The Financial Resilience Newsletter

Welcome to the sixth publication of the Financial Resilience Newsletter.

This edition provides an insight into the latest news and updates on the
Financial Resilience Support Site.

LATEST NEWS Issue #6

July 2019
Digitally Transforming Primary Care – Making it Happen
at Scale

On 19th June the Digitally Transforming Primary Care conference

was held in London, which focussed on how to make digital transformation
happen at scale in primary care. The delegates heard from clinicians on the
front line about their experience of using apps, social media, video
consultation and telehealth to provide technology enabled care and all the
benefits that are generated for the practice and the patient.

The conference was attended by around 200 delegates from Academic The Financial
Health Science Networks, CCGs, Trusts, practices, social services,
universities/academics and practising doctors and nurses. The presenters
Resilience
included Dr Roni Zeiger, Vaughn Hester and Richard Earley from Facebook team
in Silicon Valley; California.
Sue Duxbury
Dr Ruth Chambers OBE, Staffordshire STP’s clinical lead for
technology enabled care services, who chaired the event said
Head of Financial
“Transformational digital programmes have demonstrated great successes Resilience
in improving access and availability for patients to primary care by digital
clinician champions. For the future sustainability of the NHS, digital delivery Ruth Ferris
needs to be available as 'usual services' rather than special projects. Senior Finance
Our national conference at Facebook HQ in London recognised and
celebrated great examples of digital delivery via public and closed Lead
Facebook sites, interactive telehealth, video consultation between
practitioners and care homes, WhatsApp groups for clinician peer support, Kim Jackson
many health-related apps, effective use of GP Online and other Finance Lead
preventative services, such as the ability to detect and redress early
warning signs of frailty and much more. We have many examples of using
digital to transform services – these now need to become the norm for
everyone!”
Contact us:
Case Study number 86 describes how the technology-enabled care england.finance-
services in Staffordshire STP were introduced and rolled out across
resilience@nhs.net
general practices. (see page 5 for further information).

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NEW CONTENT
The following new materials have been added to the Financial Resilience
Support Site. They can both be found in the ‘Document Library’; ‘Tools and
Benchmarking’ folder:

Clinical Commissioning Policy Toolkit

The Clinical Policy Commissioning Toolkit has been produced by South Central and
West CSU. It has been developed to assist commissioners with the identification of
opportunities, development of clinical policies and decision making to ensure fair and
consistent commissioning and appropriate and equitable application of policies such
as the Evidence Based Intervention Programme, which is designed to reduce patient
harm and free up precious clinical resources.

Many commissioners will have already put in place some, most or all the elements
and measures set out in the toolkit. With this in mind, the toolkit has been designed in
chapter form so that commissioners can easily navigate to the areas of most use to
their specific needs. The “overview of chapters” section provides a link to each of the
chapters in the toolkit.

CCG Financial Control Planning Governance Self Assessment

The CCG Financial Control Planning Governance Self Assessment template and
the associated process document have been updated for 2019/2020.

NEW IDEAS
If you have any ideas which could be considered for a case study or for inclusion on the
site, please contact your regional representative below with a copy to england.finance-
resilience@nhs.net:

• Midlands / East - helen.dempsey1@nhs.net

• North East and Yorkshire / North West - tim.lowe@nhs.net
• South West / South East - sharon.kingscott@nhs.net
• London - joanna.watson2@nhs.net

To request access to the Financial Resilience Support Site, please email 2

england.finance-resilience@nhs.net
 The Financial Resilience Newsletter
NEW CASE STUDIES
Seventeen new case studies have been published since the last newsletter. You can find
them in the ‘Case Study’ section of the site and a summary in the ‘Case Study Index’:

• Case Study (70) Advice and Guidance - Humber Coast ICS. The aim of the project
was to promote alignment, best practice and innovation in the delivery of advice and
guidance across Humber Coast and Vale CCGs. The benefits include savings of £0.7m in
year 1 and £3.5m in year 2.

• Case study (71) Persistent Physical Symptoms Service - North Cumbria CCG. A
Persistent Physical Symptom Service was launched to support people in the self-
management of long-term physical symptoms e.g. chronic pain, chronic fatigue and
Medically Unexplained Symptoms. A total of £0.3m savings are estimated.

• Case study (72) Procedures of Low Clinical Effectiveness Analysis - West Yorkshire
& Harrogate ICS. The financial efficiencies across the ICS is predicted to be £9.6m,
which reflects targeting only PoLCE where there is a savings opportunity and moving the
associated spend down to the benchmark level.

• Case study (73) Reducing GP referral variation - Sheffield CCG. Initial analysis
identified a possible opportunity range of c.£0.2m - £11m relating to variation in GP
referrals.

• Case study (74) Lower gastrointestinal pathway - Sheffield CCG. The aim of this
project was to improve quality and efficiency in their lower GI service by implementing an
integrated pathway. Savings were estimated to be £0.3m in 2018/19.

• Case study (75) High Intensity Users and Care Homes - South East London. This
case study focuses on improving the quality of prescribing for patients resident in care
home settings. The schemes are expected to reduce avoidable hospital admissions for
ambulatory sensitive conditions, increase patient satisfaction, and reduce prescribing in
care homes by up to 17%. The estimated savings are £1.48m.

• Case study (76) Continuing Healthcare - North West London. The project comprised
two key workstreams, ‘Panel Optimisation and High Cost Cases’ and ‘Data Management’,
looking at the opportunities for standardisation of processes across the North West
London STP. The project is expected to generate total net savings of £1.2m.

• Case study (77) Individual Financial Requests - Humber Coast ICS. This project aimed to
facilitate cross-geography collaboration and create a shared delivery plan for IFR check and
challenges, which built on the performance of the best CCG and rolled out a single approach
across the patch. Savings of £0.8m per year are expected.

Send your ideas for new material to england.finance-resilience@nhs.net 3

 The Financial Resilience Newsletter

• Case study (78) Service Benefit Reviews - Derby and Derbyshire CCG. The
CCG calculated that by effectively applying a systematic Service Benefit Review to
each line they could release savings of between 10% and 15%, equating to
between £3.5m to £4.5m over the next 12 months.

• Case study (79) Aligned Incentive Contracts - South Tees CCG. The AIC was
established between South Tees CCG and all organisations in the local health
economy to work collectively and collaboratively to enable system-wide efficiencies.
A reduction in demand across the system at a top level is anticipated at 3%.

• Case study (80) Care Homes Deep Dive. The project investigated variation in
admissions to secondary care from residential and nursing care homes. The
introduction of a care home support team pilot is expected to result in reductions in
A&E attendances, ambulance call-outs and emergency admissions, producing net
savings of £0.4m through reduced tariff spend.

• Case study (82) CIP & QIPP Review - Somerset STP. The project involved
undertaking a review of QIPP and CIP plans across the STP. The changes are
expected to generate savings of £0.5m in 2018/19 and 2019/20.

• Case study (83) Musculoskeletal pathway - Hampshire & Isle of Wight STP. The
work focuses on the reduction of outpatient referrals to acute providers through
implementation of a single exemplar MSK model across the STP. 2018/19 savings
are estimated at £0.2m and 2019/20 at £1m.

• Case study (84) CHC High Cost Placements - Hampshire & Isle of Wight STP.
The project undertook the review and analysis of high cost placement CHC spend
across the STP, the objective of which was to enable a more strategic use of
resources, improving equity of access to CHC services across the STP footprint,
whilst enabling the identification of supportive community services for future
investment.

• Case study (85) CHC Service Transformation - Somerset CCG. This scheme
delivered savings over and above the costs involved in 2017/18 and 2018/19. Over
the course of the project £3m was invested into the CHC team delivering £13m of
savings, cash releasing £10m of savings back to the CCG bottom line. This
significantly improved the CCG CHC national benchmarking position.

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• Case study (86) Staffordshire STP – Technology-Enabled
Care Services (TECS). Staffordshire STP’s TECS programme Issue #6
aimed to drive adoption of technology-enabled care services by
general practice teams provided as routine patient care including
July 2019
via apps, video-consultation, telehealth, social media and GP
Online. The expected benefits are enhanced productivity; patient
empowerment to self care and thus improved clinical outcomes;
minimised unwarranted clinical variation and increased patient
convenience.

• Case study (87) Somerset CCG - CHC Support Worker. The

purpose of this project was to provide comprehensive
observational records on individuals requiring a CHC eligibility
assessment to provide underpinning evidence in cases where
needs are particularly challenging to evidence. £0.7m of savings
were delivered against CHC learning disability cases in 2018/19
through the identification of individuals no longer eligible for CHC The Financial
funding. Projected savings for 2019/20 are £1m. Resilience
This brings the total case studies to 87 with more still to come as the
team
write up of the good practice following the national QIPP support
programme reaches its conclusion. Sue Duxbury
Head of Financial
Resilience
USEFUL LINKS
Ruth Ferris
Links to the following articles have been added to the ‘Useful Senior Finance
Links’ page: Lead

• Integrated care in action - A new suite of case studies shines a Kim Jackson
light on how health and care organisations and staff are working in Finance Lead
new ways to improve health and wellbeing across England.

• PwC - Road to Recovery - Achieving financial balance and

sustainability in healthcare Providers and healthcare
Commissioners. The lessons shared in these two documents are Contact us:
important for a successful financial recovery. england.finance-
resilience@nhs.net
• The NHS RightCare Frailty Toolkit - The toolkit supports systems
to understand the priorities in frailty identification and care, and
key actions to take. It provides opportunity to assess and
benchmark current systems to find opportunities for improvement.

Thank you for reading. If you have any queries or feedback please contact 5
england.finance-resilience@nhs.net