Dear colleague

Re: Urgent and necessary measures to address patient demand

As a key stakeholder I am writing to inform you that we expect to announce a series of urgent and necessary measures to address a worsening of the CCG’s financial situation.

As you will be aware, last year the CCG returned a £14.5 million deficit (known as the control total) and this year we have been predicting the same.

Our confidence in meeting the control total 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 we can afford.

Whatever the actual cause of the increase in demand, it is having a serious effect on the financial position of our own organisation – and if we fail to deal with it now as the area’s main commissioner, services will suffer.

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.

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:

 Requiring morbidly obese patients to lose weight prior to routine surgery
 Requiring smokers to quit for at least six weeks prior to routine surgery
 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.

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 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 – seven days before the meeting.

Throughout the implementation of our ‘in-year’ plan we will be prioritising 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 seven 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 six weeks from referral
 Ambulance trusts to respond to 95 per cent of category A calls within 19 minutes of a request being made.

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’.

‘Business as usual’ will be led by Jerry Clough while the in-year priority areas, below, will be led by the following:

 Acute contract management – Jerry Clough, chief operating officer and western managing director
 Urgent care – Caroline Dawe, managing director, northern
 Planned care – John Finn, managing director, eastern
 Continuing Healthcare – Lorna Collingwood-Burke, chief nurse
 CCG running costs – Hugh Groves, director of finance
 Prescribing / medicines management – John Finn, managing director, eastern
 Individual patient placements – Paul O’Sullivan, director of partnerships
 Other smaller contracts – Hugh Groves, director of finance.

Finally, just a reminder that the Governing Body paper detailing the proposals will be available on our website at http://www.newdevonccg.nhs.uk from October 29.

Should you have any questions about the paper when it is published please contact .(JavaScript must be enabled to view this email address)

I will, of course, be happy to answer any queries that you have.

Thank you.

Yours sincerely

John Finn
Eastern Locality Managing Director
NHS Northern, Eastern and Western Devon Clinical Commissioning Group