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CCG Profile: Brighton and Hove

CCG Profile: Brighton and Hove
4 September 2013

Brighton and Hove clinical commissioning group (CCG) is working hard to link with neighbouring CCGs and its vibrant community to create a quality integrated local health system

Brighton and Hove clinical commissioning group (CCG) is working hard to link with neighbouring CCGs and its vibrant community to create a quality integrated local health system
The Brighton and Hove clinical commissioning group (CCG) understands the significance that the NHS plays in the daily lives of many people. We are proud to be working to meet the expectations people in our city place on their health services. We are committed to working in partnership with local people, nearby CCGs, Brighton and Hove City Council, providers, voluntary sector organisations and all other stakeholders to integrate health and social care services and make Brighton and Hove healthier.
The CCG and its 47 member GP practices serve a vibrant and diverse population of nearly 300,000 people. We have a young and growing population, with a high proportion of people aged between 20 and 44. The city has fewer children and people aged over 65 than is the case nationally, although conversely it is home to a relatively large proportion of people over 85 years old who require regular access to healthcare services. 
Brighton and Hove includes some of the most deprived areas of the South East but life expectancy in the city is as high as it has ever been and mortality rates are falling in all groups. The gap between life expectancy of males and females, however, remains wider than the national average. Similarly, although mortality rates are falling for all groups in the city, they are falling fastest for affluent groups – widening health inequality.
The city has a large LGBT population (estimated at one in six people), around 34,000 students from two universities and welcomes approximately eight million visitors per year. 
Healthcare priorities for Brighton and Hove include:
 – Emergency care.
 – Mental health.
 – Dementia.
 – Diabetes.
 – Circulatory illnesses.
 – Cancer and tumours.
Alcohol and substance addictions are also prevalent in the city, the effects of which are often exacerbated by a mental health issue. Fortunately, our vital partnership with Brighton and Hove City Council and public health teams aimed at tackling these priorities is aided in part by a shared geographic boundary.
The CCG’s partnerships are not limited to Brighton and Hove. Cooperation with other Sussex CCGs is central to our commissioning approach and we work in a pan-Sussex collaborative to align our services with those of other CCGs which helping us be more cost effective – particularly in planned care contracts. We believe collaborative commissioning will help towards resolving a number of fiscal deficits in the local health system by addressing hospital over-performance. 
We will also develop new service models for paediatrics, maternity, imaging and ophthalmology services in 2013-14.
We are working very hard to ensure real clinical dialogue across the disciplines; which has not previously been done on a systematic basis. From the Local Member Groups to our GP Clinical Forum and Urgent Care Forum, we intend to help clinicians agree and lead on change and to enlist management support to develop services around patients.  
We have recognised the importance of each practice’s contribution and, with the support of the Kent, Surrey and Sussex Deanery, instigated a learning module at the medical school for practice leads (GPs and practice nurses) in understanding the health economy, commissioning, and the environment practices now operate in. Feedback has been outstanding and participation from general practice has been as good. Simply being a clinician does not prepare us for the world we are now in, where understanding the breadth of healthcare is so essential. Managing the increasing complexity of frailty and chronic disease requires a detailed knowledge of the system we work in. 
The CCG will be moving ahead with plans to achieve greater integration of teams working across urgent care, general care, mental health and specialist pathways. We have already developed 11 Integrated Primary Care Teams which are focused around clusters of GP practices providing better coordinated and more consistent care. The more responsive and proactive our community services can be, the less the need for people to attend an emergency department or be admitted as an emergency. To build on this process, 2013-14 will see us create a single Integrated Rapid Response Service, increase the options for ambulances to treat patients, maximise other alternatives to hospital treatment and simplify access to them. There needs to be a real depth in the infrastructure supporting general practice and primary care or people will continue to resort to attending A&E with issues that do not require emergency care.
We are also driving integration of the system of care for people with physical and mental health needs. The complex interaction between physical and mental health is one we are keen to continue decoding, and all pathway redesign is specifically addressing better integration of these areas. We are developing standard psychological and assessment tools for use by generalist practitioners and improving links between services and professions – particularly between mental health and generalist services such as primary care. Mental health practitioners are now based in six GP practices in the city and we have recently announced a much-improved set of accommodation and support services.
The CCG is committed to increasing the infrastructure and support around primary care and general practice, with a wider aim of achieving a strategic shift of services from secondary to primary care and moving into a new and better era for patients. Primary care already achieves high levels of patient satisfaction but we feel there is scope for it to provide even more. We have established a clinically-led primary care team to strengthen and develop the primary care system, and are actively supporting peer review and sharing of best practice as well as challenging variation in quality and provision. We will also support member practices to consider the benefits of working in larger teams (federations, for example) and make sure that appropriate resources follow the patient when services move to primary care settings. 
In five years’ time I would like to see greater integration of services, improved primary care and a subsequent strategic shift from secondary to primary care. I also anticipate that we will have seen mental health move onto a truly equal footing with physical health, as well as a greater focus on prevention and general wellbeing rather than simply on treatment of health issues.  Along with our acute and community providers and local authority, we will play a pivotal role in providing a system of care which has good information systems and is fully subscribed to sharing essential clinical information. There will be visible seven-day general practice cover and regular joint training and dialogue between healthcare professionals. 
In terms of commissioning, I would ideally like more of the excellent voluntary sector organisations in Brighton and Hove to feel able to bid for contracts to run services we design. My aspiration is for the services commissioned by the CCG to be the best they can be, not just run by the biggest or cheapest provider. The happy balance between large, highly effective but less personal services and small, local, highly personalised services is one the CCG is keen to strike. 
Finally, I anticipate that the CCG will be working side-by-side in partnership with greater numbers of local people. We realise that we do not know everything and are always encouraging people in Brighton and Hove to talk to us, get involved in shaping their healthcare and help design services that we are all happy and proud to use. 

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