In response to an enquiry from the Eastern Daily Press, the CCGs in Norfolk and Waveney set out why 5 CCGs were established in 2012 and what they do.
Local need – local choice
With a population exceeding 1.1 million, Norfolk and Waveney’s CCG arrangements are in step with other areas of the country.
In 2011, GP practices were asked by the Department of Health to form CCGs that best suited local need. Local GP Practices were very well placed to say what was needed and in Norfolk the five CCGs emerged; there was public engagement on the geographies and a rigorous assessment process. Each CCG has very different populations, so having a local CCG means commissioning can be more closely tailored to local need.
Health services are run in localities
There are three very distinct health ‘systems’ within Norfolk, each with its own acute hospital. West Norfolk has a distinct system around QEHKL, Great Yarmouth and Waveney has long been recognised as having a unique and distinct system around the James Paget University Hospital and in central Norfolk, the NNUH sits at the geographical centre.
CCGs work to patients’ local areas
The three CCGs in central Norfolk have differing needs – Norwich has all the issues of an urban centre not seen in rural north and south; North Norfolk has a much larger retired population; South Norfolk not only has specific demographic needs but it also has long-established relationships and ways of working which suit its local area. Each CCG engages closely with its local population and meets locally with public participation.
Each CCG has a programme budget in excess of a quarter of a billion pounds yet they are very small, lean organisations, led by local doctors and nurses. They are supported by small teams who are paid according to national rates. CCG running costs are less than 2% of total budget.
The CCGs collaborate and share commissioning at scale where it makes economic and clinical sense. For example, where services are shared, one CCG will often co-ordinate commissioning – such as South Norfolk CCG co-ordinating commissioning of the new Wellbeing Service across Norfolk and Waveney. CCGs share many services to save money and to work in a more joined up way – for example many back office functions, commissioning, contracting and finance functions are provided by a local commissioning support unit based in Norfolk.
In central Norfolk, the three CCGs have established a Joint Commissioning Committee and a Joint Contracting Executive to further strengthen collaboration and there is also one System Resilience Group to manage the all-year-round pressures on the NHS, which is led and coordinated by North Norfolk CCG.
Only yesterday (Tues Jan 12th 2016) Chief Officers from health, social care and partner organisations from across Norfolk met to discuss closer working.
NHS England has put in place plans for significant transformation of the NHS over the next 5 years, such as 7-day full services and more sustainable primary care. CCGs are central to developing and putting these changes in place with clinicians and local people working together to make locally based services fit for the needs of their communities. The CCGs will collaborate to achieve this.
Case history from each CCG - the differences that local CCG commissioning has made
Norwich – There is a Healthy Norwich programme in partnership with Norwich City Council which aims to prevent ill health and addresses the particular health needs of people in Norwich. The CCG’s YourNorwich programme has established a ‘virtual ward’ where patients are cared for at home rather than in hospital, working to local systems and reducing the pressures on acute and community hospitals. Each care home in Norwich now has a GP Practice aligned to it, ensuring more co-ordinated care.
North Norfolk - The Integrated Care Programme (ICP) in North Norfolk was developed by North Norfolk CCG in close partnership with its member GP practices, Norfolk Community Health and Care (NCH&C), Norfolk County Council, and the voluntary sector. As well as supporting people to manage their own care and wellbeing, the ICP was designed to ensure that patients – particularly the over-60s and disabled – would benefit from a more ‘joined up’ approach involving GPs, community nurses, mental health practitioners, social workers and other agencies. Since its launch, it has produced positive results – providing tailored care for older people and those with long-term conditions, and achieving a significant reduction in the number of avoidable hospital admissions.
South Norfolk - Information, Advocacy and Advice Service delivered by Age UK Norfolk at 14 Practices across South Norfolk and developed at the suggestion of GPs in the area who often find older patients need social care and support rather than medical interventions to resolve their problems. Admiral Nursing was integrated into GP Practices in mid-Norfolk as a national pilot.
West Norfolk - the CCG leads the West Norfolk Alliance which has won national recognition for its programme to join health and social care services closer together. Successful innovations include establishing a frailty unit at The Queen Elizabeth Hospital King’s Lynn, creation of the LILY (Living Independently in Later Years) online directory, www.asklily.org.uk for older people living in West Norfolk, their families, professionals and volunteers, and setting up a ‘Virtual Ward’ with staff from Norfolk Community Health and Care NHS Trust and Norfolk County Council Adult Social Services, working with the QEH, to promote and support an early discharge for medically fit patients who wish to return home rather than remain in hospital.
Great Yarmouth and Waveney – through the ‘Shape of the System’ consultation NHS GYWCCG is setting up a system of out of hospital teams, community hubs and beds within local care homes. This is based on a pilot in Lowestoft which is already working very successfully and supporting people in their own homes or local community, patient feedback shows us that over 90% of people are satisfied with this new service which is designed to help them remain as independent as possible following a crisis. The new system is also proving successful in reducing emergency admissions – bucking the national trend.