2017/18 & 2018/19 Planning round Summary of the NHSE Planning Guidance National context Changes to NHS operational planning and contracting processes are designed to support Sustainability and Transformation Plans (STPs) and the financial reset 3 shared tasks Implement the Five Year Forward View to drive improvements in health and care Restore and maintain financial balance Deliver core access and quality standards
Financial outlook The level of growth is significantly less than previously available to the NHS Expectation that providers and commissioners have a relentless focus on efficiency National transformation and efficiency programmes intended to support this process, e.g. NHSE view of STPs STPs are more than just plans STP is the route map for the local NHS and its partners System-wide plan setting out locally agreed objectives and how activity will flow between care settings Different way of working, with partnership behaviours becoming the new norm What makes most sense for patients, communities and
the taxpayer should always trump the narrower interests of individual organisations Although STPs are relatively new, we see them as having a significant ongoing role in the NHS Ambition for new care models New care models that break down the boundaries between different types of provider, and foster stronger collaboration across services drawing on, and strengthening, joint work with partners, including local government Key ingredients: Effective public engagement essential System-wide set of changes Improving and investing in preventative, primary and community based care
Creating new relationships with patients and communities, Seeing the totality of health and care NHSE view of contracting Less time locked in adversarial & transactional relationships Settle the numbers earlier and for a longer duration Provide greater certainty and stability; simplify and join-up processes; cut transaction costs; & support partnership / transformation 2-year contracts with activity, workforce and performance assumptions Single NHS England and NHS Improvement oversight process STP financial control total to stop organisational boundaries and perverse financial incentives holding back transformation All organisations to be held accountable for delivering both their individual control total and the overall system control
Must do #1 - STPs Finalise an STP plan Implement agreed STP milestones Key trajectories and core metrics for 2017-19: Finance - Performance against organisation-specific and system control totals Quality A&E performance RTT performance Health outcomes and care redesign
Progress against cancer taskforce implementation plan Progress against Mental Health Five Year Forward View implementation plan Progress against the General Practice Forward View Hospital total bed days per 1,000 population Emergency hospital admissions per 1,000 population Must do #2 - Finance CCG and provider sector in financial balance in each of 2017/18 and 2018/19 Year on year improvements in efficiency and productivity (2-3% each year) from reducing growth in activity and maximising cost recovery CCG demand reduction measures: Implementing RightCare Elective care redesign
Urgent and emergency care reform; Supporting self care and prevention; Progressing population-health new care models such as multispecialty community providers (MCPs) Medicines optimisation Improving the management of continuing healthcare processes Must do #3 Primary Care Ensure the sustainability of general practice by implementing the General Practice Forward View Support general practice at scale, including expansion of Multispecialty Community Providers Workforce: Increase doctors working in general practice by 5,000 in 2020 Create an extra 1,500 pharmacists in general practice by 2020 Expand Improving Access to Psychological Therapies (IAPT) in general practice
with 3,000 more therapists in primary care Develop multi-disciplinary teams, support for practice nursing and establishing primary care at scale Optimise out of hospital care for patients including access to premises, diagnostics, technology and community assets CCG to submit development plan to NHS England on 23 Dec agreed across all member practices National sustainability & transformation package 3ph 5YFV development investment over 2 years National funding : Online general practice consultation software systems Training care navigators and medical assistants for all practices General Practice Resilience Programme
Extended access to general practice services funding targeted at successful pilots - 6 per weighted patient Estates and Technology Transformation Fund (ETTF) progressed through bid process HRW CCG currently has 10 live bids Time to Care: 10 high impact changes CCGs should have clear plans for how they will support the planning and delivery of a local Time for Care development programme, to implement member practices choice of the 10 High Impact Actions 10 High impact actions to release time for care Active signposting New consultation types Reduce DNAs
Develop the team Productive work flows Personal productivity Partnership working Social Prescribing Support self care Develop QI expertise Must do #4 Urgent and Emergency Care Deliver the 4 hour A&E standard, and standards for ambulance response times Implementing the 5 elements of the A&E Improvement Plan 4 priority standards for 7-day hospital services for all urgent network specialist services Implement the Urgent and Emergency Care Review,
24/7 integrated care service for physical and mental health in each STP footprint by March 2020 clinical hub that supports NHS 111, 999 and out-of-hours calls. Reduce ambulance 999 calls Prepare for the waiting time standard for urgent care for those in a mental health crisis Urgent and Emergency Care Networks across 100% of population Must do #5 Referral to treatment times and elective care 92% of patients on non-emergency pathways wait no more than 18 weeks from referral to treatment (RTT) 2020 goal no patient waits more than 52 weeks Achieve 100% of use of e-referrals by no later than April 2018
Streamline elective care pathways through outpatient redesign and avoiding unnecessary follow-ups. Implement the national maternity services review, Better Births, through local maternity systems. Must do #6 Cancer Working through Cancer Alliances and the National Cancer Vanguard, implement the cancer taskforce report NHS Constitution standards (e.g. 62 days, diagnostic capacity) Improve one-year survival rates by the proportion of cancers diagnosed at stage one and stage two and reducing the proportion of cancers diagnosed following an emergency admission. Patients given definitive cancer diagnosis, or all clear,
within 28 days of being referred by a GP Must do #7 Mental health Implementation plan for the Mental Health Five Year Forward View for all ages 2020 goal - To close the health gap between people with mental health problems, learning disabilities and autism and the population as a whole Ensure delivery of the mental health access and quality standards including 24/7 access to community crisis resolution teams and home treatment teams and mental health liaison services in acute hospitals Increase baseline spend on mental health to deliver the Mental Health Investment Standard Ensure delivery of the commitment to treat an additional one million people with mental illness by 2020/21
Must do #8 People with learning disabilities Deliver Transforming Care Partnership plans with local government partners, enhancing community provision for people with learning disabilities and/or autism. Reduce inpatient bed capacity by March 2019 Improve access to healthcare for people with learning disability so that by 2020, 75% of people on a GP register are receiving an annual health check. Reduce premature mortality Must-do #9 Improving quality in organisations
All organisations should implement plans to improve quality of care, Drawing on the National Quality Boards resources, measure and improve efficient use of staffing resources to ensure safe, sustainable and productive services Participate in the annual publication of findings from reviews of deaths Additional responsibilities in the NHS Mandate (links to CCG IAF)
Avoidable deaths and seven day services Patient experience Obesity and diabetes New models of care / health and social care integration Research and growth Technology Health and work Operational Plans for 2017-19 i.e. what our local plans have to do 9 must-dos; local narrative expected from NHSE (North) Delivery of the local STP and its transformation objectives Reconcile finance, activity and workforce to our agreed system control total Develop robust, stretching and deliverable activity plans Show how risks have been jointly identified and mitigated
through an agreed contingency plan Include the impact of new care models Aggregate of all operational plans in a footprint need to be consistent with the STP NHS Standard Contract for 2017-19 content / proposals Transmitting letters to GPs following clinic attendance reducing to 7 days Electronic transmission of clinic letters, as structured messages using standardised clinical headings Suspension of contract sanctions for key performance standards Commissioners to facilitate hospital discharge and on providers to comply with recent NICE guidance Mandatory data-sharing agreements for urgent and emergency care providers Mandated use of the e-Referral system and non-payment for activity and the right for providers to return such referrals to GPs
4 priority standards for 7-day hospital services for urgent network specialist services Compliance with new data security standards, new conflicts of interest guidance, and new interoperability requirements for clinical IT systems National tariff for two years using phase 3 of HRG4+ Cost uplifts in the national tariff set at 2.1% Efficiency deflator will be set at 2% in both years Increase the percentage of follow-up costs bundled into first attendances Local payment reform for first outpatient appointments and introduction of advice and guidance services New funding Sustainability and transformation funding - 1.8bn: 1.5bn general fund allocated on the basis of emergency care; 0.1bn general fund allocated to non-acute providers; 0.2bn targeted fund
Additional dedicated funding streams for mental health, cancer care, general practice New funding is a combination of centrally-held and already included in CCG allocations Different streams of transformation funding will be targeted towards the STPs making most progress Adopt Best Possible Value (BPV) framework to make investment decisions CQUIN and Quality premium CQUIN - Full 2.5% will continue to be available to providers. 1.5% of the 2.5% for nationally identified indicators. 1% will be assigned to support providers locally. 0.5% available subject to full provider engagement and commitment to the STP process. Cost free indicator for providers with clear scope for earning the full amount. Remaining 0.5% is held in the risk reserve
For acute and community services, national indicators covering mental health, ambulance services, NHS 111 and care homes. 2 year CCG Quality Premium scheme: Cancer Stage of Diagnosis and Patient Experience of Accessing their GP Anti-Microbial Resistance measure into a measure on Bloodstream Infections RightCare programme 2 new indicators, one to be selected from a Mental Health menu, and one focused on delivery of Continuing Healthcare Timetable: Sept - November START: Planning guidance, draft NHS contract, finance templates, draft tariff, national CQUIN guidance all published Provider control totals and STF allocations published Commissioner allocations published / contract consultation closes Submission of STP plans
Tariff section 118 consultation issued / final CCG CQUIN guidance issued Provider finance workforce and activity templates issued Submission of summary level 2017-19 Financial Plans CCGs to issue initial contract offer that forms reasonable basis for negotiations with providers Final NHS Standard contract published Weekly contract tracker submissions start (to end Jan) Submission of full draft 2017 19 Operational Plans National tariff section 118 consultation closes 22 September 30 September 21 October 21 October 31 October
1 November 1 November 4 November 11 November 21 November 24 November 28 November Timetable: December - January Where 23 Dec contract signature deadline is at risk, local decisions to enter mediation Contract mediation National tariff 118 consultation results announced National tariff published National deadline for signing of contracts (Final contract signature date for avoiding arbitration)
Submit local GP 5YFV Development Plan Submission of final 2017/18 to 2018/19 Operational Plans, aligned with contracts (approved by Boards / Governing Bodies) Submission of joint arbitration paperwork for contracts not signed Arbitration outcomes notified to CCGs and providers within 2 working dates after panel date Contract and schedule revisions reflecting arbitration findings completed and signed by both parties 5 December 5 23 Dec 12 December 20 December 23 December 23 December 23 December
9 January 10 31 January 31 January Glossary STPs Sustainability & Transformation Plans STF Sustainability & Transformation Fund IAF Improvement & Assessment Framework
RTT Referral to Treatment 5YFV 5 Year Forward View HRG4 Healthcare Resource Group NICE National Institute for Health and Care Excellence
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