Knowsley Clinical Commissioning Group (CCG): an introductory guide ...

Knowsley Clinical Commissioning Group (CCG): an introductory guide to the organisation

1. Introduction NHS Knowsley Clinical Commissioning Group (CCG) is made up of the 33 GP practices in the borough working alongside health practitioners from all areas, the third sector, the voluntary sector, our local council and secondary care. We have come together to put patients first and improve health services in Knowsley. The CCG has been formed to deliver a new way of commissioning health services in the borough. We want local people to feel heard, listened to and cared for, and we believe that by using our clinical knowledge and close working relationships with patients and partners we can make a big difference to health outcomes. Knowsley faces many health challenges but we have an ambition for a healthier, happier population with a better quality of life, a reduction in health inequalities and improved access to healthcare, when required, as close as possible to home. We believe that the patient must be at the centre of everything we do, through individual consultation at surgeries, to the care that is delivered in hospital and community services. We are committed to strengthening our relationships with the local population through patient participation groups at GP practices, HealthWatch and through close engagement with Knowsley’s Area Partnership Boards. It is through these partnerships with clinicians, patients and the wider community that we will be able to meet the considerable challenges ahead. We must work well together to develop a healthier future for Knowsley. This short guide outlines how we will deliver our commissioning responsibilities.

Dr Andy Pryce Chair

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Dianne Johnson Accountable Officer

2. About Knowsley and the local population Knowsley is a metropolitan borough of Merseyside, England. It comprises the towns and districts of Kirkby, Prescot, Huyton, Whiston, Halewood, Cronton and Stockbridge Village. Kirkby, Huyton, and Prescot are the major commercial centres of the borough. It takes its name from the village of Knowsley. The borough was formed on 1 April 1974 by the merger of Huyton-with-Roby Urban District, Kirkby Urban District and Prescot Urban District, along with most of Whiston Rural District and a small part of West Lancashire Rural District, all from the administrative county of Lancashire. Knowsley’s population grew dramatically in the 1950’s and 1960’s as residents were migrated from inner city Liverpool to new housing estates created on the outskirts of the city. With them came existing health challenges, some of which remain present to this day. Knowsley currently has a relatively young population, with a proportionately higher number of people under 25 years of age than the national average. The age profile of the population affects the dependency ratio, i.e. the number of children and older people in the population as a proportion of people of working age. Population forecasts predict further increases in the population aged 50 and over, including a 75% increase in men aged 85 plus in Knowsley. At the same time, it is anticipated that there will be a decrease in younger age groups, notably those aged 35 to 44. This is likely to impact on the dependency ratio.

Life expectancy for females in Knowsley in 2006– 08 was 79.2 years, compared to a national average of 82 years, i.e. Almost 3 years lower. Life expectancy for males in Knowsley in 2006–08 was 75.5 years, compared to a national average of 77.9 years, i.e. 2.4 years less. There are also differences in life expectancy within the Borough. Male life expectancy ranges from 71 years in Prescot West ward to 79.5 years in Swanside ward, a difference of over 8 years. Female life expectancy ranges from 74.7 years in Northwood ward to 89 years in Halewood North ward, a difference of more than 14 years. There are a number of other notable characteristics present in the Borough’s population. Knowsley also has a higher than average proportion of lone parent households (19%) and a higher percentage of carers (11.5%) than the average for England and Wales (9.9%). Comparisons from the 2001 Census also reveal that Knowsley residents are less likely to own their own home, have a car or have qualifications and are more likely to be unemployed or have a limiting long-term illness. The most deprived areas are often also those with the poorest health. Physical and mental health and wellbeing can be affected by many factors, including: • housing conditions • the environment • work • social contact • access to leisure and culture opportunities • experience or fear of crime and • transport access to services and facilities

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3. About NHS Knowsley CCG The geographical area covered by Knowsley CCG is coterminous with the local authority boundary of Knowsley Borough Council. This means that Knowsley CCG can make best use of available resources and facilitate an integrated approach to improving health and wellbeing in the borough. Clinical Commissioning Groups (CCGs) are made up of member practices and in Knowsley all 33 practices within the borough boundary have joined the CCG. The CCG is responsible for the commissioning of health care services for its registered population which means all patients who are registered with a Knowsley GP and this will include people living outside of the borough. The registered population of Knowsley is significantly higher than the resident population; Knowsley CCG had a registered population of approximately 161,100 at 1st April 2012. CCGs operate by planning and buying healthcare services on behalf of their local population including: • Planned hospital care • Rehabilitation care • Urgent and emergency care • Most community health services, including district nursing and prescribing • Mental health and learning disability health services Knowsley CCG was fully authorised by NHS England in March 2013.

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4. Knowsley CCG Engagement The CCG has made a firm commitment to meaningfully embrace the principles of ‘no decision about me without me’, making this a reality for Knowsley patients and is committed to developing and embedding a culture of openness, transparency and honesty. Knowsley CCG will: • Work in partnership with clinicians, patients and local communities to secure the best care for its population • Share knowledge with the aim of improving the public understanding of our activities and objectives, while also encouraging dialogue • Publish information about health services through a variety of formats and channels, including concise, understandable and comparative information about the cost, quality and performance of local services. • Act openly and honestly when making difficult commissioning decisions regarding limited resources and increasing demand for care • Adapt communication and engagement activities to meet the specific needs of different patient groups and communities

The following extract has been taken from the Knowsley CCG Constitution:

‘We believe that the patient must be at the centre of everything we do, through individual consultation at surgeries, the care that is delivered in hospital and community services. We are committed to strengthening our relationship through patient participation groups at GP practices, through Local Improvement Networks (LINks) and Health Watch and through close engagement with the Area Partnership Boards of the Knowsley Partnership.’ The CCG Communication and Engagement Strategy sets out the CCG’s intentions and arrangements for ensuring effective two way communication with its membership, patients and public, and securing public involvement in shaping and developing local health services.

• Encourage and act on feedback • Information on lessons learned and actions taken as a result of complaints will be aggregated in an annual report on complaints. This will be publicised on the CCG’s website and, where relevant, reflected in narrative on ‘you asked, we did’ in CCG annual report. • Hold Governing Body meetings in public. This approach not only reflects the communication and engagement requirements of the NHS constitution, the Health and Social Care Act 2012, and the Equality Act 2010, but goes much further into building effective engagement into all aspects of the work of the CCG.

At the CCG’s inaugural stakeholder event in March 2012, participants were asked ‘How will stakeholders contribute to the delivery of the CCG strategic vision and ensure that stakeholders make a difference for our communities?’ Among the responses was through involvement of service users and carers at all levels, widening scope and influence of patient participation groups, equal weight to patient views, and increasing participation and feedback.

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The CCG aims to have effective patient participation groups (PPGs) in place in every Knowsley GP practice. There are a number of very vibrant, active groups in place and others which are less well developed, and the CCG wants to support the sharing of best practice across all PPGs. To facilitate this a Patient Participation Group Forum has been established to bring together representatives from all PPGs. The CCG considers PPGs to be a part of the extended membership of the CCG and expects them to play a key role in improving the quality of primary care and ensuring that patient experience is captured and used to inform service development and improvement.

The CCG is actively working to gain a fuller understanding of its services and the quality of the services received by its patients and has trialled a system of obtaining such feedback from patients attending their GP practice. This has proved successful and is now being extended to all practices. In receiving feedback from current patients the CCG is able to use the information to discuss issues with providers and improve the design of future services. A Patient Experience Sub-Group has been established as a sub group of the CCG’s Quality & Safety Committee. It will be responsible for ensuring that the CCG has effective arrangements for listening to patients. This will include gathering and considering a wide range of patient experience information across the whole community and all commissioned services. Events are held bi-monthly with all GPs, clinicians and practice staff to ensure continued clinical leadership.

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5. Strategic Vision and Values Knowsley CCG’s vision and values were developed in consultation with stakeholders, including staff, GP Practices and the public, and confirmed during the first CCG led stakeholder event in March 2012. The strategic vision is:

“In five years’ time, the population of Knowsley will be happier and enjoy better health. When they need to access health and wellbeing services, they will be high quality services with improved access and which use the latest evidence based treatments and therapies. We shall see people living longer. They will be healthier and enjoying a better quality of life. They will be safer and there will be a reduction in health inequalities. They will have greater independence, more self care, more responsibility and greater involvement in decisions about their care.” In order to make these aspirations a reality, the services that the CCG commissions will be: • Patient centred • Safe • High quality • Cost effective • Outcome focussed • Closer to home • Affordable

From the patient’s perspective, all services will be integrated and appear seamless. Where appropriate, the CCG will seek to foster greater integration of services across secondary care, primary care, community care, the local authority and the 3rd sector. The CCG recognises the importance of the wider determinants of health and how social care, employment, economic prosperity, housing, sport and leisure, education, the environment and public health all help to promote health and wellbeing. The CCG aims to take a leadership role in the whole health economy, in particular in shaping how it is organised, in order to make it fit for purpose and ensure that patients are at the heart of everything it does. In order to deliver the CCG’s vision a number of vehicles for change were identified; a) Move Services Closer to Home The CCG will build upon its success with the Community Cardio Vascular Disease and Chronic obstructive pulmonary disease (COPD) Services to commission more services to be delivered closer to home. We know that our patients prefer this and that high quality services can be delivered in a more cost effective way in the excellent clinical facilities within Knowsley. b) Improving Primary Care In order to move more care closer to the patient it is essential that the CCG also works to improve the quality of Primary Care, moving everyone up the level of the best, not just in Knowsley, but nationally. A shift of care will also require the associated resource to be available within Primary care.

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c) Efficiency and Effectiveness A key driver of the CCG’s strategy will be to maximise the use of its resources to deliver increased efficiency both internally and externally within its commissioned services. This will include integrating services across primary, community and secondary care, the Local Authority and wherever appropriate to avoid duplication and improve patient experience. An integral component of increased efficiency is effectiveness of care and treatment and to achieve this, the CCG will expand its outcome focussed approach to commissioning. d) Partnership Working We believe that our strategic vision can only be realised through effective partnership working to deliver the very best quality services. The CCG will actively engage with all partners across all sectors of health and social care, our patients and our clinical colleagues in all areas. We are committed to the development of a strong Health and Wellbeing Board and will seek to use our powers to enter into formal arrangements where required e.g. pooled budgets, joint working and joint commissioning. e) Good Governance and Accountability The foundation of a successful CCG will be robust and transparent governance. As a membership based organisation, the CCG Governing Body is accountable to its membership and in order to succeed that relationship is pivotal. Equally, as a public body, the CCG is accountable for the efficient and effective use of public money and therefore the CCG Governing body will hold its meetings in public and publish its notes and papers on the CCG website. Furthermore, the CCG will publish an annual report to include the accounts and hold a public Annual General Meeting in line with its obligations as a statutory body. f) Innovative use of ICT The CCG believes that a more innovative use of developments in technology will allow it to achieve its strategic aim of efficient and effective services.

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g) Patient Education The CCG believes that a knowledgeable population will help to deliver the strategy. Patient education has been fragmented previously and the CCG plans to improve patient education. In partnership with our patients we will empower them to increase levels of self-care and make the best use of health and wellbeing services. h) Continuing Education of all Clinicians in Primary Care If the CCG is to deliver its strategy, Primary Care Clinicians (doctors, nurses, therapists etc.) will need increased levels of clinical and managerial knowledge and expertise to facilitate continuous improvement in the quality of primary care. i) Benchmarking The people of Knowsley deserve to experience the very best services. In order to improve commissioned services to the levels of the best, the CCG will utilise research and embed benchmarking within its culture. Existing services will be benchmarked against national and international standards and when new service specifications are being developed the best standards will be included as core components. j) Including People The CCG believes that to achieve the strategic vision it must work with the local population at all levels. Any service commissioned by the CCG will have the patient at its centre. There will be patient involvement in the design and commissioning of services including the award of contracts and patient experience will be a key element in the monitoring process. We will make full use of the Health and Wellbeing Board, Practice Patient Participation Groups and the Area Partnership Boards, not only to obtain views about services and planned service changes, but to inform the public about the work of the CCG.

The CCG has the following core values which will be reflected in all its work:

Professionalism

Accountability

Honesty

Transparency

Commitment to partnership working

Inclusivity

Outcome Driven

Quality

Value for Money

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6. Commissioning Priorities for 2013–14 Building on the Joint Strategic Needs Assessment (JSNA) the CCG hosted several consultation events with its membership and stakeholders to identify key priorities for 2013–14. These priorities are underpinned by the need to improve the experience of care for patients and their families/carers and also increase patient choice and transparency: a) Improve and increase timely diagnosis of dementia and improve services for patients with dementia and their carers. b) Increase access to and uptake of psychological therapies for patients who will benefit from this form of treatment. c) Review Child and Adolescent Mental Health Services (CAMHS) with partners. d) Work with the local authority and other partners to develop a Knowsley wide strategy to improve mental health and mental health care. e) Develop an enhanced Walk in Centre model at St Chad’s in Kirkby with improved community diagnostics and transfer this across Knowsley if proved to be beneficial. f) Complete the procurement and implementation of GP out of hours service. g) Implement the new national 111 service. h) Reduce hospital admissions for Paediatric Asthma and other conditions i) Complete the implementation of the Intensive Support Team to support people with long term conditions to be cared for at home. j) Increase Community Based Intermediate Care services. k) Review and re procure the Community Cardio Vascular Disease (CVD) service. l) Review End of Life Care m) Implement national changes to how maternity services are funded.

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7. Financial Summary Knowsley CCG will receive £244.9 million in 2013/14 to commission healthcare and pay for prescribed drugs. This figure includes an uplift of 2.3% which was the same for all CCGs. This figure was derived from the review of PCT baseline budgets carried out in 2012/13 which allocated Knowsley PCT’s funds between the various successor bodies – Knowsley CCG, NHS England, Local Authority Public Health etc. In addition, Knowsley CCG will receive a £3.7 million running cost allowance which must not be exceed in 2013–14.

Knowsley CCG will set a balanced budget for 2013/14 which meets the NHS England financial planning requirements of: a) Achieving a 1% surplus b) Holding a 0.5 % contingency reserve c) Keeping a 2% recurrent surplus by ensuring that 2% is spent non-recurrently on initiatives to “deliver longer term outcome improvement, financial sustainability and innovation”

The announcement of the allocations was the first element in developing a financial strategy which under-pins the Clinical Commissioning Strategy for 2013/14 and beyond.

Summary of Allocations and Expenditure Allocations Base Allocation Growth Other Anticipated Allocations Total Programme Resources Available Programme Expenditure Acute (Hospital) Services Mental Health Services Community Health Services Continuing Care & Other Joint LA Services Primary Care Services Other Programme Services Other Corporate Costs (Non-Running Costs) Operating Plan Requirements & Reserves Total Application of Funds-(Programme) Planned In-year Surplus/(Deficit) Planned Surplus/(Deficit) % Running Costs Budget

2013–14 Budgets NonRecurring Recurring £000 £000

Total £000

236,027 5,429 498 240,958

3,967 3,967

236,027 5,429 3,469 244,925

122,740 21,272 26,182 14,106 32,692 1,993 6,511 8,105 233,601 7,357 3.1% 3,728

3,597 726 891 130 3,530 8,874 4,907 -123.7%

126,337 21,998 27,073 14,106 32,692 1,993 6,641 11,635 242,475 2,450 1.0% 3,728

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8. How Knowsley CCG is governed Knowsley CCG’s constitution and governance arrangements reflect a strong model of clinical leadership. The Clinical Membership Group, which was established in May 2012, is responsible for making key decisions regarding the CCG’s constitution, strategy, budget and partnership arrangements. The Clinical Membership Group comprises representatives from each of the 33 member practices. These representatives have a key role in ensuring that information is communicated and discussed within their practice and their views reflected in decision making. The Clinical Membership Group has delegated some key decisions to the CCG Governing Body. The Governing Body is required by the Health & Social Care 2012 Act and chaired by a local GP. Clinical Leads (GPs) make up 50% of the membership of the Governing Body.

Other members include a secondary care (hospital) doctor, a registered nurse, a lay member for audit and governance and a lay member for patient and public involvement. Two key members are the Accountable Officer and the Chief Finance Officer. The Chief Executive of Knowsley Council is also a member of the Governing Body. The Governing Body has a number of committees through which duties and functions are delegated and governed. These committees are chaired by non GP members of the Governing Body and in the mail this is the ‘lay members’ to ensure scrutiny and challenge. The figure below shows the committees and subcommittee which report to the Governing Body.

Clinical Membership Group

Governing Body

Quality and Safety Committee

Medicine Management Sub-committee

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Audit Committee

HR and Remuneration Committee

Finance and Performance Committee

9. Contact Details Knowsley CCG welcomes the views and involvement of patients, their families and the general public. There are lots of different ways to contact us and get involved: NHS Knowsley CCG Nutgrove Villa Westmorland Road Huyton L36 6GA 0151 244 4126 [email protected] www.knowsleyccg.nhs.uk Speak to your GP Practice staff about joining the Patient Participation Group (PPG)

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