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Crawley’s challenge


7 February 2013

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Crawley is a ‘new’ town just south of Gatwick airport and situated in the north of West Sussex. The town stands out as it more densely populated than most in the rest of the county.


The clinical commissioning group (CCG) commissions health care for about 125,000 people, including four of the most deprived areas in the county where more than 50 languages are spoken. We have a number of legacy challenges surrounding our community services and infrastructure due to being less wealthy than our neighbouring boroughs.

Crawley is a ‘new’ town just south of Gatwick airport and situated in the north of West Sussex. The town stands out as it more densely populated than most in the rest of the county.


The clinical commissioning group (CCG) commissions health care for about 125,000 people, including four of the most deprived areas in the county where more than 50 languages are spoken. We have a number of legacy challenges surrounding our community services and infrastructure due to being less wealthy than our neighbouring boroughs.


As Crawley is significantly different from the surrounding areas, the practices, our local government partners and the population’s elected members agreed that we should be a standalone CCG, learning from our past experiences when self-determination and decision-making had been best for the health of Crawley. We also agreed that we needed to have strong partnerships with neighbouring CCGs and with local government, to mitigate against the challenges of being a small CCG.


The CCG consists of 13 practices, with a long history of working well together and the ability to have robust debates and discussions without falling out. All practices have signed the CCG constitution and are represented by the Clinical Reference Group (CRG) and the patients are represented by the Commissioning Patient Reference Group (CPRG).


We have an executive committee that comprises a chief clinical officer (accountable), four GP clinical directors (two elected and two selected), a community pharmacist, a practice manager, lay members and our officers. We also have a governing body that provides assurance and has three sub-committees – quality, remuneration and audit. All our clinical leads have a defined portfolio, a quality, innovation, productivity and prevention (QIPP) delivery plan and work closely with the head of delivery. The clinical directors work with each other across CCG boundaries sharing intelligence and workload. The clinical leads and the chair of our CPRG have a weekly meeting.

Collaboration
We share a management team with Horsham and Mid-Sussex CCG, with whom we work closely with on data sharing, care-pathways and development plans for example.


We work to an 80:20 rule, in which 80% is likely to be very similar in what we plan and do and 20% is likely to be our CCG/locality specific. So far, we have had significant success on planning and delivery depite of having a team that is currently understaffed and over-stretched.     


Currently our main issue is managing the sheer volume of internal and external meetings, which need to be simplified to make the process efficient and effective.
Our CCG works closely with six other Sussex CCGs through the ‘Sussex Together’ programme. We value the opportunity to strengthen our joint working arrangements especially for hosting teams, for example – communication, working with clinical networks and commissioning through the common Surrey and Sussex commissioning support unit (CSU).


We also have strong collaboration with our Surrey CCG neighbours, especially on acute contracting for which we have a monthly contracting and commissioning board in order to make our contracting cohesive, strong and effective. This arrangement is supported by a memorandum of understanding (MOU).


We are re-working our joint commissioning  agreement with the Sussex County Council and aligning it to the health and wellbeing board’s priorities and strategy. There are many common areas where joint working will be mutually beneficial especially with the frail and the elderly, health inequalities, dementia and continuing health care.


We are in the second wave of the NHS Commissioning Board’s authorisation process and currently have 18 areas that need further submissions after moderation. This is similar to our neighbouring CCGs, as we all have challenging health economies where collaboration, a strong CSU and partnership agreements are key.

Finances
Our CCG has the assumed authority to make decisions with the Sussex cluster on the £150+ million budget for this year. We have a financial recovery plan that we are confident in delivering; this consists of transactional challenges, reduction in demand and delivering on our transformational plans. Looking three years ahead, we will have to make 2.5% to 4% efficiencies every year to remain within budget, with the biggest risk being the control over our acute hospital spend.


We have had a number of successes over the past two years that have started giving us tangible results. With the strong practice and clinical engagement, we have seen a reduction in variation in primary care and referrals in both planned and unscheduled care. The practices are all involved in the design, delivery and analysis of priorities and work plans and own the CCG’s success.


Together with the county council, we have launched the ‘Proactive Care Programme’, which has three components to it: risk stratification, multi-disciplinary teams covering a population of 30,000 to 50,000 and self and supported care (circle of support provided by the Crawley health and wellbeing partnership). We have had a very successful launch of phase one and the other two phases will be in place by the end March 2013.


Crawley CCG, Crawley Borough Council and Public Health have had a local health and wellbeing partnership for the past six years. We work very closely with the health, local government, voluntary and charitable sector and have three on-going programmes; living safely at home, emotional and physical wellbeing and living well with dementia. We have recently won a bid to make Crawley a ‘Dementia Friendly Town’. The mission of this project is to normalise the life, as much as possible, for people suffering with dementia by working closely with businesses, police, leisure, transport and other partners.

Service redesign
We have had a local transformational board for the health economy around our local acute hospital up and running for the past three years. This means all the commissioners and providers having monthly round table solution focused meetings. This was established in response to the to the ‘£20 billion Nicholson Challenge’, so there are no surprises and our assets can be realigned and optimised. We have had success in creating a common unscheduled care plan with board sign up. It has been a bumpy ride but worth the effort.


We have commissioned a Crawley services and infra-structure strategic outline case to work with all our stakeholders to develop and define a shared co-produced plan for the future of health and wellbeing services in Crawley for the next three to five years. This plan will give us further focus and direction.


We are a small CCG with strong partnerships, a strong local mandate and a strong sense of place and purpose. There is much to do to improve the health and wellbeing of our population, especially for the most vulnerable and those with the greatest need and health inequalities. To deliver this in a time of great volatility, uncertainty, complexity and ambiguity, we will need tenacious leadership, connectedness and balance. Crawley CCG is up for this challenge and we hope the wider NHS will support us.

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