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Structured approach

Structured approach

CLINICAL COMMISSIONING
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The last year has been fast moving for the clinical commissioning in North East Essex (NEE).  

Following the appointment of the new government in 2010 and the introduction of the white paper Equity and Excellence: Liberating the NHS outlining, among other reforms, plans to “devolve power and responsibility for commissioning services to the healthcare professionals closest to patients: GPs and their practice teams”, practice- based commissioning (PBC) had some major changes to undergo throughout 2011/12.

In the early part of 2011, North East Essex primary care trust (PCT) began work with the well-established PBC groups to put in place an action plan and develop the vision and values that would be at the heart of the new organisation once instituted.

Due to the successful PBC set up, a small group of key staff began with the merger of the two PBC groups in Colchester and Tendring into a single larger, and therefore stronger, organisation.

During the Health and Social Care Bill’s pause in April 2011 the team maintained momentum in engaging stakeholders to gain a consensus within NEE to continue to lead clinical commissioning and work with the PCT to begin shaping the transition. The early proposal was to work with CCG management committees to build the necessary structure and learn the essential skills and competencies required to continue the success of the NHS within the area.

NEE CCG covers the areas of Colchester and Tendring, which are coterminous with the local authority boundaries. It has a total of 44 practices with 24 located in Colchester and 20 in Tendring, covering a patient population of about 320,000.

The needs of each locality are quite distinct as both have different demographics that are reflected in their health and social care needs.

By 2021, the population is predicated to grow by around 17% in Colchester and 12% in Tendring, creating the first demand pressure for the health service. Tendring will also see a pronounced drop in under 50s, especially in the 15 -19 age group, and a large growth in residents aged over 70 years old, further pressure will be placed on NHS services to ensure a consistent quality of care for this population.

With the growth of an aging population, a higher proportion of patients on disease registers compared to the national average, and the drive to ensure earlier identification of chronic conditions, we can expect a rise in disease prevalence and a consequential increase in demand on both health and social care services.

Significant pockets of deprivation and health inequalities are found in areas of NEE which will mean there are further hurdles to overcome.

These are just a few challenges faced by NEE CCG and they will be mirrored across the country when moving forward with the changes throughout 2012/13 in moving from PBC to the new organisations.

to make a sucess of the CCG strong clinical leadership is required with a need for those leaders to have a clear mandate from the practices to which they are accountable.

To that end, seeking the views of local practices, partners and stakeholders was vital when developing our organisational structure and governance, and this input contributed considerably to the overall development of the CCG.

Our excellent relationship with the practices in NEE has enabled us to deliver on action plans, and gain the confidence of practices in CCG leaders and key managerial staff to move forward with building a great organisation at a pace we are all comfortable with. During the last year, we have deepened our working relationships with the constituent practices as well as our PCT colleagues, who have contributed strongly to commissioning schemes in the community, hospital and mental health services.  

The CCG has taken an early lead on public, patient and carer engagement (PPCE) and strongly believes that this sector should be given the opportunity to help influence the commissioning process as much as possible throughout establishment and beyond.

With an engagement strategy and plan signed off by the board, continuous work is being undertaken to ensure that patients and the public are at the centre of all decisions made within the CCG.

Along with the patient population, many other stakeholder groups including providers, county councils and voluntary organisations were involved in developing the CCG vision of embracing better health for all and values of integrity, inclusivity, improvement, while always placing patients at the centre.
These themes are central to all discussions, decisions and actions taken by the CCG.

We are going through a period of unprecedented change in the NHS and although this has often been exhilarating, it has also been exhausting at times.

It is also astonishing the way that colleagues within CCGs and the PCTs have managed in this environment of uncertainty, to continue to work so productively to support the commissioning of services for patients in NEE. To do this in these circumstances is a testament to their courage, tolerance and professionalism.

It is to be hoped that we are now moving into an era of innovation, with a fresh approach to the delivery of services to meet the increasing needs of our population.

Our vision makes it clear that we intend to respond to the needs of our patients in an inclusive manner, both collectively and individually. This is to be achieved by a bottom up, needs-based approach, informed by the patients themselves in conjunction with their practices. We will take on board intelligence about service performance from practices and patients to improve the quality and responsiveness of services. We will also look to positively influence the wider determinants of health by working in partnership with other agencies.

The final road of this journey starts now as the aligned clinical and managerial staff within the CCG work to develop our organisation and start to take on increasing responsibility. The CCG members are demonstrating on a daily basis their commitment to the work we are undertaking, and rapidly developing the capabilities that will be needed.  

The first aim is to become authorised as an NHS statutory body, but this is only the first step towards the key objective, which is to become a truly excellent commissioning organisation that really does embrace better health for all.

Locally, our priorities include re-designing urgent care, the care of frail and elderly people and long term conditions.

A number of quality, innovation, productivity and prevention (QIPP) schemes have been developed by the CCG in collaboration with the county council to create services to work towards these priorities.

The ‘Virtual Wards’ scheme in NEE is a collaborative service for the frail and elderly whereby patients are supported to stay in their own home with user friendly technology and daily monitoring to allow early intervention. This has an associated QIPP saving of £450,000 while more importantly improving the quality of services.

The urgent care re-design is being built into the strategy for out of hospital services that is currently being developed. This will look at working with primary and community services to provide urgent care in a more productive and effective way through joined up and collaborative working within NEE. Associated savings will amount to around £500,000 while providing an innovative approach to service delivery and improved quality for the patients of NEE.

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