On Wednesday, September 24, 2014, NHS North East Hampshire and Farnham CCG held its first annual general meeting. The event gave us the opportunity to look at how the CCG has developed in its first year and what has been achieved for patients in this time.
There were a number of speakers at the event. Dr Andy Whitfield, chair and clinical lead, spoke about the year in review. He highlighted our unique geographical position and what this meant for patients. He spoke of partnerships – both clinical and those with partner and provider organisations. A video about the CCG’s first year also accompanied his presentation.
Dr David Brown spoke of how GPs and the CCG are working together for both the benefit of patients and general practice.
Colette Lane, a patient, spoke of how the Safe Haven Project at the Time Out Café has helped her and many others who have used the out of hours service when suffering a mental health crisis. A video showed other service users experiences of the café.
Dr Arfan Ahmed and Dr Sharon Boylett introduced a video about the singing group called Lungs Aloud - a group for people with breathing difficulties.
Maggie MacIsaac, chief officer, and Dr Peter Bibawy presented last where they discussed the CCG’s five year strategy, the financial challenge ahead and the six improvement programmes that will make a real difference to not only outcomes for patients but as well to help bridge the financial gap that we are currently facing.
The CCG's new lay member, Kathy Atkinson did a wonderful job at comparing for the event.
Attendees were also given the opportunity to walk around exhibitions from both the CCG and partner organisations including Southern Health and Virgin Care. At the end of the event the audience asked questions for our Governing Body to answer.
The videos played at the event are below:
- Our first year 2013/14 - http://youtu.be/H79zRDJBloc?list=UUGarm96g7rM3XuZZeqjzRYw
- Lungs Aloud singing group - http://youtu.be/mg1BMaMjfiE?list=UUGarm96g7rM3XuZZeqjzRYw
Questions asked at the event
How do GPs balance their time with patients against all these new meetings?
The clinical leads and the Governing Body GPs dedicate a set number of sessions per week to their CCG work. This is separate to the time they work within GP practice.
Is the funding for the Safe Haven Project (Time Out Café) assured from November 2014? It is obviously helping people and saving time in A&E?
Funding for the café in Aldershot, which is open seven days a week for those in mental health crisis, is secured until 1 April 2015.
This pilot project is being carefully evaluated, and a decision on future funding will be made following this evaluation.
Any figures on how the Time Out Café has reduced A&E admissions?
Calculations so far indicate that the around 15% of the attendances at the café would have resulted in an individual going to A&E if the café had been unavailable.
However we will have a much clearer picture at the end of the year. We are hoping to obtain funding from the Academic Health Sciences Network to support us with in depth analysis as part of our evaluation of this project.
What are the three most significant challenges that the CCG is facing over the next three years?
The three most significant challenges faced by the CCG over the next three years are as follows
Money: All public services are facing a financial challenge. We are fortunate in NHS North East Hampshire and Farnham CCG to have a strong set of service providers and we have not faced some of the difficulties that other parts of the NHS have. However, we cannot be complacent. Looking ahead we face a £50 million challenge. It’s imperative that we continue to work with our communities to help people stay healthier for longer, avoid unnecessary expensive treatment in hospital and reduce the bureaucracy and duplication between different parts of the health and social care system.
Complexity: We all know that we can provide more joined up services across health, social care, the voluntary sector and other public services such as housing. With our CCG population being close to many different boundaries, for example two County Councils, different district and borough councils and many of our services provided in Surrey even if you live in Hampshire – we are going to have to work very hard to achieve this for our population. We are committed to making this happen and have very positive relationships with our partners which means that we are confident that we will make significant progress on this during 2014 and into 2015.
Workforce: As our population grows and their needs increase over time, having the right skills to meet health and social care demands is essential. In common with many areas of the NHS, we face a challenge to recruit and retain an optimum workforce at times. We will continue to make every effort to use the right skills in the right place and at the right time to benefit patient care and this includes the creation of new roles when required.
How are we improving access to GPs?
We recognise that access to GPs is very important to our patients. We will be working with our GP Practices to identify how access can be improved. This may include extended opening hours, electronic access to GPs , use of other professionals for primary health care advice as well as working with Healthwatch Surrey.
What additional services does the CCG hope to introduce at Farnham Hospital and will these improve the financial viability of the hospital and its GPs practices?
In its five year strategy NHS North East Hampshire and Farnham Clinical Commissioning Group has very ambitious plans to transform its health and care system. There are a number of key programmes of work to ensure we provide, innovative, high quality, patient focused care in a community setting.
We recognise our community hospitals as valuable local assets which will help us deliver our local integrated working.
There are a number of pilot projects that could potentially expand and/or redesign the services provided at Farnham hospital. These include:
- A full review of the falls services provided in North East Hampshire and Farnham Clinical Commissioning Group. In order to provide equity of services to our communities we are currently reviewing the falls assessment service at Farnham Hospital.
- We are currently developing a Discharge to Assess pilot which includes a review of our community hospital bed provision including Fleet and Farnham Hospital as well as the inpatient beds we commission for patients with mental health. The Discharge to Assess pilot will establish trusted assessment, integrated health and social care delivery, enhanced access to rapid assessment and diagnostics, enhanced recovery and support at home. There is an opportunity to pilot the Discharge to Assess model at Farnham Hospital.
- North East Hampshire and Farnham Clinical Commissioning Group is currently developing a proposal to deliver more community geriatric services, providing specialist clinical experience in a community setting. The CCG is currently scoping this project and the potential delivery model across its locality.
We recognise that there is more work to do. We are eager to engage with people who use services and service providers.
What improvements in community services do you expect in the coming years?
We want to see our community services operating in a more joined up way with primary care, acute care and other agencies. This benefits the patient, and makes best use of all resources (not just financial).
We want more person-centred care. This means that care is provided around an individual’s needs, whether these are physical or mental health needs.
We want to see our community health workforce becoming more resilient through working in partnership with other agencies and using nursing skills at the right time and in the right place.
Finally, we want to see the quality of our community services improve with good feedback from people using services and their carers, as well as a reduction in the incidences of infectious diseases.
Where are services for children with autism on your agenda? How do you plan to meet the need?
Representatives from the CCG are arranging to meet with the Mustard Seed Autism Trust.
We have been working closely with Hampshire County Council to develop a Hampshire Autism Strategy for Children and Young People, and this is currently out for consultation. It outlines the proposed priorities for Hampshire.
The draft strategy for consultation is available from Hampshire County Council’s website, and comments can be made online: http://www3.hants.gov.uk/autism-consultation
Representatives from the CCG regularly meet with the National Autistic Society in Surrey and Children and Adolescent Mental Health Services (CAMHS) to discuss how services can be improved .
We are currently procuring a new service for CAMHS in Surrey but also including in this a review of services for children with ASD and ADHD . We also are focusing on differential diagnosis with ADHD and Autism and engagement with CAMHS
How do we get our services known to the CCG and what is the process for meeting with the CCG to discuss how we can work together?
We are a very collaborative CCG and we look to many partners for ideas and joint solutions. We have strong relationships with the voluntary sector too.
You can get in touch with us through our website and enquiries will be targeted to the right person in the CCG.
Is there a clinical lead for neurological conditions such as MS and Parkinson's, which typically (for Parkinson's) benefit from a multi-disciplinary approach and may be further complicated by other conditions (eg arthritis making mobility a real issue).
We have a Governing Body GP lead for planned care who would oversee this work along with the rest of his portfolio.
We do not, at present, have a dedicated clinical lead for neurological conditions, but we will review if evidence demonstrates that this is required.
Why is AQP Hearing not available in Farnham when it is in the rest of the CCG? When will it be available for people to be seen on the 'high street' in Farnham?
Audiology AQP (any qualified provider) was commissioned by the former Primary Care Trusts in 2012. Surrey PCT did not commission audiology services, however Hampshire PCT commissioned audiology services. Specsavers were successful in the procurement and are providing community based services in a range of locations across Hampshire.
How does the CCG monitor quality in services for its local population?
We work hard to ensure that local services are safe, caring, responsive, effective and well led. We put quality at the heart of all we do and we act quickly to put things right when they do not go as well as we would have liked. Ensuring high quality services requires collective effort, working together with patients and the public and with colleagues at all levels within and between organisations that provide health care and beyond (e.g. social care, public health).
We have in place a framework to ensure that the CCG is commissioning high quality services. This framework brings together a wide range of information from many different sources. This includes ‘hard’ data (e.g. quality standards set out in NHS contracts, healthcare acquired infection data, complaints data and serious incidents data) and ‘soft’ data (e.g. patient and health professional feedback, walkabouts, quality networks). We gather this information and cross reference it to ensure we know where we should focus our support, identify quality trends and themes and to celebrate and share good practice when excellence in care is delivered.
We also ensure that we listen to what people tell us about local services. This feedback is gathered from a variety of sources such as patient experience data, feedback from our patient participation groups, practices and other wider engagement and stakeholder feedback. We want you to tell us your experiences of using local services and some of the ways you can get in touch are through your own GP practice patient participation group, via the CCG website and CCG engagement events.
Working together with patients, providers of services, clinical commissioning groups and other partners, including the Care Quality Commission, local authority and Healthwatch, we bring together all of the information we have about local services and use this to make the NHS even better, for everyone, now and into the future.
There is to be a large amount of development in your area. Has the CCG taken this increase in population into consideration when devising commissioning plans?
When we plan for our services for the future we use our Joint Strategic Needs Assessment to consider the type, demand, location and cost of services that our population needs. We work very closely with our colleagues in Public Health across Hampshire and Surrey County Councils to make sure that our everyday work reflects the needs of our population as well as planning for the future.
Considering the population needs in the future has helped us to be clear about the challenges ahead to help people stay healthier and avoid expensive hospital care so that our budget can stretch to meet the needs of our communities.
The CCG also liaises with NHS England regarding the provision of sufficient General Practice services and community pharmacists.
When I spent large periods in police custody suites I was concerned by the large numbers in cells as the only places of safety for people with mental health problems. Has this practice ceased?
We continue to work with partners in the delivery of the mental health crisis concordat which includes reducing the use of police stations as places of safety.
The next multi agency group is in October and mental health commissioners will be attending.
Why is there so much difference in the treatment and supply of medication for diabetics? Following guidelines by Diabetic UK more needs to be done. Eg 1 example is the issue of the test strips some practices prescribe, some don’t unless you are on insulin.
Medication will depend on which type of diabetes a person has and on individual needs and situation. The National Institute for Health and Care Excellence (NICE) has produced guidelines for the management of diabetes for clinicians to follow. Self-monitoring of blood glucose is also based on individual needs and the decision on the type of meter and, therefore test strips, will be made in conjunction with a healthcare professional. Self-monitoring is vital for patients with type 1 diabetes. For people with type 2 diabetes self-monitoring should form an integral part of the patient’s self-management and the purpose, interpretation of results and action required should be clear.
You are already addressing the £150m gap in funding – but how will you handle the additional growth in GP load (+16%, unexplained) and the huge latest demand for mental health services, at primary and secondary levels, not handled by the Improving Access to Psychological Therapies programme?
The CCG recognises the increasing demand on primary care and the significant demand for mental health services. We are undertaking a number of initiatives which will provide improved services to people much earlier in their mental illness. This will include supporting people out of hospital and closer to their own homes. These include:
1) earlier intervention and prevention, for example helping to reduce stigma within the community. This is being achieved via a Time To Change campaign within North East Hampshire and Farnham
2) working with the third sector to support people with mental illness as early as possible eg via the Time Out Cafe in Aldershot, the Wellbeing Centre and community connections, developing integrated services 'wrapped around' primary care, comprising health, social care and third sector support. These services will be aimed at helping people as soon as they start becoming unwell, and will enable easy access to both physical and mental health support in one place.
3) working with our specialist providers, such as Surrey and Borders Partnership NHS Foundation Trust, to intervene much earlier to support people and their carers close to home.
4) further development of IAPT (Improving Access to Physiological Services) services to support primary care. The CCG has further invested in this service so that more services are available to support patients who also have a long term condition. There are also plans to extend the service so service so that patients can self- refer to IAPT, without getting an appointment with their GP first.
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