UCCs

111 and DoS

OOHs

Projects:

ENT

Cardiology

Respiratory

Pain

Management

Urology

Dermatology

C2C referrals

Gastro

T&O

Projects:

IAPT

CHC beds

Seacole Unit

Out of Area

Treatments

Projects:

Maternity Pathways

Primary Care Paeds

PAU

Cross cutting: BEH Clinical Strategy, Medicines Management, PoLCE, Acute Productivity, Referral Management, Other

budget areas

Delivering our commissioning plans (2)

• Continued engagement on our commissioning plans

• Reporting back to you on our progress and achievements

• Continue to develop and deliver our 3 year commissioning strategy plan

Next steps