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CCG Series: A&E attendance hike and DDES CCG

CCG Series: A&E attendance hike and DDES CCG


Dr Stewart Findlay, chief clinical officer of Durham Dales, Easington and Sedgefield CCG (DDES CCG) steps up to the CCG Series platform to write about the next steps for an organisation that, like many, has been hit by an A&E attendance surge.

Our CCG was formed from three existing localities, all of which wished to stand alone as independent CCGs. All have very strong and often quite different cultures. The CCG covers a large area from the centre of the country to the sea, covering the localities of Durham Dales, Easington and Sedgefield in the West, South and East of County Durham.

In common with other CCGs we have been hit by a huge rise in emergency attendances at our local hospitals. This has resulted in significant ambulance handover delays, deteriorating performance on ambulance response times and patients filling up our A&E departments.

We have good primary care services and good out of hours arrangements in place and this is a sign of a whole system problem that needs to be improved before next winter.

We have therefore started a huge programme of reviews which will include intermediate care, community nursing, ambulance services, NHS 111, urgent care  and ambulatory care within our FTs. We have also asked our member practices to begin work on reducing variation in primary care quality across the CCG through their participation in a quality framework.

Although we were authorised with no conditions, now at the end of our first month as a standalone organisation we have only just filled all of our vacant positions. Even the North of England Commissioning Support (NECS) still have vacancies and so we have relied on everyone in the CCG working above and beyond their contracted hours to survive.

The last couple of months have been taken over by the contracting process with our three local acute trusts. We have negotiated a block contract with each. This is a huge change to the way we work with them and will allow us to move services from secondary to community care without the disincentive of PBR. We have set up a clinical programme board to begin working on emergency care and community services with our main provider and we will have to make rapid progress if we are to engage clinicians on both sides of the hospital divide.

We are keen to continue working in localities and to make sure that our member practices are really engaged in everything we do. All of our practices already attend locality meetings on a monthly basis to look at commissioning, primary and secondary care performance, quality and prescribing. In addition we are now asking them to think beyond the boundaries of their own localities and consider what is best for the CCG as a whole.

And finally, we have to implement the recommendations in the Francis report. We will do this with our patients, public and member practices and it is another significant piece of work we need to complete. We also need to be mindful that as clinicians leading our new CCGs we have an ethical and now legal duty to speak out where we see unsafe practice. 



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