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Planned Care : Getting a GripHow can we deliver the same quality
of care while making savings?
CHANGES IN THE NHS
To see a video produced by The Kings Fund which was watched in the workshop, please click on this link:https://www.youtube.com/watch?v=8CSp6HsQVtw
AGENDA
• Welcome and introductions (10)
• Setting the context: (15)– Why Planned Care
matters?– The financial and
demographic picture in North Somerset
– What do we intend to do?– How can you get involved?
• Introduction to group activity (10)
• Break• Group activity: A Vision for
Planned Care (30)• Next Steps (10)• CLOSING
Setting the context
The NHS has been asked to find savings of £20bn by 2015 to cope with rising demands.
In North Somerset, we need to find £11m of savings over the next 2 years.
…We are dealing with £15 to £20bn (in reduced costs), you don’t save that by not providing biscuits at a board meeting
Gerry O’DwyerRoyal College of Nurses
Nursing Times 2009
What is Planned Care?
Planned care covers all services provided for adults, 18 years or over, which are planned (scheduled), including all primary care, community and hospital services.
This does not include emergency (unscheduled) care.
THE LOCAL CONTEXTPlanned Care: Getting a Grip
North Somerset Total SpendingKey messages
Total Spend £252m Nearly 90% of acute
spend is with local acute providers
Fastest growing areas of spend are acute• Medical Emergency
admissions• A&E• Elective Orthopaedics• NICE• Diagnostic scopes
Accounts for 59% of all spending
How does this compare?
0.37% of NHSE budget
A cataract operation on one eye costs the NHS about £900.
A hip replacement costs the CCG more than £5,000.
Local Information
• North Somerset population 202,566 (2011 census)
• 214,068 are officially registered with a GP– 97% White Ethnic – Two thirds live in Weston-super-Mare,
Clevedon, Nailsea and Portishead. – One in five are over age 65
• 88,200 households of which 29% are single owner occupied – We have Lower Super Output Areas in the
most and least deprived 1% Nationally
THE CASE FOR CHANGEPlanned Care: Getting a Grip
The need for change in North Somerset
1. Our acute hospital spend is increasing at a faster rate than our funding and faster than our growth in population.
2. Our acute hospital spend is increasing relative to our neighbours or our peers.
3. Our acute spend is increasing in the areas that we are trying to reduce.4. Non acute spend is beginning to accelerate.5. Not only is our spend higher than our allocation it is now higher than
our target allocation.6. We have signed up to deliver changes in service delivery that will save
£11m over the next 2 years.7. These savings are still largely embryonic.
Acute hospital spend is increasing faster than our funding and faster than our growth in population
GROWTH IN SPENDING 2012/13 - 2013/14
The problem is getting worse In 2013/14 growth in acute hospital
spend is £8m (6%) In 2012/13, our unfunded growth in
acute spend was £5m (4%)
This is well above what we would expect for overall population growth of 0.6%.
Even allowing for our aging population we would expect the impact of demographic change to be around £2.5m
Note: Based on M11 Contract Performance
Non-acute spend is broadly flat
This is our key cost driver
Focus Areas
• Trauma & Orthopaedics/ Musculo-Skeletal• Ophthalmology• Urology• Dermatology• Diabetes and other general medicine• Diagnostics
Our spend is not only higher than our actual allocation it is now higher than our target allocation ----
-30 -25 -20 -15 -10 -5 0 5 10
2011/12
2012/13
2013/14
Value above or below target (£m)
Distance from Target (Funding and Expenditure)
Expenditure Funding
NORTH SOMERSET NEEDS BIG IDEAS AND BIG CHANGE
In 2011/2012, our expenditure met our funding allocation
In 2012/13, the financial picture shifted into a less favourable position
In 2013/14, we find ourselves with a gap of 7% between spending and our funding. We are in the process of understanding the change.
HOW WE INTEND TO GET A GRIPPlanned Care: Getting a Grip
DECISION TO REFER REFERRAL PATHWAY OUTCOMES CHALLENGE:
Raise the bar
IMPROVE: Support GPs confidence to diagnose and treat
: OPTIMISEProvide GPs with greater clarity on pathways
Monitor and Share
Fewer hand-offs
Clear and agreed protocols
DESIGNCreate different/better pathways
Patient centred
Senior decision-makers early on
REVIEWKeep quality high on the agenda
MANAGEExternal referrals
Clear + Comprehensive Pathway
Efficient + High quality
Cost Effective
Copes with complexity
Appropriate Flexibility
A real time example
• Dermatology: Keeping more of the work in GP practices– 1636 referrals into Acute (April- December 2013)– Advice and Guidance– Tele-dermatology– Redesign the pathway and enable the pathway with Map of
Medicine– Explore developing GPs with special interest in dermatology
and specialist nurses– Ensuring appropriateness of referrals and prescribing
Dermatology
Present• Pathways not clear• High numbers of referrals into
acute and growing waiting list• Variation in skills and
confidence of doctors to treat• High demand on primary care
appointments• Shortage of dermatologists
nationally
Future• Effective pathway• Reduction in number of
inappropriate referrals• Greater skill and confidence in
primary care• Improve speed of access to
specialist treatments• Reduced variation in standards
of care• Improved prescribing
THE CHALLENGES ARE SIGNIFICANTOur elective T&O hospital spend is increasing relative to our neighbours and our peers
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SAR - T&O Elective (HB - Non Trauma)
North Somerset Bristol South Gloucs
Key Messages:Trauma & Orthopaedics spend accounts for around £18m ( 20% ) of hospital spend on outpatients/admissions There has been a sharp increase in more complex high cost procedures locally which is not mirrored nationally
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SAR Elective T&O ( HR - Reconstructions)
North Somerset Bristol South Gloucs
Key Messages
• We have a big challenge but we are getting a grip• We are NOT going to reduce costs by slashing
quality• The first year as a CCG was a period of stabilisation
but there is a renewed focus and energy• We are seeking innovative solutions to old
problems
FINAL THOUGHT
• If every GP took out one referral a week, we would save a £1m.
• The challenges are not intractable• The solutions are within reach
HOW CAN YOU HELP US?PLANNED CARE: GETTING A GRIP
Next Steps
• Exercise to gather reaction and feedback• 3 questions• 10 minutes timed discussion on each• Facilitator at each table
3. You are here!
1. North Somerset is embarking on an ambitious programme to reduce unnecessary acute activity by introducing greater efficiencies in clinical pathways, improving the quality of referrals and engaging active patient citizenship. 2. Planned Care Programme Board
Questions
• What, in your understanding, were the top 3 issues the Planned Care presentation?
• How can we engage patients and the public in transforming Planned Care in North Somerset?
• Is there a role for you/your organisation in this agenda? What can you contribute and how would you like to be involved?