Driving innovation and getting the most from our budget


Summary

Increasing demand for local health and care services is putting an unprecedented strain on our budget.

In 2018/19 we need to save a further £6.2m.

We are working with our GP practices and partners to transform primary and community services.

New innovative projects have been launched to improve the patient experience, including the Falls Rapid Response Team.

We have taken difficult decisions to ensure we keep within our budget, such as restricting access to non-urgent services like fertility services.

Bath and North East Somerset (B&NES) has a growing population with increasingly complex health needs, which is placing unprecedented demands on all types of local health and care services.

As a result, our health budget is being stretched and we need to make savings. In 2017-18, the CCG avoided a financial deficit and delivered savings of £11.6m by working in new ways that encouraged innovation, greater collaboration between teams and a whole-organisation focus on our five ‘big ticket’ work programmes. You can read more about these programmes on pages 21-22 of our 2017-18 Annual Report.

In 2018/19 we need to save a further £6.2m to avoid a financial deficit.

We are also working closely with our GP practice members and partners across the local health and social care sector to transform primary and community services. Changes that are already happening include practices merging, and others working more closely together to share services and clinical expertise for the benefit of patients.

We continue to work with our partners and service providers to enable more people to be treated at home or close to home in the community, rather than in hospital. Our Early Home Visiting Service and Falls Rapid Response Team are just two examples of how we are successfully improving patient experience and outcomes, while generating savings and balancing the pressures GPs and the wider health sector are facing.

We are also encouraging people to exercise ‘self-care’ and take responsibility for keeping themselves fit and healthy. This year we have backed the Royal College of General Practitioners ‘3 Before GP’ campaign, which encourages people to speak to their pharmacist, use over-the-counter medications or visit the NHS Choices website before making an appointment to see their GP. This keeps GP services available for those who need them the most.

As part of our commitment to tackling obesity and smoking, we have made the decision that patients in B&NES who need non-urgent, routine surgery and who have a BMI (body mass index) of 30 or more or who smoke, will be supported to lose weight and/or quit smoking prior to their procedure.

Click on the tabs above to read more about our innovative projects as well as the more difficult decisions we have had to make this year about restricting access to non-urgent services to make essential savings.

Early Home Visiting Service

People living B&NES who are unwell and cannot get to their GP surgery to be seen can now call the practice first thing in the morning to request an early home visit. Depending on where in B&NES you live, a dedicated GP, advanced nurse practitioner or specialist paramedic from the Early Home Visiting service will come to your house and assess you.

Traditionally, home visits are done by a GP after their morning session, which means that if a patient at home needs to visit hospital, they are not often conveyed until the middle of the afternoon or even the evening, potentially resulting in an unnecessary overnight stay.

Since the Early Home Visiting Service started in April 2017, it has seen over 1,000 patients and the goal of the service is that patients who might need to go to hospital for a check-up can do so and return home again on the same day.

The initiative is designed to help balance some of the pressures that GPs and the wider health sector are facing as a result of stretched NHS budgets and an increased demand for services. It frees up time for those GPs who remain based in the surgery seeing patients who can get there themselves, allowing time for longer appointments.

The service pilot is a result of collaboration between BaNES CCG, GP practices, B&NES Enhanced Medical Services (BEMS) and the South Western Ambulance Service NHS Foundation Trust.

Falls Rapid Response Team

In 2017, health and care services in B&NES came together to pilot a new community-based rapid-response service for people over the age of 65 years who fall over at home.

The Falls Rapid Response Team, which includes a specialist paramedic, a physiotherapist and an occupational therapist, responds to up to four B&NES patients per day if they have contacted the emergency services for assistance after a fall. The team will help the person get comfortable, carry out a home-based falls risk assessment and recommend any necessary interventions that could help prevent future falls.

The pilot is the result of collaboration between BaNES CCG, South Western Ambulance Service NHS Foundation Trust (SWASFT), Virgin Care – who deliver community health and care services in B&NES – and Bath’s Royal United Hospital. It operates between 8am and 6pm, seven days per week and in its first year of operation, visited an average 60 patients per month. Of those, 50 patients per month were able to stay at home rather than be conveyed to hospital.

Getting Fit for Surgery

As part of our commitment to tackling obesity and smoking, we have made the decision that patients in B&NES with a BMI (body mass index) of 30 or more, or who smoke, will be supported to lose weight and/or quit smoking prior to being referred for non-urgent, routine surgery.

Studies show that patients who succeed in adopting a healthier lifestyle before surgery have a reduced risk of complications during and after their operation, recover more quickly and experience long-term health benefits.

The decision followed a 10-week public consultation where the majority (82 per cent) of survey respondents agreed that the NHS should encourage people to stop smoking for a period of time before non-urgent surgery. Most people (79 per cent) also agreed that the NHS should encourage people with a BMI of 30 or more to lose weight.

The CCG Board carefully reviewed and discussed the consultation feedback and decided that three months was a reasonable period of time for patients to attempt to stop smoking and/or lose weight prior to referral for surgery.  The Board felt this three month duration allows enough time for patients to try and lose at least five per cent of their body weight and  start off on a journey towards healthier habits.

The CCG worked in partnership with local GPs, the Public Health team at B&NES Council, wellbeing experts at Virgin Care (lifestyle service) and consultant anaesthetists and surgeons at the Royal United Hospitals Bath NHS Foundation Trust to develop this scheme.

Restricting access to vasectomy, sterilisation and IVF

In November 2017, we proposed restricting access to three services in  B&NES: vasectomies, female sterilisations and fertility treatment. We consulted widely on these proposals from November 2017 until the end of January 2018.

A summary of the public’s feedback was included in this report, with recommendations, which were presented to the CCG Board in March 2018.

The final decision, on the basis of public feedback and the likelihood of incurring greater costs associated with unplanned pregnancies than the costs incurred by vasectomy, was to continue to fund vasectomies. Similarly, women will still be able to access NHS-funded sterilisations if they have first explored alternative, less-invasive forms of contraception.

With regard to fertility services, the Board balanced public feedback with clinical evidence on IVF success rates and the CCG’s financial position. You can read more about the rationale for our decision in our news story.

The Board decided to change the CCG’s policy on fertility services so that:

  1. The female partner receiving treatment must be aged between 23 and 37 years
  2. The male partner of the woman receiving treatment must be aged 55 years or under
  3. The female partner receiving treatment must have a body mass index (BMI) in the healthy range for women wanting to conceive, of 19–30
  4. The male partner of the woman receiving treatment must have a healthy BMI of under 30
  5. Heterosexual couples must have been trying to conceive for at least 2 years where the female partner is aged 35 years or younger, and 1 year where the female partner is aged 36 -37 years.

This policy came into force on 2 June 2018.

Curbing the prescription of over-the-counter medicines

In January 2018, we formally adopted NHS England guidance that aims to curb routine prescriptions for over-the-counter medicines for minor, short-term conditions. Many of the conditions targeted by this guidance will cure themselves or cause no long-term negative effects on health.

It is estimated that this new guidance, the result of a joint public consultation carried out by the NHS Clinical Commissioners (NHSCC) and NHS England, could release around £136m a year for CCGs to reinvest in other services.

The new guidance will curb the routine prescribing of products that are for:

  • A self-limiting condition, that does not require any medical advice or treatment as it will clear up on its own, such as sore throats, coughs and colds.
  • A condition that is suitable for self-care, which can be treated with items purchased over-the-counter at a pharmacy, such as remedies for indigestion, mouth ulcers, warts and verrucas.

The guidance does not affect the prescribing of over-the-counter medicines for longer term or more complex conditions, or where minor illnesses are symptomatic or a side effect of something more serious.

The consultation received more than 2,500 responses nationwide with the majority from patients, members of the public and clinicians, including responses from 140 CCGs. Over 70 per cent of the responses supported the proposals.

Stopping gluten-free products on prescription

Following a public consultation in early 2017, we advised local GPs to prescribe gluten-free products to only the most vulnerable people living with coeliac disease. Before we took this decision, the CCG was spending £112,000 each year on gluten-free products.

Historically, gluten-free foods were not widely available to buy, and receiving them via prescription was often the only way that many patients could access them. However, today there is much more awareness of coeliac disease, gluten sensitivity and other similar conditions, and gluten-free foods are much easier to get hold of, with an increasingly varied range of products available from supermarkets and online retailers.

The price paid by the NHS for gluten-free foods on prescription is much higher than the price of similar products found in supermarkets, representing poor value for money for the NHS.

As a result of our public feedback, we have provided GPs with guidance to help identify and support vulnerable people, such as those on low incomes, children, people with learning difficulties and those with complex medical needs, and GPs will continue prescribing gluten-free products to these individuals.