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Northamptonshire Teaching

Primary Care Trust

2012-13 Annual Report and Accounts

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Northamptonshire Teaching

Primary Care Trust

2012-13 Annual Report

Annual Report

2012-13 Contents Page Welcome and introduction Annual Report – Operating and Financial Review About NHS Northamptonshire The transition to local clinically-led commissioning Performance and Quality Our Workforce Health and Safety Sustainability Report Financial Review Annual Accounts Remuneration Report Annual Governance Statement Appendix 1: Summary of Sustainability Performance Welcome and Introduction Welcome to the NHS Northamptonshire Annual Report for 2012/13.

This was a year of transition and change as we continued to prepare for the new commissioning arrangements and other reforms set out in the Health and Social Care Bill which passed into law in March 2012.

We have continued to support the development of our Clinical Commissioning Groups (CCGs), NHS Corby CCG and NHS Nene CCG, as well as the emerging National Commissioning Board. We also worked closely with our local authority in developing the new health and wellbeing board. Our public health team are now based within Northamptonshire County Council, ready for the transfer of functions and responsibilities in April 2013.

NHS Northamptonshire officially closed down on 31 March 2013 and we would particularly like to acknowledge the hard work and dedication of all our staff over the years especially during the transition period where their professionalism has ensured a smooth transfer of responsibility to the new receiver organisations, the CCGs, the National Commissioning Board and the Public Health team now based in Northamptonshire County Council.

We are proud of what NHS Northamptonshire has achieved, and believe we have built a strong legacy for our CCGs to take forward to ensure that the NHS continues to deliver the best healthcare possible for the residents of Northamptonshire.

Annual Report All NHS organisations are required to publish an annual report and financial statements at the end of each financial year. This report provides an overview of the work of NHS Northamptonshire, the Primary Care Trust (PCT) for the county, between 1 April 2012 and 31 March 2013.

The report is made up of two parts. The first part includes information about the details of our performance as well as commentary on wider events which have shaped our business and priorities. The second part is a summary of the organisation’s financial statements for the financial year 2012/13 including the remuneration report and governance statement.

Operating and Financial Review About NHS Northamptonshire Our history NHS Northamptonshire was formed on 1 October 2006 when the three previous Primary Care Trusts (PCTs) merged – Daventry and South Northamptonshire, Northampton Teaching and Northamptonshire Heartlands.

In July 2011, NHS Northamptonshire completed the process of the separation of all its directly provided services from those commissioning functions as set out in the NHS Operating Framework for 2010/11. Through this transfer, NHS Northamptonshire became solely a commissioning organisation which contracts with community providers rather than providing these services directly.

Following the introduction of the government’s NHS reforms, NHS Northamptonshire formed a PCT cluster with NHS Milton Keynes in June 2011.

The cluster supported local CCGs across Northamptonshire and Milton Keynes to enable a smooth handover of PCT functions to new commissioning arrangements.

The community we serve Northamptonshire has a growing and ageing population - currently the resident population is 691,900, which is predicted to increase to 762,300 by 2019. Although the number of people in all age groups is likely to increase, the biggest increase is in the number of people aged 65 and above. It is predicted that almost one in five of Northamptonshire’s population will be 65 or over by 2019. Similarly the number of people aged over 85 is expected to increase by around 5,000 in the next ten years.

These changes have predominantly been driven by the increase in life expectancy. In Northamptonshire the average life expectancy for men in the county is 78.3 years, and for women 82.2 years which is similar to the England average. However there are significant differences in life expectancy across the county. There is a difference of 9.1 years for men and 5.5 years for women between areas with the highest and lowest life expectancy.

Whilst more people in Northamptonshire are living longer there is a discrepancy between improvements in total life expectancy and healthy life expectancy. Across the county, disability-free life expectancy can vary from 52.78 to 68.43 years for men and 58.82 to 70.63 years for women.

As a result, people are living longer and they are likely to spend a greater proportion of their life living with disability and long term illness, therefore requiring health and social care support.

Currently approximately 1 in 4 people is aged under 20 in Northamptonshire. Over the next ten years the number of children and young people in the county is estimated to grow by around 18,000, but as a group they will decrease slightly as a proportion of the population.

The most significant growth will be in amongst 5 to 9 year olds, a result of the recent increasing trend in fertility rates. In 2009 there were 67.1 live births per thousand women aged 15-44 in Northamptonshire, a peak after many years of decline and a higher rate than the general fertility rate for England. About 1 in 5 of these children were born to mothers who were born outside the United Kingdom.

The ethnic mix of the population is changing, with more ethnic diversity found in the younger age groups. Current estimates suggest that 89% of the under 16 population are white, compared to 92% of the adult population and 97% of the retirement age population.

The transition to local clinically-led commissioning The government’s Health and Social Care Bill includes plans to hand the annual NHS budget of around £80bn directly to family doctors who, it says, are better placed to decide which services are needed for their patients.

By 1 April 2013 all GP practices in England will join with colleagues to become part of a Clinical Commissioning Group (CCG), and the Primary Care Trusts has been abolished.

Northamptonshire has two Clinical Commissioning Groups (CCGs) within the county:

NHS Nene CCG covers 70 GP practices in the county, and over 350 GPs. The Chair • is Dr Darin Seiger.

NHS Corby CCG includes all five GP practices in Corby covering around 67,000 • patients. The Chair is Dr Peter Wilczynski.

The Oundle Surgery and the Wansford & Kings Cliffe practice have joined NHS Cambridgeshire and Peterborough CCG.

In 2011-12 partial commissioning budgets were delegated to the CCGs who have been developing their own governance structure underneath the overarching NHS Northamptonshire and Milton Keynes Board. For 2012-13 full commissioning budgets were devolved to the CCGs.

Authorisation During 2012/13, both CCGs in Northamptonshire were successfully authorised by the National Commissioning Board to become standalone statutory NHS organisations on 1 April 2013. This means that they are deemed able to handle their local commissioning budgets and make clear decisions about how services will be designed and where they should be delivered.

The authorisation process assessed every CCG against a set of 119 criteria. CCGs had to submit evidence for each area and also host a panel day where questions were asked by an independent team of NHS experts. Although successful in authorisation Nene CCG still have 4 of the 119 criteria outstanding at this point in time but an action plan is in place to clear these outstanding items.

The cluster PCT objectives and strategy NHS Northamptonshire and NHS Milton Keynes formed a cluster in June 2011, effectively pooling the resources of the two PCTs in order to maintain robust capacity and capability.

This clustering arrangement continued in operation until 31 March 2013 when the PCTs were abolished and their responsibilities passed over to the new receiver organisations.

Professor John Parkes and Professor William Pope were appointed as Chief Executive and Chair respectively of the cluster on its formation in June 2011 but, on 1 October 2012 Jane Halpin, Local Area Team Director took over as Chief Executive..

During 2012/13, the cluster continued to support the local CCGs in Northamptonshire to enable a smooth handover of PCT functions to the new commissioning arrangements.

The cluster’s aims were to ensure:

• Delivery of the strategic plan

• Transformational changes to the local health economy

• Business continuity

• Financial stability

Through the transition, the cluster:

• Managed limited resources and reach financial control

• Provided high quality support to development of GP commissioning arrangements

• Continued to develop and improve healthcare services for the Northamptonshire population

• Jointly established the Health and Wellbeing Board with Northamptonshire County Council

• Worked with partners within and outside the health economy to ensure preparedness for new arrangements This resulted in a legacy to be proud of and for the new CCGs to inherit and build upon as they strive to become leading CCGs nationally with the aim of delivering high quality healthcare services for the people of Northamptonshire.

QIPP (Quality, Innovation, Productivity and Prevention) During the year, we have worked with our health and social care partners across Milton Keynes and Northamptonshire to improve quality and productivity across the health and social care system as part of the national QIPP (Quality, Innovation, Productivity and Prevention) programme to reinvest efficiency savings of up to £20 billion nationally in improving services and health outcomes.The aim is to do more with the funding we receive to meet the challenges of a growing and ageing population, rising patient expectations and the extra costs of medical advances and new treatments.

For 2012-13 QIPP plans have been fully developed by the CCGs and they have taken on devolved responsibility for delivering the QIPP programmes. The QIPP target for 2012-13 was set at £33m with additional schemes being developed as ‘headroom’. In addition, providers had their own separate CIP (Cost Improvement Plan) to deliver for the year to cover the 4% efficiency reductions to their contract tariffs as required by commissioners with further savings to cover any additional cost pressures that they may face.

Greater East Midlands Commissioning Support Unit (GEM CSU) During 2012/13, the PCT also supported the creation of the local office of the Greater East Midlands Commissioning Support Unit.

Commissioning Support Units have been created as the most efficient and cost-effective way of providing excellent 'at scale' commissioning support activities. This allows Clinical Commissioning Groups (CCGs) to maximise their investment in frontline healthcare services and to improve health outcomes.

GEM CSU is one of the biggest Commissioning Support Units in the country, serving 20 CCGs, with a population of around 5 million.

Healthier Together NHS Northamptonshire has been a fully involved partner in ‘Healthier Together’, a commissioner-led review of local health services across the South East Midlands region, covering Bedfordshire, Luton, Milton Keynes and Northamptonshire.

In the year since its launch, the Healthier Together programme has carried out invaluable work;

• More than 200 clinicians have collaborated in six clinical working groups

• Through communications and engagement activities, Healthier Together has come into direct contact with more than 12,000 local patients and residents and indirect contact with many tens of thousands more.

The programme now has an extensive bank of clinical evidence and local knowledge about how to meet the health challenges of the present and future.

This current phase is now complete and the work of the Clinical Senate and the six clinical working groups has concluded with the publication of their reports.

From April 2013, the next phase of the programme will be taken forward more locally in the north and south of the region, with Clinical Commissioning Groups and hospitals working together to find the right solutions for their local populations. These will be based on the principles established by Healthier Together, including the commitment to providing more care closer to home.

This will enable each area to move at a pace that reflects their own local issues, including closer working partnerships between the hospitals in Northamptonshire and also between Milton Keynes Hospital and Bedford Hospital.

The challenges that face our healthcare system remain:

The population is increasing and people are living longer.

• There are significant shortages of skilled and experienced clinicians in several key • disciplines – including A&E and maternity services.

The NHS – in common with all UK public services – is under financial constraint.

• That is why all the partner organisations remain committed to continuing the work of Healthier Together.

Health and Wellbeing Board The Health and Wellbeing Board in Northamptonshire will act as an advisory body to the Council’s Cabinet, NHS Commissioning Board and Clinical Commissioning Groups in the context of relevant sections of the Health and Social Care Act.

The Shadow Health and Wellbeing Board continued to act as a Shadow until the formal constitution of the Health and Wellbeing Board in April 2013.

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