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«Annual Report 2014/15 Contents: • Introduction..Page 2 • Strategic Report..Page 5 • Members’ Report..Page 43 • Remuneration Report ...»

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Bracknell and Ascot

Clinical Commissioning Group

Annual Report 2014/15


• Introduction ………………………………………………………………….Page 2

• Strategic Report …………………………………………………………...Page 5

• Members’ Report ………………………………………………………...Page 43

• Remuneration Report ……………………………………………….….Page 59

• Sustainability Report………………………………………………….….Page 69

• Statement of the Accountable Officer’s Responsibilities…Page 73

• Governance Statement ………………………………………………...Page 75

• Auditor’s Report ……………………………………………………………Page 107

• Financial Statements …………………………………………………….Page 112 1|Page Introduction Foreword from the Clinical Chairman – Dr William Tong The CCG’s first year was one of transition. This second year has been one of consolidation and development. We have worked hard, along with our partner organisations, to improve quality of care and our financial position whilst working

towards delivering our vision:

To commission local outcome-based, cost-effective services for the health benefit of our population now and in the future’ At the time the CCG was authorised our member practices agreed the values by

which we continue to operate:

• Always being dignified, respectful, open and honest

• Being innovative and evidence-based

• Putting the needs of our population at the centre of everything we do

• Being a strong, dynamic passionate team

• Being responsible for delivering a sustainable future.

All GP practices are members of the CCG, and the views of the health professionals at these surgeries inform the priorities of the CCG. Regular meetings of GPs and other practice staff ensure this continued engagement and we are seeking to engage different clinicians in commissioning work so that we can be confident in sustaining the clinical leadership for the future and ensure they are involved in the decisions that affect their patients.

We have reviewed the effectiveness of the Governing Body and our collaborative arrangements with our neighbouring CCGs. We have always believed in the value collaboration brings to our organisation and our ability to do the best for our patients and the population as a whole. We are reviewing our Organisation Development Plan and management structure to ensure we maximise this benefit. As a Governing Body we have also undergone regular Assurance Reviews with NHS England as part of the CCG Assurance Framework. The CCG annually reviews the Governing Body’s and related committees’ performance, and assessment of their effectiveness based on good practice corporate governance principles.

2|Page The year has been marked by the successful acquisition of Heatherwood and Wexham Park Hospitals by Frimley Health Foundation Trust and this was an opportunity to bring partners together across the system to agree a plan for transforming the care provided to frail older people. This work will engage all local providers and commissioners, working with voluntary sector and patient representatives to deliver our vision of integrated care and sustainable services for the future. This work will continue into the new financial year and will be a catalyst for transforming other areas of care for the benefit of local people.

The experience of patients who use local health services is a good indication of the quality of the services provided. We have developed our feedback opportunities from GPs, patients and Healthwatch, building a robust reporting structure into our quality management. Healthwatch and clinicians are members of our joint Quality Committee, ensuring the voice of patients is heard. We have a very ‘hands-on’ approach to monitoring quality and make regular visits to hospital wards and other care settings to talk to staff and patients about the care being provided. Together with other performance monitoring data and feedback from patients we can understand where there is need for change and where we have good practice.

We have been building other routes for engaging with the local community and have launched HealthMakers for the CCG and supported the practices’ Patient Groups to join up to form the Patient Assembly. Local people can join HealthMakers and participate in a number of different roles. We have recruited patients with long-term conditions to train as facilitators of self-management training. We have also recruited patient leaders who have participated in leadership training. This has included students from Bracknell College who will be our first young HealthMakers, helping us reach the young people of the area. We have listened to our patients and public and we will continue to embed the patient/public engagement in this CCG’s work.

We are aware of the rising population and its changing age profile. We are conscious of the challenges ahead in terms of rising life expectancy, growing number of people living with one or more long term conditions and the restricted resources available to us. We know that we will need to take advantage of the opportunities to do things differently. We need to embrace technology, share data and provide care differently so that care is truly integrated. We need to shift our focus from reactive to proactive and invest in prevention. We need to do more in the community supporting people to stay healthy and independent for as long as possible.

Considering the expected population growth, we are working with Bracknell Forest Council, the Royal Borough of Windsor and Maidenhead and NHS England on mapping the future need for Primary Care provision for our local population. As much as demand has increased in most areas of health and social care, we are particularly concerned about the rising demand in Primary Care. We intend to address this through Primary Care Co-commissioning.

3|Page At the same time, we need to recognise that demand on urgent care services has increased more than would have been expected. This is similar to the rest of the country and while we are directing resources to managing the demands felt in our A&E Departments, we have less to direct to the areas we know will make the biggest difference for our patients now and in the future. We have been working hard to provide more services to support people in other ways and to reduce the attendance at A&E for minor conditions and to reduce the chances of emergency admissions being needed. For example, we have commissioned new services that are delivered in the Royal Berkshire Bracknell Healthspace.

Key facts about Bracknell and Ascot CCG The estimated registered population at 1 April 2014: 139,393 People aged over 65: 13.8% Children aged 0-14: 18.8%

–  –  –

As a result of the specific demographic and disease pressures, a key part of our strategy going forward is transforming services and care for older people.

Relationships with our key partners Bracknell Forest Council, the Royal Borough of Windsor and Maidenhead, Frimley Health NHS Foundation Trust (FHFT), Royal Berkshire Hospital Foundation Trust (RBH) and Berkshire Healthcare NHS Foundation Trust (BHFT) are hugely important to us. We have worked hard on these relationships and believe that they are stronger now than they were at the start of the year. Working with our local authorities in developing the Better Care Fund, working with our local practices to improve primary care services and working with FHFT on the trust acquisition have provided a common purpose and improvements in care for patients.

Dr William TongClinical ChairBracknell and Ascot Clinical Commissioning Group

4|Page Strategic Report Bracknell and Ascot Clinical Commissioning Group was established on 1 April 2013 following the passing into law of the Health and Social Care Act 2012. This piece of legislation resulted in a change in the commissioning of health services. Across the country, Clinical Commissioning Groups took on many of the commissioning responsibilities of primary care trusts. CCGs are independent bodies that are clinically led by GPs that plan, buy and oversee health services from a range of NHS, voluntary, community and private sector providers. CCGs put clinicians, who are attuned and responsive to the health needs of the local population, at the forefront of commissioning.

The CCG has reviewed and refreshed its five year strategy and operational plan, responding to the opportunities presented during the year. We have taken up the opportunity to co-commission primary care with NHS England as well as the opportunities presented from the acquisition of Heatherwood and Wexham Park Hospitals Foundation Trust by Frimley Park Foundation Trust in transforming health services locally.

The CCG has been developing further its partnership working with Bracknell Forest Council (BFC), the Royal Borough of Windsor and Maidenhead (RBWM) and its neighbouring CCGs as well as further developing the clinical engagement with GPs and other local clinicians.

Priorities were developed with the Health and Wellbeing Boards of BFC and RBWM:

1. Increase the number of patients feeling supported to manage their condition(s)

2. Help people to recover from ill health or following an injury

3. Improved patient experience of general practice

4. Improve quality in planned care pathways and reduce follow-up rates

5. Reduce inappropriate, unplanned hospital admissions Below is a review of the year including key achievements.

Review of the Year Delivering the Health and Wellbeing Strategy The CCG Chair is the vice-chair of the Bracknell Forest Health and Wellbeing Board and along with the Head of Operations plays a full role in the work of the Board and the delivery of the work programme.

5|Page A key part of the role of the Health and Wellbeing Boards is the development and delivery of the Joint Health and Wellbeing Strategies. The CCG is a member of the Bracknell Forest steering group for this work. This is evidenced by the delivery of the workstreams, which feature many examples of integrated delivery such as the selfcare and prevention work programme which is jointly funded and delivered and features strong clinical leadership.

In addition, the CCG contributes to the Health and Wellbeing Board and strategy for the Royal Borough for Windsor and Maidenhead, as it relates to the Ascot population. A GP from the Governing Body is a member of the Health and Wellbeing Board and additional management support is provided.

Many of the programmes of work being delivered by the CCG are being done so in partnership with neighbouring CCGs and local authorities.

Some examples of the work that has been delivered are outlined below.

New Services in Bracknell Healthspace Urgent Care Centre The Urgent Care Centre (UCC) at Bracknell Healthspace opened in April

2014. This was a significant achievement and one that had been in the planning for many years. During its first year of operating 29,000 people came through the door looking for help. The service is comprehensive for minor illnesses and injuries. Having a GP on site during opening hours means patients needing medical advice can be seen without being directed elsewhere.

The UCC is an important part of the urgent care services available to the public and we are ambitious about its role in extending care by GPs to include the evenings and weekends which should take the pressure off our A&E departments in hospitals. It is located in Bracknell where we know the population is growing. Access is good and the parking is free.

6|Page Rapid Access Community Clinic A Rapid Access Community Clinic (RACC) opened at the Bracknell Healthspace in December. Older people who need an urgent specialist medical review no longer need to travel to a hospital or the RACC in Maidenhead. The clinic offers a multidisciplinary review to avert a crisis and keep people out of hospital when this is not needed.


A new service opened in June 2014 offering assessment and treatment for musculoskeletal problems. GPs refer patients to this service when the patient has a problem that may respond without the need for an operation. The specialist physician and therapists see people with painful shoulders, knees, hips and other joints.

Improving Primary Care As we develop our plans for expanding access to primary care services across Bracknell, the role played by the UCC is described above. This includes the GP Out of Hours Service (OOH) which is now co-located in the Bracknell Healthspace and we are beginning to see the synergies between the UCC and OOH. Whilst it will need regular and consistent communications from us, the message must be clear A&E is for “blue light” ambulance conditions only.

Member practices have been working hard in response to two national initiatives.

Firstly the opportunity to ‘co-commission’ primary care services with the NHS England Area Team, who took full responsibility for this under the reforms. A bid was submitted to jointly commission with the Area Team, which would bring accountability closer to home and we will manage the potential conflict of interest for GPs on the CCG Governing Body through robust governance.

A second initiative has been the Transformation of Primary Care and whilst we were unsuccessful in our bid for the Prime Minister’s Challenge Fund, we had planned that we could fund this and invest in Primary Care at this time of unprecedented demand for GP services and when there is a shortage of newly qualified doctors wanting to be a GP and a similar lack of nurses.

Our member practices have come together to form a legal entity; the company is called Berkshire Primary Care Limited (independent of the CCG), to be the single voice of the GP practices as a provider organisation, giving them the ability to negotiate with other provider organisations and the CCG to transform primary care.

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