October 2014

Urgent and necessary measures to address patient demand

Please note: The press release below contains information that is now out of date. 

29 October 2014

Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) has today (Wednesday 29 October) published its proposals to prioritise NHS constitution requirements – and reduce its deficit.
 
The proposals are to be discussed by the NEW Devon CCG Governing Body on Wednesday 5 November 2014.
 
The proposed series of measures include:
 
·         Improvements in the referral management for dermatology treatment, meaning better access for patients at their doctors’ surgeries rather than at large acute hospitals
 
·         Additional effort in helping to reduce attendances at hospital emergency departments. This will include quicker access to a clinician when phoning NHS 111.
 
·         Developing a business case to identify where and how to expand a GP home visiting service. This will allow home visits to start earlier in the day to anticipate care needs particularly of frail elderly to help avoid admissions to hospital ·         A further reduction in the CCG’s general running costs – on top of the £2 million already saved this year.
 
·         Prioritise healthcare spend to maintain investment in essential services – to be led by an international expert
 
·         Introduce threshold limits at Body Mass Index (BMI) of greater than 35 for hips and knees – and consider increasing the range of procedures this limit will apply to
 
·         Consider cost reductions in the prescribing budget without compromising quality
 
·         Consider a range of other measures to reduce overall costs
 
·         Requiring smokers to quit for at least six weeks prior to routine surgery
 
NICE guidance recommends weight loss and exercise as a core treatment for osteoarthritis – the main cause of hip and knee elective activity. Patients with a higher BMI have a greater surgical risk and worse outcomes than patients with a healthy BMI.
 
Rebecca Harriott, the CCG's chief officer, said it was vital to take these measures to reduce the CCG’s deficit to safeguard NHS services for people in the future.
 
“We must act to protect essential services through our busiest winter months and ensure that care is there for our patients when they really need it,” she said.
 
“The CCG has already begun to implement a series of measures designed to improve efficiency in the system and encourage patients to contribute to improving their own health outcomes.
 
“We are in discussion with partners to help us to quickly establish the most appropriate way to implement these measures.
 
“This will take into account impacts on patients and populations, the availability of preventative and support services we have to offer for smoking cessation and weight loss, in particular, and how we fairly manage patients who do not meet the criteria we decide upon.”
 
The CCG’s Governing Body will now be asked to agree these urgent and necessary measures at its Board meeting on 5 November.
 
This paper has been published on the CCG’s website today, Wednesday 29 October.
 
The CCG is making it clear that it will prioritise those services and requirements laid out in the NHS Constitution.
 
They include (but are not limited to):
 
·         Consultant-led treatment within a maximum of 18-weeks from referral for non- urgent conditions
·         Maximum four-hour wait in A&E from arrival to admission
·         Maximum 7 day wait for follow-up after discharge from psychiatric in-patient care
·         Being seen by a cancer specialist within a maximum of two weeks from GP referral where cancer is suspected
·         Maximum 62-day wait from referral from an NHS cancer screening service to first treatment
·         Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
·         Ambulance trusts to respond to 95 per cent of category A calls within 19 minutes of a request being made
 
Last year the CCG returned a £14.5 million deficit (known as a control total) and this year it had been predicting the same.
 
But its confidence in meeting this at the end of the current financial year has gradually declined as the situation has become clearer; in short, demand for services is outstripping what it can afford.

View the extract from the 5 November 2014 NEW Devon CCG Governing Body papers relating to urgent and necessary measures below.
Urgent and necessary measures paper - 29 October 2014

Urgent and necessary measures to address patient demand

Please note: The press release below contains information that is now out of date. 

27 October 2014

Northern, Eastern and Western Devon Clinical Commissioning Group (NEW Devon CCG) is set to announce a series of 'urgent and necessary' measures to address a worsening of its financial situation.
 
Last year the CCG returned a £14.5 million deficit (known as a control total) and this year it had been predicting the same.
 
But its confidence in meeting this at the end of the current financial year has gradually declined as the situation has become clearer; in short, demand for services is outstripping what it can afford.
 
Whatever the actual cause of the increase in demand, it is having a serious effect on the financial position of the CCG and if it fails to deal with it now, services will suffer.
 
Rebecca Harriott, the CCG's chief officer, said it would be prioritising services in the NHS Constitution.
 
“We must act to protect essential services through our busiest winter months and ensure that care is there for our patients when they really need it,” she said.
 
“The CCG has already begun to implement a series of measures designed to improve efficiency in the system and encourage patients to contribute to improving their own health outcomes.
 
"This includes the following:
 
  • Establishing weight loss as part of the clinical pathways for morbidly obese patients prior to an increased range of routine, non-urgent surgical procedures
  • Establishing smoking cessation as part of the clinical pathway prior to an increased range of routine, non-urgent surgical procedures
  • Introduce criteria-based approval for routine procedures such as hernias, botox injections and cataracts
  • Reduce unnecessary consultant to consultant referrals
  • Suspend treatments where there is little or poor evidence of outcomes
 
“We are in discussion with partners to help us to quickly establish the most appropriate implementations of these measures.  This will take into account their impacts on patients and populations, the availability of preventative and support services we have to offer for smoking cessation and weight loss in particular, and how we fairly manage patients who do not meet the criteria we decide upon. These measures bring the CCG into line with similar organisations in the NHS. However, they are not enough.
 
“The CCG is working up a series of measures to prioritise those patients most in need, while at the same time, increasing efficiency in the wider system – and the CCG itself.
 
"Our clinical chairs (who are family doctors) and managing directors are now busy working up proposals, in collaboration with NHS England and others, so that we can submit a paper to the next Governing Body on November 5."
 
This paper will be published on the CCG’s website on October 29.
 
The CCG has already saved £2 million in its running costs but it is now intending to make the organisation even more efficient - cutting more internal costs.
 
The CCG is making it clear that it intends to prioritise those services and requirements laid out in the NHS Constitution.
 
They include (but are not limited to):
 
  • Consultant-led treatment within a maximum of 18-weeks from referral for non- urgent conditions
  • Maximum four-hour wait in A&E from arrival to admission
  • Maximum 7 day wait for follow-up after discharge from psychiatric in-patient care
  • Being seen by a cancer specialist within a maximum of two weeks from GP referral where cancer is suspected
  • Maximum 62-day wait from referral from an NHS cancer screening service to first treatment
  • Patients waiting for a diagnostic test should have been waiting less than 6 weeks from referral
  • Ambulance trusts to respond to 95 per cent of category A calls within 19 minutes of a request being made
 
Rebecca Harriott added: "To meet the challenge of prioritising patient need while at the same time meeting our control total, the Governing Body will be asked to temporarily change how we work.
 
"We are intending to split our management and administration resource between ‘business as usual’ and ‘in-year priorities’.”

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